#497： The Meaning, Manifestations, and Treatments for Anxiety
Episode Stats
Summary
According to recent statistics, the number of Americans dealing with anxiety disorders is over 40 million, and that number is increasing. My guest today is one of those Americans who suffered from bouts of anxiety all of his life. He s also a successful journalist, so he decided to use his journalistic chops to explore the history of anxiety and how he treated it, in the hopes of gaining more insight about the mental disorder that has plagued him since his youth.
Transcript
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Brett McKay here and welcome to another edition of the Art of Manliness podcast. According to
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recent statistics, the number of Americans dealing with anxiety disorders is over 40 million and
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that number is increasing. My guest today is one of those Americans who suffered from bouts of
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anxiety all of his life. He's also a successful journalist, so he decided to use his journalistic
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chops to explore the history of anxiety and how he treated in the hopes he could gain more insight
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about the mental disorder that has plagued him since his youth. His name is Scott Stossel. He's
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an editor at The Atlantic and the author of My Age of Anxiety, Fear, Hope, Dread, and the Search for
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Peace of Mind. We begin our conversation discussing Scott's experience with anxiety that began as a
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child, what anxiety feels like, and how he's treated it throughout his life. We then dig into the history
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of anxiety, looking at how it's been viewed differently through time, and at what point
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psychologists classified it as a mental disorder. Scott then walks us through the different theories
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about what causes anxiety and what the research says about the best ways to treat it, and we
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in our conversation discussing the state of Scott's anxiety today and whether he thinks he'll ever
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be cured. After the show's over, check out our show notes at aom.is slash ageofanxiety. Scott joins me
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now via clearcast.io. All right, Scott Stossel, welcome to the show. Thanks so much for having me.
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So you wrote a book, My Age of Anxiety, which is a cultural history, a scientific history of anxiety,
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which is something that a lot more Americans are struggling with, they are reporting struggling
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with. But not only is this a history, it's a narrative of your own struggle with anxiety
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throughout your life. So let's start there. How long have you been struggling and dealing with
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anxiety? It's honestly been pretty much a lifelong struggle from a very young age. I mean, the earliest
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I can remember, I had terrible acute separation anxiety when I was a little kid. Anytime I was
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away from my parents, I was convinced that they were dead or had died in a car crash or that they were
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actually robots and I was part of some experiment. And then by the time I got to school, I would have
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anxious stomach aches and anxious headaches. And I didn't always end up in the nurse's office.
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I would worry incessantly about all kinds of things. So really from the time I was, my earliest
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memories, I remember being worried about things. So I have, I think, a temperamental tendency towards
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anxiety and worry that manifested itself at a very, very young age. And did it manifest itself
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differently over the years as you got older? Yeah. I mean, the separation anxiety, and that's
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sort of a classic early manifestation of people who grew up to develop what's clinically called
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anxiety disorders. But over time, I sort of developed specific phobias, fear of heights,
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fear of enclosed spaces, fear of cheese, and fear of vomiting, fear of flying, which was a pretty
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acute one that still plagues me today. I also, as I got older, started developing and sort of having
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panic attacks, which anyone who's experienced them knows are awful. And when they recur with any
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frequency over a period of time, that becomes clinically known as panic disorder. So I had
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that. And then when I got to middle school and high school, I had all kinds of social anxiety where
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I'd worry about interacting with other people, particularly performing in public. I was in the
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school play in sixth grade and it was humiliating. I had to walk off stage because I lost the ability
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to speak. And then I carried all that with me into adulthood. Basically, these anxieties were
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unfortunately additive, not substituting. I wasn't switching one for the other. It was just every time
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I got a new anxiety, I would just add that to the ones I already had. And so by the time I got to
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high school and then young adulthood, I was not all the time, but pretty constantly struggling with
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some collection of fears about going to school, traveling, getting sick, dealing with other people.
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And the strain of dealing with that would lead to depression. So it was a pretty toxic stew of
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negative emotions I was dealing with by the time I was a young adult.
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Right. One, two punch. And I imagine, I mean, you're still, I mean, we'll talk about it. You're
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still working with this stuff today, but like you're, you know, you're a public, you're a writer
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for, you know, the Atlantic. I mean, you're a public figure. I mean, has that, I mean, is it still
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something you struggle with? And then like the fact that you have to do speaking engagements or things
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like that, is that something you have to manage as well?
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It is. And, you know, I'm, I'm what they call, you know, I'm a high functioning person with anxieties.
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Or, I mean, there's some people who get so anxious that they, you know, they're what's
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called agoraphobia where they're, you know, their panic disorder gets so bad that, you know,
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the range of things they can do gets smaller and smaller. And eventually there are people who are,
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you know, confined to their houses or even confined to one room in their house and can't
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do anything for years at a time. And I've had periods like that, fortunately short periods where
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I could feel the world closing in on me. But for the most part, with a combination of
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medication, other kinds of therapy, just, you know, sort of force of will sometimes have managed
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to, you know, mostly manage to, you know, live a normal life and, and, and have a career,
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you know, and there are ways in which, and I talk about this in the book in which, you know,
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anxiety has its benefits, or at least it's, it's connected to temperamental traits that are,
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that are good. So if you're super anxious about things, you know, you're kind of hypervigilant,
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which makes you, you know, good at scanning the environment and being aware of your social
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situations or being able to read social cues. I mean, people with social anxiety probably
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overread them, but it can be a useful skill. You know, preparing, worrying a lot can be
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debilitating if it's excessive, but it also helps you to plan for different eventualities.
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You can kind of look ahead. You know, I think that just the, the struggles I've had with,
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with my mental health have made me more empathetic towards other people who have those struggles
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and even to people who don't have those struggles. So I think it helps with communication.
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So there are a lot of ways in which, even though I hate my anxiety when it's, you know,
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flaring up, it's probably propelled me along and it just, it makes me conscientious because
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I'm afraid of screwing up. I'm afraid of looking bad. And that becomes kind of a motivator.
