“To some people, I may seem calm. But if you could peer beneath the surface, you would see that I’m like a duck—paddling, paddling, paddling…” – Scott Stossel

You don’t have to have a therapist on speed dial to relate. You don’t need a prescription to Xanax or Ativan, or a shelf full of ‘dealing with anxiety’ books to know what he’s talking about. You don’t even need to be interested in mental health. If you have a pulse, you know. Of course, it helps if you have an Internet connection too. The skyrocketing rates of anxiety in America are no longer much of a secret. It seems like every few days bring some new angle on the story. Case in point, a trio of noteworthy articles that have cropped up over the last couple of weeks, each worth highlighting here as we begin the long(ish) trek to our upcoming conference in New York with it’s “Identity, Anxiety and the Christian Message” theme. First, there was Nicholas Kristof’s New Years column for The NY Times, where he made public his resolve to talk more about mental illness in 2014. Depression and anxiety and PTSD may not have the transporting or exhilarating/enraging quality that makes other headlines more marketable, but it is where Kristof believes people actually live, as well as something that (largely) cuts through ideological and socioeconomic lines. We need all the unifiers we can get, do we not?

Sage is Scott's sister, and Starling is the world's first anxiety-ridden superhero

Sage is Scott’s sister, and Starling is the world’s first anxiety-ridden superhero

One-quarter of American adults suffer from a diagnosable mental disorder, including depression, anorexia, post-traumatic stress disorder and more, according to the National Institutes of Health. Such disorders are the leading cause of disability in the United States and Canada…

A parent with depression. A lover who is bipolar. A child with an eating disorder. A brother who returned from war with P.T.S.D. A sister who is suicidal.

All across America and the world, families struggle with these issues, but people are more likely to cry quietly in bed than speak out. These mental health issues pose a greater risk to our well-being than, say, the Afghan Taliban or Al Qaeda terrorists, yet in polite society there is still something of a code of silence around these topics.

When it comes to de-stigmatizing anxiety, though, The Atlantic may have a significant lead on other media outlets. Exhibits A-Z being the Jan/Feb cover story by Scott Stossel referenced above, “Surviving Anxiety”, which is adapted from his new book on the subject, My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind. It’s a thorough and deeply vulnerable account of his own lengthy history of anxiety, which runs the gamut of treatments and symptoms, remission and relapse.

I for one was unfamiliar with the term ‘emetophobia’ – fear of vomiting – but no longer. It occupies a central place in Stossel’s narrative. In fact, considering the extended and hilarious anecdote about another bodily function, some might find the piece bracingly scatalogical. But it’s also quite memorable, as he’s a great writer–given his struggles, it’s perhaps surprising that his prose isn’t more overbearing. For example, as the product of a Frasier-Lilith-type union, he describes his ethnic predisposition toward his condition as “a mixture of Jewish and WASP pathology—a neurotic and histrionic Jew suppressed inside a neurotic and repressed WASP. No wonder I’m anxious: I’m like Woody Allen trapped inside John Calvin…”

It’s not the easiest article to excerpt since it covers so much ground, both in the questions it asks about anxiety (nature or nurture? biological or psychological?) and the possible solutions it surveys (exposure therapy, psychoanalysis, all kinds of SSRI medications, meditation, etc). You won’t find any definitive answers, perhaps because there are none to be had. But you will find some vivid descriptions of what anxiety feels like and plenty of helpful information about the debate over how to treat/classify it, as well as some real compassion for all those who suffer from similar conditions:

Stigma still attaches to mental illness. Anxiety is seen as weakness. In presenting my anxiety to the world by writing publicly about it, I’ve been told, I will be, in effect, “coming out.” The implication is that this will be liberating. We’ll see about that. But my hope is that readers who share this affliction, to whatever extent, will find some value in this account—not a cure for their anxiety, but perhaps some sense of the redemptive value of an often wretched condition…

9780307269874_custom-702f0ffcb51debfd68af6dcf55e5ac83bd501600-s6-c30Is pathological anxiety a medical illness, as Hippocrates and Aristotle and many modern psychopharmacologists would have it? Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it? Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes once had it? Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? Or, finally, is it—as W. H. Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?

