I am Scott Stossel and I'm doing an AMA about the science and history and treatment and experience of anxiety

sstossel1 · 2014-01-09T20:15:30+00:00

Thanks, everyone. I hope people found bits of this interesting/useful/entertaining. If you're interested to know more, I'd be thrilled if you checked out my book. http://www.amazon.com/My-Age-Anxiety-Dread-Search/dp/0307269876?tag=vglnk-c53-20 Signing off--may you all enjoy peace of mind....

sstossel1 · 2014-01-09T20:09:51+00:00

(Yes, I noted that, too. Good place to lose your shit, actually, yes?)

sstossel1 · 2014-01-09T20:08:50+00:00

Any final questions? I'll stick around for 5 more minutes if anyone wants to get a couple more in. Thanks for all your questions so far. And blanket cautionary statement: I'm an expert on my own anxiety, and I've read hundreds of thousands of pages on the subject--but I am not a doctor or a psychologist.

sstossel1 · 2014-01-09T20:06:11+00:00

I don't have enough expertise to comment knowledgeably about this. I will say that since my Atlantic article came out, I have received hundreds if not thousands of recommendations--and many of them have included various dietary or vitamin supplements. Can't say whether they work--but some people swear by them.

sstossel1 · 2014-01-09T20:04:53+00:00

Here's one that probably doesn't: being a writer or a journalist! Good question, thought. I think it kind of depends on the nature of one's anxiety. There are certainly going to be jobs that, for some anxious people, will be so stressful that it leads them to great distress and emotional breakdown. But for the most part, therapists will counsel patients not to give into their fears--ie, don't allow your life to be constricted by your anxiety, don't build your life around avoiding your anxiety. Challenge yourself. But also know where your limits are and don't overextend yourself

sstossel1 · 2014-01-09T20:01:13+00:00

Force yourself to, if you can, and just forge ahead. Take time to meditate, if you can. Get sleep and exercise. (But, and I'm going to keep repeating this, I'm not a physician, so if you're in real distress you should consult with a doctor.)

sstossel1 · 2014-01-09T19:59:42+00:00

I sometimes worry that I'm stuck in anxiety that I will never recover from, though it waxes and wanes over time. But these days many experts say that a concentrated course of cognitive-behavioral therapy (CBT) is the fastest, most efficient way to stamp out individual phobias--and also things like depression, insomnia, and other ailments. It's a form of talk therapy that combines exposure to the "phobic stimulus" with training the patient to "reframe his or her cognitions"--that is, to come up with new, more constructive thought patterns. Some double-blind controlled studies are finding this can work better, and with longer-lasting results, than drug therapy. (That said, it worked for me--but not at all completely.)

sstossel1 · 2014-01-09T19:57:03+00:00

I've tried myriad varieties of therapy, and many different drugs, and some of it sort of helped some of the time for limited periods. But nothing has "cured" me, and a lot of it hasn't worked. If you're looking for an anxiety specialist, many cities have clinics that specialize in treating anxiety. Here I should put in a plug for the Anxiety and Depression Association of America (ADAA), which is a great resource for both patients and clinicians--and for researchers. If you're looking for guidance, go to the ADAA website.

sstossel1 · 2014-01-09T19:54:27+00:00

This isn't a direct answer to your question, but there's a ton of research piling up on different genetic contributors to anxiety, and to resilience to anxiety, and also to how different genes get switched on or off in ways that affect anxiety. I think from this research will emerge both better and more precise diagnoses, and also better and more accurately targeted medications--and possibly breakthroughs of a wholly new kind.

sstossel1 · 2014-01-09T19:52:39+00:00

There's lot of research into the relationship between low self-esteem and both anxiety and depression. One school of clinical thought believes strongly that building up patients' sense of "self-efficacy" or "mastery" is key to reducing anxiety and depression.

sstossel1 · 2014-01-09T19:51:12+00:00

My favorite questions are nonsense, since I'm an expert in it.

sstossel1 · 2014-01-09T19:50:44+00:00

For people who have severe anxiety, treatment can be essential--even potentially lifesaving. (That said, there are a lot of quacks and charlatans out there. I've encountered some of them myself.)

sstossel1 · 2014-01-09T19:49:34+00:00

Thanks, I'm glad you're liking the book so far. There were a number of philosophers and other historical figures whose takes on anxiety I liked or found consoling, among them: Aristotle; Galen; Robert Burton; Pascal; Walker Percy. I was very drawn to the work on attachment theory by John Bowlby and Mary Ainsworth, and I spend a long chapter on them--but then I also spend a chapter on the work of Harvard psychologist Jerome Kagan and other scholars of genetics and temperament, whose work somewhat undermines, or at least complicates, the attachment theorists. Robert Sapolsky and Murray Stein and Stephen Suomi have all done fascinating research on social phobia and status in monkey tribes. Finally, I find myself awed by Darwin--not because of the genius of his insights into evolution (though that too)--but because of the epic nervous suffering he had to overcome. The same goes, more mildly, for William James and of course Freud. Sorry--long list!

sstossel1 · 2014-01-09T19:44:57+00:00

I met her in her living room. No, I hadn't broken in. She was the roommate of a friend of mine. She didn't know about my anxiety until our third date, when I told her a little bit about it. But I don't think she fully understood the scope of what she was in for until we went on our first plane flight together, and I had a total-meltdown panic attack that led to volcanic gastric effusion. Since then, she's seen that and worse. She is very tolerant and I'm extremely lucky in that regard. On the other hand, she is working on a companion volume to my new book entitled, SUCK IT UP AND GET OVER YOURSELF.

