My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind

After reading this excerpt in The Atlantic, I had to read the book itself. My Age ofAnxiety: Fear, Hope, Dread and the Search for Peace of Mind, by Scott Stossel, is an exhaustive look at the author’s experience with debilitating anxiety. He is trying to understand why he is so anxious and also how best to treat it. He has every reason to be anxious: his genes, his parents, and his own temperament. He describes some harrowing early experiences with separation anxiety and the less–than-sensitive ways his parents dealt with it. But in another chapter, he describes how his own kids, despite a much different family environment, exhibit some of the same phobias. So after a thorough examination of the research, he sees his anxious self as a product of both nature and nurture.

The book seems more positive about treatment than the magazine article. Stossel has been treated by a bunch of different therapists and psychiatrists over the years. Some of the therapeutic choices seem questionable. For example, Stossel’s father, when he needed a therapist, started seeing his son’s longtime psychiatrist. (It’s nearly always a bad idea for people that close to one another to be separate clients of the same psychotherapist.) The author is most positive about his current therapist, a psychologist who has tried to help him understand the sources and meaning of his anxiety, to provide him with concrete skills to reduce and cope with his anxiety, and who is supportive of medication.  This doctor also makes a point of helping the author to look at his strengths and what he has overcome, rather than simply focusing on his deficits.

This book is filled with information about anxiety and its sufferers—I did not know that Charles Darwin suffered from so much anxiety or that Matt Lauer was phobic about vomiting. There is also much about the history of anxiety and how our definitions and diagnoses have shifted based on research and medication; some disorders, such as social phobia, were popularized after medications were developed. But the most interesting parts are the author’s descriptions of his own struggles. It was terrifying for him to feel so much fear at such a young age. It’s impressive that he has been able to accomplish so much despite it.

Surviving Anxiety: One Man's Story

This month’s Atlantic Magazine features its editor Scott Stossel’s brave discussion of his longstanding and crippling anxiety. What makes it brave? His willingness to graphically describe some of his most shame-filled moments, such as clogging the toilet (loose bowels being one unfortunate symptom of his anxiety) while at the Kennedy compound in Hyannisport researching a book on Sargent Shriver.  I was feeling his pain as he described the experience and his awkward efforts to deal with it.

Where did all this anxiety come from? The author describes himself as something of a perfect storm for anxiety and depression.  There’s a family history of anxiety on both sides of his family going as far back as great-grandparents --including a set of grandparents who fled the Nazis and hid their Jewishness after they were safely in the United States. More immediately, the author’s mother had a host of her own set of fears and phobias, stemming in part from two miscarriages and other difficulties getting pregnant before he was born. In addition, he had a hard-drinking father with little empathy for his son’s emotions. It’s not difficult to see how both the genetic links and the environmental effects might produce an anxious person.  

He describes a host of treatments beginning at age 10 for medication and 11 for therapy. According to the author, nothing has worked. The article certainly gives you a sense of the great variety of treatments for anxiety and also the complexity of helping someone with such a number of symptoms and issues. His article also has you hoping that there is a less dangerous solution out there for a fear of public speaking than Stossel’s own remedy of Xanax, Inderol and scotch and vodka. One thing that struck me in his treatment descriptions was that his therapists and psychiatrists seemed to be very either/or in their approaches—either therapy or medication—so it didn’t seem that there was too much coordination between them.  It seemed he almost needed to hide one from the other.

On a bright note, this man, despite his severe anxiety, has managed to marry and become the editor of the Atlantic. It’s impressive, given the struggles he describes. He describes himself as a duck: “To some people , I may seem calm. But if you could peer beneath the surface, you would see that I’m like a duck—paddling, paddling, paddling.” How brave to let others see how hard you have to paddle.

College Students and Prozac

What does it mean that there has been an explosion in the number of college students taking psychiatric medication? Does it mean that more students with mental illness are attending college? That people are more willing than in the past to seek treatment for anxiety and depression? That mental illness has been redefined? Or is it something else?

Katherine Sharpe -- a writer who discloses that she took antidepressants while attending college in the late 1990s -- makes a thoughtful attempt to answer these questions in the latest issue of the Chronicle of Higher Education. Facing increased stress, competition and pressure on campus, students feel the need to present themselves to others as being without flaws or weaknesses, writes Sharpe. Citing the research of Joseph Davis, a sociology professor at the University of Virginia, Sharpe says that students use medication to protect themselves from experiencing the emotions that they deem unacceptable -- emotions such as “discouragement and loneliness, nervousness and insecurity, jealousy and emotional vulnerability, shame and humiliation, shame and self-blame.” The desire to avoid such emotions diminishes, for these students, the appeal of traditional therapy, any form of which will require some exploration of the unpleasantness they feel. Medication, by contrast, can seem quicker and less painful.

What is going on, Sharpe writes, is a kind of “medicalization” of negative emotions -- a perception that if you experience these emotions, they must be connected to some kind of disorder. What can be lost is the opportunity to explore and reflect on normal negative emotions that may in fact have some significance and meaning. Overall, the emergence of effective psychiatric medications has enabled many students and non-students to thrive and few would argue with that. However, it is unfortunate if these medications also contribute to college students’ sense that they must achieve emotional perfection, and their mistaken belief that those around them have already achieved it. Much research shows that medication and psychotherapy can be more effective when used in tandem than either approach is when used by itself; it would be a shame if college students were to lose the added benefit of therapy because they want to avoid feelings of vulnerability.

Therapists in Therapy?