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So, you know, a lot of times I feel like I'm kind of patched together or barely holding it
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together because my anxiety is so bad or, you know, I'm, I'm sort of pharmaceutically
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armored against, against my anxiety and that's how I've, I've struggled through. But yeah,
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and it's, and I still struggle with it today a lot. And we can talk about that more later if you want.
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But I, I've been fortunate enough to manage to, you know, mostly be a productive member of,
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Well, this book came out 2014. So it's been five years. You're seeing all these reports come out,
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you know, week after week about how Americans, particularly young Americans and, you know,
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young Westerners, right. In general are increasingly feeling like they're anxious or they're suffering
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from anxiety. What are the numbers? Like how many Americans do we know, like have a reporting
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They're, they're really high. And there was a study, a couple, it was before my book came out,
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but, but some years ago that talked about how, you know, the average level of anxiety for a typical
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high school student now self-rated report of anxiety is the same as it was for inpatient,
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you know, psychiatric patients in the 1950s. So basically, you know, the average kid today
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is as anxious and neurotic and miserable as people who are in, you know, in, in psychiatric
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hospitals, uh, a couple of generations ago. And then there's all kinds of other, you know,
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statistics that just show levels of stress, worry, anxiety, anxiety disorder, diagnoses,
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you know, are much, much higher in young people, you know, pretty much across all Western countries,
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you know, particularly there's a lot of data about Europe and the United States in the U S I think,
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I mean, there's so much data that, that there is, you know, that this is something real.
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I think part of it is our definitions of what constitutes, you know, a clinical anxiety disorder
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have expanded and become a little bit more elastic probably because we know more about
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these disorders. And so people now can identify them partly because you've got now drugs that
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have been approved to treat them. So you've got kind of the marketing imperatives of the drug
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companies, you know, the, the, the broader you can define more broadly, you can define an anxiety
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disorder, the more people you have, um, that you're able to prescribe it to. So, so partly this is
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inflation of a diagnostic category. I think in any society, there's a, you know, some compliment of
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people who will be anxious, you know, under many circumstances. But I also think that there are a
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lot of factors about the culture and the society right now that are driving people and particularly
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young people to be more anxious. And, you know, at the largest kind of societal level, it's, you know,
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we're in a long period really going all the way back to the industrial, dawn of the industrial
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revolution, but, you know, accelerating now in the internet age of just, you know, rapid change,
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economic dislocation, all kinds of transitions. There's just a lot, you know, the pace of life
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because of the internet, the way people, you know, select themselves into tribes, the pressure to
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create your own personal brand on the internet. There are just so many sort of countervailing
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pressures that confuse young people about what their identity is. And, you know, in, in, in centuries
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past, you, you're kind of born into your role. You, your, your family had a status in the tribe or in the
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medieval village you lived in, or even, you know, in, in your, you know, farm village in the, in the
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19th century America. Now, you know, you, who are you, you know, what's your, you can choose your
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gender. You can choose your sexual preference. You can choose your group, the groups you affiliate
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with socially. And all of this creates a lot of stress. And then the last factor I would say is just,
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there's been a lot written about this, you know, particularly people in the millennial generation and
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younger, there's so much, you know, helicopter parenting and your parents are super involved
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and, you know, driven and trying to make their kids succeed. But the combination of like over
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protectiveness and trying to, you know, and, and, and pressure to achieve is really toxic because on
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the one hand, these kids feel all this pressure to succeed and do better than their parents and get
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into good colleges or, or do whatever. And at the same time, the parents are doing things for them
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that parents of previous generations wouldn't, it sort of robs them of their feeling of autonomy
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and resilience. And it's really sort of an epidemic thing. And I've talked to a lot of
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psychiatrists, you know, both for the book, but then also just, you know, people I've come to know
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who are now friends who are psychiatrists or therapists, and they, and they see this as just
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kind of an epidemic phenomenon. So all those factors kind of combined to create soaring levels of anxiety.
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So let's talk, you mentioned, you know, there's sort of a cultural component to anxiety. It's not that
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like it's a, you know, anxiety is a cultural construct, right? Like it exists, it's biology,
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it's rooted in biology, but like the culture has an influence, you know, for example,
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you know, the diagnostic of anxiety disorder didn't exist 35 years ago. Like I'm older than
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that, right? I'm 37, 30, how old am I? 36. I forgot how old, at some point you stop counting
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how old you are. That's right. Yeah. It becomes a defense mechanism. Right. But that doesn't mean
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that people weren't anxious. So like, what did we call anxiety, like say like 2000 years ago or a hundred
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years ago, or even 50 years ago? Yeah, no good question. And it's been called all different
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things. I mean, obviously the emotion that we feel or the set of emotional and physical
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experiences you have in your body, when you are feeling what we now call anxiety, you know,
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have humans have experienced since there were humans, you know, what did they call it before
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there were, you know, in preliterate times when they were cavemen, you know, they made it
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out of, they didn't have a concept of anxiety, but when they went out of the cave and they were
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worried about getting eaten by a saber tooth tiger, you know, their palms would sweat, their hair
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would stand on end, their stomachs would hurt. Like that is anxiety. Even in animals, you know,
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the fight or flight response is a sort of evolutionary, you know, programmed instinct
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to help keep species alive. So what we call anxiety today sort of, you know, emanates from
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that deeply rooted evolutionary biological reality. But over the years, you know, different cultures
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have, and, you know, science has called it all kinds of different things. So, you know, for many
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years, you know, in the Renaissance, they would group anxiety, what we now call anxiety and
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depression together under, you know, melancholy. If you were, if you, if you suffered from what,
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you know, you were, you were worried about things or you were, had depressed, you were called
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melancholy. You know, once you get into the 19th century in Europe and America, they would
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call it asthenia. And it was meant to describe, this described a kind of set of traits that was
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a combination of physical things. And it could be like dizziness, sweats, you know, gastrointestinal
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problems and emotional things, you know, phobias, worry, a whole, and basically could encompass
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anything because, you know, your anxiety is, you experience it in your brain, but it has
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effect throughout your body. So neurasthenia is what they call it. You know, getting into
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the Freudian age, you know, Freud became very influential through the, through the 20th
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century, particularly into the mid, mid 20th century. And, you know, he would, he, he talked
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about what we today call anxiety as neurosis. And it really, that was just sort of a, I mean,
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he had a different theory of what caused it, you know, childhood sexual, you know, repressed
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sexual desire, conflict with your parents, the Oedipal complex, which a lot of which has
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sort of been debunked now, but, but as a kind of cultural idiom, the idea of neurosis
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became very prominent in the culture. So that was kind of through, you know, World War II
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up until, really until 1980, when the Diagnostic and Statistical Manual, which is the Bible of
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the psychiatric profession, they redefined the neuroses as anxiety. So technically anxiety
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disorders didn't exist when you were born and they didn't exist when I was a little
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kid. I'm 49 now. So, you know, for the first 10 years of my life and I was starting to get
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taken to psychiatrists, they would say, I have, you know, childhood neurosis or something like
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that. It's now been redefined as anxiety. So the labels we put on this do kind of inflect
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how we think about them and how we treat them, but it is the same underlying set of, you
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know, you, you and I, or I speaking for myself, I would be feeling the same set of unpleasant
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thoughts, emotions, and physical sensations, whatever age I was in and whatever we choose
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to call it. It's just now we, we, we classify them as anxiety disorders.
