Self Help

My Age of Anxiety - Scott Stossel

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Matheus Puppe

· 77 min read

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  • The passage describes the author’s lifelong struggles with severe anxiety, including debilitating panic attacks in crucial moments like his wedding ceremony.

  • He experiences intense physical symptoms like sweating, shaking, nausea, vertigo, and thoughts of death during anxiety episodes.

  • In addition to panic attacks, he suffers from constant low-level worry about health, work, finances, and other issues. This background worry often manifests physically.

  • He has multiple specific phobias including enclosed spaces, heights, public speaking, flying, vomiting, germs, cheese, and more.

  • As a child he had extreme separation anxiety when his parents were away and frequently went to the nurse’s office sick with anxiety-induced headaches and stomachaches.

  • His anxiety has negatively impacted his ability to function normally in important life events and everyday activities. It has caused profound suffering and self-doubt throughout his life.

The passage discusses the author’s lifelong struggle with severe anxiety and the many treatments they have tried over decades, including various therapies, medications, and other approaches like yoga and meditation. Nothing has significantly or permanently reduced their underlying anxiety.

Some key points:

  • The author has experienced debilitating anxiety since age 2 and was first hospitalized for it at age 10.

  • Treatments have included psychotherapy, CBT, medications like Xanax and antidepressants, hypnosis, lifestyle changes, and more.

  • Medications provided some temporary relief but did not fundamentally reduce the anxiety.

  • Anxiety is extremely common in the US and globally, affecting over 25% of people at some point in their lives according to studies. It represents a large economic and social burden.

  • Though often seen as an American problem, anxiety disorders are common in many countries and increasing overall. Chronic stress is a hallmark of modern life.

  • The understanding and diagnosis of anxiety has evolved greatly in recent decades as research has expanded tremendously.

In summary, the passage details the author’s lifelong personal struggle with severe anxiety and discusses recent research showing anxiety is a widespread and growing mental health issue.

  • Anxiety can manifest in brain scans as excessive activity in the anterior cingulate or as a disturbance in the circuit linking the frontal lobes and basal ganglia.

  • The amygdala processes fearful emotions and behaviors, and has been a focus of neuroscientific anxiety research over the past 15 years.

  • Neurotransmitters like serotonin, dopamine, GABA, norepinephrine and neuropeptide Y can increase or decrease anxiety levels.

  • There is a strong genetic component to anxiety, with researchers identifying “candidate genes” associated with certain disorders.

  • Historically, there have been debates around the causes and treatments of anxiety. Hippocrates viewed it as a biological/medical issue, while Plato saw it as philosophical. Cognitive-behavioral therapy traces its roots to Stoics and Spinoza arguing faulty cognitions cause anxiety.

  • The truth is anxiety has multiple influences - biological, philosophical, psychological, social and cultural factors all contribute to its origins and experience. It involves both nature and nurture.

  • Family history shows anxiety can be genetically inherited, as the author’s great-grandfather suffered acute anxiety treated at McLean Hospital.

  • The author describes a history of anxiety disorders running through four generations on their mother’s side, including their mother, sister, various relatives, and themselves.

  • They explore various possible reasons for this trend, including genetics, environmental factors like trauma experienced by ancestors, modeling anxiety behaviors, prenatal stress, and cultural/historical influences.

  • Their mother exhibited severe anxiety and panic attacks. The divorce of the author’s parents added to an unstable childhood environment.

  • Jewish ancestry on the father’s side and suppressed emotions on the mother’s WASP side may have contributed to the author feeling like “Woody Allen trapped in John Calvin.”

  • Broader cultural anxieties during the Cold War and today’s uncertain times could also be considered normal responses rather than psychopathology.

  • Moderate anxiety may be adaptive and even improve performance, while complete removal of anxiety could diminish creativity and risk-taking behavior important for survival. Understanding anxiety may provide insights into the human condition and mind.

  • Early Freudians saw anxiety as stemming from sexual inhibition, whereas modern views see it as a medical/neurochemical condition of malfunctioning biology. These shifting interpretations represent both the progress of science but also cycling cultural lenses.

  • Different cultures experience and interpret anxiety disorders in distinct ways reflecting cultural norms. For example, Americans think panic attacks are heart attacks, Japanese think they’ll faint, Latin Americans experience “ataques de nervios.”

  • However, descriptions of anxiety disorders from ancient times like Hippocrates are remarkably similar to modern diagnostic terms, showing the underlying experiences may be universal despite cultural filters.

  • The book explores anxiety through a synthesis of history, literature, philosophy, religion, culture and science. The author also examines their own experiences with anxiety to better understand it.

  • While focusing extensively on one’s own anxiety could potentially worsen it, the author sees it as a quest to understand and find relief/redemption from their suffering, in the tradition of thinkers like Freud who used personal experiences to develop theories.

So in summary, it discusses both the universal underpinnings of anxiety but also how cultural lenses shape its expression and interpretation over time, through a highly personal and scholarly approach. The aim is to better understand this “riddle” from multiple perspectives.

The author expresses concern that writing openly about their personal experiences with anxiety in a book could be seen as self-absorbed, shameful, and damaging to their professional standing. Their therapist Dr. W. argues that revealing their struggles with anxiety could help reduce feelings of isolation and shame.

The author worries stigma still exists around mental illness. They are concerned being so candid could be seen as weakness or Too Much Information. However, when the author began cautiously mentioning the personal aspects of the book to others, it led people to open up about their own experiences with anxiety.

The author thinks anxiety may be more common than recognized. They provide examples of successful individuals also struggling with anxiety disorders. While understanding anxiety intellectually can provide perspective, lived experiences of panic attacks are simply unpleasant experiences one wants to end.

Overall, the author is wrestling with exposing vulnerabilities in their writing while their therapist encourages an open approach could be therapeutic by helping the author and others feel less alone. But stigma and potential professional consequences keep the author apprehensive about being so candid.

  • Kierkegaard argued that the ability to experience anxiety is what separates humans from mere animals and angels. Anxiety stems from our existential uncertainty about choices and our awareness of mortality.

  • For Kierkegaard and Freud, the most anxiety-producing threats come from inside ourselves rather than the outside world. Confronting this internal anxiety expands one’s soul and fulfills the self.

  • Kierkegaard argued that “learning to know anxiety is an adventure which every man has to affront if he would not go to perdition.” Facing anxiety head-on is the most important thing one can do.

  • The author is trying to follow Kierkegaard’s advice by confronting their own anxiety through writing this book. Writing about anxiety is their effort to properly experience and understand it, rather than sinking under it.

So in summary, the passage discusses Kierkegaard and Freud’s view that anxiety stems from internal existential concerns rather than external threats, and that properly experiencing anxiety through confrontation is psychologically beneficial for self-fulfillment. The author is using the book writing process as a way to do that for themselves.

  • The passage describes three experiences of anxiety disorders across three generations of one family - the narrator’s great-grandfather Chester, the narrator as a child, and the narrator as an adult.

  • Chester was diagnosed with “psychoneurosis” and “reactive depression” in 1948 after experiencing severe anxiety and insomnia for months.

  • The narrator was diagnosed with “phobic neurosis” and “overanxious reaction disorder of childhood” after exhibiting obsessive behaviors and fears as a child in 1979.

  • As an adult in 2004, the narrator was diagnosed with “panic disorder with agoraphobia,” “specific phobia,” and “social phobia” based on questionnaire scores indicating anxiety, depression, and worry.

  • The passage discusses how anxiety diagnoses and understanding of anxiety have changed over time, with concepts like “neurosis” being replaced. This explains the different diagnoses received over time.

  • It explores the challenges of defining anxiety scientifically due to differing views on its nature and lack of consensus even among experts like Freud on what anxiety fundamentally is.

  • Karen Horney in 1937 distinguished between fear (a reaction to a serious or legitimate threat) and anxiety (a reaction to minor or imagined threats). Freud later made a similar distinction between “normal anxiety” in response to real threats versus “neurotic anxiety” from unresolved psychological issues.

  • Modern psychiatry further distinguishes between normal nervousness/worry and clinical anxiety disorders based on the severity and frequency of symptoms as defined by the DSM. However, determining the distinction remains largely subjective.

  • Anxiety and depression are physiologically and genetically similar. They were not historically distinguished and tend to co-occur. Stress is a major risk factor for both.

  • Brain imaging can associate anxiety with increased amygdala activity, but identical scans could represent anxiety, arousal, or other emotions. Imaging cannot definitively diagnose clinical anxiety versus normal emotions.

  • Animal studies suggest fear/anxiety responses have common biological and behavioral roots across species, but do not fully resolve the distinction between normal and pathological anxiety in humans. The definitions remain somewhat ambiguous.

  • Darwin observed that animals exhibit physical symptoms of fear such as trembling, pale skin, increased heart rate, etc. in threatening situations. This “fight or flight” response is evolutionarily adaptive as it prepares the body to confront or flee danger.

  • Walter Cannon coined the term “fight or flight” and further documented the physiological effects, like increased blood flow to muscles and decreased flow to organs like digestion. This primes the body for emergency action.

  • William James argued that modern threats often trigger this response even if the threat is not true “danger” like predators. This can lead to pathological anxiety from stress hormones like cortisol being elevated long-term.

  • Both animals and humans can develop conditioned fear responses through classical conditioning, as seen in John Watson’s experiment conditioning a fear of rats in a baby. Early views saw anxiety as a learned response.

  • Even simple organisms like snails and bacteria exhibit avoidance behaviors and physiological stress responses to threats, showing the roots of “anxiety” are primitive and shared across species. However, it’s debated if simple responses equate to human anxiety with its cognitive aspects.

So in summary, the passage discusses Darwin’s and Cannon’s theories of the evolutionary benefit but also potential downsides of the fight or flight response, and debates how comparable human and animal experiences of fear and anxiety truly are.

  • There is no universal definition of anxiety. Experts disagree on whether anxiety can be reduced to simple biological/mechanical processes or if it requires higher-level human experiences like awareness of the future.

  • Animal behavior studies show retreat/avoidance from fearful stimuli, which some see as evidence of anxiety. However, others argue animal behavior does not fully capture human experiences like worrying about personal, financial, or social issues.

  • The DSM definitions focus on associated symptoms rather than providing a clear definition. And the DSM categories are currently being revised.

  • Different perspectives view anxiety through different lenses:

    • Psychoanalytic: Repressed conflicts/thoughts lead to anxiety
    • Behavioral/CBT: Anxiety is a conditioned fear response and disorders arise from faulty thinking
    • Biomedical: Focuses on biological mechanisms in the brain and genetics underlying anxiety
    • Experiential: Emphasizes the subjective experience of pain, paralysis, fear of death etc.
  • The narrator’s therapist, Dr. W., takes an “integrative” approach that draws on the useful aspects of these perspectives rather than sticking rigidly to one view. His definition helps the narrator manage their anxiety by providing a framework to understand different theories.

