Feeling Anxious?

Author: Andrew Santella

Walking up Wells Street in Chicago not long ago, I passed a storefront yoga studio. Nothing unusual about that, now that yoga studios have become about as ubiquitous as drug stores in some upscale neighborhoods. But what made me stop and take notice that day was a sign in the studio’s window.

“Stress,” it announced, “is connected to 99 percent of all diseases.”

That message, with its air of statistical authority (Ninety-nine percent! That’s almost all of them!) stuck with me all day. I had been worrying a lot—worrying about work, worrying about friends, worrying about the list of chores waiting for me at home—and that sign didn’t do much to ease my worries.

I suppose I could have taken the yoga people up on their offer of salvation, walked in, done a little Downward-Facing Dog, stopped stressing.

But nothing stresses me out more than someone telling me I need to relax. And once I had read that sign, I had something else to stress about. Now I was worried that all that worrying was going to kill me.


I’m not the only one who’s so fretful about fretting. Read the steady stream of reports detailing the health dangers of workplace stress, the prevalence of anxiety among teenagers and adolescents, and the development of a thriving relaxation industry that aims to soothe the wigged-out and worried. Aromatherapy, massage, deep-breathing, prescription drugs like Xanax and, don’t forget, yoga: the array of weapons available in the war against worry is growing all the time.

But worry won’t go down without a fight. The National Institutes of Health warns that so many of us “now harbor anxiety and worry about daily events” that “stress hormones continue to wash through our systems, never leaving the blood and tissues.” The result of such long-term activation of the stress system? “Increasing risk of obesity, heart disease, depression and a variety of other illnesses.”

“In headaches and in worry/Vaguely life leaks away,” wrote W.H. Auden in his poem “As I Walked Out One Evening,” published in 1940. Who knew that poets could be such masterful diagnosticians?


According to the National Institute of Mental Health, anxiety is the nation’s No. 1 mental health problem, affecting about 19 million people with various phobias, panic attacks and obsessive-compulsive disorders. The Anxiety Disorders Association of America is less conservative with its numbers, estimating about 40 million Americans with anxiety disorders. According to their 2006 survey, almost half of American workers experience “persistent stress or excessive anxiety on a daily basis” and nearly a quarter have taken prescription medication for their stress problems.

Digest enough of these mental-health statistics and you begin to form a picture of a nation on edge, an anxious nation. Just as impressive, and almost as numerous, are the theories that aim to account for all our nervousness. Maybe the aftershock of the 9/11 attacks left too many of us expecting the worst. Maybe an increasingly rootless, mobile society leaves people unmoored in times of trouble. Maybe it’s the relentless flow of news about war, terror, kidnappings and environmental peril. Certainly, as another presidential season begins, politicians can be counted on to exploit Americans’ fears—of an uncertain future, of economic disaster, even of people who speak different languages—in their campaigns.

But are our times really that much more frightening than past times? Or is there something in the American character that inclines us to worry?


In 1869, a doctor named George M. Beard introduced a new disorder into the medical lexicon. He called it neurasthenia. Its defining symptoms—a catalog that expanded over the last few decades of the 19th century to include insomnia, excessive worry, nervous exhaustion and premature baldness—were brought on, said Beard, by exposure to the relentless pace and dizzying stimuli of modern life. (Some say neurasthenia sounds a lot like what we would today call chronic fatigue syndrome.)

For Beard, neurasthenia was a new problem, a response to the new stresses of life in Gilded Age America. “The Greeks were certainly civilized, but they were not nervous, and in the Greek language there is no word for that term,” Beard wrote in his study of neurasthenia in 1881. The problem was not with civilization but with modernity. “The modern differs from the ancient civilizations mainly in these five elements—steam power, the periodical press, the telegraph, the sciences and the mental activity of women. When civilization, plus these five factors, invades any nation, it must carry nervousness and nervous disease along with it.”

Beard’s diagnoses rang true to many, and especially so to the professional classes that could afford to be sensitive and distraught. By the end of the 19th century, as Tom Lutz explains in his book, American Nervousness, 1903, neurasthenia had become nearly epidemic among artists, intellectuals, managers and other members of the urban elite. The disorder even came to be seen as a mark of refinement and status. Only the most “advanced” races and religious groups were affected by neurasthenia, according to Beard. “No Catholic country is very nervous,” he sniffed.