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 seem to have a simple, single source—a bad gene, say, or a childhood trauma—may not…

Tens of millions of Americans—including me and many people I know—collectively consume billions of dollars’ worth of SSRIs each year. Doesn’t this suggest that these drugs are effective? Not necessarily. At the very least, this massive rate of SSRI consumption has not caused rates of self-reported depression to go down—and in fact all of this pill popping seems to correlate with substantially higher rates of depression… “We have hunted for big, simple neurochemical explanations for psychiatric disorders,” Kenneth Kendler, a co-editor of Psychological Medicine, conceded in 2005, “and have not found them.”…

In his 1941 essay “The Wound and the Bow,” the literary critic Edmund Wilson writes of the Sophoclean hero Philoctetes, whose suppurating, never-healing snakebite wound on his foot is linked to a gift for unerring accuracy with his bow and arrow—his “malodorous disease” is inseparable from his “superhuman art” for marksmanship. I have always been drawn to this parable: in it lies, as the writer Jeanette Winterson has put it, “the nearness of the wound to the gift,” the insight that in weakness and shamefulness is also the potential for transcendence, heroism, or redemption. My anxiety remains an unhealed wound that, at times, holds me back and fills me with shame—but it may also be, at the same time, a source of strength and a bestower of certain blessings.

Screen Shot 2013-07-05 at 3.13.42 PMOne is reminded of that great line in Thornton Wilder’s “The Angel That Troubled the Waters” that the angel speaks to the newcomer at the healing pool: “Without your wound where would your power be? It is your very remorse that makes your low voice tremble into the hearts of men.” Wilder was referring mainly to the spiritual significance of suffering, that is, of its unparalleled utility in ministry and relationships, of vulnerability and weakness being the starting points of connection and therefore love. An allusion to the power of the crucifixion, in other words. It could be that Stossel is trying to say something similar–certainly his own vulnerability in the essay is what lends it such electricity–but I’m skeptical. (One is also reminded of the masterful talk Matthew Sitman gave at our Charlottesville conference in 2012, “The Wound and the Gift“.)

Over the past few years, there’s been a rash of attempts to alleviate/exonerate mental anguish by highlighting the links between depression and leadership, or anxiety and intelligence, anger and creativity, etc, and Stossel goes down that road toward the end of his essay, listing a number of great achievers whose chronic anxiety has given them some kind of advantage. No doubt those relationships do exist in some form or other, and you certainly can’t blame him for mentioning the research. We’re all looking for a little consolation, are we not? My hesitation about these so-called “upsides” is simply that, consciously or not, they so often become minimizations of the issue, ways to avoid facing the essential pain of it all, or deny the extent of our brokenness and need. There might even be something legitimately humblebraggy about it.

I don’t know anyone who suffers from chronic anxiety or depression who would rather not suffer from it, upsides be damned, or who feels actively unknown (and unhelped) by those who try to get them to look on the bright-side (see Todd’s wonderful post about traumatized bathmats). And I suspect Scott Stossel would agree. Which is why it’s a bit confusing that he seems to jump the shark there at the end and fall for a scientistic form of silver-lining-itis. (Theologically, we are talking about the difference between a theology of the cross and a theology about the cross). Admittedly, he’s in a double-bind. Though I’m exceedingly glad he wrote it, the very existence of his article (and book) would seem to suggest his anxiety isn’t crippling. But what about those for whom it is? Those for whom anxiety is a dead-end rather than a path to higher forms of expression? Louis Menand raised similar questions in his extended review of Stossel’s book for The New Yorker:

William Styron wasn’t able to write “Darkness Visible” when he was clinically depressed; Andrew Solomon had to get over his depression to be able to write his marvellous book “The Noonday Demon.” Though Stossel’s disorder must have made progress painful, he does not appear to have been in remission when he wrote “My Age of Anxiety.”

Menand’s article is very much worth reading in its entirety, if for no other reason than it serves as a much-needed reminder that the whole business of anxiety is fairly new, period, and still pretty formless. Or at least more formless than Big Pharma would have us believe. I found his tracing of Soren Kierkegaard’s influence on post-war America, especially in our understanding of anxiety and mental illness, to be particularly helpful. Moreover, his caution about conflating all psychological and emotional agitation under the term ‘anxiety’ is something to take seriously:

The existentialist’s anxiety, the psychoanalyst’s anxiety, and the anxieties of theologians, sociologists, and evolutionary psychologists have almost nothing to do with one another. They are not even compatible with one another. If anxiety is a product of modern life, then it is not the result of unconscious drives. If it’s the result of unconscious drives, then it is not a sign of our existential awareness of the nature of freedom. It can’t be entirely conscious, unconscious, socially conditioned, and hard-wired at the same time. The most we can say is that a mood that almost everyone experiences has featured prominently in various theories of human life and the world we inhabit.

The term itself is a catchall. People describe themselves as excited, nervous, apprehensive, tense, stressed out, bugged, worried, panicky, vapor-locked, scared shitless, sick to their stomach, and feeling like they’re gonna die. Each of these moods is arguably a form of anxiety, but they are experienced as very different affective states.