Here is a summary of the key points about medication from the passage:

  • Medication is an effective treatment for reducing the symptoms of anxiety according to Dr. W, however he believes it does not address the underlying existential issues that may be causing the anxiety.

  • Studies show psychiatric medications can enhance exposure therapy by strengthening new, non-fearful memories in the brain that help extinguish phobias and anxious associations.

  • Meditation and relaxation techniques can produce tangible, physical changes in brain structures like the amygdala that are similar to the effects of medications. This suggests approaches like therapy and meditation can be as “real” as medication in treating anxiety.

  • While competing theories of anxiety disorders sometimes conflict, the biomedical perspective increasingly recognizes non-drug approaches can also change brain physiology. The approaches are not necessarily mutually exclusive.

  • Medication is viewed by some as a way to treat anxiety by correcting chemical imbalances, while others like Dr. W see anxiety arising from existential issues and unresolved inner conflicts or psychic distress. Both biological and psychological factors likely play a role.

  • Dr. W. views anxiety and panic as reflecting deeper existential concerns and losses that patients displace or project onto external triggers. phobias of things like rats or honey actually represent fears of mortality, decline, or threats to one’s self-image.

  • He treated a pianist who developed panic attacks after being told he lacked talent for his dream career. The panic represented grief over lost professional aspirations and identity.

  • A physician developed panic when his tennis injuries coincided with his son leaving for college, representing dual losses triggering existential concerns about aging and death.

  • Dr. W. believes anxiety shields people from underlying sadness or pain related to these existential threats. Exposing patients to the root emotions under the anxiety can help them process losses and reduce symptoms.

  • The author experienced this approach firsthand in therapy with Dr. W., where imagining phobia triggers led to unexpected bouts of sadness and crying. Dr. W. said this indicated accessing a deeper “wound.” The author felt relief from crying but uncertainty about why anxiety still feels more intense than the underlying sadness.

Here are the key summaries:

  • Karen Horney said anxiety conflicts might be about “dependency needs.” Erich Fromm said about “security needs.” Alfred Adler said about “the need for power.”

  • Modern research suggests anxiety is both a physical phenomenon mediated by things like the amygdala and autonomic nervous system, as well as a psychological experience. The relationship between the physical and psychological aspects is complex and not fully understood.

  • Different theorists have proposed different views on the causes and nature of anxiety. These include Freud’s id/ego/superego model, behavioral views like Watson’s conditioning experiments, and evolutionary perspectives on innate fears. More recently neuroscience has provided insights but the field remains intricately intertwined with psychology, philosophy and history.

  • Diagnosis of anxiety disorders is an evolving area involving both clinical judgment as well as political and commercial factors, as seen in debates around revising diagnostic manuals like the DSM. Clear definition and classification remains difficult given the complexity of related factors.

  • Researchers at Columbia gave subjects an injection of adrenaline, which increased heart/breathing rates in all subjects and intensified emotions. However, the specific emotion felt (happy, angry, anxious) depended on the experimental context provided, not just the adrenaline. This suggests physiological arousal enables emotions but context determines the specific emotion.

  • Other research supports James and Lange’s view that physiological processes are crucial for driving and intensifying emotions. Studies show facial expressions can produce, not just reflect, associated emotions (e.g. smiling makes you happy, trembling makes you afraid).

  • Even as Freudian theory has been discredited, some empirical findings support elements of Freud’s work, like the idea that physiological processes influence emotions.

  • The therapy described uses exposure therapy principles by having the patient give a speech while watching vomiting videos. Exposure therapy aims to extinguish phobias by exposing patients to feared stimuli under therapist guidance. Extended exposure is meant to reduce the fear response over time.

  • Exposure therapy aims to gradually expose someone to their feared stimulus in order to reduce anxiety and “extinguish” the fear over time. This could involve facing heights, trains, planes, etc. progressively.

  • Flooding calls for more intense, rapid exposure to strongly provoke anxiety and teach the patient they can cope with it. Some therapists induce vomiting in severe emetophobes through ipecac syrup.

  • The patient tried exposures with his therapist Dr. M. but they did not generate enough anxiety (e.g. public speaking to a few people). Dr. M. proposed taking ipecac to induce vomiting as the core fear.

  • After several attempts, the patient agreed to try it. However, the environment was less than ideal due to scheduling issues. He took ipecac but only dry heaved intensely for 40 minutes without vomiting. This heightened his anxiety and misery without relief. Dr. M. suggested a second dose but the patient feared prolonging the intense nausea.

In summary, the exposure therapy attempted to induce vomiting through ipecac was poorly executed due to logistical issues and failed to achieve its intended effect of helping the patient confront and learn to tolerate his fear and associated sensations. It instead prolonged his suffering without therapeutic benefit.

The passage describes an exposure therapy session where the individual (referred to as “I”) was given ipecac by Dr. M. and nurse R. to try to overcome their emetophobia (fear of vomiting). Despite taking the ipecac, the individual did not vomit even after several hours, much to the frustration of nurse R. The experience was extremely traumatic and anxiety-provoking for the individual.

In the days following, the individual experienced intense anxiety, panic attacks, and nightmares about vomiting. Their phobia was now much worse than before. Interestingly, watching the individual’s struggle with the ipecac ended up making Dr. M. vomit as well.

The passage then discusses the strong connection between the mind, anxiety, and the gastrointestinal system. It outlines research showing that many stomach and digestive issues are linked to or caused by stress and anxiety. People with conditions like irritable bowel syndrome tend to be highly sensitive to bodily sensations and more prone to anxiety. The experience demonstrated how exposure therapy done improperly can backfire and exacerbate underlying fears and phobias.

  • In the 1820s, Dr. William Beaumont observed a patient named Alexis St. Martin who had a fistula (hole) in his stomach due to an accidental musket wound. This allowed Beaumont to directly observe St. Martin’s stomach and how it responded to different emotions and states.

  • Beaumont noticed St. Martin’s stomach lining would change color in response to his emotional states, becoming pale when anxious. This showed a link between emotions and digestion.

  • In the 1940s, Drs. Stewart Wolf and Harold Wolff observed another patient, referred to as “Tom”, who also had a hole in his stomach. They conducted experiments on how Tom’s stomach responded to different emotions, confirming Beaumont’s earlier findings.

  • The author then relates their findings to their own experiences with anxiety exacerbating gastrointestinal issues. Travelling often resulted in stressful trips to various restrooms. Their trips with a girlfriend to Eastern Europe in particular involved much time spent in public restrooms.

  • The passage concludes noting an experience of the author almost having an accident while visiting the Kennedy family on Cape Cod but making it to a bathroom just in time.

The author describes an incident where they had some sort of accident in the bathroom at a fancy estate where a party was being held. Their clothes and the bathroom got covered in sewage after something exploded under the toilet. They tried frantically to fix the issue and stop the flooding.

After the flooding stopped, they changed out of their soiled clothes and hid the evidence before the dinner bell rang. They then did their best to clean up while people were socializing downstairs. In their attempt to escape and join the party, they nearly ran into John F. Kennedy Jr. while half-naked and covered in sweat.

The author reflects on feelings of humiliation and not fitting in with the illustrious guests. Later that night, they snuck back to fully clean the bathroom and dispose of evidence in a dumpster. The experience left them convinced the staff was whispering about the incident.

The summary then transitions to discussing emetophobia (fear of vomiting) as an anxiety disorder, and how the author lives with constant fears related to their stomach and potential vomiting. It describes how support communities have emerged online to help sufferers.

  • The passage discusses Charles Darwin’s lifelong struggle with debilitating stomach issues and anxiety. He suffered constant vomiting, nausea, palpitations and other symptoms from his late 20s until his death.

  • While many theories have been proposed over the years for what specifically caused Darwin’s illness, studies of his diaries and letters indicate it was primarily anxiety-related. His worst periods of illness correlated with stressful events like anticipating his wedding or work on his theory of evolution.

  • His symptoms like vomiting, trembling and faintness resemble those of modern panic disorder diagnoses. The voyage on the Beagle was healthy for him, but he became increasingly homebound and anxious after returning to England.

  • Writing Origin of Species was an immense struggle due to his illness. Excitement or socializing often triggered vomiting attacks that left him bedridden for weeks or years. He took many unsuccessful treatments over decades to try to cure his “nervous stomach.”

  • The passage draws parallels between Darwin and other famous intellectual figures who struggled with nervous physical complaints like stomach issues linked to high levels of anxiety and mental strain.

  • Darwin attempted various 19th century medical treatments for his chronic stomach issues, including using brass and zinc wires meant to electrify and galvanize his insides, as well as drenching his skin with vinegar. Some of these provided temporary relief through placebo effect or distraction.

  • Minor disturbances like trips to London or disruptions to his routine would often result in “very bad vomiting” that kept him bedridden for days or weeks. Working on his book Origin of Species in particular laid him low for months at a time due to vomiting brought on by the stress.

  • When the book was finally published in 1859 after over 20 years of work, Darwin was seriously ill in bed with vomiting, swollen legs, nearly closed eyes, rashes and boils - describing it as “living in Hell”.

  • Even after publication, Darwin continued suffering poor health and daily discomfort and vomiting. However, when he would stop working and go on trips to ride or walk, his health would improve, suggesting his illnesses were stress and anxiety-related.

  • Darwin’s lifelong gastric issues and dependence on his wife provide an apt and ironic example, as the man who studied fear and identified its gastrointestinal impacts suffered greatly himself from an anxious stomach. His accomplishments also provide reassurance to those with similar illnesses.

  • Many famous figures throughout history, including Cicero, Darwin, and Demosthenes, suffered from performance anxiety related to public speaking.

  • The author has developed a regimen involving Xanax, Inderal (a beta-blocker), and alcohol to manage his extreme public speaking anxiety. He takes these medications close to when he needs to speak to find the right balance between calming his anxiety and impairing his abilities.

  • If he doesn’t take enough medication, he will be too anxious and uncomfortable to speak effectively. But if he takes too much, he risks being impaired or incoherent. Getting the timing and dosage just right is key.

  • While acknowledging this strategy is unhealthy and dangerous, he says it is the only way he can effectively speak in public without experiencing miserable dread for months beforehand.

  • Some other historical figures also reportedly used substances like laudanum and alcohol to cope with performance anxiety before important speeches or presentations. However, self-medicating often brings risks of overuse, addiction, and impairment.

  • William Wilberforce, an 18th century British abolitionist politician, would take opium before his speeches in Parliament to calm his nerves, which he credited for his success as a public speaker.

  • Laurence Olivier confessed to Dame Sybil Thorndike that he feared having to suddenly retire from the stage due to stage fright. Thorndike advised him to “take drugs” like they did.

  • Many famous historical figures struggled with public speaking anxiety, including Demosthenes, Cicero, Moses, William Cowper, Thomas Jefferson, Mahatma Gandhi, and Henry James.

  • Modern entertainers and performers like Barbra Streisand, Carly Simon, Donny Osmond, Jay Mohr, Hugh Grant and Ricky Williams either developed severe stage fright or had careers disrupted by anxiety disorders.