Even if only the elite were subject to the disorder, neurasthenia was portrayed as an emblem of a more industrialized and urbanized national culture. In fact, the pioneering psychologist and philosopher William James called neurasthenia by a different name.

James called the disorder “Americanitis.”


Last winter, for about a week, I stopped sleeping. I was at the time fretting excessively over nothing more than the usual daily hassles, yet when it came time for me to go to bed I was so frazzled that rest was out of the question.

You learn a few things when you go through a bout of insomnia. You learn, for starters, that if you stay up all night a few nights in a row you will quickly catch up on your backlogged reading. You also find yourself, addled by lack of sleep, doing things like leaving your car keys in the microwave.

It was after one of these car-key misplacements that I went to see the family doctor for help. Two appointments later, after the sleep-aid he initially prescribed turned out to be no match for my condition, he sent me home with a new prescription, this one for an anti-anxiety med. I was no mere insomniac, after all; I was officially anxious.


Maybe chronic nervousness is the American Way. Beginning with George Beard, we’ve seldom lacked voices decrying the price we pay for our way of life. In 1925, Dr. William Sadler told a medical gathering that the “hurry, bustle and increased drive of the American temperament” was to blame for 240,000 deaths each year. And in 1983, a Time magazine cover story posed the dire question, “Stress: Can We Cope?” The article quotes one doctor who sounds amazingly like Beard more than a century earlier when he posits, “Our mode of life itself . . . is emerging as today’s principal cause of illness.”

The seeming paradox is that our nervousness apparently reached something like epidemic proportions at the very moments in history when we were becoming notably healthier and wealthier. Today we live longer, get richer and enjoy safer lives than ever before—and yet we seem more anxious and fearful than ever. Journalist Gregg Easterbrook’s recent book, The Progress Paradox, asks: If everything is so good, why do we feel so bad?

Is it possible that anxiety thrives precisely in the absence of trouble? It could be our very prosperity, the very safety and security we enjoy—and the anomic self-indulgence it engenders—that makes us fret. (Poet John Donne: “Temporal prosperity comes always accompanied by much anxiety.”)

Maybe our nervousness is a product of our triumph. No less an authority on scaring the hell out of people than Wes Craven, the director of the Scream films, seemed to suggest as much: “I think America will always be afraid, in a sense, exactly because of its great success.”


Part of the difficulty with understanding all our various kinds of nervous failure stems from our confusion about the names we give them. Is anxiety just a dressed-up clinical term for excessive worry? Where does fear leave off and phobia begin? Even the American Psychological Association includes everything from obsessive-compulsive disorder to social phobia to post-traumatic stress in the capacious category of anxiety. Would the scarred and troubled survivor of trauma have anything meaningful to say to the social phobic terrified of entering a cocktail reception? What exactly are we talking about when we talk about anxiety?

I remember the confusion I felt as a kid in Mass hearing a priest asking God to “protect us from all anxiety.” The term seemed too squishy, too nebulous, too psychological for that context.

Most of us use the term anxiety to mean a response to some diffuse or abstract or even unknown disturbance. “Uneasiness or trouble of mind about some uncertain event,” says the Oxford English Dictionary. When we mention fear, on the other hand, we’re usually talking about a reaction to a concrete, knowable danger.

Anxieties can be focused and specific, too. Search for the term in news databases, and a lot of the hits will have to do with economic insecurity, stock-market jitters or the unnerving confluence of killer mortgages and looming layoffs. Then there’s the whole sub-category of websites and blogs devoted to documenting—but never mocking, the proprietors insist—the wide world of phobias you never knew existed. Consider hippopotomonstrosesquippedaliophobia—the fear, of course, of long words.

Nervousness sparked by the threat of terrorism gets a lot of play, as well. A recent New York Times story reported that commercial-airline flyers who were worried about terrorism were turning in increasing numbers to such anti-anxiety medications as Xanax and Klonopin to help them make it to touchdown.

In his new book, Negative Liberty, Darren W. Davis, a Notre Dame political science professor, explores what he calls the “newfound sense of anxiety and vulnerability” that followed the 2001 terror attacks and asks how far Americans are willing to go in trading civil liberties for security. Among the elements stoking public anxiety, Davis lists terror-alert warnings and the media’s “overemphasis on negative and problem-oriented news that promotes a sense of vulnerability.” He asks, “Why are people fearful? They are fearful because they’ve been told to be.”

