May 18, 2014

#Anxiety — an inside story

My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of MindMy Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind by Scott Stossel

My rating: 5 of 5 stars

A very good, and somewhat sad, and definitely sympathetic read here.

I had seen the excerpt from this book in a recent issue of The Atlantic, where Stossel is the editor, so this jumped off the shelves when I spotted it at the library.

Stossel mixes biography with scientific research on anxiety to tell us what we seem to know pretty well, what we may know, and what we still really don't know, about anxiety.

As Stossel and others know, and as he documents well in the biography part, is that a tendency to anxiety seems inherited. But, is it? He mentions a bit about epigenetics, the "tags" that can control when, how and for how long genes are activated (that's oversimplifying) and how anxiety is one of the big topics in epigenetics research. He also mentions psychodynamics, and the idea of how anxious children may learn to be anxious from anxious parenting, and thus pass that on. Meanwhile, he notes that starting with the wonder, in the 1950s, of the first drug that seemed to help depression, then others for anxiety, neuroscientists have promoted happier living through better chemistry.

This plays out in Stossel's search for help, with a "Dr. Stanford" telling him he just needs to tweak, or up, his meds, while "Dr. Harvard" says he needs to discuss his family, his personal life, and specific anxiety situations, including some existential ones.

Stossel hints they're both partially right, and that as a generally non-confrontational sufferer of anxiety, he can't tell them that neither is fully right.

Stossel, whose one grandfather was a dean at Harvard, started seeing a child psychiatrist in elementary school. That same grandfather had multiple institutionalizations later in life and eventually had to leave Harvard. His wife committed suicide. That's on his dad's side. Similar, albeit somewhat lesser, "strains" of anxiety run in his mom's family.

So, Stossel knows anxiety is real, even crippling.

His own story included gulping both Xanax and booze before flying and before giving public speeches. He admits on the latter that it's a fine issue, trying to find the sweet spot between being halfway numbed out on his anxiety and slurring his words. He also admits he knows he's playing with addiction/alcoholism fire.

Stossel also notes that he stand on the shoulders of giants -- previous literary giant sufferers of anxiety, and tells bits of some of their stories in this book as well.

I'm with Stossel in the general idea that, sadly, we don't have a complete handle on the causes of anxiety yet, only that they're complex, and the problem itself is still only roughly defined — general anxiety disorder, and its DSM definition, overlap a fair degree with major depressive disorder. I'm also with him that the "one neurotransmitter, one solution" idea of many neuroscientists and Big Pharma is way, way, way too reductive. Given that the "big three" of dopamine, norepinephrine, and serotonin all have multiple different receptor sites on neurons, and we don't know which ones antidepressants and anxiolytics affect, and we don't know what others of the roughly 100 neurotransmitters also may or may not affect anxiety or depression, this approach is reductionistic indeed.

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