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Right. And the way we describe it and the way we talk about it has changed. Like, for example,
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in the Renaissance melancholia, like, yeah, you were sort of depressed and anxious, but like
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it was sort of romantic too, right? Like it was like, well, you're just like ponderous
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romantic person who's thinking about big thoughts. And so it was actually, there was like a
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positive spin on it, but then like Freud kind of saying, no, neurosis is bad. We got
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to, you know, solve your neurosis by sitting on a couch and talking to a therapist over
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and over again until you, you solve it. So there's that sort of swing back and forth
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between, yeah, there's some good and bad, but then it's all bad.
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Yeah. And there, there's, there's often been, you referenced the Renaissance era, you know,
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this sense that, you know, having melancholy is attached to having an artistic or refined
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or sophisticated sensibility. And it was actually seen to be sort of a desirable trait. You
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know, if you were melancholic, that meant you are creative and artistic and must be very
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smart. And sometimes that, you know, they're, they're, this is contested, you know, among
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actual experts about whether is there a link between mental illness of various kinds, including
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anxiety and depression and creativity. You know, so many famous writers, for instance,
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and artists have had, you know, very prominent psychiatric disorders or, or alcoholism or things
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like that. You know, is that, is there an alliance between the things that make you anxious
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and depressed and the things that give you a kind of artistic sensibility? Maybe there's,
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like I say, different, different people dispute that. And you're right that the, the sort of
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cultural interpretation we put on anxiety changes. And, you know, one thing in particular, you
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know, as a man, you know, that this has been changing recently, but there's a lot of shame
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associated with, you know, is anxiety cowardice, you know, and is, and cowardice is shameful.
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You know, there's not no, almost no worse epithet you can sling at a, at a man than being
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a coward or whatever. And yet, and it's, but suppressing this stuff or not treating it can
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be very dangerous. And so, you know, instead of going to a therapist, a lot of people turn
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to alcohol or drugs and, and, and, and basically try to manage their anxiety in very unhealthy
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ways that can be quite dangerous. And we'll, we'll get into that a little bit more because
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I'd like to talk about stuff like Navy SEALs and neuropeptide wide and whatever. But, you know,
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talking about the current diagnosis of anxiety, I thought it was interesting. You explore the DSM
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and how they kind of came up with it. And we've talked about some other people when we talked
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about, you know, depression, how a lot of this stuff, it's sort of like ad hoc. Like it was,
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there was like this when I threw spaghetti at the wall, or sometimes there's like dinners and they're
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like, well, here are the five things that we think that you can use to diagnose anxiety. Like it
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often seems very arbitrary sometimes. It's, it's often completely arbitrary. I mean, I was fascinated
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when doing research for this book and hearing some of these people talk, like, so the people who did
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the last edition, a previous edition of the DSM, you know, every, every, you know, 10 or 20, 30 years,
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they, they reissue a new one. And they were, when they introduced all the anxiety disorders for the
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first time, that was in 1980 with the DSM three, the third edition. And yeah, that, you know, I would
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hear people who are part of the committee that, that came up with the categories and yeah, they'd be
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like sitting around and they would have come up with, you know, a definition for like panic
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disorder, but even that was arbitrary. They'd say, well, if you have, you know, it's, it's,
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if you have six, I'm trying to remember if you have, you know, X number of panic attacks
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over a period of six months, well, then you have panic disorder. Well, why did they choose
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six months? Like instead of, you know, a year or two months and why X number of panic attacks
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instead of why? And the more interesting one was then they were talking about, well, we've
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got all these different kinds of anxieties categorized into discrete disorders. So you've
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got, you know, phobias, which is fear of specific things. You've got social anxiety, which
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is fear of social situations. We've got panic disorder, which is panic attacks. You've
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got OCD, which is obsessive compulsive disorder. But then what about, so they're at this dinner
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and they're like, well, what about our colleague, you know, Joe, he's just sort of generally anxious
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and they're like, oh, well, let's come up with something called generalized anxiety disorder.
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And so they wrote that into the third edition of the DSM. And then once it exists as a real
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category, then researchers and drug companies start to treat it as a real thing. And they, you
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know, do studies based on the sets of symptoms that you're supposed to have to be, to be
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characterized with that disease. And it starts to become sort of reified into, you know, like,
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well, you're testing for a thing that you made up in the first place. And again, it's not that
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the underlying suffering is not real and not there, but is generalized anxiety disorder really
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its own separate disorder? Or is it, as some people now think, just a subset of depression,
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you know, or depression with anxiety? People who are depressed often worry a lot and get sort of
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sucked up into their own head. Well, that's what people with generalized anxiety disorder do.