Not that our interest in anxiety is a recent phenomenon. Descriptions of anxiety symptoms in medical literature go at least as far back as the 400 B.C. work of Hippocrates, Of the Epidemics, which describes a man who is “beset by terror” whenever he hears a flute.


Is anxiety ever useful? Søren Kierkegaard, the 19th century Dane who was the first philosopher of anxiety, thought so. He called anxiety a “school which teaches people to face death and accept a human situation frankly.” Kierkegaard located the roots of anxiety and dread in man’s freedom to choose. “When I behold my possibilities,” he wrote, “I experience that dread which is the dizziness of freedom, and my choice is made in fear and trembling.”

For Kierkegaard, anxiety can be a kind of sign of progress toward real faith: “This is an adventure that every human being must go through—to learn to be anxious in order that he may not perish . . . the individual through anxiety is educated into faith.”

If anxiety is so essential, is somehow a sign of our aliveness, why is it the goal of most therapies to reduce our anxiety? Isn’t that aim asking us to become less fully alive? In medicating our way to serenity, are we failing to honor the uniqueness of the individual?

The novelist Walker Percy, influenced by Kierkegaard, asks questions along these lines in such late novels as The Second Coming and The Thanatos Syndrome. Percy, Catholic to the core, casts a suspicious eye on what he calls “brain engineers, neuropharmacologists, chemists of the synapses.” One of his heroes, Dr. Thomas More, who calls himself an old-fashioned “psyche-iatrist,” poses the key question this way: “If one can prescribe a chemical and overnight turn a haunted soul into a bustling little body, why take on such a quixotic quest as pursuing the secrets of one’s very self?” Percy’s hero insists that our anxieties are signs, not just symptoms, and that they might be trying to tell us something important.

The idea that the symptoms of our nervousness are a gift to us has become a staple of the self-help circuit. Listen to your anxieties, goes the advice, attend to them, and change your thoughts and behaviors accordingly.

Listening to our anxieties, though, is no easy work. As a father and homeowner who spends most of his time worrying needlessly about my kid, my health, my job and that funny noise the furnace keeps making, I am frankly tired of listening to my anxieties.

I want my anxieties to shut up and mind their own business for a while.


One of the most remarkable things about the neurasthenia epidemic of the late 19th century is that so many Americans of the time seemed proud to be so unhinged. Beard bragged that neurasthenia was “modern, and originally American; and no age, no country, and form of civilization, not Greece, nor Rome, nor Spain, nor the Netherlands, in the days of their glory, possessed such maladies.” You get the feeling that some neurasthenics flaunted their nervousness like the latest fashion. No American could consider himself fully refined unless he was at least a little neurasthenic. It was the It Diagnosis.

I don’t know how to reconcile this prideful dysfunction with the shame I have always felt about my own anxiety. At that doctor’s visit last winter when I was first enrolled in the ranks of the officially anxious, I took a look around the waiting room at my doctor’s other patients. There was an elderly woman with a gauze bandage over one eye, there was a man toting an oxygen tank, there was a young mother with two little kids in tow, ailment or ailments unknown. These, I remember thinking, were people with real problems.

Of course, anyone who’s ever been really anxious knows just how frighteningly real the problem can be. My anxiety might have been all in my head, but I could still feel it in my chest.

Which is why everyone from the National Institutes of Health to the corner yoga studio wants me to do something about all that stress, all that worry, before it kills me.


A century ago, the remedy might have been a potion called Americanitis Elixir, a popular tonic for the neurasthenic set. Today’s menu of remedies is much longer, taking in all kinds of behavioral therapies, relaxation techniques, alternative spiritualities, and cabinets full of tranquilizers and antidepressants.

Granted, sometimes the cure can seem almost as disturbing as the disease. The celebrated psychotherapist Albert Ellis, who died last year at age 93, wrote proudly of conquering his social phobia by staking out a park bench and approaching 100 women, one at a time, to strike up conversations. Maybe some of those women were not so pleased to be part of his therapy. But Ellis’ message—that each of us can change the way we think and behave—is a hopeful one.

If there is any measure of hope to be found in anxiety it is this: That this nemesis, even as it seems to want to kill us, is also sporting enough to warn us of the need to do something to stop it.

Andrew Santella (andrewsantella.com/) has written for The New York Times Book Review, Slate, GQ_and other publications._