My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind is written by Scott Stossel, who lives with generalized anxiety disorder (GAD) as well as several phobias. The book looks at his own experience but also contains extensive research on theoretical perspectives on anxiety and how these have evolved over time, the evolution of diagnostic categories, and the history behind various treatment approaches including the development and marketing of anxiolytic drugs. While it offers wide-ranging information, at times it struck me as a bit excessive.
Something I struggled with in this book, and I feel bad saying this, was that it felt kind of like when I’m reading a novel and I just don’t like the character you’re supposed to like. Sometimes this just happens, but I also think I need to question whether there’s there’s an underlying bias in play as well. The author is a man who seems to have high levels of neurosis as a stable trait. He wrote: “Writing this book has required me to wallow in my shame, anxiety, and weakness so that I can properly capture and convey them – an experience that has only reinforced how deep and long-standing my anxiety and vulnerability are.” I’m usually a pretty compassionate, empathetic, and not overly judgmental person. Perhaps it’s the wallowing bit that gets to me, or perhaps it’s that the anxiety and shame seems so fused with who he is and who he always has been. Yet temperament isn’t something we choose, so why should that make a difference in how I react to someone?
Perhaps it’s to do with changeability, and that brought to mind a question: if you’re highly neurotic by nature, does anxiety treatment work or are you shit outta luck? Stossel looked at the question of nature versus nurture, both of which play a role. Temperament is thought to be innate, there is certainly evidence of a genetic element to anxiety disorders, and parenting styles are also believed to have an impact. The development of phobias in childhood is a predisposing factor for the development of adult psychopathology. For the author, who has a strong family history, the cause is likely a combination of a heaping helping of all of these. He admits that judges himself for being anxious, and worries that “resorting to drugs to mitigate these problems both proves and intensifies my moral weakness.” He has done many years of psychotherapy, including Freudian-style psychodynamic and cognitive behavioural, and tried various medications, “but none of these treatments have fundamentally reduced the underlying anxiety that seems woven into my soul and hardwired into my body and that at times makes my life a misery.”
It was clear from an early age that the author had an anxious temperament, beginning with frequent temper tantrums as a toddler. He experienced significant separation anxiety, which intensified at age 6, coinciding with his mother starting night school. He began experiencing emetophobia (fear of vomiting) around the same time, and this worsened in grade 7 after he overheard a teacher describing vomiting due to food poisoning. Grade 7 was also when he had to attend a new school, which resulted in daily battles and social withdrawal, and at that time he was put on medications (chlorpromazine and imipramine).
Stossel’s mother was highly over-protective and over-involved, but he writes that she deliberately withheld affection in the hope that might prevent anxiety similar to what she herself had experienced as a child. She physically dressed him until age 9 or 10, picked out his clothes every night until age 15, ran baths for him while he was in high school, and didn’t allow him to walk anywhere that streets might be too busy to cross or neighbourhoods might be dangerous. As I read the chapter that covered this I freely admit I judged, thinking no wonder this kid had problems.
It has been shown that people with IBS (irritable bowel syndrome) and/or panic disorder are more physically reactive to stress and tend to convert emotional distress to physical symptoms. The author describes significant physical symptoms with his anxiety, particularly gastrointestinal symptoms, which then feeds into his emetophobia. As an adult, a therapist had attempted to do exposure therapy using ipecac to make him vomit. The ipecac was ineffective, and the experience only contributed further to the emetophobia.
The book covers the history of various types of medications used for anxiety, including opium, barbiturates, and benzodiazepines. When chlordiazepoxide became the first benzodiazepine on the market in the United States in the 1960’s, it quickly became the most prescribed drug in the country. Medication use for anxiety increased even further with the introduction of the SSRIs (selective serotonin reuptake inhibitors). The author observed that “the explosion of SSRI prescriptions has caused a drastic expansion in the definitions of depression and anxiety disorder (as well as more widespread acceptance of using depression and anxiety as excuses for skipping work), which in turn caused the number of people given these diagnoses to increase.”
The book covers an array of research studies that have been conducted on anxiety as well as a wide range of relevant theories, from Freud who thought anxiety was the basis of all mental illness to attachment theories to Klein’s false suffocation alarm theory of panic attacks. Societal views on anxiety over time are also discussed, including American General George Patton’s belief in World War II that in order to prevent the contagion of “combat exhaustion” from spreading it should be punishable by death.
At 401 pages including footnotes, this book isn’t a quick light read. It took me over three months in fits and starts to read it, in part because my concentration wasn’t always up to it. It’s jam packed full of information, so it’s a lot more to absorb than just a first-person account of mental illness. I think what I appreciated the most about it was how it forced me to reflect on and question my own ideas and judgments. It’s well-researched, and I would say it’s a good choice for anyone who’s looking for a broader historical view to help contextualize their own experience as the author does in this book.
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My first book, Psych Meds Made Simple: How & Why They Do What They Do, is available on Amazon as an ebook or paperback.