The First World Problem

Across the world, generally speaking, the higher the GDP, the higher the incidence of anxiety. So why are wealthy, prosperous nations so damn neurotic?

||Julianne Moore in the Todd Haynes film Safe

I was jogging the other day across a wide intersection when a black SUV turned into me. The thing missed me by inches, only—in retrospect—thanks to a moment of uncharacteristic agility, purely evolutionary, that allowed me to dodge its path. Presented with the real threat of a bigger, faster menace, my body threw together a little cocktail of epinephrine and cortisol to bound me out of danger’s way. The Toyota was my sabre tooth tiger.

And then I got righteously pissed. This is where I admit to calling the driver a fucktard. I shouted this in the car’s general direction because it’s what people do, what I do, and no appropriately sharp alternative presented itself. I stood momentarily frozen in the crosswalk as the blinking pedestrian countdown threatened to flash my green light to amber. I ran the next couple miles wracked by guilt. Not the daily, should’ve-watered-the-houseplants variety of guilt that keeps us from melting into our mattresses in sheer resignation, but the type that comes from being convinced of deep personal deficiency. I’d just narrowly escaped death, but more pressing was the word that had fled me in its aftermath, the ugly suffix stapled onto a perfectly usable F-bomb that turned my wounded impulse into a piece of borderline hate speech. Maybe worse, a dorky one. It had to be the result of a rotten core, something I was trying to distract myself and the world from with a guise of conscientiousness.

An investigation into the strength of my character spun at 80 beats per minute, in half-step with my Nikes’ slaps on the pavement, and it kept on for days. Its pernicious pull found new targets: career path doubts, inquests into relationships, prolonged broodings on my totally reasonable collection of 20-something debts. It lingers, still—this critical narcissism that functions on the premise that that my worth is an unfixed currency.

When another car narrowly missed me a week later, I reflexively sputtered, “sorry.”

*

This is what anxiety is: not fear, but a self-propelled treadmill. It’s worry in search of a target, turning biologically engrained defence mechanisms inward in the absence of concrete threats. And for an ever-widening swath of the North American populace, it’s become a defining element of our existence. One in six American adults count themselves among the afflicted, according to the Anxiety and Depression Association of America. At a rate of one in eight, Canadians fare only slightly better. Beyond North America, our tendency toward nail-biting is rivalled by the British; Europe, on the whole, boasts comparable averages. A 2002 World Mental Health Survey turned up the counterintuitive finding that people in the developing world—confronted with more survival-centric woes—were markedly less likely to show clinically worrisome levels of anxiety than people dwelling in wealthy Western nations.

Over the decades the labelling’s changed, but anxiety’s association with humanity’s tonier ranks is nothing new. (Consider silver-spooned Atlantic editor Scott Stossel, whose lifelong wrestlings with anxiety are detailed in the magazine’s January 2014 cover story.) “Neurasthenia” was the name the neurologist George M. Beard gave it, and in his 1881 book American Nervousness: Its Causes and Consequences, he deemed it “the product of American civilization.” It was a “distinguished malady,” he said, one of thinkers and men (or rather, thinkers who were men; he stressed that “the nervous female patients of our time do not come from the most intellectual of the sex,” though he did cite women’s increased “mental activity” as one of modern civilization’s defining bummers).

Anxiety and its accoutrements are now, by some accounts, held up as aspirational totems. Patricia Pearson, author of A Brief History of Anxiety (Yours & Mine), told me of a friend living in Mexico who, at recent house parties, observed bowls of the anti-anxiety drug Xanax offered up the way Pearson remembered her own mother dishing out smokes at the shindigs of her childhood. The distinguished malady is a status symbol. “A cultural affectation,” Pearson mused.

Later I’d observe a version of this online, with middle-class North American kids congregating in well-meaning cults of shared diagnoses on Tumblr. The impulse to unite under duress is hard-wired. There’s strong evidence to suggest that activity in our brains’ fear-regulating amygdalas is tempered by environments that emphasize social harmony over individual drive, a biological remnant of our early mammalian origins. Our little fuzzy ancestors did not likely have an expression for “work-life balance.”

Given that rugged individualism and hard-nosed capitalism are such swell bedfellows, it might come as little surprise that a 2008 World Health Organization survey measuring the global prevalence of anxiety and mood disorders by nation draws a correlate between psychopathology and strongly individualistic—and divided—Western societies. Where income inequality rises, so too does anxiety, not a consequence of the human condition but of our human condition: the price we pay for fumbling to erase our brains’ hard-wired yearnings for collectivity as we race to the finish line of self-determination. Anxiety thrives under the illusion that we are the masters of our own destinies, quietly undermining our every step.

When we think of it this way it can be easy to dismiss, the same way so many of our daily frustrations can (and, often, should) be laughed off as “first-world problems” sans or avec hashtag. But motivated self-starter that anxiety is, it poses a stubbornly resilient foe. How to defeat an enemy that resides firmly within its sufferer’s own psyche?