  • Elfriede Jelinek refused the Nobel Prize in person due to acute social phobia.

  • The author reflects on whether taking solace from the struggles of great historical figures could help alleviate their own performance anxiety.

  • Excerpts are included on social anxiety disorders and the cruel irony of physical symptoms like blushing betraying one’s anxiety in social situations.

  • The passage discusses shame and social anxiety, referencing an 1839 work that argued blushing served to display inner emotions and act as a check on violating social norms.

  • Later work by Darwin and others viewed blushing as a physiological signal of self-awareness and sensitivity to others’ perceptions, allowing one to show deference and conform to social standards.

  • While social anxiety disorder is a recent diagnosis, descriptions from 1901 match its modern definition. It involves physical and emotional symptoms in social situations.

  • Some see it as pathologizing normal traits, but it became widespread after the 1999 approval of Paxil to treat it, leading to billions in profits. However, severe cases cause real distress, depression, alcoholism and even suicide for some individuals.

  • In summary, the passage explores the history and controversies surrounding social anxiety disorder, from early biological and social theories to its definition and massive rise in diagnosis after the marketing of SSRIs to treat it. It acknowledges both overdiagnosis concerns but also evidence that severe cases warrant medical intervention.

  • The author describes experiencing severe performance anxiety and social phobia from a young age, with various humiliating experiences giving public presentations or being the center of attention.

  • Performance anxiety has concrete physical symptoms like increased heart rate, blood pressure, and adrenaline levels due to heightened activation of the autonomic nervous system. Studies show socially anxious individuals have excessive activation in brain areas linked to emotional processing.

  • Ancient philosophers like Epictetus viewed anxiety as a problem of desire and false beliefs - that one’s self-worth should not depend on others’ approval or applause. Cognitive-behavioral therapy also aims to overcome irrational fears of disapproval.

  • Exposure therapy is a standard CBT technique where patients are intentionally put in embarrassing social situations, to show imperfections are tolerable and desensitize fears. The author underwent this but found it only marginally helpful for his severe social phobia.

So in summary, the passage discusses the biological and psychological factors underlying severe performance anxiety, as well as ancient and modern therapeutic approaches focused on challenging irrational thoughts and exposing patients to feared social situations.

  • Social phobics tend to have a hypersensitive awareness of social cues and status in interactions. Their “social antennae” pick up subtle signals that others may miss.

  • This includes carefully scrutinizing facial expressions, body language, verbal tones for any signs of negative reaction or judgment.

  • However, social phobics often overinterpret or misread these cues, assuming they mean disapproval when they may not. Their “emotional barometer” is too sensitive.

  • Neurologically, the amygdala and medial prefrontal cortex of social phobics are hyper-reactive to perceived social threats, criticism, and negative self-views. This suggests low self-esteem and social anxiety have a biological basis.

  • Even extremely brief, subconscious exposures to negative social cues like angry or fearful faces can trigger an amygdala response and influence social judgments, though the person is unaware.

  • Having finely-tuned unconscious social perception may have evolved to help with survival, but it can cause problems for social phobics by provoking anxiety and negative self-views.

  • Social status and level of stress hormones are strongly linked in primate groups like baboon troops. Higher ranking baboons have higher testosterone and lower stress hormone levels, while lower ranking baboons experience more stress and have higher cortisol levels.

  • Psychologist Robert Sapolsky found a direct correlation between a baboon’s rank and its stress hormone levels. Lower ranking baboons must closely monitor their behavior to avoid conflicts with dominants.

  • Psychiatrist Murray Stein observes similarities between subordinate baboons and humans with social anxiety disorder. Both experience high stress hormone levels from anticipating social interactions.

  • Serotonin and dopamine levels also impact social behavior and ranking. Monkeys with altered serotonin function display more avoidant behaviors, while those with more dopamine tend to be more dominant. Studies find similar neurotransmitter irregularities in humans with social anxiety.

  • Introducing uncertainty into baboon troops, like a new male joining, increases stress hormone levels for all baboons as the social hierarchy becomes unclear. Rates decline once the new ranking is established. Similar effects are seen in human military recruits during transitions at boot camp.

The passage discusses the relationship between anxiety and performance. It notes that moderate anxiety can enhance performance by increasing physiological arousal and focus, as described by the Yerkes-Dodson law. However, too much anxiety is counterproductive.

The author describes their own lifelong struggles with competitive anxiety, dating back to middle school tennis matches where they would intentionally lose to escape intense nerves and stomach issues. Their only undefeated season was playing JV squash in high school, when they took a small dose of Valium each day to take the physical edge off anxiety and allow a focus on playing well.

Even a decade later as an adult, the author collapsed from anxiety while just two points away from winning a recreational squash tournament final in front of an audience. Their account highlights how potent and enduring a sense of shame and fear of failure can be in fueling debilitating competitive anxiety. Treatment involved exercises to diminish the power of shame and potential consequences of failure. But stopping caring what others think, as advised, is not that easy for those with social anxiety disorder.

The passage describes various examples of athletes who choked or developed crippling performance anxiety under pressure. It discusses how Greg Norman fell apart down the stretch at the 1996 Masters, and how Jana Novotna sobbed after blowing a lead at Wimbledon in 1993. It also mentions Roberto Duran quitting in the middle of a boxing match in 1980.

Beyond isolated choking incidents, some athletes develop chronic issues. Nick Anderson missed four critical free throws in the 1995 NBA Finals and then struggled from the line for the rest of his career. Chuck Knoblauch and Steve Sax suddenly lost the ability to throw from second base to first during games, though they could throw fine in practice. Pitcher Steve Blass abruptly lost control of his pitches during games in 1973, after being one of the best in baseball. Some catchers even developed phobias about throwing the ball back to the pitcher.

In summary, the passage provides several examples of elite athletes who have choked under immense pressure or developed crippling performance anxieties that derailed their careers, highlighting how mental fortitude is a crucial part of athletic success.

The passage discusses how anxiety and choking under pressure can negatively impact athletic and military performance. It explores the “explicit monitoring theory” which suggests focusing too much on mechanics can impair performance. Some key points:

  • Anxiety can become a self-fulfilling prophecy, causing athletes to do the very thing they fear by overthinking their movements.

  • Brain scans show choking athletes have increased neural activity related to self-monitoring, while elite athletes perform efficiently.

  • Militaries have tried various methods to reduce soldiers’ anxiety like drugs, harsh punishment for cowardice, and branding/tattooing anxious soldiers as dishonorable.

  • During WWII psychiatrists began treating battle fatigue, though some generals saw this as coddling and wanted anxious soldiers sterilized or punished with death.

  • The military still struggles with how to classify and handle soldiers whose nerves are shattered by combat, particularly around issues of honor vs acknowledging psychiatric illness.

So in summary, it discusses how anxiety negatively impacts performance in sports and war, and the various institutional approaches taken by militaries historically to prevent and deal with anxiety in soldiers.

  • Studies during WWII found that 5-6% of combat soldiers lost control of their bowels (“self-soiling”), with some divisions over 20%. Many troops suffered from diarrhea before combat. More than half showed signs of anxiety like sweating and faintness during battle.

  • Combat stress causes a range of physiological reactions like trembling, sweating, losing bowel/bladder control. Very few reported never feeling fear.

  • William Manchester experienced anxiety during his first combat, vomiting and urinating on himself after killing a sniper. The author argues this shows a moral sensitivity rather than cowardice.

  • Controlling bodily functions is culturally linked to courage, but most experience some anxiety under fire until experiencing it firsthand.

  • Studies show around 10-20% can remain calm in combat, 10-15% react very anxiously, and most are confused and lethargic. Rates of breakdown are consistent across populations.

  • Combat trauma often causes long-term issues like PTSD, depression, suicide. Rates of these are very high among recent war veterans. Military is working to address the mental health impact of combat stress and trauma.

  • The Pentagon has made addressing post-traumatic stress disorder (PTSD) a high priority, as suicide rates among current and former service members have reached alarming levels. However, PTSD was only officially recognized as a diagnosis in 1980.

  • Recent research suggests that an individual’s likelihood of developing PTSD or breaking down under stress may be influenced more by their innate neurochemistry and genetics rather than just the nature of the trauma experienced.

  • Studies have found that elite soldiers like Navy SEALS tend to have higher levels of the brain chemical neuropeptide Y (NPY), which is linked to increased stress resistance and resilience. High NPY levels can predict who will graduate from intense special forces training programs.

  • Individuals also differ in the sensitivity of their stress response systems, like the hypothalamic-pituitary-adrenal axis. Those with more sensitive stress responses are more vulnerable to developing PTSD after trauma. But genetics also play a role in determining stress response sensitivity.

  • While genetics and innate traits influence stress resilience, great athletes like Bill Russell demonstrate that anxiety and effective performance are not mutually exclusive - for Russell, nerves correlated with enhanced performance. Courage is not always absence of fear.

  • Floyd Patterson was a heavyweight boxing champion in the late 1950s and early 1960s. He became the first boxer to regain the title after losing it in 1959 and 1961.

  • However, he considered himself a coward. He would bring disguises like fake beards to fights in case he lost and needed to escape or hide after a loss.

  • When asked about this, Patterson said “within every human being there is a certain weakness…because I am a coward.” However, his definition of cowardice may have differed from typical definitions.

  • The passage discusses how anxiety can be coupled with outward physical bravery. It gives examples of how anxiety did not stop some people from acting heroically during World War II in Italy. Giuseppe Pardo Roques and Pietro both helped others despite being impaired by severe anxiety disorders. Their illnesses in some ways enabled their acts of courage.

  • So the passage suggests anxiety does not preclude strength, and in rare cases anxiety can even be a source of heroism when real danger arises, as it did for Roques and Pietro during the war.

  • o discusses recent studies finding that social phobics show increased activation of brain regions involved in processing the human gaze compared to healthy individuals. This suggests their brains are hypersensitive to social cues.

  • h describes a difficult choir director who would scream at students during practice and get stuck on words due to a severe stutter, making practice an anxiety-inducing experience.

  • i notes that exposure therapy for social anxiety was occasionally taken to an embarrassing extreme, with therapists having patients make obvious mistakes or ask strange questions at a local store, confusing the employees.

  • k explains that even positive social attention can activate fear circuits in social phobics’ brains from an evolutionary perspective, as it could incite jealousy or rivalries.

  • l discusses how anxiety becomes self-reinforcing over time as the amygdala and hippocampus consolidate phobic responses, making the individual more anxious in the future.

  • o contrasts how Asperger’s patients and social phobics both struggle with social interactions but from opposite perspectives - Aspbergers patients lack insight into others’ minds while social phobics have too much insight.

  • y discusses boxer Floyd Patterson seeing himself as a coward after his first loss to Ingemar Johansson, being unable to face others and admit defeat.

  • The passage describes the author’s experience dealing with anxiety and considering different treatment approaches before an upcoming book tour.

  • He consulted both a Harvard psychopharmacologist (Dr. Harvard) and a Stanford-trained cognitive behavioral therapist (Dr. Stanford).