Is being in therapy a mark of personal defect? Or is it an indicator of strength? Dr. Steven Reidbord, a California psychiatrist, explores this question in a recent blog post on Psychologytoday.com. Reidbord describes a patient who asked him whether he had been in therapy himself. Behind that question was the patient’s feeling that if his doctor had been in therapy it would mark him as deficient, since the patient himself felt deficient because he was in therapy with Reidbord.

Many people share this feeling. They believe that they must be defective if they are in treatment and can’t just deal with their problems on their own. If they are coming to therapy twice a week, instead of once, well then they must be twice as defective. I think about it the opposite way. Why struggle alone with something when you can get help with it and possibly master it? Dr. Reidbord writes that chefs go to restaurants where meals are cooked by other chefs. Lawyers often have their own lawyers. What is the problem with shrinks having their own shrinks?

I myself often compare the person who believes it’s better to solve a problem on his or her own to an injured runner who feels a sharp pain in his ankle but believes that no sports medicine specialist can help him. He continues to run or devises his own cure for the injury, figuring out a way to work around the problem. Often, though, he’ll end up re-injuring himself. And when he finally does go to the doctor, the problem is worse. I feel the same way about psychological pain that I do about a sports injury: Rather than suffer alone, I think it’s better to seek help in reducing pain and suffering. And it makes sense to me that a psychotherapist who feels that therapy helps his patients would recognize its value in his own life.

I found Dr. Reidbord’s words refreshing as he tries to destigmatize therapy and mental illness. Does acknowledging that there is a behavior or emotion that is troubling you and that you need help managing mean you’re defective? Hardly. It means you’re human.

Don't Blame your Parents

The recent death of Alice Miller, an influential European psychoanalyst, revives a question that has nagged people for decades, whether or not they’ve been in therapy: To what extent are our parents responsible for our own psychological problems?

Dr. Miller, in her book The Drama of the Gifted Child, spotlighted the effects of childhood abuse and trauma on people’s emotional development. The headline version of her work is this: Blame your parents for your psychological problems. It’s a pretty simple, powerful idea, and one that has taken root as a stereotype of what happens in psychotherapy: An adult patient and his or her therapist sit around talking about how the patient’s parents are at fault for the psychological problems the patient is facing.

But this isn’t true. The lesson that I and most other psychotherapists have drawn from Dr. Miller and others is that adults’ psychological problems can indeed be rooted in childhood trauma. If a patient comes in wanting to address self-defeating behaviors, one step of the therapy process is to understand where and how these behavior patterns developed. Some of that may be traced to a patient’s parents or to other circumstances of one’s early life. But exploring how something started isn’t the same as blaming. And what gets explored in psychotherapy isn’t just what other people did, but also how the patient reacted to that, understood it at the time, and interprets it now. In other words, other people’s actions are only one part of the puzzle.

Furthermore, re-examining long-ago events isn’t the point of psychotherapy; it’s just a step. The ultimate goal, if you’re in therapy, is to change your life now. Reflecting on how you understand and interpret your past can help you better see why you’re engaging in counterproductive behavior in the present. Do you find yourself fighting with your coworkers or bosses over and over again? Do you keep having the same unsatisfying and destructive relationships with romantic partners? If so, that’s not your parents’ fault. What it may be instead is your treating people today as if you were the same person you were when you were a child. The responsibility is on you to take your awareness of what drives your behavior and use that to change.

Therapy and the Internet

Here’s one more arena in which Google has changed our lives: the process of psychotherapy.

How the internet can complicate the patient-therapist relationship is the subject of an interesting story by Dana Scarton that ran in The Washington Post this week. Scarton writes about the growing amount of information that patients can find about their therapist online -- and that therapists can find about their patients.

Googling your patient or therapist, or checking out the other’s Facebook page, if he/she has one, raises all sorts of issues relevant to the therapeutic relationship. The most significant, I think, is that the internet enables both the patient and therapist to learn all sorts of things about each other’s lives that they haven’t learned directly from the other.

I think it’s a bad idea for therapists to google their clients, and I don’t do it myself. I think it’s essential that my understanding of my clients be based on what they disclose during a therapy session. What patients tell me -- or don’t tell me -- about their lives, when they tell me, and how they tell me are all, in and of themselves, important things for us to talk about while helping them work out their problems. Researching a patient’s life online would put me in some awkward situations: If I don’t tell the patient what I’ve done, I end up with information about him or her that I know but can’t talk about. And if I do tell the patient what I’ve done, the patient may interpret my outside research as a sign that I don’t believe what he or she is telling me in person. Either way, my research would destroy the trust and honesty that are necessary for a productive therapist-client relationship.

I know that many people seeking therapy start by researching therapists online (I have my own website, after all). I also know that searching online for one’s friends and acquaintances is an inevitable part of modern-day life, and it’s a hard habit to break. If you’re a person googling your therapist while in treatment, I would suggest that you bring this up with your therapist. Searching online in this context is usually a reflection of a patient’s curiosity about the therapist and the therapist’s life. These questions and feelings can be extremely helpful when discussed in the course of therapy. What does a patient want to know about the therapist that he isn’t learning in therapy? Why does he want to know this? How does he think this knowledge will help him? Discussing these questions in therapy, and trying to answer them, can often give patients insight into their own problems and their relationships with people in their lives other than the therapist.

As a psychologist with a private practice, I think it’s important that I have a presence online; the challenge for me is to not be too online. But aside from my website and initial emails with potential clients, I try to keep my professional communications with clients on the phone or in person.