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They just worry incessantly and kind of spin in circles in their head. Being very anxious can be
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depressing. So, you know, no wonder that anxiety and depression are so often, you know, co-occur in
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people. And then many people with depression experience anxiety. So it's unclear how these
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things really, you know, in the DSM, they're very neatly cleaved from one another. So, you know,
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this disorder is distinct from that disorder. A lot of people are now starting to think maybe,
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especially as they start to look at the neuroscience of this, which is still in early stages, but maybe
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this is all kind of variants of the same thing. I imagine like a hundred years from now when
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scientists look back, they may think that our categorizations of these things are pretty crude,
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Right. Like when we think about how people talk about neurostenia, right? Well, that's kind of silly.
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Or hysteria, you know, hysteria, you know, it was a sort of, you know, particularly for women,
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but it was, there was some, you know, what was that? Was that a cultural phenomenon? Was it a
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medical phenomenon? It was kind of both. And these things always intersect. That's always interesting
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to me. Like how to, when you have a real biological thing that gets interpreted culturally,
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that's fascinating and really does change how we treat and think about people who have these disorders.
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We're going to take a quick break for your word from our sponsors. And now back to the show.
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And I imagine it can cause a lot of confusion and frustration for people struggling with it.
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They're going to help and they're getting inconsistent diagnoses from different, like,
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because like, you know, one therapist was like, well, you have this, but not this. So you're this.
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And it's like, well, what am I like? What am I supposed to be doing with what I,
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Yeah. After my book came out, I had a lot of people say that, or, you know, versions of that,
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that they, you know, struggled a lot. But in general, I would say, you know, most therapists,
00:19:47.220
that there's a lot of agreement and it may change, but, you know, there are certain things
00:19:51.600
that there's emerging data about what works for kind of all these things or many of these things.
00:19:57.160
So for instance, there's a form of therapy called cognitive behavioral therapy,
00:20:00.780
which is basically a combination of, you know, helping people to change their thoughts to make them
00:20:08.120
less maladaptive, you know, break the cycle of negative thinking and sort of reality test in a
00:20:12.900
better way. You know, people are worried about things who have, you know, generalized anxiety
00:20:16.160
disorder. They always see the worst case scenario. And cognitive behavioral therapy helps you restructure
00:20:20.660
your way of thinking so you can see things in a more realistic way and then help you change your
00:20:25.300
behavior and exposing yourself to the things, you know, if you have anxiety, exposing yourself to the
00:20:29.620
things you're afraid of to kind of decondition you from the fear. There's a lot of evidence over now,
00:20:35.660
you know, more than a decade that that kind of therapy can work for all kinds of anxiety disorder,
00:20:40.440
for obsessive compulsive disorder, for depression. So there are things that work. And then there are
00:20:44.460
certain medications. I mean, medication is, you know, we may talk about that. That's a whole complex
00:20:48.840
stew where my sense is medications can work, but there is a great mystery about how they work,
00:20:54.280
when they work, who they work for, what the downsides are. But there are some studies and a lot
00:20:59.240
of evidence that suggests that for some people, certain medications can help them with their anxiety,
00:21:02.800
their depression. So even though we're still kind of groping around for, you know, proper definitions and
00:21:06.880
everything is kind of, these categories are messy. There are things that, that are generally believed
00:21:11.800
to, to, to work. And we'll, we'll talk about medications. That's interesting as well. Cause
00:21:15.560
that's, again, it's like the coming with the, how we define and diagnose anxiety. A lot of the,
00:21:21.580
the medication developed were very ad hoc and we'll talk about it because it's really interesting as
00:21:25.300
well. But let's talk about like what causes anxiety because like some people will look at it,
00:21:29.360
well, it's just like a choice. Like it's a, you can just snap out of it. Like, you know,
00:21:33.440
get, get your, get yourself together. But there's also evidence that says, no, there's,
00:21:37.500
there's a genetic component to it. So what's going on when, what, what causes anxiety?
00:21:41.520
There are, it's, it's, there are multiple causes, but there is a very strong, you know,
00:21:45.880
there's tons of evidence that there is a strong genetic component, you know, and just about
00:21:49.440
everybody has some adaptive predisposition to experience, you know, have a fight or flight
00:21:54.940
response, to have a fear response. But there are some people who, because of their genes
00:21:58.640
are born with, you know, what psychologists call a temperament that is more highly reactive.
00:22:03.220
And so it's literally, you know, the, the, the genes in their, you know, their, their DNA
00:22:07.920
and codes for a physiology that is more high reactive. And so those people, you know, just,
00:22:13.520
and you can detect it in babies, you know, you can often tell the ones that are going to grow up to
00:22:17.640
have, you know, anxiety disorders because they have a more exaggerated, what's called startle
00:22:21.640
responses. You know, if you, if you make a loud noise or flash a light at them, you know,
00:22:25.840
you can see their, their heart rate increases more, they sweat more, they have, you know,
00:22:29.640
electric conductance in their skin is greater. So it literally is at some level you can't control
00:22:34.720
it. It's, it's, it's deeply, deeply wired in and, you know, scientists are starting to look
00:22:39.640
at the various, you know, clusters of genes that, that lead to that. So some people are just born
00:22:44.380
with a ready press predisposition to be anxious. But then on top of that, there's kind of the
00:22:49.580
environmental factor. And there's also tons of evidence that, you know, and this is where Freud
00:22:54.500
wasn't wrong. You know, early childhood experiences have a profound impact on your psychology and your
00:23:00.340
sort of mental resilience, psychological resilience for the rest of your life. So people, kids and
00:23:05.100
adults who are exposed to trauma, you know, it changes your brain chemistry and even your brain
00:23:09.240
structure in such a way that, you know, this is what PTSD is. You're, you're now much more prone
00:23:13.480
to anxiety and depression, you know, panic attacks. So, you know, it's, it's a gene environment
00:23:18.840
interaction. And there are some people who are born with such an anxious predisposition that even
00:23:25.560
small stressors are going to send them into spiraling anxiety or depression and make them
00:23:30.780
develop a disorder. There are other people who are going to be much more resistant to it, but,
00:23:35.360
you know, even those people, most of them, many of them anyway, if exposed to enough trauma, you know,
00:23:41.000
war or, you know, something horrific in childhood will develop the elements of an anxiety disorder.
