Today one in four people can expect to be struck with debilitating anxiety—why are we so stressed out?

Book Review: ‘My Age of Anxiety’ by Scott Stossel

Today one in four people can expect to be struck with debilitating anxiety—why are we so stressed out?

DANIEL AKST

Jan. 3, 2014 4:52 p.m. ET

Confronted with the problem of spirituality, William James argued that we should study “the acute religion of the few”—mystics, ascetics, spiritual revolutionaries—in order to shed light on “the chronic religion of the many.”My Age of Anxiety

By Scott Stossel
Knopf, 400 pages, $27.95

If the same is true of anxiety, everyday worrywarts can take comfort in the knowledge that Scott Stossel has done our work for us. A learned and energetic journalist, Mr. Stossel has managed to become editor of the Atlantic while suppressing a world-class anxiety disorder. “My Age of Anxiety,” his wide-ranging and personally revealing new book, reflects his desire “to find some redemptive quality or mitigating benefit to my being, too often, a quivering, quaking, neurotic wreck.”

All of us have our worries, but we’re rank amateurs compared to Mr. Stossel, a virtuoso of anxiety who, like geniuses in so many other fields, got his start young. Riddled by panic and fear since the age of 2, he was first evaluated at a mental hospital when he was 10. He has been in therapy more or less ever since, having conducted what amounts to a one-man tour of almost every permutation of the talking cure, with side-trips into acupuncture, yoga and Stoic philosophy. He has also been on Thorazine, Paxil, Valium, Ativan and other psychotropic medications, at times reverting to such time-tested, over-the-counter palliatives as gin, bourbon and Scotch.

A maestro of phobia, Mr. Stossel is terrified of heights, germs, flying, fainting and cheese, among much else. He also lives in continual fear of vomiting, a terror known as emetophobia that he seems to have inherited from his mother and passed along to his daughter, who developed it without ever knowing of her father’s disorder. Anxiety is a rude rebuke to those of us still nursing a belief in a mind-body distinction, and like many anxiety sufferers, the author is afflicted with a variety of nervous symptoms. Lots of people get cold feet at their wedding, but Mr. Stossel’s panic attack at his left him sopping in sweat. A decades-long tendency toward diarrhea, meanwhile, leads to chronic worry as to when his bowels will rebel. His description of one ill-timed outbreak among the Kennedys in Hyannis Port, where he was researching a book on Sargent Shriver, is both harrowing and heartbreaking.

Mr. Stossel, in short, has got it bad in the anxiety department. Yet “My Age of Anxiety” is far from the exercise in exhibitionism that it might have been, and the merely fretful will get a great deal more out of it than just schadenfreude. Even truly accomplished worriers should be cheered that the author, in spite of his difficulties, has wrapped his arms around a vast body of science and intellectual history to gain useful perspective on his own agonizing experiences. The result is a work that sheds light not just on a particular disorder but on the human condition that gives rise to it.

The real question, after all, is why more of us aren’t crippled by anxiety. Few of us are afraid of cheddar, cholesterol notwithstanding, but we all know that time flies and that at every moment every living thing is hurtling toward the abyss. The good fortune that most Western adults enjoy—unprecedented freedom, health and prosperity—might easily make us frantic at the thought that the party will someday end and the universe will swallow us up without so much as a burp. As the author puts it, “the brute biological factness of anxiety challenges our sense of who we are; anxiety reminds us that we are, like animals, prisoners of our bodies, which will decline and die and cease to be. (No wonder we’re anxious.)”

Under the circumstances, why bother getting out of bed? Even if you can forget your own mortality now and then, what about the general tenuousness of life, the fragility of economic and social relations? We restless Americans couple and uncouple at a faster rate than our counterparts in comparable countries, and we have less job security and a flimsier social safety net. We also tend to be more mobile. The comforts of tradition and religion have ebbed even as technology has upended familiar—if at times confining—roles and relationships. “One of the hallmarks of modernity,” Mr. Stossel writes, “is an abiding uncertainty about status.” Life is freer now and richer with possibility, yet also more of an emotional high-wire act. We’ve traded the urgent problems of survival for the chronic problem of meaning.

And so anxiety seems to be the characteristic malady of the age. At any given time some 40 million Americans have an anxiety disorder, and, Mr. Stossel reports, “one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetimes.” He adds that, in 2005, Americans filled 53 million prescriptions for Ativan and Xanax, just two of the many antianxiety drugs on the market. Nor is the problem uniquely American; anxiety, like obesity, seems to be breaking out the world over.

Then again, people have always flattered themselves with the conceit that they live in an especially anxious age. What was once called nervous exhaustion or neurasthenia was a sign of status a century ago, and in fact anxiety is strongly associated with intelligence and creativity. As “My Age of Anxiety” makes clear, the pantheon of the world’s most accomplished people could double as an anxiety Hall of Fame. Prominent inductees would include Kafka and Proust, Woody Allen and T.S. Eliot, Samuel Johnson and Søren Kierkegaard. Like the author, Thomas Jefferson, Mahatma Gandhi and even Demosthenes suffered from an intense fear of public speaking, and Carly Simon’s stage fright was so bad that, Mr. Stossel tells us, “she would sometimes drive needles into her skin or ask her band to spank her before going on stage to distract her from her anxiety.”