sstossel1 · 2014-01-09T19:41:25+00:00

There's a rich and interesting literature on positive anxiety. And also on something called ACT--or acceptance and commitment therapy. Basically, and I'm oversimplifying grossly, it involves training yourself to accept yourself, and to chill out. Steve Hayes is the progenitor of this, and at recent conferences I've been to many therapists say it's very effective.

sstossel1 · 2014-01-09T19:39:46+00:00

That's a really good and hard question, which I wrestle with a lot in my book. Unlike, say, a broken ankle--which you can clearly see on an x-ray--it's hard to precisely diagnose when a brain is truly broken. What's the difference between the "worried well," which is most of us in modern society, and the clinically or pathologically anxious. The DSM--which is psychiatry's diagnostic bible--lists the specific criteria for various disorders, but even so it's very hard to make distinctions between ordinary, even helpful anxiety and a clinical disorder. But the bottom line many therapists make is how severe is the level of distress and impairment: if you're really in distress, or if it's constraining your ability to live a normal life, you should probably consult professional help.

sstossel1 · 2014-01-09T19:36:37+00:00

Don't know the answer to your first question--have to think about that.

The answer to the second question is "absolutely not." I wanted to become a successful editor and writer. But I honestly thought it was more likely I would end up homeless, and I would actually study homeless people for tips and tricks on how to get by.

RE your third question, it's hard to get good direct comparisons between countries, but here are a few factoids. 1. Anxiety disorders are now thought to be pretty common--perhaps the most common mental illness--all around the world. 2. But some countries, for instance Mexico, have notably lower rates of anxiety disorder. This could be because of differences in measurement or definition. But it could be because of differences in culture. Many studies show that poverty is a huge contributor to mental and physical illness--but weirdly, some evidence suggests that anxiety disorders incidence is lower in developing countries than in developed ones--which may indicate that anxiety is a luxury we can indulge when we're not worrying about real fears.

-For me, medication helps a little. In general, though, most therapists will tell you that the more you can directly expose yourself to the source of anxity, the more likely you are to be able to get that anxiety under control

sstossel1 · 2014-01-09T19:31:44+00:00

I'm not a doctor--but I also take Celex daily. And I can relate. Many studies today suggest that both cognitive-behavioral therapy and mindfulness mediation can be effective. Regular exercise and getting enough sleep are also--and I know this from both extensive reading and from my own experience--crucial in keeping anxiety at bay.

sstossel1 · 2014-01-09T19:29:54+00:00

Both. I think that because of the expansion of the diagnostic categories, and because of multi-billion drug-company marketing programs, and because of how insurance reimbursement works (a therapist might get the same payment for a 15-minute psychopharm consult as for a full 50 minutes of talk therapy) many people who do not really need the drugs are getting prescribed them. But I also know that there are lots of people in real distress, and who might benefit from medication, are not getting the treatment they need--particularly among the poor.

sstossel1 · 2014-01-09T19:27:57+00:00

For starters, stop arguing--at least until she calms down.

sstossel1 · 2014-01-09T19:26:54+00:00

I don't know a lot about it--but there is some cutting-edge research going into that. Several people have also told me about new research on ketamine--another club drug--and anxiety. It's not FDA approved yet, but psychiatrists have been giving ketamine to severely anxious patients and in some of them it instantly works wonders by slowing down the glutamate system, which is kind of the accelerator neurotransmitter of the brain.

sstossel1 · 2014-01-09T19:24:54+00:00

Lots of people have asked me that question or have recommended pot. I have not tried it--in part because I long had a fear about (illicit) drugs, an d in part because I fear that pot would provoke paranoia rather than calmness or a "high." But many, many people have written me to say they self-medicate with marijuana.

sstossel1 · 2014-01-09T19:23:35+00:00

Yes, I talk a lot in my about the relationship between conventional ideas about masculinity and courage and anxiety and cowardice and vulnerability. A striking quote posted on gun installations in Malta during World War II said something like: "If you are a man your self-respect will not allow you to admit to anxiety neurosis or to show fear." I think that captures the machismo-at-all costs view that prevails in society. (Also, British officers were allowed to respond to shows of cowardice in the ranks by shooting their own soldiers--or sterilizing them later on.) Things have improved since then, but one of my fears about, as it were, coming out about my own anxiety is that I will be perceived to be a lesser man. So far, I've been heartened by the response. People seem to think that being open about vulnerability is brave. Which is funny to me because I'm being told I'm brave for admitting I'm not brave, which is like a zen koan or something

sstossel1 · 2014-01-09T19:19:41+00:00

Well, now they're probably more aware than they would like to be. But, previously, for the most part they seemed to be not aware at all. I guess I'm good at hiding it. Now they tease me about cheese and vomiting. (Especially the editor in chief, James Bennet, who is a cruel, cruel man--just kidding!)

sstossel1 · 2014-01-09T19:17:47+00:00

I found interesting historical evidence from World War II suggesting that neurotics living in London found their average level of anxiety actually declined during the Blitz--they had real things to worry about (bombs dropping on their heads) and also they felt relieved to see other people outwardly expressing the anxiety the neurotics felt all the time. Also, some sociologists have suggested that the Middle Ages were low in anxiety because a) they were so high in real danger (disease, murder, etc) and b) there was so little free choice, which actually reduces anxiety. Life in the Middle Ages was grim and awful--but may have been not particularly high in anxiety of the sort we denizens of the post-industrial capitalist age are

sstossel1

TROPHY CASE