00:23:47.400
And then overlaid on top of that, as we were talking about earlier, they're kind of the
00:23:50.160
cultural and social level stuff, you know, are there certain cultures or periods of history that
00:23:57.140
are more anxiety causing than others? And I think the evidence suggests that, that there are,
00:24:02.080
but I think the strongest contributor by far is, is your genes. You know, there are some people who
00:24:06.680
are just have the misfortune to be born highly anxious and some people who are born sort of more
00:24:10.740
serene, but, you know, as with all human traits, then environment plays a role too. So.
00:24:16.000
Yeah. Well, you talk about even your own family, anxiety seems to run, run in your family.
00:24:21.040
Yeah. So, you know, when I was both in my therapy, but as I was researching the book,
00:24:25.900
you know, I was trying to figure out, well, what is the source of my own anxiety? And, you know,
00:24:28.820
my mom, you know, super high worrier, had a lot of phobias, which I got from her, you know,
00:24:33.960
and did I get them from her by watching her? Did I learn them from her, from environmental or is it,
00:24:39.340
you know, genetically encoded? And then her, you know, parents, you know, both had kind of elements of,
00:24:45.060
you know, had worrying personality traits. Her grandfather, my great grandfather,
00:24:49.200
you know, had struggled terribly with what they then called anxiety neurosis and was
00:24:52.520
institutionalized in psychiatric hospitals, you know, many times. Again, he had a very successful
00:24:56.960
career, was a smart, accomplished guy, but then would just get completely incapacitated
00:25:00.320
by his anxiety, would have to go to the mental hospital and get electroshock therapy to kind
00:25:04.880
of get his brain reset. And then, you know, I've got other relatives who struggle with this.
00:25:10.240
So, and then, and then studies show that once you have, you know, some number of anxious people
00:25:14.480
in a family, it just, you'll find many, many more. And, you know, is that transmitted by
00:25:20.540
environment? You know, did I learn it from my mom, from watching my mom, from watching my
00:25:23.940
grandparents? Maybe. Or was it transmitted through my genes? Well, probably that too. And
00:25:28.600
you can never, you know, completely disentangle them.
00:25:31.640
Well, yeah, going back to that idea that some, that you brought up that, you know, for men,
00:25:36.020
anxiety can be like a slap in the face. Cause like, look, if you have it, like you're a coward,
00:25:40.460
but like, you know, we were talking about Navy SEALs. Like some people are born with a predisposition
00:25:45.240
to be very anxious, but some are born with just like, they're just, just water off a duck's back,
00:25:50.080
right? Like Navy SEALs, they've done research on them where they found like they're actually
00:25:53.840
have a genetic predisposition to be hyper resilient, even in super stressful situations.
00:25:59.260
Exactly. I was fascinated by that study. So, I mean, Navy SEALs are really interesting to study
00:26:04.520
because they're such extreme like human specimens, you know, and to get to the point where you,
00:26:09.000
you know, get through Navy SEAL training, it's like, you must be, you know, incredibly physically
00:26:12.320
fit. And then they put you through these physical hardships, like sleep deprivation and, you know,
00:26:16.480
incredible hardship. And, you know, the physical part is hard enough, but these guys, you know,
00:26:21.080
they're able to withstand almost like a form of, you know, torture that would cause, you know,
00:26:26.920
me or many other people to just kind of break down. And so there's a guy at Yale who was
00:26:32.360
studying, you know, what, what is it that makes these guys so resilient? And he was actually
00:26:36.020
looking, you know, he would take, I think it was from their blood samples, you know,
00:26:39.680
measuring different neurotransmitters in their brain. And he found that the Navy SEALs who succeeded
00:26:44.940
in doing the Navy SEAL training had unusually high levels of something called neuropeptide Y.
00:26:51.520
And, you know, basically if you have a high level of, and they could actually predict in advance
00:26:55.260
to try to determine cause and effect, like, is it, you know, finishing the course that like gives
00:26:59.200
you a boost of confidence or something that causes your neuropeptide Y to rise, or do you have
00:27:02.860
kind of a natural baseline level of it? When you, when they looked at these people in advance,
00:27:08.360
they could almost predict how they would do on the test by their levels of a neuropeptide Y in
00:27:12.740
advance. And there are other studies that show that neuropeptide Y, you know, your levels of that
00:27:16.900
are kind of genetically determined, or at least partly genetically determined, which, you know,
00:27:21.660
to me is powerful evidence that your level of psychological resilience is, you know, conferred by your
00:27:26.620
genes, which, you know, allows you to produce this neurotransmitter that makes you unusually
00:27:31.180
psychologically resilient. But what psychologists now are really interested in studying, and in the
00:27:35.880
military too, is, you know, how can you cultivate this in non-genetic ways? You know, many of us would
00:27:40.920
benefit from being more resilient. So are there things that we can do through therapy or through
00:27:45.480
life experiences that boost our levels of neuropeptide Y, or that create the kind of psychological
00:27:50.980
structures in our head that are associated with neuropeptide Y, and that make us resilient and
00:27:55.540
resistant to anxiety, traumatic stress, that kind of thing. And it's a really promising area of
00:28:00.660
research. You know, it's basically taking, focusing on the people who are the least anxious and figure
00:28:04.760
out how can we use what they have going for them, both in terms of how they think and what's in their
00:28:09.140
brain, to treat people who, you know, are particularly non-resilient or highly anxious.
