ANXIETY

Abstract We worry. Nearly one in ve Americans suffer from anxiety. For many, it is not a disorder, but a part of the human condition. This series explores how we navigate the worried mind, through essay, art and memoir.

Contents
I JANUARY 5
5 8 12

1 January 14, 2012: Its Still the Age of Anxiety. Or Is It? 2 January 22, 2012: Searching the Brain for the Roots of Fear 3 January 28, 2012: An Appointment With Dread

II

FEBRUARY

17
17

4 February 05, 2012: A Thief in the House.

III

MARCH

21
21 26 30 35

5 March 11, 2012: The Mountain Man. 6 March 17, 2012: The Danish Doctor of Dread. 7 March 25, 2012: Finding Clues in the Fearful Brain. 8 March 31, 2012: Panic in Paradise.

IV

APRIL

41
41 43 47 52

9 April 09, 2012: Tattoos for the Terried. 10 April 16, 2012: In the Arcadian Woods. 11 April 23, 2012: Prelude to a Kiss. 12 April 30, 2012: Up in Smoke.

MAY

57
57 61 66 72 75

13 May 07, 2012: Cycle of Fear. 14 May 14, 2012: Meltdown in Motherland. 15 May 21, 2012: Control. 16 May 25, 2012: Control. An Update. 17 May 25, 2012: Do the Jews Own Anxiety?

VI

JUNE

80
80 84 87 91 96

18 June 02, 2012: Cancer on the Brain. 19 June 18, 2012: Toasted. 20 June 11, 2012: Survivors. 21 June 25, 2012: Haunted Heart. 22 June 30, 2012: The Busy Trap.

VII

JULY

101
101 106 112 117

23 July 09, 2012: Two-Way Mirror. Facing a Daughters O.C.D. 24 July 15, 2012: Jokers Wild. 25 July 23, 2012: A Desert Beyond Fear. 26 July 29, 2012: The Song Remains the Same.

VIII

AUGUST

122
122 129 133 136

27 August 06, 2012: My Son, Lost and Found. 28 August 11, 2012: The Anxious Idiot. 29 August 20, 2012: Childs Play. 30 August 25, 2012: Drugs, Sweat and Fear.

IX

SEPTEMBER

140
140 144 149 154

31 September 01, 2012: Music of the Unquiet Mind. 32 September 09, 2012: On Being Nothing. 33 September 15, 2012: Surviving the Pain at the Roots. 34 September 22, 2012: America the Anxious.

OCTOBER

159
159 165 168

35 October 01, 2012: From Hunger. 36 October 07, 2012: Brain Scan. 37 October 14, 2012: Anxiety Art. This Mortal Coil.

Part I

JANUARY
1 January 14, 2012: Its Still the Age of Anxiety. Or Is It?

By DANIEL SMITH Its hard to believe that anyone but scholars of modern literature or paid critics have read W.H. Audens dramatic poem The Age of Anxiety all the way through, even though it won a Pulitzer Prize in 1948, the year after it was published. It is a difcult work allusive, allegorical, at times surreal. But more to the point, its boring. The characters meet, drink, talk and walk around; then they drink, talk and walk around some more. They do this for 138 pages; then they go home. From a sufferers perspective, anxiety is not epochal. It is always and absolutely personal. Audens title, though: that people know. From the moment it appeared, the phrase has been used to characterize the consciousness of our era, the awareness of everything perilous about the modern world: the degradation of the environment, nuclear energy, religious fundamentalism, threats to privacy and the family, drugs, pornography, violence, terrorism. Since 1990, it has appeared in the title or subtitle of at least two dozen books on subjects ranging from science to politics to parenting to sex (Mindblowing Sex in the Real World: Hot Tips for Doing It in the Age of Anxiety). As a sticker on the bumper of the Western world, the age of anxiety has been ubiquitous for more than six decades now. But is it accurate? As someone who has struggled with chronic anxiety for many years, I have my doubts. For one thing, when youve endured anxietys insults for long enough the gnawed ngernails and sweat-drenched underarms, the hyper-

