Worried sick: What's up with today's rampant anxiety?

07.50    



Fearful days: anxiety disorders affect 1 in 5 Americans every year (Image: Andrew Ferguson/getty)


Anxiety disorders are the most common mental illness of our age, but it wasn't always so. Two books approach the topic from two different perspectives


ANXIETY disorders are the most common mental illness today. Panic attacks, social anxiety and phobias afflict almost 20 per cent of Americans annually, for example. Yet as recently as 1980, when anxiety disorder first became a formal diagnosis, estimates put US incidence at just 2 to 4 per cent. What's happened?


The answer, of course, has a lot to do with changing perceptions of anxiety, and in particular our tendency to treat as a disease what used to be viewed as an innate tendency – or even a moral failing. To understand anxiety as an illness, it helps to take a step back and trace these changes over time.


Both Allan Horwitz and Scott Stossel take on this challenge in their respective books, Anxiety: A short history and My Age of Anxiety. Horwitz, a sociologist of mental illness and mental health at Rutgers University in New Jersey, and Stossel, editor of The Atlantic magazine, give remarkably similar historical overviews. They seem to have read the same sources, cite identical quotes from The Iliad, and come to the same conclusions. It's almost as if they had shared a desk at the library. Despite that, they have written very different books.


Horwitz's book gives an objective, somewhat detached look at anxiety through the ages. The ancient Greeks thought it a form of cowardice. In medieval Europe, it was a natural product of hard lives and uncertain salvation. By the 17th and 18th centuries, "nervous disorders" were a mark of upper-class sensitivity.


The rise of science in the 19th century began to mark anxiety as "


From this perspective, today's epidemic says as much about social attitudes and economic pressures as it does about actual anxious feelings. To oversimplify just a little: anxious people need diagnoses to legitimise maladies and allow insurance to pick up the tab, hence psychiatrists diagnose diseases. "The current divisions between normal and pathological anxiety minimize the former and maximize the latter," Horwitz writes. "Many influential groups benefit when conditions are defined as 'mental disorders' as opposed to normal anxiety."


Stossel would agree. But he has spent most of his life in the grip of such powerful anxieties that he often struggles to make it through the day – and that perspective makes all the difference. It's one thing to read a dispassionate discussion of whether social and economic pressures have medicalised anxiety, and quite another to read of Stossel's lifelong torture from overpowering anxiety, despite trying 20 different therapies and 28 different anti-anxiety drugs, none of which gave lasting relief.


Wherever you draw the line between normal and pathological anxiety, there's little doubt where Stossel belongs. Gliding between his own story and a broader perspective, Stossel first describes what severe anxiety is like: in his case, it is an obsessive fear of vomiting, coupled with uncertain bowel control, crippling social anxiety and panic attacks.


In several chapters focusing on drug treatments, he explores what we know about the physical underpinnings of anxiety. Where do the differences come from? What causes over-the-top anxiety? In a powerful chapter describing his childhood and drawing on other scientific studies, Stossel makes a strong case that it started when his mother – anxious herself – began law school, plunging the youngster into separation anxiety.


But in the next chapter he makes an equally plausible case for a genetic basis for his anxiety, which has run in his family for generations. Again, he presents a mass of scientific evidence to bolster this opposing view. So clearly, the answer is not simple.


This leaves us – like Stossel – in an uncomfortable place. We don't understand where pathological anxiety comes from, and we don't really know how to make it go away. It's not even clear we should want it to go away completely.


In his final chapters, Stossel notes the strong link between severe anxiety and creativity. Writers such as Marcel Proust, Emily Dickinson and Virginia Woolf, along with scientists such as Charles Darwin, Michael Faraday and Freud, suffered debilitating anxiety. Can we separate the genius from the pain? Maybe not, says Stossel.


Even in his own case, Stossel thinks, anxiety leads him to be more sensitive to those around him, and this may make him a better editor and, in many ways, a better person. Those gains may not be worth the anguish, but at least Stossel has the satisfaction of knowing he's able to live an effective life, anxiety and all.


This article appeared in print under the headline "Worried sick"


Bob Holmes is a consultant for New Scientist


Issue 2955 of New Scientist magazine


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