  • Dr. Harvard advocated strongly for medication like benzodiazepines and SSRIs to control the biological and physiological aspects of anxiety. He used the argument that anxiety is a medical illness like diabetes.

  • Dr. Stanford wanted the author to get off medications in order to do proper exposure therapy through confronting anxieties directly. She saw anxiety as more cognitive and behavioral in nature.

  • The author struggled to get off medication due to how severely it reduced his anxiety in the short-term. He had more likability for Dr. Stanford’s approach but was not sure he could cope without drugs.

  • The passage discusses the debate between viewing anxiety as a biological problem best solved by medication, vs a cognitive problem best addressed through therapies like CBT. It also references historical usage of drugs like cocaine by Freud to treat his own anxiety.

  • Freud experimented with cocaine in the late 19th century and initially praised it as a treatment for various mental and physical ailments. However, his enthusiasm waned after a friend became fatally addicted.

  • Many early psychiatric drugs were discovered accidentally while researching other conditions like tuberculosis or were originally developed for non-medical uses like dye or rocket fuel.

  • Terms like “anxiety” and “depression” did not exist as clinical diagnoses until the mid-20th century when drugs were developed to treat associated symptoms.

  • Early popular “nerve tonics” contained unlisted addictive substances like alcohol, opium, or marijuana. Heroin was also once available over the counter.

  • Barbiturates like Veronal and Luminal dominated the anxiety drug market in the early-mid 20th century but were highly addictive and lethal in overdoses.

  • Frank Berger accidentally discovered the antianxiety effects of mephenesin while researching penicillin preservatives, eventually leading to the development of meprobamate/Miltown, one of the first major anxiety drugs.

  • Berger discovered the calming effects of mephenesin while testing its toxicity in mice. This led to the development of meprobamate as a more potent sedative.

  • Early studies found mephenesin reduced anxiety in patients. This was novel at the time as it showed psychiatric drugs could treat mental states.

  • Meprobamate was patented in 1950 and found to be longer lasting than mephenesin with fewer side effects. However, Carter executives doubted the market potential.

  • Berger persisted, sending it to psychiatrists who found it helped anxiety in most patients. This convinced Carter to pursue FDA approval as Miltown.

  • Miltown was marketed in 1955 and became hugely popular as a treatment for “anxiety, tension, and mental stress.” Celebrities publicly endorsed its effects.

  • Within 18 months, Miltown became the most prescribed drug in history. It transformed views of treating anxiety with medication and paved the way for many other tranquilizers to hit the market.

The passage traces the shift from Freudian psychoanalysis to biological psychiatry, as exemplified by new psychoactive drugs. It begins with a Freud quote acknowledging the limitations of psychological terminology and desire for physiological explanations.

In the 1950s, two new classes of drugs began transforming mental healthcare - the tranquilizer Miltown and the antipsychotic Thorazine. Thorazine was first tested in 1952 in France, where it showed potent calming effects on psychotic patients. It was brought to North America in 1953 and marketed as Thorazine, leading to a decline in institutionalization.

Thorazine was also prescribed to the author as a young teenager in the 1970s suffering from severe anxiety and phobia. It provided relief but had side effects like fogginess and involuntary movements. The emergence of these new drugs during the mid-20th century challenged Freudian ideas and reinforced the view that mental illness had biological/chemical causes that could be treated pharmacologically, shifting views and treatment from the psychoanalyst’s couch to the family doctor’s office and interventions focused on neurochemistry.

  • Earlier in junior high school, the author had been selected for an elite soccer team based on their skills at dribbling.

  • When they started taking psychiatric medications Thorazine and imipramine, they moved slower and tired more easily. Their coaches were confused by the change.

  • Even while medicated, the author still experienced high anxiety. They would leave class and stay in the school infirmary with the nurse, begging to go home.

  • Other students noticed the author wandering with the nurse and wondered what was wrong. The medications allowed the author to survive 7th grade, but they still felt miserable.

  • In the 1980s, the author briefly took phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). However, it did not reduce their anxiety and caused worries about dangerous side effects.

  • MAOIs played a role in developing modern understanding of psychiatry by helping link mental illness to neurochemistry in the 1950s alongside other early drugs like imipramine. However, MAOIs have limitations and are no longer considered a first-line treatment.

  • Reserpine was an early psychiatric drug that was found to decrease serotonin levels in rabbits, producing lethargic and apathetic behavior resembling depression. This established a clear link between biochemistry and behavior.

  • MAOIs like iproniazid were found to prevent the breakdown of neurotransmitters like serotonin and norepinephrine by inhibiting the MAO enzyme. This allowed neurotransmitter levels to remain higher for longer.

  • Iproniazid was shown to prevent the lethargic effects of reserpine in rabbits, supporting the idea that iproniazid’s antidepressant effects were due to increased norepinephrine and serotonin.

  • Imipramine, the first tricyclic antidepressant, was found to unexpectedly energize and elevate patients’ moods rather than sedate them like the antipsychotic Thorazine. This established imipramine as the first true antidepressant.

  • Research identified that imipramine blocked the reuptake of norepinephrine and serotonin, linking these neurotransmitters to mood elevation and depression relief. This supported the chemical imbalance theory of depression.

  • Schildkraut’s 1965 paper argued depression was caused by elevated brain levels of neurotransmitters like norepinephrine, cementing the chemical imbalance theory as the center of biological psychiatry.

  • In the late 19th century, physicians began experimenting with and prescribing various new pain relievers and sedatives, some of which later took on broader meanings as generic terms. This included Heroin, originally used for physical pain, and Aspirin, sometimes used improperly for “nervousness.”

  • Potassium bromide was used as an antiseizure medication in the late 19th century and as a sedative in the early 20th century, until its toxic side effects led to its abandonment. The word “bromide” then came to mean a dull or unoriginal saying.

  • Chloral hydrate was first synthesized in 1832 and used as a sleep medication from 1869 onward. It was abused as an ingredient in spiked drinks in the early 20th century.

  • First synthesized as a dye in the 1880s, phenothiazine was later found to have antiseptic, anthelmintic, antimalarial and antihistamine properties. It was commercialized as an insecticide in 1935.

  • Imipramine, the first effective antidepressant, significantly changed psychiatry by providing relief from both acute psychosis and moderate neuroses through drug treatment rather than just talk therapy from the 1950s onward.

  • Serotonin was first isolated in 1933 and found in blood and brain tissue in later research, establishing its role as a neurotransmitter in the 1950s. This helped enable understanding of drugs like imipramine.

  • The author describes experiencing a panic attack while sitting in his office, with thoughts racing about potentially being sick, having a heart attack or stroke, etc. The physical symptoms escalate, and he feels the urgent need to flee the building.

  • He sprints down 7 flights of stairs, trembling and convinced he is about to die. The exit door is locked, and he slams into it before falling to the ground. A security guard finds him confused and says he is sick.

  • Panic disorder was not formally recognized as a psychiatric condition until the 1970s. The author discusses how Donald Klein, a psychiatrist in the 1950s, noticed that the drug imipramine was remarkably effective at stopping panic attacks for some patients, even while general anxiety remained.

  • This got Klein thinking that prevailing Freudian theories of anxiety did not fully capture what was going on with these acute panic episodes. The story outlines the historical understanding and diagnoses of “anxiety neuroses” prior to the modern conceptualization of panic disorder.

  • In the early-mid 20th century, Freud and psychoanalysis dominated views of anxiety and mental illness. Anxiety was seen as stemming from unresolved inner psychic conflicts and repression of desires.

  • Robert Klein studied the effects of the antidepressant imipramine and found it eliminated panic attacks but not other mental illnesses like schizophrenia. This challenged the idea that anxiety underlies all psychopathology.

  • Klein proposed the “false suffocation alarm theory” - that panic attacks stem from a biological malfunction triggering a physiological response like suffocation, rather than psychic conflicts. This was highly controversial.

  • Klein’s work played a role in shifting psychiatry from a dimensional, spectrum model of mental illness to a categorical model that carved disorders into distinct categories with different biological roots.

  • The rise of psychiatric drugs both helped define new illness categories based on drug effects, and fueled increases in diagnoses as those drugs became available to treat more conditions.

  • Editions of the DSM have reflected the dominant theoretical approaches of their times, with psychoanalysis dominating early editions and biological perspectives gaining influence later on.

  • The publication of the DSM-III in 1980 represented a shift away from Freudian psychoanalysis toward a more biological perspective in psychiatry. It introduced new diagnoses like anxiety disorders and moved away from concepts like neuroses.

  • This medicalization of mental illness expanded the number of people considered disordered or ill, benefiting drug companies who could market more medications. While it reduced stigma around conditions, it also drew many healthy people into taking medication unnecessarily.

  • Definitions of disorders like depression and anxiety have become very broad, but it’s unclear if rates of these issues truly increased or if conditions were defined too broadly to expand markets for drugs.

  • The DSM revisions aimed to seem more scientific but were also political documents representing certain psychiatric views over others. Criteria for disorders were sometimes arbitrarily set.

  • Disorders like generalized anxiety disorder may have been conceived casually and taken on a life of their own through research even if they don’t truly reflect distinct conditions in nature.

  • The discovery and development of benzodiazepines like Librium and Valium expanded the use of anti-anxiety medications dramatically in the post-WWII decades.

  • Librium, synthesized in 1960, became the best-selling drug in America until 1969 by being prescribed for a wide range of conditions from hangovers to anxiety.

  • It was displaced by Valium, another benzodiazepine synthesized by Leo Sternbach. Valium lacked Librium’s bitter aftertaste and was more potent.

  • Valium replaced Librium as the best-selling drug and by the 1970s, one in five women and one in thirteen men had taken a benzodiazepine like Valium or Librium.

  • Concerns grew about overprescribing and dependence/withdrawal symptoms in the 1970s. The 1979 Senate hearings and books like “I’m Dancing as Fast as I Can” brought more attention to issues of addiction.

  • Xanax was introduced in 1981 and became the best-selling drug due to being approved for panic disorder after it was included as a diagnosis in DSM-III. It has dominated the tranquilizer market since the 1980s.

  • Researchers eventually discovered that benzodiazepines work by enhancing the inhibitory neurotransmitter GABA in the brain, slowing neuronal firing rates and calming activity. However, long-term use and dependence issues remained a concern.

  • In the 1970s, when Valium was popularized, both patients and doctors tended to define psychological problems in terms of anxiety.

  • Later, when Prozac and other SSRIs arrived, there was a shift toward defining such issues as depression.

  • The author describes their own experience taking the SSRI Paxil in 1997. They experienced a brief period of mild mania, followed by a lifting of their mood. While on Paxil, they got a promotion at work, ended a dysfunctional relationship, and experienced less anxiety.

  • However, the author questions how much of the positive effects were directly due to Paxil versus other life changes at that time like gaining confidence from a new job.

  • The placebo effect is also raised as a possible explanation - that the perceived benefits came from believing the drug would help, not necessarily its chemical properties.