ventilating and crippling panic attacks calling the 20th century The Age of Anxiety starts to sound like calling the 17th century The Age of the Throbbing Migraine: so metaphorical as to be meaningless. From a sufferers perspective, anxiety is always and absolutely personal. It is an experience: a coloration in the way one thinks, feels and acts. It is a petty monster able to work such humdrum tricks as paralyzing you over your salad, convincing you that a choice between blue cheese and vinaigrette is as dire as that between life and death. When you are on intimate terms with something so monumentally subjective, it is hard to think in terms of epochs. And yet it is undeniable that ours is an age in which an enormous and growing number of people suffer from anxiety. According to the National Institute of Mental Health, anxiety disorders now affect 18 percent of the adult population of the United States, or about 40 million people. By comparison, mood disorders depression and bipolar illness, primarily affect 9.5 percent. That makes anxiety the most common psychiatric complaint by a wide margin, and one for which we are increasingly well-medicated. Last spring, the drug research rm IMS Health released its annual report on pharmaceutical use in the United States. The anti-anxiety drug alprazolam better known by its brand name, Xanax was the top psychiatric drug on the list, clocking in at 46.3 million prescriptions in 2010. Just because our anxiety is heavily diagnosed and medicated, however, doesnt mean that we are more anxious than our forebears. It might simply mean that we are better treated that we are, as individuals and a culture, more cognizant of the minds tendency to spin out of control. Earlier eras might have been even more jittery than ours. Fourteenth-century Europe, for example, experienced devastating famines, waves of pillaging mercenaries, peasant revolts, religious turmoil and a plague that wiped out as much as half the population in four years. The evidence suggests that all this resulted in mass convulsions of anxiety, a period of psychic torment in which, as one historian has put it,

the more one knew, the less sense the world made. Nor did the monolithic presence of the Church necessarily help; it might even have made things worse. A rm belief in God and heaven was near-universal, but so was a rm belief in their opposites: the Devil and hell. And you could never be certain in which direction you were headed. Its hard to imagine that we have it even close to as bad as that. Yet there is an aspect of anxiety that we clearly have more of than ever before: self-awareness. The inhabitants of earlier eras might have been wracked by nerves, but none xated like we do on the condition. Indeed, none even considered anxiety a condition. Anxiety didnt emerge as a cohesive psychiatric concept until the early 20th century, when Freud highlighted it as the nodal point at which the most various and important questions converge, a riddle whose solution would be bound to throw a ood of light upon our whole mental existence. After that, the number of thinkers and artists who sought to solve this riddle increased exponentially. By 1977, the psychoanalyst Rollo May was noting an explosion in papers, books and studies on the subject. Anxiety, he wrote, has certainly come out of the dimness of the professional ofce into the bright light of the marketplace. None of this is to say that ours is a serene age. Obviously it isnt. It is to say, however, that we shouldnt be possessive about our uncertainties, particularly as one of the dominant features of anxiety is its recursiveness. Anxiety begins with a single worry, and the more you concentrate on that worry, the more powerful it gets, and the more you worry. One of the best things you can do is learn to let go: to disempower the worry altogether. If you start to believe that anxiety is a foregone conclusion if you start to believe the hype about the times we live in then you risk surrendering the battle before its begun.

January 22, 2012: Searching the Brain for the Roots of Fear

By JOSEPH LEDOUX You are taking a walk in the woods pleasant, invigorating, the sun shining

through the leaves. Suddenly, a rattlesnake appears at your feet. You experience something at that moment. You freeze, your heart rate shoots up and you begin to sweat a quick, automatic sequence of physical reactions. That reaction is fear.