00:28:14.440
Well, let's talk about sort of the history of treating anxiety. So you mentioned earlier,
00:28:17.920
right now, there's a lot of promising research and, you know, studies have shown that cognitive behavior
00:28:22.900
therapy can help mitigate or help people manage their anxiety. But besides that, what are some
00:28:27.480
of the other ways, as far as therapy goes, and we've used to try to treat anxiety disorders?
00:28:32.400
Well, so these days, there's cognitive behavioral therapy. There's more traditional talk therapy.
00:28:37.560
I mean, CBT is kind of a form of talk therapy, but, you know, more of what you think of from the
00:28:41.300
movies, which is, you know, just talking to a psychiatrist or a psychologist or a social worker
00:28:46.660
or a therapist or some other kind, you know, psychodynamic therapy, that's called. And there's a lot of
00:28:50.700
evidence that just, you know, talking to someone who listens sympathetically to your problems has
00:28:56.060
some training in, you know, both helping you solve basic life challenges, but also, you know,
00:29:01.520
helping you resolve childhood issues. There's some evidence that that works. And then there's
00:29:06.820
medication. And, you know, going back really millennia, I mean, you know, if you read, you know,
00:29:12.600
the ancient Greeks or, you know, even Hippocrates, you know, the sort of original,
00:29:16.580
you know, most famous doctor in history, you know, talks about, you know, how wine can treat
00:29:21.900
anxiety. And, you know, for years, people have been using alcohol and opium and things like that
00:29:27.420
to medicate anxiety. But, you know, just going back a hundred and some years, there've been sort
00:29:32.400
of waves of different things that have been used to treat, you know, particular anxiety and then
00:29:36.220
anxiety and depression. You know, way back at the turn of the 20th century, you had kind of
00:29:40.740
barbiturates and other sedatives that were used to treat anxiety. Then around mid-century,
00:29:46.500
you had the dawn of what are called the benzodiazepines. So it's Valium and Librium.
00:29:52.300
And these days you have Klonopin, Xanax, Ativan, even Ambien that work on your, you know,
00:29:58.700
set of neurotransmitters in your brain called GABA that basically calms your brain down. And that can
00:30:03.760
be very effective in treating anxiety, but very dangerous too, in terms of its addictive potential
00:30:08.760
and, you know, the tendency to form, you know, habit and dependency. For depression,
00:30:13.600
you know, there've been different waves of drugs. There was the, you know, wave of what they call
00:30:17.280
the tricyclic antidepressants. Tricyclic just describes the structure of the molecule that,
00:30:22.200
these were things like imipramine, dezipramine. And then in the 80s, you had the first, what's
00:30:26.920
called the SSRI, serotonin, selective serotonin reuptake inhibitors. And the first one and most famous
00:30:31.800
one is Prozac. But these days you've got Prozac and Paxil and Zoloft and Celexa and Lexapro and a whole
00:30:37.840
bunch of others in that category and related ones too that affect serotonin and norepinephrine.
00:30:42.940
And basically all these drugs work on different sets of neurotransmitters to kind of, you know,
00:30:47.420
augment their levels in the brain in ways that we still don't fully understand how they work,
00:30:52.300
but seem to have some efficacy in reducing anxiety and reducing depression. And I've taken a lot of
00:30:59.560
these drugs myself and some of them seem to work and some of them don't. Some of them have terrible
00:31:03.020
side effects. The depressing thing about a lot of this is that, you know, a lot of treatment just
00:31:10.660
doesn't work. You know, it takes a lot of trial and error. You know, therapy can be effective and
00:31:14.480
I would encourage anyone who's suffering with these things to, you know, seek out treatment because
00:31:18.340
it can be a lifesaver. But it can sometimes, sometimes it takes a few tries to find a therapist
00:31:22.900
that you like or a medication that works. And if you look at the long-term evidence, you know,
00:31:26.840
really it's like a third to a half or something of any treatment works. And it's not always clear
00:31:31.760
why the thing that's working is working. And that's why CBT is probably the best evidence,
00:31:36.740
has the best evidence in its favor. And it also has in its favor, since it's not a drug,
00:31:41.660
it's not addictive, it's not dependency forming, it doesn't, you know, and ideally you can kind of
00:31:45.320
learn the skills from CBT and take them with you through your life, you know, and keep practicing.
00:31:50.960
Unlike, you know, if you're on a drug and it works, what happens if you go off the drug?
00:31:54.300
Like sometimes, you know, have, you know, withdrawal issues.
00:31:57.280
Yeah. So, I mean, I think you brought up an interesting point that anxiety sounds like
00:32:01.700
it's something that you can't really, you're never going to be cured of it, right? Like
00:32:04.900
you're always going to have to just, just manage it for most of your life.
00:32:08.600
I would love to be able to be cured of it. And I still, you know, some of the time with,
00:32:13.500
you know, 10% of my brain hope that I could be, you know, to achieve like complete serenity.
00:32:18.380
And not that there won't be things that scare me or that I don't, you know, worry about
00:32:21.280
legitimately, but it's not something that plagues me. And I think,
00:32:24.140
you know, some people, they get really, the one thing I didn't mention is, is, you know,
00:32:27.520
mindfulness practice. These days, there's tons of evidence that the, you know, various meditation
00:32:32.480
skills and practices and, and, and other forms of mindfulness really can help confer the kind of,
00:32:38.900
you know, resiliency and calm that say neuropeptide Y does in these Navy, Navy seals. And, you know,
00:32:44.280
so I, in my therapy, I've tried, you know, a combination of CBT with trying to do meditation stuff.