  • In summary, the author reflects on how medications can shape how people understand and define their psychological distress, but also questions how much is a direct pharmacological effect versus other factors like lifestyle changes or placebo. Both medication and the meanings attached to problems have changed over time.

The author had been taking Paxil (paroxetine) for anxiety and panic disorder for around 10 months. During this time, they experienced relief from anxiety and was able to fly with only moderate anxiety. However, during one flight that encountered turbulence, the author had a severe panic attack and felt the Paxil was no longer working effectively.

Over the next few months, the author’s general anxiety level rose again and panic attacks became more frequent and severe. They continued taking Paxil for several more years but it lost its effectiveness. The author saw a new psychopharmacologist, Dr. Harvard, who was surprised they had gone unmedicated at times previously. They switched to Effexor (venlafaxine) but later tried stopping all medication.

Coming off Paxil resulted in extreme withdrawal symptoms like headaches, nausea, vertigo and increased anxiety. After a week off medication, the author restarted Effexor which provided almost immediate relief, though it likely hadn’t started working yet pharmacologically. The author faced additional life stresses like an upcoming book deadline and their partner’s pregnancy. It was difficult to determine the cause and effects of withdrawing from one drug while starting another, versus external stressors or their baseline condition.

  • Both anti-drug and pro-drug perspectives contain some truth but neither can be fully trusted. Drug companies have profit motives, while drug takers tend to be unhappy and prone to focusing on physical symptoms.

  • The narrator initially finds some relief from Paxil but struggles with withdrawal symptoms. Effexor then increases anxiety and akathisia (physical restlessness). Dr. Harvard keeps increasing dosages instead of considering alternatives.

  • Transitioning to Celexa goes smoother than previous switches, but anxiety persists despite chronic SSRI use. The narrator fears repeating withdrawal trauma and wonders if returning to early Paxil would provide relief, though research shows drugs may lose effectiveness.

  • SSRIs have saturated culture and the environment despite early clinical trials showing little benefit and side effects concerns. Their popularity grew as understanding of anxiety/depression changed, driven by research into serotonin’s role in depression from the 1950s onward. Zimelidine was an early SSRI later pulled for safety issues, as the companies competed to develop improved versions.

  • Researchers at Eli Lilly tested compounds related to the antihistamine diphenhydramine (Benadryl active ingredient) to find one with potent effects on serotonin but weak effects on norepinephrine. They identified LY-82816 as having this “clean” or selective profile.

  • Eli Lilly biochemist David Wong reformulated LY-82816 as LY-110140 (fluoxetine) and published findings in 1974, but work was still exploratory as the market potential for serotonin-boosting drugs was unknown.

  • When the competitor drug Zelmid started causing paralysis, Eli Lilly saw an opportunity for fluoxetine to be the first SSRI on the market. It was approved in Belgium in 1986 after clinical trials, then the US in 1988 as Prozac.

  • Peter Kramer’s 1993 book Listening to Prozac brought widespread attention to Prozac’s effects in enhancing well-being and transforming lives for the better. However, concerns emerged around long-term effects, side effects, and whether SSRIs truly worked or just masked underlying issues.

  • While SSRIs became hugely popular treatments, evidence later showed they may be barely more effective than placebos for many patients. Rates of diagnosed depression and anxiety also sharply increased even as SSRI usage rose dramatically.

  • Americans are ambivalent about psychiatric medication. On one hand, they acknowledge medications can be effective, but there is also a stigma against relying on them as a sign of weakness or moral failure.

  • The author struggles with taking antidepressants and tranquilizers, believing they work to some degree but also feeling their use proves a character flaw or moral weakness on their part.

  • As genetics research has shown anxiety and other disorders have biological bases, views have shifted from seeing them as moral failures to health problems. However, the biological underpinnings of psychiatry are more complicated than initially thought.

  • Research on the serotonin theory of depression and the roles of specific neurotransmitters like serotonin has produced mixed results that complicate simplistic notions of chemical imbalances causing mental illness.

  • Critics argue psychiatric drugs often do more harm than good or that their benefits are overstated, while proponents counter that drugs can effectively relieve suffering even if not perfectly understood or for all patients.

  • Individual responses to medications vary greatly, with some patients helped enormously while others experience adverse effects. Both clinical experience and research show a complex reality around psychiatric medication.

Dr. W. is a psychotherapist who has collaborated for many years with a psychopharmacologist in treating patients with anxiety disorders. When a patient recovers, they jokingly credit each other’s treatments - Dr. W.’s psychotherapy or the psychopharmacologist’s drugs. But the truth is they don’t really know what specifically helped a given patient recover.

The passage argues that it is cheaper for governments and the pharmaceutical industry to just medicate anxious people, especially isolated housewives, rather than address the social causes of their distress. Treating anxiety solely through medication can “medicalize” problems that are actually socially determined.

Walker Percy was a novelist who struggled with depression and questioned whether modern psychiatry’s biological explanations reduced human problems too much. Before effective antidepressants, interpreting one’s anxiety was important, but drugs seemed to drain anxiety of meaning. For some, like Percy, anxiety can be a signal to change one’s life, not something to avoid through medication. The passage discusses how Percy’s views may have differed if he had been treated with early antidepressants rather than focusing on philosophy. It acknowledges the role of medication for some while still questioning its overuse and societal implications.

  • The passage describes struggling with anxiety, hopelessness, racing thoughts and physical symptoms like shaking hands. To cope, the author would take prescription medications like Klonopin and Xanax along with drinking alcohol, which is recognized as an unhealthy approach.

  • More constructively, the author has tried approaches like drawing inspiration from philosophers Kierkegaard and Percy, as well as yoga, acupuncture and meditation. The goal is to activate the body’s natural regulation of hormones and neurotransmitters, as some believe is possible through techniques like meditation and biofeedback. However, the author reports still fumbling to unlock this “inner pharmacy.”

  • The passage references childbirth as a significant life stress according to a standardized stress scale. It also describes walking to a church as a way to try and find calmness and solace, but still experiencing panic episodes.

  • In summary, the passage shares the author’s personal struggles with anxiety and hopelessness, their efforts to cope both constructively and destructively, and references from psychology and philosophy as ways they have sought relief and understanding.

  • The passage discusses the nature vs nurture debate around the development of anxiety disorders.

  • It describes the author’s early experiences with extreme separation anxiety as a toddler and shy behaviors as a preschooler. While concerning, these were considered within the normal range developmentally.

  • At age 6, the author developed emetophobia (fear of vomiting) as a specific phobia, which often predicts later anxiety disorders.

  • Around this same time, his mother started law school at night. This coincided with an intensified resurgence of his separation anxiety each evening while waiting desperately for his parents to return home.

  • Despite evidence every night that his parents did come home, he was convinced they had died or abandoned him, experiencing exquisite agony for 15-30 minutes each night.

  • The passage discusses how early childhood fears and phobias are predictive of later anxiety disorders and comorbid conditions like depression. It presents the author’s progression as a textbook case linking his early experiences to developing social phobia, panic disorder, agoraphobia and depression as an adult.

  • The passage describes the author’s severe separation anxiety as a child. He would experience intense worry and fear whenever his parents left the house, convinced they had died or abandoned him. This anxiety affected him greatly.

  • His mother tried to soothe his anxiety by providing estimated return times from trips, but he would continually factor in more time to account for delays, escalating her stated times.

  • He had intense anxiety being alone and would engage in a ritualistic question/answer with his mother each night to reassure himself.

  • This separation anxiety negatively impacted his ability to participate in activities away from home like sports practices or camp. He would frequently break down crying from missing his parents.

  • The passage analyzes Freud’s theories on separation anxiety and the significance of the early parent-child bond on lifelong well-being and mental health.

  • It notes Freud struggled with his own phobia of train travel, which he attributed to imagined incestuous feelings for his mother on a train as a child, rather than potential issues with childhood separation or abandonment. This informed his theories around the Oedipus complex.

  • In summary, the passage provides an autobiographical account of severe childhood separation anxiety and analyzes Freud’s own experiences and theories on the topic.

The passage discusses Sigmund Freud’s theory of anxiety and how it evolved over his career. It focuses on Freud’s childhood experiences and how they may have shaped his views.

As a child, Freud experienced losing his infant brother Julius to illness. His mother Amalia then went into depression, leaving young Freud emotionally unavailable. His nursemaid was later imprisoned, abandoning him.

Freud originally argued that anxiety stems from repressed sexual urges and the Oedipus complex. However, one of his students, Otto Rank, argued that birth trauma itself is the original source of anxiety. This forced Freud to reconsider the role of early childhood experiences.

In his later work The Problem of Anxiety, Freud acknowledged that the prolonged human dependence on mothers means separation from the mother is a primary cause of anxiety. Phobias may also represent “atrophied remnants” of innate fear responses that protected early humans.

The passage then discusses how John Bowlby further developed these ideas through his theory of attachment. Bowlby emphasized how a child’s anxiety levels are shaped by their early relationships with caregivers like mothers. This moved psychoanalytic thinking away from fantasies and toward real-world parent-child dynamics.

  • Bowlby noticed in his early work treating children under Klein’s supervision that the emotional well-being of the mother greatly impacted the child. Klein disregarded the mother-child relationship. This disturbed Bowlby and motivated him to study the effects of the real relationship between mothers and children.

  • In the 1940s-50s, Bowlby researched the effects of separation from mothers on children’s psychological development and mental health. He found that prolonged separation was harmful. This challenged psychoanalytic theories that detachment from the mother did not matter as long as basic needs were met.

  • Bowlby hypothesized that the quality of the early attachment relationship between mother and child shaped the child’s attachment style and ability to form relationships later in life. He began exploring this through observations at a London clinic.

  • Mary Ainsworth conducted seminal research on attachment styles in Uganda in the 1950s through naturalistic observation of babies and mothers. This supported Bowlby’s theories over psychoanalytic views.

  • Ainsworth developed the “Strange Situation” experiment to further study attachment behaviors. This involved observing infant responses to a stranger and separation/reunion with the mother, and established patterns of secure, avoidant, and anxious attachment styles in children.

  • Together, Bowlby and Ainsworth developed the theory of attachment, establishing the importance of the early mother-child relationship and defining different attachment styles that shape future development and relationships. Their research challenged previous psychoanalytic theories.

Researcher Mary Ainsworth conducted experiments in the 1960s where she observed babies interacting with their mothers in a laboratory setting. She found that babies displayed different attachment styles - secure, ambivalent, or avoidant - when separated from and reunited with their mothers. Secure babies were distressed during separation but recovered promptly upon reunion. Ambivalent babies demonstrated anger and anxiety, while avoidant babies seemed indifferent.

Long-term longitudinal studies found secure attachment correlated with positive outcomes like higher self-esteem, independence, empathy and income. Insecure attachment predicted later emotional difficulties. Mothers’ parenting styles also correlated with children’s attachment - responsive mothers had securely attached children while unpredictable or rejecting mothers had insecure children.