“Medicate!”He’s right about this–one person’s stress is another person’s nerves, which is another person’s ennui, and so forth. There is something a bit histrionic about the way the word gets thrown around these days (which figures, I guess), and Lord knows we’re guilty of some carelessness here. Of course, just because there may be too much latitude in the term itself doesn’t diminish the increasing prevalence of all of the above. People are suffering, and making others suffer in turn, and a lot of it has to do with irrational, self-perpetuating fear. The target and degree of the fear may vary according to person, but the effects seem to be pretty constant: exhaustion, sadness, and alienation. To say that they don’t have anything to do with one another feels like an overstatement. From where I’m sitting, the convergence is uncanny.

Back to Stossel. Perhaps the chief takeaway from his excellent article is also one of its most sober points: the admission early on that “none of these treatments has fundamentally reduced the underlying anxiety that seems hardwired into my body and woven into my soul and that at times makes my life a misery.” Ooof. I doubt he’s trying to say that talk therapy and medication haven’t provided any relief–like us, I can’t imagine he wouldn’t endorse both options to someone who’s being swallowed up by nervousness. Pills and shrinks can be agents of remission, which people experience all the time, thank God. But in Stossel’s own life–and this is key–that relief has been provisional. That is to say, as miraculous as a good therapist (or church) or the right prescription can be, they are not cure-all’s. They can’t and weren’t meant to bear that kind of weight; in fact, such expectations may shortcircuit their effectiveness. They are not saviors and should not be treated as such.

Neither should self-understanding. In fact, one of the principal ironies of this whole enterprise is that, when it comes to things like anxiety (or depression or anger or addiction), awareness and knowledge–enough, say, to fill a book–have their limits. Which means it only matters so much if our anxiety is strictly biological or strictly social or some combination thereof. It only matters so much if it’s a product of changing social climates or a manifestation of a default faithlessness. Which isn’t to say introspection is worthless, of course not. Just that it can exacerbate the very anxiety it is trying to analyze. I believe The Onion captured it best when they reported that, “Anxiety Resolved By Thinking About It Really Hard.”

And now we’re squarely in the realm of religion and theology. We can know (or think we know) everything there is to know about why we do something or feel something, but insight can seldom change or help us in a lasting way. Or if it does with Problem X, it doesn’t with Problem Y. The person drowning in a sea of fear doesn’t need an explanation–at least not first and foremost–they need, well, salvation. The person whose anxiety has landed them on the operating table–maybe they’re too anxious to take their medication, maybe they took too much–isn’t interested in a diagnosis. They may even be too far gone for a cure. But they might be interested in something as antiquated as atonement. Because there are some wounds we’ll never get over. Problems we’ll never fix, thorns so deeply lodged they cannot be excised. Some of our weaknesses grow worse over the years. If the Christian message is to be of any genuine comfort, it must address those situations. It must address the impasse.

W.H. Auden, the poet who coined “the age of anxiety” saw the beauty of a hope that depends on its object rather than its subject (and their ever-changing, never-changing infirmities). Hope that depends on the One throwing the lifesaver, rather than the one catching it–or the color and size and undulation of the ocean surrounding him.

Auden described this counter-intuitive hope-that-looks-like-anything-but in his poem “The Shield of Achilles”. Thankfully, you don’t have to be familiar with The Illiad to understand it. It’s told from the point of view of Thetis, the mother of Achillles, who is watching the god Hephaestus make Achilles’ shield. Instead of the scenes of glory she expects to find, she glimpses something else entirely, what some have termed–you knew it was coming–a merciful impasse. A few stanzas to close:

She looked over his shoulder
For ritual pieties,
White flower-garlanded heifers,
Libation and sacrifice,
But there on the shining metal
Where the altar should have been,
She saw by his flickering forge-light
Quite another scene.

Barbed wire enclosed an arbitrary spot
Where bored officials lounged (one cracked a joke)
And sentries sweated for the day was hot:
A crowd of ordinary decent folk
Watched from without and neither moved nor spoke
As three pale figures were led forth and bound
To three posts driven upright in the ground.

The mass and majesty of this world, all
That carries weight and always weighs the same
Lay in the hands of others; they were small
And could not hope for help and no help came:
What their foes like to do was done, their shame
Was all the worst could wish; they lost their pride
And died as men before their bodies died.

She looked over his shoulder
For athletes at their games,
Men and women in a dance
Moving their sweet limbs
Quick, quick, to music,
But there on the shining shield
His hands had set no dancing-floor
But a weed-choked field.

A ragged urchin, aimless and alone,
Loitered about that vacancy; a bird
Flew up to safety from his well-aimed stone:
That girls are raped, that two boys knife a third,
Were axioms to him, who’d never heard
Of any world where promises were kept,
Or one could weep because another wept.