If anxiety is America’s most prevalent psychological disorder, it is also true that nobody is quite sure what causes it, how to treat it or even exactly what it is. As with so many things, the dose makes the poison. A little anxiety may even be helpful, but too much is trouble. We mostly know what this looks like: Fear out of all proportion to any legitimate threat; worry and terror and panic that get in the way of normal life. To philosophers it’s existential, to theologians it’s spiritual, to cognitive therapists it’s a misunderstanding, and to neuroscientists it’s biological. Sports fans take note: Anxiety stems from the Latin angere, meaning “to choke.” And that is just what too much anxiety does to people.

The remarkable thing is that, until 1980, anxiety disorders weren’t even an official diagnostic category; it wasn’t until the third edition of the Diagnostic and Statistical Manual of Mental Disorders that they, um, displaced Freudian neuroses. Once commonplace, talk of neurosis has of late all but vanished, while anxiety’s stock has soared. “As recently as 1994,” the author reports, “the term ‘social anxiety disorder’ had appeared only fifty times in the popular press; five years later, it had appeared a million times.”

Mr. Stossel explains how advances in pharmaceuticals, some of them accidental, led to blockbuster medications that in turn led to a tsunami of diagnoses by physicians eager to help fretful patients tap into the wonders of modern science. Take Miltown, that iconic midcentury anodyne. Its inventor, a formerly homeless refugee from the Nazis, was working on penicillin preservatives when he discovered that a disinfectant he had modified, injected into mice, “had a quieting effect on the demeanor of the animals,” as the scientist recalled. The rise of Miltown and Thorazine, Mr. Stossel observes, “reinforced a culturally ascendant new idea—that mental illness was caused not by bad parenting or unresolved Oedipus complexes but by biological imbalances, organic disturbances in the brain that could be corrected with chemical interventions.”

The discovery of chemical treatments for psychological problems may have been haphazard, but talk therapy—still today widely applied despite the burgeoning pharmacopeia—arose virtually untouched by science, and judging from Mr. Stossel’s long and futile experience of it, remains one step removed from witchcraft. Freud did at least recognize the centrality of anxiety to psychopathology, including his own. The day of his family’s relocation to Vienna when he was a child was the occasion for terror: an acute fear that their train would leave without him. “For years thereafter,” Mr. Stossel notes, “train travel caused him anxiety attacks.”

Yet instead of focusing on his fear of abandonment, Freud at some point seems to have imagined that he saw his mother naked in their train compartment. He theorized that his repressed incestuous desire had resulted in “anxiety that he neurotically transmuted into a phobia of trains,” Mr. Stossel writes.

Thus, over time, was born the great man’s crackpot Oedipal theory. Late in life, and toward the end of his book “The Problem of Anxiety,” Freud finally moved toward the idea that phobias might have an evolutionary basis. But by that time, Mr. Stossel says, “Freud’s followers were off to the races with ‘Oedipus conflicts’ and ‘penis envy’ and ‘castration anxiety,’ ” thereby blighting the field of psychology and the lives of too many patients with the notion “that anxiety was caused by dammed-up sexual drives.”

Later, “attachment theory”—pioneered by psychoanalyst John Bowlby in the 1940s—suggested that much of the general sort of anxiety that afflicts people arises from early experiences with their mothers, when parent-child relations develop to be secure, ambivalent or avoidant, depending on the parenting style. Mr. Stossel points out that the theory has a good bit of science behind it: “By now scores of studies support the idea that the quantity and quality of a mother’s affection toward her children has a potent effect on the level of anxiety those children will experience later in life.”

Yet the evidence for a genetic role in anxiety disorders is perhaps even more compelling, as Mr. Stossel can attest, his grandfather having been anxious in spades. “The number of studies on the heritability of anxiety,” he writes, “is climbing into the tens of thousands, and the overwhelming conclusion of almost all of them is that your susceptibility to anxiety—both as a temperamental tendency and as a clinical disorder—is strongly determined by your genes.” He adds that neither Hippocrates nor Darwin would have been surprised by this finding.

Or any sensible person. Excessive anxiety, it turns out, is like most things that beset humans: partly nature and partly nurture. And it may even have its virtues. Worriers tend to be conscientious, sensitive to others and detail-oriented. These can be useful traits in many aspects of life: in a marriage, say, and in the workplace.

They appear to be useful in an author as well, judging by Mr. Stossel’s achievement in “My Age of Anxiety.” As a worrier, he is practically in a class by himself. But in dissecting his own acute case, along with the disorder that afflicts him, he offers a degree of understanding to the rest of us—along with a modicum of comfort and even hope to those who must trudge through life chronically anxious despite their seeming good fortune.

—Mr. Akst is the author of “Temptation” and writes the R&D column for the Saturday Journal.