John Bowlby proposed an evolutionary explanation for attachment behaviors based on ethology research. Maintaining proximity to caregivers offered survival advantages. While controversial, research by Harry Harlow on isolated monkey infants supported the idea that food alone did not drive attachment - infants showed distress without physical comfort from caregivers. Overall, the experiments yielded insights into the impact of early attachment on social and emotional development.

Harry Harlow conducted an experiment separating rhesus monkey infants from their mothers and placing each in a cage with two surrogate “mothers” - one made of wire mesh and one covered in soft terry cloth. Against the behaviorist idea that feeding drives attachment, the infants preferred clinging to the soft cloth surrogate even when the wire surrogate provided milk. This showed attachment is not just about feeding and damaged the behaviorist theory.

John Bowlby, who was researching human attachment relationships, saw the relevance of Harlow’s work. Harlow’s findings supported Bowlby’s ideas and protected him from criticism by Freudians and behaviorists. Later, the monkeys from Harlow’s study suffered long-term effects from the separation, exhibiting abnormal social behaviors and being poor parents themselves. This confirmed Bowlby’s view that early separation experiences cause long-term impacts.

Subsequent animal experiments also found separations cause increased anxiety later in life. The “variable foraging demand” experiments found that stressing monkey mothers made them less available to infants, and the infants displayed increased stress levels and anxiety even into adulthood. This provided strong evidence that subtle disruptions to the mother-child relationship can have lasting psychological and physiological effects. In summary, Harlow’s seminal experiment and subsequent research supported Bowlby’s theory that early attachment relationships are crucial and separation can cause long-term harm.

  • Research from the 1970s found that children whose mothers showed moderate amounts of affection were less anxious and experienced fewer psychosomatic symptoms, supporting John Bowlby’s attachment theory.

  • Bowlby believed that providing unstinting love and affection from a young age helps children develop a secure attachment and resistance to anxiety. His views contradicted behaviorists like John Watson who believed limiting affection was better.

  • Subsequent longitudinal studies through the 2000s continued finding links between insecure infant attachments and later anxiety disorders, supporting Bowlby’s theory that early caregiving experiences shape mental health.

  • The diary of the author at age 11 showed he was already very anxious and self-absorbed, constantly questioning triggers for his anxiety like experiences on a family vacation.

  • The author’s mother consciously withheld affection from him, believing her own overaffectionate mother contributed to her anxiety issues, but she was also overprotective.

  • This combination of withheld affection and overprotection deprived the author of autonomy and likely contributed to his dependent and anxious tendencies as an adult, supported by numerous studies linking parenting styles to later psychopathology.

  • The article discusses various studies that have found associations between childhood experiences/relationships and later psychological outcomes in adulthood. However, it notes that these studies do not prove that childhood factors cause later issues.

  • There are multiple possible explanations for predictive associations, including common environmental/genetic factors, childhood issues being early manifestations of later disorders, or symbolic projections of inner conflicts onto outward fears.

  • Freud originally proposed actual childhood sexual traumas caused neuroses, but later emphasized fantasies/the Oedipus complex. Some criticized Freud for deriving his theories too much from his own life experiences.

  • Later attachment theorists like Bowlby and Ainsworth emphasized the importance of the child-caregiver relationship for development. Research on monkeys and rats supported this, finding maternal care impacts stress response.

  • While studies strongly associate childhood and adult mental health, more research is still needed to fully understand directionality and mechanisms of influence between early and later life factors. The article cautions against concluding childhood definitively “causes” adult issues based on correlations alone.

  • Early life stress can generate later psychopathology by disrupting brain development. Elevated stress hormones in childhood correlate with adverse effects on serotonin and dopamine systems, which are implicated in anxiety and depression.

  • Neuroimaging studies show that prolonged childhood stress tends to have “neuropathological consequences,” such as hippocampal shrinkage. The hippocampus is crucial for forming new memories.

  • There is strong evidence from twin and family studies that genes account for about 30% of individual differences in vulnerability to anxiety disorders. Having a close relative with an anxiety disorder increases one’s own risk.

  • While environment plays a role, thousands of studies point to genetic bases for clinical anxiety. Families with one anxious individual tend to have more cases of anxiety and depression, indicating “familial aggregation due to genetic risk.”

  • Jerome Kagan’s longitudinal research found about 10-20% of infants are biologically more timid or fearful from a very young age, as shown by physiological measures such as heart rate and stress hormone levels. This inhibited temperament appears to be stable across the lifespan.

  • Kagan labels children with high-reactive physiology and exaggerated responses to novelty as “inhibited”.

  • A study found those identified as inhibited as toddlers had more amygdala response to unfamiliar faces as young adults, suggesting reactive temperament is biologically determined.

  • Children identified as inhibited are more likely to become shy, nervous adolescents and adults, and develop anxiety/depression, than their less reactive peers.

  • Studies support the idea that temperament is innate and fixed from birth, influenced by genes. Those born highly reactive tend to remain so.

  • Animal studies show selective breeding can produce more or less anxious strains of rats, supporting genetics’ role in anxiety. Mouse gene studies also link specific genes to fear responses.

  • Shared genes between mice and humans, like RGS2, affect brain fear systems and are linked to shyness/anxiety in both.

  • A long-term study found babies identified as “high-reactive” at 4 months were more likely to exhibit behavioral inhibition as toddlers than “low-reactive” peers, supporting the stability of reactive temperament.

  • A study in the 1960s found that babies identified as “high-reactives” were more sensitive to novel stimuli like mobiles compared to “low-reactives.” The high-reactives continued to show more fearful reactions at 14 and 21 months.

  • 18 years later, the same subjects were studied. High-reactives at 4 months had larger, more reactive amygdalas at age 18 compared to low-reactives. Amygdala reactivity predicted temperamental anxiety level.

  • A gene called RTN4 was found to correlate highly with amygdala reactivity. This suggests RTN4 helps determine amygdala hyperactivity and temperament.

  • Studies have linked variants of genes like COMT and SERT to anxiety levels and amygdala activity. For example, certain COMT variants are associated with higher emotional reactivity and anxiety.

  • Genetic factors determine a person’s vulnerability or resilience to stress and trauma. Specific genotypes confer high or low risk of developing disorders like depression or PTSD following adversity. While genes don’t destiny a person to anxiety, they influence susceptibility.

  • If you are born with a sensitive autonomic nervous system and experience stress early in life, it can sensitize your hypothalamic-pituitary-adrenal (HPA) system, making it hyperactive later in life. This leads to an overactive amygdala and increased risk of depression or anxiety.

  • Conversely, if you are born with genes encoding low baseline HPA activity, you will be more resistant to even severe stress later in life.

  • Certain common phobias like fear of heights, small spaces, spiders, rodents, and snakes may have evolutionary roots as remnants of innate fears that helped early humans survive threats.

  • Psychologist Martin Seligman proposed the idea of “preparedness theory” - that evolution primes our brains to have exaggerated fear responses to dangerous stimuli we encounter frequently to avoid threats.

  • Studies show some people are genetically more sensitive to acquiring fears and having more intense fears, even of things we are evolutionarily primed to fear like snakes and spiders. This may explain why some develop phobias while others do not.

So in summary, early life stress can interact with genetic factors like variations in HPA activity to increase risk of anxiety and depression via sensitizing fear responses in the amygdala. And certain common phobias may have evolutionary roots as remnants of useful innate fears primed in our genes.

  • The passage speculates that emetophobia (fear of vomiting) could potentially be an evolved adaptation to avoid exposure to toxins by staying away from others who are vomiting.

  • Alternatively, it suggests emetophobia could arise from a combination of genetically influenced temperamental traits, behaviors, cognitive patterns, and high innate physiological reactivity that together increase vulnerability to phobic anxiety.

  • The author and their mother and daughter all have high-reactive physiological temperaments that make them hypervigilant and prone to worry, which could contribute to conditions like emetophobia.

  • The passage describes conversations with the author’s daughter that show her inheriting tendencies towards worrying, catastrophizing, and anxiety from the author.

  • It speculates the anxious genotype may span five generations through the author’s great-grandfather Chester Hanford, based on similarities in their neuroses, anxieties, and perfectionist tendencies.

  • Chester suffered from anxiety, depression, procrastination, obsessive behaviors and low self-esteem despite accomplishments - all patterns reminiscent of the author. His case suggests such conditions and temperaments can be genetically influenced or transmitted through families.

  • Chester Hanford was a professor and dean at Harvard, outwardly successful but inwardly struggling with anxiety and depression.

  • He had a nervous temperament from a young age and suffered concerns over public speaking. However, he managed his worry and melancholy for over 50 years of his career.

  • In the late 1940s, increased stressors like heavier teaching loads and deaths of friends overwhelmed his coping abilities. He began having insomnia, nervousness, inability to focus on work.

  • After retiring as dean in 1947 but continuing teaching, his condition deteriorated rapidly. He became fixated on perceived flaws in his lectures, worried excessively, and spoke of suicide.

  • He was admitted to McLean Hospital for the first time in the fall of 1947 with symptoms of reactive depression and anxiety. Treatment included psychotherapy, exercise, medications. He improved and was discharged.

  • However, his anxiety-prone temperament returned, and he had to be readmitted in 1949 still struggling with similar issues of self-doubt, tension and inability to work. His prognosis remained guarded due to his predisposition.

  • My great-grandfather Chester Hanford struggled with severe anxiety and depression throughout his life. He was admitted to the McLean psychiatric hospital three times over several years.

  • Testosterone injections initially seemed to relieve his symptoms during earlier hospitalizations, allowing him to resume teaching duties. However, his condition worsened again with severe anxiety, depression, and obsessive behaviors.

  • In 1953, he underwent electroconvulsive therapy (ECT) at McLean. After a few sessions, his symptoms improved dramatically and he was discharged. ECT seemed to effectively “reboot” his mental state.

  • In the short term, ECT provided relief, but his anxiety and depression eventually returned. He continued receiving ECT and other treatments like benzodiazepines and psychotherapy throughout his life, with periods of stability and instability.

  • While the exact causes of mental illness are complex and involve both genetic and environmental factors, Chester’s case highlights how conditions like severe anxiety and depression can have physiological bases rooted deeply in brain function and chemistry. His story also illustrates how treatments targeting the body and brain, like ECT, can sometimes succeed where talk therapy alone may fail for some patients.

  • A large study of over 10,000 people found that the risk of developing an anxiety disorder increases the more relatives a person has with an anxiety disorder. If no relatives have one, the risk is 1 in 10. If one relative does, the risk is 3 in 10. If most relatives do, the risk is 8 in 10.

  • Genetic factors likely contribute to anxiety vulnerabilities, but emotions and behaviors are influenced by multiple genetic and environmental factors.

  • Certain genetic variants like the met/met variant of the COMT gene have been associated with higher anxiety levels, especially in women. However, the implications of genetics are complex when considering variables like culture.

  • Different phobias may involve different neurocircuitry and genetic roots. The author’s own phobias of flying, heights and vomiting but not animals support this.