00:32:48.980
So, so I think it is, and you're not cured. You're, you're always going to have your underlying
00:32:52.900
genetics. So if you're a high reactive person, someone who is prone to be nervous about things,
00:32:58.360
that's probably always going to be the case, but you can reduce, you know, the amount of it. And
00:33:02.140
you, as you say, you can learn to, to manage it with different sets of skills from whatever kind
00:33:06.520
of therapy you're using or to manage it with medication or to, you know, sort of adjust your
00:33:10.880
lifestyle. I mean, sometimes if you're anxious or depressed, that's your body and your brain
00:33:15.120
telling you something's not right in your life and you need to, you know, make some changes and
00:33:19.340
sometimes having a better lifestyle and all this obvious cliche and stuff that people tell you is
00:33:23.160
true. You know, it's really important to get sleep. You know, for me, if I'm, if I'm underslept,
00:33:27.640
my anxiety goes to the roof. It's for me also, and tons of studies support this regular exercise. I
00:33:32.520
mean, these are basic things that don't cost anything. You don't need insurance for, but in
00:33:36.460
modern life, it's sometimes hard to work out regularly. It's hard to get a good night's sleep when
00:33:39.860
you've got deadlines. So all these things, you know, if you, if you do them all, you can
00:33:44.160
actually minimize the effect that anxiety has on your life. And there's always going to be,
00:33:49.040
I mean, for me, you know, there's things that erupt that cause my anxiety to spike,
00:33:52.200
but when I'm doing well, I can both have those spikes be fewer and farther between. And also
00:33:59.260
when they happen, manage them better and not have them, you know, send me spiraling off the rails or,
00:34:03.920
or, you know, sort of over-medicating myself. So there's a long-winded way of saying, yes,
00:34:08.380
you know, if one can learn to, to, to manage them and if, and if you can do that, then you can live a
00:34:12.240
pretty, you know, fulfilling and rewarding life. That's not, you know, the constant misery that
00:34:15.900
anxiety can sometimes be. Right. I think that's hopeful because I mean, if there's a strong
00:34:20.020
genetic component to anxiety, you know, people who have that problem, they're listening, they're
00:34:23.340
like, well, crap, I'm, I'm hosed. Yeah. That's, that could be the approach or it could be like,
00:34:27.680
well, okay, this is the thing. I got to work with it. It's not great, but I can manage it. There's
00:34:32.920
things I can do. Yeah. And I mean, I, when I, I remember talking to my therapist when I was sort of
00:34:36.760
learning about my great grandfather and all the terrible troubles that he had had and then
00:34:41.760
multiple, you know, hospitalizations. And I was like, God, you know, he reminds me so much of
00:34:45.460
myself and I have, you know, his genes and this, I'm doomed to this. And my therapist was like,
00:34:49.260
first of all, he's your great grandfather. You have like a tiny fraction of his genes.
00:34:52.760
And second of all, you know, there's medications we have now that he didn't have access to that can
00:34:59.140
help you. And, you know, there, there, there's just lots of stuff that you can do. You're not,
00:35:03.000
yes, genetics is powerful, but you're not doomed to your genetic fate and we can learn to cultivate
00:35:08.760
resilience. And a lot of the therapies that are effective, like I say, you know, kind of behavioral
00:35:12.900
therapy, but just in general, you know, facing your fears and I'm, you know, it's easy for me to say
00:35:17.820
this and sometimes hard for me to do, but the more you, you know, if you have specific phobias like
00:35:22.080
fear of flying or fear of public speaking, the more you do it, the easier it gets. And that's sort of a,
00:35:27.540
you know, simple lesson, but it's, it's, it's true. It's just, you know, for me,
00:35:31.200
sometimes those things can be so anxiety producing that I can't do them. And then I feel like it's
00:35:35.560
a setback and my anxiety gets worse. But what my therapist always tell me is, you know, get up,
00:35:39.380
persist, do it again, and you will get better. So.
00:35:42.200
Right. Exposure therapy. I think that's what that is.
00:35:43.760
Exposure therapy. Exactly. Yeah. So if you have fear of heights, they'll take you up on higher and
00:35:46.960
higher buildings. I mean, you know, sometimes these treatments sound kind of extreme. Like if you
00:35:50.900
have severe claustrophobia, there's actually therapists who will put you in like a coffin and, you know,
00:35:55.260
you have a horrible anxiety, but then you just wait it out and you realize I didn't die. You know,
00:35:58.960
I'm okay. I can manage it. It was just a really unpleasant emotion, you know, for,
00:36:03.380
for people who have flying phobia, there are pilots who will take you up. A lot of airports have
00:36:07.780
programs where you can go and, you know, get walked around the plane by a pilot who explains how the
00:36:12.840
whole thing works, you know, and basically little by little expose yourself, you know, sit in the
00:36:16.520
plane, then go on a short plane ride. And eventually, hopefully you can be flying to Europe without
00:36:20.040
being completely miserable as I've sometimes been on, on international flights.
00:36:24.380
And I think that's an important point for parents who might have children who are,
00:36:26.880
you know, hypersensitive or super anxious. You know, oftentimes when you're a parent,
00:36:29.880
you're like, well, I just don't want my kid to freak out. So I'll just avoid the thing that,
00:36:33.980
you know, causes them lots of anxiety and gets them worked up. Rather, the better approach might
00:36:38.420
be, well, just sort of slowly introduce that thing over and over again. So they don't get scared.
00:36:43.060
They're not scared of it or doesn't worry them anymore.
00:36:45.400
That's absolutely right. And I think that's really important. And what I'm about to say may sort of
00:36:49.340
sound paradoxical, but it's not, you know, if you think that there's all kinds of evidence that
00:36:53.800
suggests that if you think your kid might be developing, you know, unusual level of anxiety,
00:36:57.980
you know, what could be a clinical level anxiety, the evidence says, you know, if you, the earlier
00:37:02.100
you can get help and get them therapy, the better, the better outcome they'll have, the less likely
00:37:06.520
they'll be to, you know, suffer anxiety disorders as an adult. So early intervention is key, but early
00:37:12.260
intervention doesn't mean sparing them from anxiety. And, you know, what almost any therapist
00:37:16.280
they would tell you is actually, you know, don't, and this is where, you know, it's the antidote to
00:37:20.300
helicopter parenting. Don't try to do everything for your kids. Don't try to spare them the unpleasant
00:37:26.780
experience or the thing that's making them nervous, you know, particularly if it's being, you know,
00:37:30.020
anxious about going to school. And I know how hard that is, you know, both having been, you know,
00:37:33.820
a very anxious kid and now being a parent who has anxious kids, you know, it's incredibly painful
00:37:39.780
and hard to watch your child, you know, suffering and feeling nervous. And everything in my body wants
00:37:43.720
to be, I just want to take him out of that situation so he's not nervous. But what, you know,
00:37:48.360
their therapists, every therapist, you know, I've ever seen says, no, no, you have to let them,
00:37:53.440
within reason, experience the anxiety and learn that they can overcome it. And that's how they
00:37:57.180
develop resilience. Don't do it for them. That's how you, you know, you'll helicopter your parent,
00:38:01.540
your kid into being kind of a helpless, neurotic, you know, 22-year-old who can't make his own dinner.
