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The Culture and Costs of Anxiety | Brain Pickings

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Among those most mercilessly fettered by anxiety’s grip is Scott Stossel, familiar to most as the editor of The Atlantic. In his superb mental health memoir, My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind (public library), Stossel follows in the tradition of Montaigne to use the lens of his own experience as a prism for illuminating insight on the quintessence of our shared struggles with anxiety. From his personal memoir he weaves a cultural one, painting a portrait of anxiety though history, philosophy, religion, popular culture, literature, and a wealth of groundbreaking research in psychology and neuroscience.

Why? Because anxiety and its related psychoemotional disorders turn out to be the most common, prevalent, and undertreated form of clinically classified mental illness today, even more common than depression. Stossel contextualizes the issue with some striking statistics that reveal the cost — both financial and social — of anxiety:

According to the National Institute of Mental Health, some forty million Americans, nearly one in seven of us, are suffering from some kind of anxiety disorder at any given time, accounting for 31 percent of the expenditures on mental health care in the United States. According to recent epidemiological data, the “lifetime incidence” of anxiety disorder is more than 25 percent — which, if true, means that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetimes. And it is debilitating: Recent academic papers have argued that the psychic and physical impairment tied to living with an anxiety disorder is equivalent to living with diabetes — usually manageable, sometimes fatal, and always a pain to deal with. A study published in The American Journal of Psychiatry in 2006 found that Americans lose a collective 321 million days of work because of anxiety and depression each year, costing the economy $50 billion annually; a 2001 paper published by the U.S. Bureau of Labor Statistics once estimated that the median number of days missed each year by American workers who suffer from anxiety or stress disorders is twenty-five. In 2005 — three years before the recent economic crisis hit — Americans filled fifty-three million prescriptions for just two antianxiety drugs: Ativan and Xanax. (In the weeks after 9/11, Xanax prescriptions jumped 9 percent nationally — and by 22 percent in New York City.) In September 2008, the economic crash caused prescriptions in New York City to spike: as banks went belly up and the stock market went into free fall, prescriptions for anti-depressant and antianxiety medications increased 9 percent over the year before, while prescriptions for sleeping pills increased 11 percent.

The most common mental illness because our current culture causes anxiety?

Is it the food? Television? Supernormal stimuli?

I think it's "none of the above".

From my perspective, it's a fear of fear (thanks FDR for pointing this out). 

Lots of people do lots of things which are by definition scary and I'm pretty sure they are not psychopaths.

The think I notice that these people have in common is their ability to approach fear as just another sensation like cold or hungry or the pressure on my left hip from my wallet.

It's when we are afraid of the fear - or self critical of the fear - that we drive ourselves into that downward spiral. 

Somewhere along the way, we humans have the ability to say "hmmm, this thing won't actually kill me - so why am I afraid?". I used to be terrified of speaking in front of crowds. Operative words there being "used to be". 

We have a lot of cultural programming that expressing fear (or really any of the vulnerable emotions) isn't OK.

Recognizing and getting past the cultural programming is where freedom lies.

If we can suck up the self confidence to say "wow, this is scary and that's 100% OK" - it then frees up the space to ask the next question - "what's so scary?".

The answer to that second question is almost never "this may kill me".

It's a most excellent game....

That's interesting that you think it's internal (fear) vs external (food, TV, etc).

Will think about that.

But despite anxiety’s catapulting into cultural concern, our understanding of it — especially as far as mental health stereotypes are concerned — remains developmentally stunted, having evolved very little since the time of seventeenth-century Jewish-Dutch philosopher Baruch Spinoza, who asserted that anxiety was a mere problem of logic and could thus be resolved with tools of reason. This is hardly different from present cognitive-behavioral therapy approaches or the all too common just-get-over-it cultural attitude towards this particular problem of mental health, which of course misses the debilitating dimensionality of what makes anxiety as crippling as it is. Looking back on his own messy lineage of Jewishness and Antisemitism and describing himself as “Woody Allen trapped in John Calvin,” Stossel counters such oversimplification with a case for layered, complex causality of the disorder:

The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts). The origins of a temperament are many faceted; emotional dispositions that may seem to have a simple, single source — a bad gene, say, or a childhood trauma — may not.

True to this complexity, different epochs have attributed anxiety to various causes. Stossel probes what these historical patterns reveal:

The differences in how various cultures and eras have perceived and understood anxiety can tell us a lot about those cultures and eras. Why did the ancient Greeks of the Hippocratic school see anxiety mainly as a medical condition, while the Enlightenment philosophers saw it as an intellectual problem? Why did the early existentialists see anxiety as a spiritual condition, while Gilded Age doctors saw it as a specifically Anglo-Saxon stress response — a response that they believed spared Catholic societies — to the Industrial Revolution? Why did the early Freudians see anxiety as a psychological condition emanating from sexual inhibition, whereas our own age tends to see it, once again, as a medical and neurochemical condition, a problem of malfunctioning biomechanics? Do these shifting interpretations represent the forward march of progress and science? Or simply the changing, and often cyclical, ways in which cultures work?

Kierkegaard saw a connection:

“Because it is possible to create — creating one’s self, willing to be one’s self… — one has anxiety. One would have no anxiety if there were no possibility whatever.”

It's simple, but not easy:

Anxiety is a result of the choice architecture of our current biology and its epigenetic response to environment.  

In other words, if we chose to live in high stress circumstances (most first world competitive urban areas and third world cultural conflict zones) and if our diet is the crap that most industrial agriculture is producing, then it is highly unlikely that our biology will support our mind/body homeostasis in dealing with all those stimulating inputs and circumstances.  It's absurd to expect that any of us would not have anxiety throughout such day to day living circumstances, well unless we're sociopaths or have a daily practice designed to specifically address and reduce the overstimulating effects of those persistent and continuous inputs from our relentless environments, like Delta Force training or yoga or tai chi and etc.

More and more we are living in high capacity, multi-stimulus conflicting neurological combat zones and we don't even consider that we might have an option to train and/or provision ourselves to better handle that--or simply move away from it--in order for us to do better.  Some of us wonder why things are more difficult... well, it's because they are.

Our nervous system is still on dial-up, but we're living in a broadband world now, Alice.  And with crappier food and less nutrition.

It really does feel like our environment got worse for anxiety over the last 50 years.

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