Anxiety disorders are now the most common mental illness among Americans. At least 19 million adults in the United States—more than 13 percent of the country’s adult population—suffer from some form of the condition, and experts don’t expect that number to drop anytime soon. That’s hardly surprising: both biological and environmental factors play a part in anxiety disorders, and there’s certainly been plenty to worry about in the past few years.
Millions have lost their jobs to outsourcing or corporate layoffs and are struggling to cover their bills—not to mention holiday gifts. The flu-vaccine shortage has prompted fears of an influenza pandemic. The threat of another terror attack looms large, particularly in cities like New York and Washington, D.C. And the war in Iraq plays out on the front pages of the newspaper almost every day. Even those who don’t suffer from a clinical disorder are familiar with the feelings of anxiety. It’s a part of our daily lives now, writes neuropsychiatrist and best-selling author Dr. Richard Restak in his latest book, “Poe’s Heart and the Mountain Climber: Exploring the Effect of Anxiety on Our Brains and Our Culture” (Harmony), NEWSWEEK’s Jennifer Barrett Ozols spoke with Restak about the prevalence of anxiety in this country and how Americans can learn to cope with it. Excerpts:
NEWSWEEK: Why write this book now?
Dr. Richard Restak: After September 11, and living in Washington, I naturally became curious about anxiety. I saw it all around me, in people I knew, in patients—in myself. I thought, anxiety is really the inner dynamic that really fuels so much our modern day life. We have consumer anxiety, social-comparison anxiety. Anxious people are people who purchase more things, eat and drink more, buy more luxury items—so there’s a fueling of that in our culture. But, obviously, the more important stimulus for the book was the fact that people were frightened, fearful in ways they hadn’t been before. I got interested in the whole topic. First of all, what’s the difference between anxiety and fear?
What is the difference?
Fear is focused. When we turn down a dark alleyway and there’s someone behind us, we are fearful. Are they going to attack us? We either turn back, or we get attacked, or we get to the end of the alley. So it stimulates fight or flight and occurs over a short time period. Anxiety is more diffuse—a lot of times we’re not sure what we’re anxious about. It persists over longer spans of time. And instead of retreat, it’s both approach and avoidance. If we’re anxious about our boss because we’re afraid of being fired, one part of us wants to get closer to the boss to make sure we don’t get fired and another part wants to stay away—out of the sights—of the boss. It’s a feeling of restlessness and foreboding, a sense of threat and vulnerability. [The main character in Edgar Allan] Poe’s “Telltale Heart” is the quintessential example of anxiety, starting with a low level to outright psychotic panic.
What about the rest of the book’s title?
I was interested in mountain climbers because they really don’t show fear. They have overcome it. They aren’t dare devils. There’s a lot of planning and training and work that go into their efforts. What they’ve done is taken something and mastered it.
You write a lot about two parts of the brain—the amygdala and the frontal lobe. How they are related to anxiety?
If you’re crossing Fifth Avenue and you suddenly see in the periphery of your vision a bus coming at you and you jump back on the curb, that’s the sensory-visual connection to what’s called the amygdala, which gave you the fear response that caused you to jump back so you’re safe. When you stop and think about why you responded, that’s the frontal lobe. It
explains why you responded as you did.
With anxiety, there have been many, many experiments where people look at fearful faces that are shown so rapidly they don’t consciously see them but yet they become anxious. It never went to the frontal lobe in the way that if I showed you a photo of a bleeding, suffering person and you saw it and became anxious, you would understand why. If I show it to you so fast you don’t consciously see it, you’ll still feel anxious but you don’t realize why. That’s the amygdala.
We are in a culture where hopefully our frontal lobes—and executive functions—are gaining mastery over our more primitive, autonomic and automatic responses. But it takes time. It is a challenge to look at anxiety differently and realign our attitude. It’s going to be a part of
our inner landscape forever—anxiety is a part of normal living now.
Are we really living with more anxiety than past generations who lived during the two world wars?
Absolutely, because of the imagery. Let’s talk about World War II. I don’t remember it, but how did they learn what happened in the war? They read about it or heard about it on the radio. It was real, but it is not as real as turning on CNN and seeing those images of soldiers being carried off the field or various images we are seeing all the time. There are higher levels of anxiety in the 1990s compared to the 1950s. There’s another fact about children in the 1980s experiencing levels of anxiety higher than psychiatric patients in the 1950s. Why are so many
children on medication? It’s an anxious time.
Do you think the government might unintentionally be increasing Americans’ anxiety with the terror-alert system and talk about the potential for another attack?
The problem is that neither you nor I know what’s really going on. We just don’t know. We are being told all this stuff. There’s certainly the potential there for someone to do the unthinkable: saying, let’s use anxiety as a way of gaining and keeping political power. I want to be careful how I put this. It’s an intriguing and anxiety-provoking question. Could and would a government say, let’s use this in a conscious way as a way of controlling the populace? I would hope not.
I would hope not, too. You also blame the media as “probably the greatest contributor to anxiety in our culture.” Why?
I’m not really talking about the print media. I should put “video” in front of that. Print media hasn’t changed so much. But the video image can be anxiety-arousing by having people exposed to images before seen by only soldiers or EMTs or doctors. I’m not criticizing it, I’m just saying we need to think about it and the effects on us and realize every little thing is not a crisis. And there are some really wonderful things going on in this world, too.
Are there specific symptoms you look for in patients to indicate that they suffer from above normal anxiety?
There are all different symptoms—restlessness, poor sleep, they can’t relax, indigestion. None of these by themselves indicate anxiety. But if you have a whole palette, you can diagnose it and treat it.
What advice would you give to readers who worry they may be suffering from too much anxiety?
I think of medication as the last option. I believe in journal writing, so you can look upon it as something objectifiable rather than something that is happening to you and you can’t control. The key thing—and the reason I wrote this book—is to say that we are in this age of anxiety and not to deny it. Stay informed, but I wouldn’t keep yourself jived up all the time with these horrific images [on TV] that can have that effect on you or about subjects that you can do nothing about.
Newsweek health. Dec. 2004
THE CURE = THE GOSPEL
See “Peace of Conscience and peace of mind,” November 2004 Ensign