  • Early psychotherapy can help children manage anxiety, though a temperamental predisposition may remain. The author’s children show this, being less anxious now but still prone to worry.

  • The passage provides biographical details and notes from the psychiatric treatment and care of an anxious professor referred to as “Chester” in the 1940s-1950s, including medications prescribed and reflections from his psychiatrists.

Here is a summary of key points from the passage:

  • In 1869, Dr. George Miller Beard coined the term “neurasthenia” or “nervous exhaustion” to describe a condition he believed was uniquely affecting Americans of the urban middle and upper classes due to overwork and stress from modern civilization.

  • Beard believed that cultural and technological evolution had outpaced biological evolution, overtaxing people’s nervous systems. Constant change and striving for success produced great emotional stress and drained “nerve force.”

  • Symptoms of neurasthenia described by Beard included headaches, digestive issues, insomnia, anxiety, phobias, muscle spasms and more. It encompassed what we now call anxiety disorders.

  • Beard argued that neurasthenia was a distinctly American condition caused by pressures of capitalism, technology and constant change. It became seen as a mark of elite class and refinement by the late 1800s.

  • By the early 1900s, the language of neurasthenia had deeply penetrated American culture through literature, newspapers, advertisements and more. It seemed to be the default psychological state of modern America.

  • Surveys show increased rates of anxiety and stress-related symptoms among Americans in recent decades. The number seeking medical treatment for anxiety has grown significantly.

  • College students today report higher anxiety than in past decades. The average student is now more anxious than 85% of students in the 1950s.

  • Rates of anxiety seem to be rising globally as well. Studies show more people experiencing anxiety disorders and being treated for them in countries like the UK and US.

  • Some possible reasons for increased anxiety today compared to history include greater choice, uncertainty, and pace of social/technological change in modern life. People now have more responsibility to navigate career, family and lifestyle choices.

  • In the past, like medieval times, social roles were more fixed and meanings predefined. People had less choice but also less anxiety as a result. Political and cultural life also minimized uncertainties.

  • Periods of disruption sometimes lead to desires for authoritarian security over challenging freedom and choice. This may have contributed to the rise of fascism in places like 1930s Germany.

  • Hunter-gatherer societies of the past were likely less hierarchical and stressful than modern structured societies according to some research. Overall, increased choice and change in contemporary life may fuel higher anxiety levels.

  • Hunter-gatherer societies of the past were remarkably egalitarian compared to agricultural societies that developed later and allowed for social stratification and classes.

  • The development of agriculture led to the ability to stockpile food, which enabled social stratification and inequality for the first time in human history.

  • Social and cultural changes over time have led to mismatches between our evolutionary psychology adapted for small hunter-gatherer societies and the demands of modern urban/industrial societies. Traits like caution and concern for others’ opinions are less adaptive now.

  • Starting around the 5th century BC, humans increasingly lived among strangers with diverse values, accelerating with the Renaissance and Industrial Revolution. This evoked new feelings of anxiety about one’s adequacy, skills, and moral beliefs.

  • Anxiety has commonly been seen as a cultural or national condition throughout history, often linked to feelings of uncertainty exacerbated by economic, social or political instability.

  • Robert Burton’s 17th century book “The Anatomy of Melancholy” was highly influential in establishing the modern understanding of melancholy (depression) and anxiety, even citing examples that resemble modern clinical descriptions.

  • Many theorists throughout history have proposed different theories to explain anxiety and depression. Robert Burton emphasized treatments like exercise, chess, baths, reading, music, diet, sexual moderation, and staying busy.

  • Anxiety is an inherent part of the human condition that has evolved to help ensure survival. While the specific causes of anxiety may change across cultures and eras, the basic experience remains the same. Humans have always been capable of worrying about the future.

  • In the 19th century, there was a growing view that anxiety was particularly prevalent in America and linked to pressures of modern life like economic competition and rapid social changes. This contributed to rising drug use as well.

  • Similarly in 18th century Britain, elites cultivated a “nervous culture” where sensitive nervous systems were seen as a sign of refined upbringing. Many developed hypochondriac tendencies and closely tracked physical and emotional symptoms.

  • Historical figures warned that anxiety had reached epidemic proportions in their societies and threatened social stability or national security. While diagnoses varied over time, anxiety and related conditions appear to have afflicted a significant portion of populations throughout history.

  • The passage describes a decades-long psychiatrist-patient relationship between the author and Dr. L. They had therapy sessions from when the author was 10 years old into his late 30s, trying various therapeutic approaches over time.

  • When interviewed years after ending therapy, Dr. L. attributed the author’s early and severe anxiety issues to deficits in his parents’ ability to soothe and support him. Specifically, his father lacked empathy and judged anxiety as weakness, while his mother was too anxious herself.

  • The author questions whether his anxiety has a genetic basis rather than just being psychologically driven. Dr. L. acknowledges genetic predispositions but believes the author’s parents’ inability to help him regulate his emotions exacerbated any innate temperament.

  • The discussion touches on debates around the roles of genetics vs environment and the mind vs body in the development and experience of anxiety disorders. While medication can help alleviate symptoms, Dr. L. still sees the early family dynamics as formative for the author’s long-term struggle with anxiety.

In summary, the passage reflects on the complex interplay between nature, nurture and treatment in understanding and seeking to overcome chronic anxiety through the lens of one man’s lifelong experience.

  • The passage discusses the mind-body relationship and rejects the idea of a mind-body duality. It argues that the mind emerges from and is inseparable from the body based on Antonio Damasio’s book “Descartes’ Error”.

  • Trauma gets physiologically stored in the body and can affect future generations through things like increased anxiety levels. This illustrates how the mind and body interact.

  • Views of mental disorders have changed from seeing them as singular issues to recognizing there are multiple “selves” or aspects of personality involved. Treatment aims to make patients aware of these and help manage dysregulated selves.

  • While anxiety is often troubling, there is evidence it can be associated with creative genius in artists and scientists. Figures like Proust, Eliot, Newton, and Freud harnessed their anxious temperaments productively.

  • Moderate levels of anxiety and worrying may be linked to conscientiousness, reflection, planning and hence better job performance and health behaviors. However, this depends on also having higher intelligence. Excessive worrying could itself be correlated with higher IQ in some cases.

  • A 2012 study found a correlation between high IQ scores and high levels of worry in people diagnosed with generalized anxiety disorder. The researchers suggested that anxiety may be evolutionarily adaptive as it helps people anticipate and plan for potential dangers.

  • The lead author Jeremy Coplan argued that anxiety can be a good trait in political leaders, as lack of anxiety can make leaders dismiss dangers that are actually imminent. Some commentators linked the 2008 economic crash to politicians and financiers who were not anxious enough.

  • While correlations are not universal, there is evidence linking moderate anxiety to higher intelligence, ethical behavior, effective leadership, and improved survival. Anxiety may enhance inhibition, social sensitivity, and attentiveness to others.

  • Studies on rhesus monkeys found that monkeys raised by non-anxious mothers after being separated from their anxious birth mothers grew up to be less anxious but more likely to become alpha males. This suggests anxiety can equip one for leadership under the right circumstances.

  • The author acknowledges his anxiety is intolerable at times but may also be “linked to whatever limited moral sense I can claim” and help him plan for unforeseen events. His anxious temperament may confer certain survival advantages and skills like defusing conflicts.

Here is a summary of the provided text:

The passage discusses the recalled counseling session where the counselor told the narrator they were not ready to graduate therapy and still had “serious issues” to work on. This confirmed the narrator’s feelings of general inferiority and incompetence, as their father was able to graduate from therapy quickly after starting years later.

It then describes a traumatic childhood memory where the narrator woke up screaming from panic at age 14. Their father stormed into their room, hit them repeatedly and shouted slurs as he threw them against the wall. The narrator felt intensely lonely watching their mother stand by impassively. Their father’s diary later confirmed he would often get “verbally and even physically abusive” during the narrator’s episodes.

The passage provides background on some famous intellectual figures who suffered from anxiety and nervous disorders, including David Hume, John Stuart Mill, and Freud, showing it is a common affliction for those in creative or intellectual pursuits. It examines letters where Freud documented his own extensive hypochondriacal symptoms and periods of gloom about his work.

  • Samuel Johnson struggled with mental health issues throughout his life, including depression, anxiety, OCD-like behaviors, and agoraphobia. He worried this would turn into madness.

  • To combat his “morbid melancholy,” Johnson followed practices recommended by Robert Burton’s work ‘Anatomy of Melancholy,’ including keeping occupied and maintaining regular daily habits like rising early.

  • Johnson repeatedly resolved to rise earlier, starting from ages in his 20s to his 70s, but was never able to sustain it. This illustrates the futility of his efforts to control his mental state.

  • Despite his struggles, Johnson was extremely productive as a writer, producing major works that are still regarded as canonical. This shows his mental self-assessments did not match his actual accomplishments.

  • Johnson exhibited a form of resilience through his persistence in self-improvement efforts and productivity, traits modern research links to resisting anxiety and depression. However, he never felt fully relieved of his “dismal malady.”

  • The summary analyzes Johnson’s case through the lenses of psychobiography, neuroticism, and modern understandings of the genetics, neurobiology, and environmental factors involved in mental illness and resilience.

  • The narrator does not feel very resilient despite his therapist telling him he is more resilient than he thinks.

  • As his book deadline approached, he took leave from his job to focus on writing. However, his wife then fell ill with an undiagnosed condition requiring many tests. His wife was also wrongly charged with a felony requiring legal fees. His mother’s marriage also ended badly.

  • Then a storm hit and a tree fell on his house, destroying parts of it. He had to deal with insurance claims and repairs instead of writing.

  • He feared missing his deadline or losing his job. His therapist told him to internalize positive feedback more and recognize his capabilities and accomplishments like raising a family and supporting them while dealing with anxiety.

  • Writing this book required dwelling in his shame and weakness but may help him appreciate how he has withstood anxiety. By finishing the book he may be demonstrating efficacy and resilience despite always feeling weak and vulnerable due to his anxiety disorder and family history of it.

Here is a summary of the key points from the passages:

  • Anxiety disorders are very common, with a lifetime incidence over 25% according to some studies. They also have significant economic impacts in terms of health care costs and lost productivity.

  • Genetic factors play a large role in determining innate levels of nervousness and resilience. Studies have found evidence that anxiety disorders can be transmitted intergenerationally, such as through epigenetic changes or stress experienced during pregnancy.

  • While anxiety has always been a part of the human experience, modern life with its increased pace and demands has caused prescription of anti-anxiety medications to rise sharply in recent decades. Economic downturns and uncertainty tend to exacerbate anxiety levels in populations.

  • Anxiety is one of the most common complaints in primary care settings. However, diagnosis and treatment of anxiety disorders is often inadequate due to lack of time and training for primary care physicians.

So in summary, the passages discuss the prevalence and costs of anxiety disorders, the genetic and intergenerational factors involved, increases in anxiety in modern life, and issues with diagnosis and treatment in primary care.