*

We aren’t simple products of our surroundings. Some people are born worriers, and I was one of them. Throughout my childhood, my mother delighted in sharing infant stories of my younger brothers and I as the wine flowed at family gatherings. “After Kelli, he was such a surprise!” she’d say of my jolly next-in-line, the universally beloved teacher’s favourite who I’d watch competently leap off a swimming pool high dive as a kindergartener because failure wasn’t the sort of thing that dogged him. While he’d emerged good in his skin, I was a kid whose phobias rerouted walks to preschool (though in my defence, that decoy owl in the neighbourhood sporting goods store window was objectively creepy), nightmare-prone and moody. My brother entered high school with a band and a grade 12 girlfriend. Me, an eating disorder and Celexa script. (Similarly, Stossel mentions an early onset of both unease and unsuccessful intervention.)

The difference was that, for better or worse, I’d come into the world programmed with a heightened sense of caution. Eventually I came to interpret my instinct as a deficit. In a world that so elevates “go-getters” (and consider for a moment the utter stupidity of that term) and an irrepressible veneer, hesitation feels like a moral failing. This makes the worry worse.

“There’s clearly a genetic component [to anxiety],” says Dr. Dawn Huebner, a New Hampshire-based psychologist and the author of What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety, a self-help picture book for the playground set. “That gets coupled with learning.” A cognitive behavioural therapist, Huebner is adamant that anxiety is “very treatable” across the age spectrum. But there are more stressors nowadays than maybe there once were, she says. One trigger she has encountered in her practice is a sense of information overload, which sets off activity in the anxious brain’s amygdala. “When we’re bombarded with lots of stimulation, or information, that part of our brain gets activated more,” she says. “So there’s more tendency for people who are prone to anxiety to get kind of hijacked.” So, surprise: reading about things like the shrinking certainty of a middle-class existence or internalizing pressures to, say, establish a showier personal brand than the friend you’re competing with for work can really raise a person’s blood pressure.

Then there’s the sheer volume of stimuli: The New York Times recently determined that the average American consumes 34 GB of data per day, which is more than twice what my iPhone can hold. It’s easy to see how a certain kind of person might feel like Lucy Ricardo in the chocolate factory assembly line, bogged down by the burden of the information conveyor belt.

Where we direct our anxieties over the course of our lifetimes also reflects environmental influences. Early childhood anxiety, according to Huebner, manifests in fears of concrete threats like bad weather and illness, but older elementary school-aged children tend to turn their worry toward the possibility of making mistakes. By the time youth enter adolescence, anxiety becomes centred around social hierarchies and the future. With the progression of age, the feedback loop grows ever more nebulous, fixed on outward achievement, competition, and control. Drive is the enemy of serenity. When I met with Patricia Pearson this September at an almost cartoonishly bourgie West Toronto cafe (“a fitting setting for the anxiety of everyone still thinking they can live a middle-class life when they’re actually tumbling into and below the working class, financially,” she offered) she revealed that her book on anxiety had begun as a book about ambition.

While he’d emerged good in his skin, I was a kid whose phobias rerouted walks to preschool (though in my defence, that decoy owl in the neighbourhood sporting goods store window was objectively creepy), nightmare-prone and moody. My brother entered high school with a band and a grade 12 girlfriend. Me, an eating disorder and Celexa script.

“In the US and Europe, people feel they need to be that much more successful in order to have status [and] be valued,” she told UK newspaper The Independent when promoting her book in 2008, explaining the link between anxiety and achievement. “When I was starting out as a writer, my anxiety was enhanced by the fact that I didn’t appear to have any control over getting noticed.”

During our meeting, she offered an anecdote of a road trip through the US bible belt with her daughter. Faces smiled from the starkness of America’s poorest rural enclaves, car bumpers affixed with cheerful requests for Jesus to take the wheel. People seemed remarkably at ease, and why not? There’s a great relief in relinquishing control.

*

This past May, the American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), America’s dictum on the disordered mind since 1952. Conditions have been added and removed over the years under the pressure of new research and, crucially, changing social norms (notably, homosexuality was declassified as a mental disorder by the 1974 printing of the DSM-II, though the horrifyingly imprecise classifications that took its place deserve their own essay). As the DSM’s definitions of GAD have broadened, the disorder has practically become the status quo.

In an article for Psychology Today, Dr. Allen J. Frances, a professor at the Duke University School of Medicine and chair of the DSM-IV Task Force, underlined ten of the DSM-V’s most potentially harmful updates—among them, the manual’s revised criteria for Generalized Anxiety Disorder. Where, previously, an anxiety diagnosis was contingent on a person recognizing that their worry was excessive or ill-directed, the DSM now simply requires a general sense—not an overwhelming sense, not a debilitating sense—of unease lasting longer than six months. It’s no longer a question of who suffers from anxiety, but rather who doesn’t. “DSM-V obscures the already fuzzy boundary between Generalized Anxiety Disorder and the worries of everyday life,” wrote Frances. “Small changes in definition can create millions of anxious new ‘patients,’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.” He declared its release as “the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry.”

