By Scott Stossel Knopf, 2014 Review by Donald L. Beahm, Ph.D. on Jun 10th 2014
It took courage to write this book. I suppose all publicly shared writing endeavors take some amount of courage to initiate and complete, but when the writing reveals this much about a personal struggle that can range from frustrating and humiliating to completely demoralizing, well, it just takes an inordinate amount of courage to expose this much of one’s self, especially when you have been burdened with so many mental health challenges. Beyond revealing his own outright nearly lifelong brawls with anxiety, Scott Stossel writes a book that does a superb job of discussing and analyzing anxiety from a medical, philosophical, cultural and historical perspective. The focus of the book is on trying to understand anxiety, its causes, manifestations and how it can be treated, with the added dimension of hearing it from someone who has boat loads of experience trying to grasp its dimensions and cope with it.
One of the things I liked most about the book is that he manages to intertwine the various aspects of his evaluation of anxiety without muddling them. He begins each chapter and then delicately intersperses quotes from a number of revered historical authorities from philosophy, medicine and psychology (Kierkegaard, Freud, and William James, to mention a few). He includes his own struggles with anxiety where appropriate but I never felt as if he was making the book a “woe is me” exercise. In fact, the way Stossel tells some of his personal stories about trying to cope with anxiety you are more likely to laugh with him about how ridiculous things get than to cry over how terrible the situations are. It is clear that what he is trying to do in writing the book is answer a number of interrogatives, such as, what is anxiety? Where does this affliction come from (nurture v. nature or child rearing v. genetics)? How does one treat this illness (therapy v. medication…both…neither)? He states that he is hoping that writing the book will help him deal with his own anxiety, but the book is far more than what he has gone through, and he has been through a lot. It has more to do with what anxiety is, how it has been understood and where we are going with treating it.
Stossel relies on various sources to claim that anxiety is today the most common form of officially classified mental illness, where thirty-five years ago it didn’t exist as a diagnostic category in the Diagnostic Statistical Manual of Mental Disorders published by the American Psychiatric Association and used by mental health practitioners to identify types of mental illness. Conditions such as general anxiety disorder and panic disorder were not listed in the manual then but are now. He argues that although anxiety was not a new condition these specific illnesses did not become diagnostic categories until after the drugs were discovered to treat it. In other words, and as he puts it in part of the title of Chapter Six in the book, …How Drugs Created a New Disorder, these new drugs became heavily prescribed for illnesses that just a short period before had not been diagnosable.
The trajectory of ascertaining new drugs, such as benzodiazepines (two of the best known are Valium and Xanax) to treat anxiety led to an explosion of the use of these drugs. He does recognize that large numbers of people have benefited from the use of these drugs, a group that includes him by his own admission. However, his concern appears to be that these drugs were created in search of an illness, or at the least these drugs just happen to treat mental illnesses that hadn’t been identified. Also, he has legitimate concerns that too many patients are being prescribed these drugs when they may not be necessary.
I have no doubt that he is correct in observing the two diagnostic categories came after the advent of some of the drugs being developed. Also, I don’t doubt that many anti-anxiety medications and anti-depression medications are over prescribed. Nevertheless, anxiety had been identified by both Herodotus and Hippocrates by the fifth century. Is it such a revelation that medications would have been discovered to treat certain types of the malady, or the general condition itself? It seems that over prescribing is the problem that physicians need to reign in, not so much that pharmaceutical companies develop drugs that don’t yet fit a specific diagnostic category, although, there are plenty of problems with how pharmaceutical companies go about their business.
Despite concerns about how some of the drugs used to treat anxiety came about, and what they may be doing to his brain, Stossel continues to use them and fairly strong doses of alcohol at times to try to reign in his anxiety (he lists what he has taken over the years and it is a very long list). He knows this is not healthy but feels it is necessary to persevere. He indicates that many other accomplished people have struggled with anxiety, such as Darwin, Freud and William James. Stossel is quite accomplished himself currently editing The Atlantic and having authored a previous book titled Sarge: The Life and Times of Sargent Shriver, in addition to numerous other articles and essays in The New Yorker, The New Republic, The New YorkTimes and the Wall Street Journal. His writing skills are well presented in My Age of Anxiety. He takes on the affliction of anxiety with a clarity and grasp of its complexity that few would be able to harness. His research and his own experiences have motivated him to write this book as a “…quest to understand, and to find relief from or redemption in anxious suffering.” I believe that he has succeeded to a great degree and I believe his readers will largely benefit as hoped.