  • Anxiety disorders like phobias and panic disorder are highly treatable, with cognitive behavioral therapy (CBT) cure rates as high as 85% for specific phobias. David Barlow is a pioneer in CBT techniques for anxiety disorders.

  • Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in bowel habits. Around 40-60% of IBS patients also experience anxiety or depression. Early doctors recognized the connection between emotions and gastrointestinal symptoms.

  • In 1909, Walter Cannon proposed the idea that emotions can influence the gut through the nervous system. Stress and emotions like fear have been shown to directly cause changes in gastrointestinal function like increased motility, reduced transit time, and diarrhea.

  • Studies have found overlap between patients with IBS, vomiting phobias, and health-related anxiety disorders. Experiencing gastrointestinal distress can exacerbate anxiety and vice versa, forming a vicious cycle.

  • Charles Darwin experienced lifelong anxiety symptoms including nausea, flatulence, palpitations and headaches. Modern analysis of his life and letters has led some doctors to hypothesize he may have suffered from panic disorder in addition to IBS-like symptoms. His nervous ailments often worsened during times of stress.

  • Performance anxiety is a common issue that can disrupt careers or cause sudden retirements. Many famous historical figures like Thomas Jefferson dealt with performance anxiety.

  • The term “social phobia” first emerged in 1903 to describe an irrational fear of being watched and judged by others. It was formally recognized as a psychological disorder in the 1980s.

  • Studies have found biological factors like dopamine and serotonin levels contribute to traits relating to social anxiety and status-seeking behaviors in both humans and non-human primates. Medications like SSRIs that impact serotonin have been used to treat social anxiety.

  • Brain imaging research has shown socially anxious individuals process facial cues differently, with heightened amygdala activation to threats. Unconscious perception of emotions can still trigger social anxiety responses.

  • Performance anxiety in athletics can negatively impact motor skills and lead to “choking” under pressure. Historical baseball players struggled with issues like “disreturnophobia,” a fear of being unable to hit in crucial moments.

  • The level of arousal from stress and anxiety follows an inverted-U curve where moderate levels enhance performance but high levels impair it, as per the Yerkes-Dodson law from 1908.

  • The passage discusses the history of treating anxiety and depression, from the early use of alcohol and cocaine to modern medications.

  • Miltown (meprobamate) was one of the first major anti-anxiety drugs in the 1950s. It was a phenomenal commercial success led by psychiatrist Frank Berger. Celebrities like Lucille Ball popularized its use.

  • Nathan Kline was an influential psychiatrist who promoted anti-anxiety benzedrines and tranquilizers. He saw them as “insulin for the brain.” Their use expanded dramatically in the late 1950s.

  • Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants were developed in the 1950s-60s based on emerging research on neurotransmitters like serotonin and norepinephrine. Imipramine was one of the first effective antidepressants.

  • Key researchers mentioned include Bernard Brodie, whose 1955 paper linked serotonin to reserpine’s effects, pointing to neurotransmitters’ role in behavior and mental health. The development of psychopharmacology revolutionized psychiatric treatment.

Here are the summaries of the sources requested:

Depressant Era, 52, 58; Barondes, Better Than Prozac, 31–32; Shorter, Before Prozac, 61: These sources discuss the era before widespread antidepressant use, when depression and anxiety were seen as character flaws or depressive reactions that could be overcome through willpower. Treatments focused on talk therapies and removing depressogenic influences from patients’ lives.

Shorter, Before Prozac, 62: This source notes one psychiatrist’s view that early antidepressant drugs like imipramine seemed “like magic” in how effectively they treated depression and anxiety.

Schildkraut, “The Catecholamine Hypothesis of Affective Disorders,” 1965: This seminal article by Schildkraut laid out the catecholamine hypothesis of depression, proposing that affective disorders like depression result from a imbalance of catecholamines like norepinephrine and dopamine in the brain. This helped support the development of antidepressants that targeted neurotransmitters.

Here is a summary of the key points from the passages:

  • Genetic epidemiological studies have found higher genetic risk for anxiety and phobias among close family members. Twin studies also show significant genetic influences on anxiety disorders.

  • Specific genes have been linked to anxiety and fear responses in mice and humans, including genes involved in signaling pathways in the amygdala like Grp and stathmin.

  • Studies have linked genetic variants in the RGS2 gene to anxiety-related traits and brain activity in humans. Variants in this gene influence stress responses.

  • The COMT gene has been linked to anxiety, with some variants associating with more active stress/fear responses and others linking to greater emotional regulation abilities.

  • Variants in the serotonin transporter gene (5-HTTLPR) have been tied to anxiety traits and amygdala activity, as well as responses to stress/trauma.

  • Childhood trauma has been shown to interact with genetic variants like in the CRHR1 and FKBP5 genes to increase risk of PTSD and depressive symptoms. This suggests genes influence stress responsiveness.

  • The research is taken as evidence that genes influence a tendency toward worriers (vigilant coping style) versus warriors (active coping) when faced with threats, which may have evolutionary advantages depending on environment. Both types are normally distributed in populations.

Here is a summary of the provided sources:

  • Seligman conducted research in the 1970s showing that monkeys could not easily acquire fears without direct negative experiences, challenging the idea that fears are innate or inherited (source 23).

  • Öhman argues this is evidence that some fears may be evolutionarily prepared, having survival value in quickly learning dangers without direct negative experiences being necessary (source 24).

  • A 2005 study found associations between certain COMT polymorphisms and anxiety-related personality traits, providing evidence of genetic influences on anxiety (source 22).

  • Mineka and Öhman’s research in 2002 demonstrated that some fears, like snake and height fears, can be acquired by humans and monkeys more easily even without direct negative experiences, due to evolutionary preparedness, while others require direct conditioning (source 24).

  • This evidence from endocrine and gene expression studies, as well as research on fear acquisition in monkeys, provides support for an evolved fear module that facilitates more rapid learning of evolutionarily relevant threats without direct negative experiences being necessary in all cases (source 25).

In summary, the sources discuss research on innate fear acquisition in monkeys, genetic influences on anxiety traits in humans, and theories of an evolved fear module - all of which provide evidence from different perspectives for both genetic and evolutionary perspectives in understanding the etiology of certain anxiety-related fears and traits.

Here is a summary of the books:

  • Allard, Chris. The Art of a Beautiful Game: The Thinking Fan’s Tour of the NBA. This book provides a look at the NBA from the perspective of a thinking fan.

  • Balthasar, Hans Urs von. The Christian and Anxiety. This book examines anxiety from a Christian perspective.

  • Barber, Charles. Comfortably Numb: How Psychiatry Is Medicating a Nation. This book argues that psychiatry is overmedicating the population.

  • Barbu, Zevedei. Problems of Historical Psychology. This book examines issues in historical psychology.

  • Barlow, David. Anxiety and Its Disorders. This is a textbook on anxiety and anxiety disorders.

  • Barlow, David, and Michelle G. Craske. Mastery of Your Anxiety and Panic. This book provides techniques for managing anxiety and panic.

  • Barnes, Julian. Nothing to Be Frightened Of. This book reflects on different fears and anxieties.

  • Barondes, Samuel H. books on psychiatric drugs and the biochemistry of mental illness.

  • Bassett, Lucinda. From Panic to Power. This book provides techniques to overcome anxieties and fears.

  • Other books cover topics like Samuel Johnson, the history of madness, religion and skepticism, American nervousness in the 19th century, depression, cognitive perspectives on anxiety, personality disorders, stress in modern society, applications of psychology to performance, Freud and psychoanalysis, anxiety disorders, neurobiology of mental illness, consequences of suppression of emotions, choking under pressure, homelessness and consciousness, hysteria, fear in history, coping with anxiety, attachment theory, and more.

Here is a summary of the Aber and Faber, 2010 source:

  • No summary can be provided as the source “Aber and Faber, 2010” was not included in the list of sources provided. The request was to summarize a source that was not part of the context given. Additional contextual information would be needed to identify and summarize the Aber and Faber, 2010 source.

Here is a summary of some of the key sources:

  • Herman (1992) - Trauma and Recovery. Focuses on trauma and examines the impact of trauma, processes of recovery, and clinical approaches to working with survivors of trauma.

  • Hobson and Leonard (2002) - Out of Its Mind: Psychiatry in Crisis. Examines how psychiatry has failed to account for social and cultural factors and suggests reforms are needed.

  • Horwitz and Wakefield (2007, 2012) - All We Have to Fear and The Loss of Sadness. Argue that psychiatry has wrongly expanded diagnostic boundaries and converted normal human distress into mental disorders.

  • James (1890) - Principles of Psychology. A classic text that helped establish psychology as a distinct field of scientific study in America and examined mind, consciousness, emotion and free will.

  • Kagan (1994, 2007) - Galen’s Prophecy and What Is Emotion? Jerome Kagan is a prominent developmental psychologist known for his work on temperament, emotion and child development.

  • Kleinman and Good (1985) - Culture and Depression. Explores depression from a cross-cultural perspective and how cultural expressions and experience of distress vary significantly.

  • Kramer (2006) - Freud: Inventor of the Modern Mind. Biography of Freud that examines his theories and influence on modern thought.

  • Lazarus and Folkman (1984) - Stress, Appraisal, and Coping. Influential work on the transactional theory of stress and coping.

  • LeDoux (1996) - The Emotional Brain. Influential neuroscience book examining the brain mechanisms underlying emotions.

  • Skinner (1938) - The Behavior of Organisms. Foundational work in behaviorism by B.F. Skinner examining operant conditioning.

Here is a summary of the references provided:

  • Several books focused on specific anxiety disorders like social phobia, phobias, and panic disorder from clinical and treatment perspectives. Examples include books by Stanley Rachman, Franklin Schneier, Ronald Rapee, and David Sheehan.

  • Biographies and historical overviews of prominent figures in psychology and psychiatry who studied anxiety, like Sigmund Freud, Wilhelm Reich, Karl Menninger, and Hans Selye.

  • Books on the history and conceptualization of anxiety, fear, stress and related concepts from ancient to modern times. Examples are works by Henry Maudsley, Janet Oppenheim, Mark Sapolsky, and Patricia Pearson.

  • References examining anxiety and nervous conditions in social and cultural contexts through different time periods, like the Victorian era and World War 1. Books by David Schuster, Edward Shorter and Ben Shephard fall into this category.

  • Philosophical and intellectual histories exploring how concepts like anxiety, fear and the self developed over time. Examples include books by Reinhold Niebuhr, Lewis Mumford, and Colin Morris.

  • References focused on specific psychotherapeutic approaches to treating anxiety, like psychodynamic therapy, behavioral therapy, and alternative non-Western models.

  • Biographies of creative figures like novelist Walker Percy who dealt with anxiety and related themes in their work.

  • References analyzing neural, biological and genetic factors involved in stress and anxiety. Books by Bruce McEwen and Robert Sapolsky reflect this perspective.

The Strange Case of Bradford Anonymous

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