Insofar as the psychiatric profession is concerned, “therapy” has more or less become innuendo for dosing. In my early 20s, while still covered by my parents’ Milwaukee Public Schools employee health insurance, I had a psychiatrist I’d see twice a year for prescription refills during my occasional visits home. I’d scan the parenting magazines in her waiting room for ten or so minutes, go into her office for five, emerge with my scripts, and cordially bid her “see you in six months!” On one of these occasions, after an unsuccessful attempt to wean myself off of the coo-coo cocktail that coincided with my undergraduate career’s end, I wondered aloud whether it’d be useful for me to try talking over my problems. Maybe, even, with her. “Oh,” she said, amused. “You want to see a counsellor.”

I didn’t get a counsellor. What I did get, like so many others, were more drugs. An early-2000s study by the University of Toronto found a 353 percent increase in antidepressant prescription by Canadian physicians from 1981 to 2000. In the U.S., the Centers for Disease Control and Prevention pointed to an almost 400 percent increase in their prescription between 1988 and 2011. And it isn’t just adults being prescribed for: an estimated one in 50 American kids between 12 and 19 reported being on at least one antidepressant medication in another recent study. I’d wager I wasn’t the only early-aughties high schooler writing Morrissey-esque love poems to my SSRIs, which dulled the symptoms without getting at their root.

While it’s easy to accuse the APA of using the DSM-V to further fellate Big Pharm, the likelihood of increased diagnoses in and of itself doesn’t seem so terrible. A diagnosis can validate difficult feelings, offering a solace of its own. And the more people diagnosed, the more likely people are to face their vulnerabilities, raising the possibility that weakness might be accepted as part of the human experience.

Diagnosis can be a step to self-care, and permission to join the ranks of the flawed. Not such a bad deal, when so much of our unrest comes from the sense that we’re alone and unworthy.

*

If you want to know how kids these days feel about their mental health diagnoses, Tumblr’s a good place to start. There are dozens of individual blogs dedicated to the topic of anxiety alone, most of which are run by women in their teens to early 20s and range from the broadly encouraging to the deeply confessional.

Anxietythings! reads like an affirmation board as lovingly curated by your been-through-it bestie. “If you are reading this, you have survived your entire life up until this point,” reads one of its posts, a handwritten dedication of blue ballpoint ink on white notepaper. “You go, motherfucker. You are awesome.”

“I kind of found a support group for myself, but also a place where others could come and feel comfortable to say exactly what they were afraid to say,” the blog’s 21-year-old founder Kaela Brundage told me, days after its two-year anniversary. Brundage experienced what she describes as a mental break in the spring semester of her freshman year at SUNY Purchase, after a close friend from her upstate New York hometown died of cancer. She sought treatment from a university health counsellor—to the horror of her usually unflappable mother—and the blog was born shortly thereafter.

Now, she speaks articulately and with great conviction about the de-stigmatization of mental health management, and doesn’t think it’s particularly wacky for people who are suffering to try and seek relief. She’s also open about her use of the somewhat controversial anti-anxiety medication Paxil despite their relationship’s rocky start: two weeks of headaches and vomiting. She feels better equipped to provide guidance to others in similar binds, and has found herself in a position to do just that: since its inception, anxietythings! has attracted over 950 followers. A great number of these, Brundage tells me, are girls in their teens who wind up writing in for advice. Many of them report relatives who cringe at the idea of a loved one with a mental health disorder, or reject the labelling altogether.

Still, few of the blogs deal primarily with the issue of mental health stigma. Instead, they tend toward daily mood check-ins and self-care techniques, carrying a strain of something that reads almost like pride. The distinguished malady has become a galvanizing force for a kind of virtual sisterhood.

The Reddit thread for Anxiety claims 31,853 readers—enough fretters to populate a small city—and dozens of active readers at any given moment. The Anxiety and Depression Association of America lists numerous in-person support groups across the US and Canada, from “Phobics Victorious” in Rancho Mirage, California to “Freedom From Fear” in Barrie, Ontario. Online support communities abound, including the vaguely New Agey AnxietyTribe, whose homepage states, simply, “Because it takes a tribe…”

*

This Fall I decided I’d make a point of spending time with people. In previous years I’d use the season change as an excuse to hole up and plunge into projects, to improve myself as a product, bolster my worth. It never worked; I’d come out of winter isolated and depressed, and the disjointedness was never worth the cost. Certainly I deserved better. If not me, the people in my life dragged into my misery.

I’d own my neurosis. Not dwelling, but acceptance. I’d exist in the world. I’d shift my ruminations outward. It’s taken work, but it’s working.

Connectedness is the answer, somehow. Having a family helped alleviate Pearson’s constant whirr of dread, at least for a time, by diverting her energy away from the internal hamster wheel. For Brundage, being a community hub became its own therapy.

While our culture defines disorder and dispenses products to treat it, we might be best off making peace with our ever-changing positions on the spectrum of ease. We might even relish the messy togetherness of being human.

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