Who's Afraid of the Big Definitive Book?: Scott Stossel's My Age of Anxiety

We live in an anxious time, or at least that's what we tell ourselves. It seems that more than ever we are distracted by anxiety about ourselves and about the world. There is no doubt that our increasingly inescapable awareness of world disorder has something to do with it. It has to. We can't just shake off the news of wars and rebellions, terrorism, financial turbulence, nuclear annihilation, or missing jetliners. And we seem less and less capable of handling stress.

What makes it all the more frustrating is that we don't really know what causes anxiety (behavior, upbringing, biochemistry, genes) or how to effectively treat it (drugs vs. therapy). Even its definition is hazy. The public perception of anxiety changes from era to era and even today vacillates from denial that anxiety constitutes anything more than cowardice to what may be an overemphasis on its pervasiveness as a problem or the helplessness of those who are afflicted with it.

In My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, Scott Stossel, editor at The Atlantic, offers a detailed overview of how, why, and about what we are anxious. Over the course of the 400-plus page book, Stossel outlines every aspect of the subject of anxiety imaginable. His focus shifts between history of thought on the subject (highlighting such illustrious figures as Kierkagard, Freud, and Spinoza), descriptions of scientific experiments and research, and his own phenomenological experience of dealing with the condition.

He also talks about important historical figures who struggled with anxiety symptoms all their life while continuing to function at a high level. It is his recounting of his own experiences with anxiety that hooks in the reader -- some of the more academic sections of the book can be pretty dry though informative. It is obvious that grappling with anxiety for so long has made Stossel acutely sensitive to how it manifests both psychologically and physically. His level of self-awareness is remarkable, although it is also interesting that it does not keep the anxiety at bay. He says that the book is itself a kind of therapy, an attempt to calm the beast by trying to understand it.

Stossel is candid in admitting that he is deathly afraid of public speaking, of embarrassment, of flying on an airplane. He even has a fear of cheese. He also has general dread about everything from exams and job interviews to simply walking down the street. He has tried many methods to keep the problems at bay: talking therapy, immersion therapy, medication, drinking. Some things help more or less for a little while, but nothing seems to completely solve the problem and usuaully just when he think he's been cured it finds a way to come roaring back.

Some of the most interesting sections are where he recounts episodes of panic or uncontrollable fear. A story involving an over-flowing toilet at a Kennedy house party is gripping, cringe-inducing, and quite funny all at once. He is also very good at itemizing the physical symptoms or the sensations of anxiety as they occur, giving us insight into what anxiety or panic feels like.

At times, however, he goes on too long about his own experiences. A drawn-out section deals with Stossel trying to overcome his fear of vomiting, a condition known as Emetophobia. He elucidates the various therapies he underwent at great length, describing his failure to overcome the phobia. A doctor, who he refers to only as Dr. M. (he gives pseudonyms to the many doctors he talks about in the book), tries to use immersion therapy on him, a technique designed for the anxious person confront what he or she fears in order to realize that the fear itself is wholly imaginary.

To do this, she gave Stossel an emetic called Ipecac. The result backfired. Stossel, who had not vomited for years, willed himself not to throw up and was just miserable from the whole experience. He ended up more afraid of vomiting and more committed to preventing himself from doing so. Stossel was upset and confused, and his doctor was embarrassed. In the end, we learn very little from Stossel's ordeal about whether immersion therapy is effective. Stossel's personal stories often feel too subjective and particular, revealing only his own feelings about a particular doctor or therapy.

He also wavers. A large section of the book deals with the issue of the effectiveness and downsides of medication in treating anxiety. He lays out the fascinating science behind the way medications do or do not work: the basis for this is research in the study of chemical imbalances in the brain, history of the various types of medication, both Benzodiazepines and SSRIs as they developed towards the present day culminating in the eventual triumph of such drugs as Xanax and Prozac.

Also highlighted are the powerful early effects of the drug, followed by a slow but steady tolerance buildup and eventual ineffectiveness as well as the sometimes extremely harmful side-effects and unpleasant and difficult withdrawal symptoms, even the brain damage that can occur. Finally he talks about the potential good or ill that may result from the expanding definitions of mental illness related to the spread in popularity of medications and the moral ambiguity associated with the profit-making incentive of drug companies.

The waffling nature of his discussion on the drug issue becomes readily apparent. He starts by saying he was uncomfortable with the idea of taking medication to treat anxiety then went ahead and did it anyway. He is quick to point out the positive sides of these drugs and that they can be very beneficial to some while other times stating they might not do anything at all and in fact raise the incidence of depression and anxiety in society at large.

Stossel has difficulty drawing much of any conclusions from the large amount of background research he has done, and therefore, so do we. His discussion about his own experiences with drugs such as Paxil only muddies the issue further, leading us to not know how to judge it, since he himself seems not to know whether the drugs have hurt or helped him, but nonetheless continues to take them to treat or lessen his anxiety.

As well-researched and balanced as his considerations of the issues of anti-depressants and other drugs for anxiety are they are nonetheless frustrating as it is hard to come out of this section with any firmer understanding of whether or not medications are beneficial or harmful in the treating of anxiety. What we want is a firm grasp of the issue and perhaps his own verdict. Stossel gives us neither.

The real trouble with the book comes when Stossel tries to combine his wealth of research with his personal history. Both are done well or at least adequately on their own. He attempts to stitch them together, but often it feels like a stretch. For instance, he relates his own personal problems with a nervous stomach to the similar symptoms suffered by Charles Darwin, who was known to suffer from a variety of physical ailments exacerbated by his anxiety. While this is an interesting comparison, it is hard to draw much from it beyond the fact that they both suffered from a similar affliction.

The problem may be insurmountable. It might be that Stossel is too close to his experience of the condition to treat it with the kind of clinical, scholarly, or even narrative distance necessary to effectively mix history, science, and memoir. The book might've been better had he chosen to focus on one or the other.

Despite these drawbacks, much of My Age of Anxiety is very entertaining and sheds light on definition, historical and philosophical exploration, and scientific discoveries on the subject of anxiety. It is a rich, informative, and often entertaining investigation of a difficult subject and it should be praised on that account even if it falls short of the overly-ambitious intentions of its author.