00:38:06.720
Right. So what's the state of your anxiety today? So you've said you're doing cognitive behavioral
00:38:10.780
therapy, some mindfulness meditation. Are you taking medication?
00:38:13.360
I am. So I'm still really bad at the mindfulness. And I think it's one of these catch-22s that like
00:38:19.340
the more, the people who need, who benefit from like mindfulness and yoga and that kind of thing,
00:38:24.180
meditation the most are the ones who are worst at it because, you know, I'm just,
00:38:27.260
my thoughts are always racing. I have a hard time sitting still, but I'm trying that,
00:38:31.180
doing CBT with a really good therapist and that's helped doing exposure therapy, which is
00:38:34.840
really unpleasant, but I think does help. And then, yeah, I am currently on Lexapro,
00:38:40.540
which is one of these SSRI medications. And then around the, I take a medication called
00:38:45.760
gabapentin, which was originally a anti-seizure medication and a medication for pain, but has
00:38:51.760
shown some effectiveness in treating anxiety. And then, you know, I've, I used to take a lot of
00:38:57.600
benzodiazepines. I've now tried not to, they work incredibly well for me. You know, for me,
00:39:03.140
that was always like my magic bullet. If I was, you know, I knew I could always survive if I could
00:39:06.540
have access to, you know, enough, enough Xanax. The problem is it worked a little too well.
00:39:12.040
And, you know, the danger is I, you know, I started to become too dependent on it. And,
00:39:16.340
you know, you, the more of it you take, the more you need to take in order to get the same effect.
00:39:20.200
And it can be very dangerous and people become dependent on it. So I'm trying not
00:39:23.720
to use that now. And, you know, it's pretty widely prescribed by both psychiatrists and...
00:39:31.400
Just family doctors, because it is so effective. But there's also, you know, a pretty big school of
00:39:35.380
thought out there that it's like, they really shouldn't be prescribing it so wildly because
00:39:38.380
it can be, in certain people, very addictive and dependency forming.
00:39:42.660
And so I imagine it's like, and also you're doing the things like getting enough sleep,
00:39:45.760
exercising, managing stress, reducing that when you can, et cetera.
00:39:51.040
Yeah. I mean, I don't know why this is the case, but for me, you know, getting, you know,
00:39:55.340
regular exercise is, it's like night and day. And my wife can even tell, you know, if at the end of
00:40:00.660
the day I'm on the phone with her, she'll be like, why don't you go work out? And I'm like,
00:40:03.620
how can you, she's like, I can just tell in your voice that you haven't. And it's like,
00:40:06.060
my personality changes somehow. And, you know, not, you know, you don't always feel like working
00:40:10.340
out. There's some people who just don't exercise at all. And, but for me, forcing myself to work
00:40:14.720
out, even when I'm, don't feel like it, you know, just is so good for my state of mind and good for
00:40:19.480
my physical health as well. And that's true for just about everyone.
00:40:23.400
Right. Well, and I imagine if there's someone who's listening to this podcast, they're struggling
00:40:27.360
with anxiety, best advice, go get help, go talk to somebody. There's things you can do to help
00:40:32.280
manage it. So you have a flourishing, productive life like yourself. Like you said, like, yeah,
00:40:35.860
you've, you've struggled with your entire life, but you have a good career and you're doing a lot
00:40:39.600
of great things. Yeah. And there, there are a lot of ways you can get help. I mean, there's,
00:40:43.420
I'm forgetting what it stands for, but NAMI, it's like the National Alliance of Mental Health
00:40:47.760
Initiative or something like that can help you find, even if you don't have insurance or, you know,
00:40:52.200
help you find access to, you know, individual therapy or group therapy or just resources in your area.
00:40:57.260
If you have anxiety in particular, there's an organization, nonprofit organization called
00:41:01.340
the Anxiety and Depression Association of America. It's the ADAA. And if you go on their website,
00:41:06.900
you know, they have lists of therapists in your area and you can always just go to your
00:41:12.040
primary care physician and they, they can help refer you. You know, if any, any city that has a
00:41:19.020
university will often have like an anxiety disorders clinic. So there's lots of help available out
00:41:24.280
there. Well, Scott, is there some place people can go to learn more about your work?
00:41:27.280
You can go to my website. I'm embarrassed. I'm blanking on now what the...
00:41:33.440
scottstossel.com. Yes. Thank you. I never go to it.
00:41:38.100
Right. Well, hey, Scott, this has been a great conversation. Thanks so much for your time.
00:41:44.760
My guest today was Scott Stossel. He's the author of the book, My Age of Anxiety. It's
00:41:48.500
available on amazon.com and bookstores everywhere. You can also check out our show notes at
00:41:51.880
aom.is slash age of anxiety, where you can find links to resources,
00:42:03.180
Well, that wraps up another edition of the AOM podcast. Check out our website at
00:42:07.360
artofmanliness.com, where you can see our podcast archives. We're coming up on 500 episodes here
00:42:11.740
pretty soon. You can see them all there. While you're there, check out our articles we've written.
00:42:15.140
We've got a couple thousand there about just about anything. Depression, how to manage that,
00:42:19.220
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00:42:22.620
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00:42:30.380
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00:42:34.280
Until next time, this is Brett McCary. Remind you not only to listen to the AOM podcast,