Human anxiety is greatly amplied by our ability to imagine the future, and our place in it. A week later, you are taking the same walk again. Sunshine, pleasure, but no rattlesnake. Still, you are worried that you will encounter one. The experience of walking through the woods is fraught with worry. You are anxious. This simple distinction between anxiety and fear is an important one in the task of dening and treating of anxiety disorders, which affect many millions of people and account for more visits to mental health professionals each year than any of the other broad categories of psychiatric disorders. Scientists generally dene fear as a negative emotional state triggered by the presence of a stimulus (the snake) that has the potential to cause harm, and anxiety as a negative emotional state in which the threat is not present but anticipated. We sometimes confuse the two: When someone says he is afraid he will fail an exam or get caught stealing or cheating, he should, by the denitions above, be saying he is anxious instead. But the truth is, the line between fear and anxiety can get pretty thin and fuzzy. If you saw the abovementioned snake at a particular rock on the path of your walk, and are now at that spot, the rock may stand in for the snake and elicit fear, even though the snake itself is nowhere to be found. In modern life, many fear states are like this they are brought on by things, signposts or signals that stand

for harm rather than things that are truly harmful. After the Sept. 11 attacks, for instance, many New Yorkers felt uneasy at the sound of low ying airplanes. How do things come to symbolize threats? Remember Pavlovs dog? When the bell rang the dog salivated because the bell had previously been rung as the dog was being fed (actually, it wasnt a bell, but no matter). The dogs brain formed an association between the sound and the food, and the sound came to elicit salivation in preparation for the imminent food. As the snake and Sept. 11 examples above illustrate, the same thing happens in dangerous situations. ~~~ We actually know a tremendous amount about what goes on in the brain when stimuli present during danger become memory triggers for the danger. To make a complicated story very simple (though not inaccurate) a region in the brain called the amygdala connects the two events, forming an unconscious memory of the association. When the neutral stimulus (the rock or the sound of an airplane) later occurs, it automatically activates the amygdala like the original danger did, eliciting fear, and also triggers worry anxiety. The automatic nature of the activation process reects the fact that the amygdala does its work outside of conscious awareness. We respond to danger, then only afterward realize danger is present. Every animal (including insects and worms, as well as animals more like us) is born with the ability to detect and respond to certain kinds of danger, and to learn about things associated with danger. In short, the capacity to fear (in the sense of detecting and responding to danger) is pretty universal among animals. But anxiety an experience of uncertainty is a different matter. It depends on the ability to

anticipate, a capacity that is also present in some other animals, but that is especially well developed in humans. We can project ourselves into the future like no other creature. While anxiety is dened by uncertainty, human anxiety is greatly amplied by

our ability to imagine the future, and our place in it, even a future that is physically impossible. With imagination we can ruminate over that yet to be experienced, possibly impossible scenario. We use this creative capacity to great advantage when we envision how to make our lives better, but we can just as easily put it to work in less productive ways worrying excessively about the outcome of things. Some concern about outcomes is essential to success in meeting lifes challenges and opportunities. But at some point, most of us probably worry more than we need to. This raises the questions: How much fear and worry is too much? How do we know when we have skipped the line from normal fear and anxiety to a disorder? Fear and anxiety are in the brain because they helped our ancestors and theirs cope with lifes challenges. But when these states interfere with our ability to survive and thrive, one has an anxiety disorder. These include phobias, panic disorder, posttraumatic stress syndrome, generalized anxiety disorder, among other conditions. While fear plays a key role in some anxiety disorders (phobia, post-traumatic stress), it takes a back seat in others (generalized anxiety). Pathological fear and anxiety are due to alterations of the brain systems that normally control fear and anxiety (structures such as the amygdala). A tremendous

amount has been learned about the normal system from studies of other animals. This gives us a good shot at understanding the pathological forms, and developing ways to treat and maybe even prevent them. Indeed, recent research in animal models are giving us new clues about how to treat problems of fear and anxiety in humans, both pharmacologically and behaviorally, and helping us gure out how we can pull people back once theyve crossed the blurry line. BONUS TRACK Its been proposed that the poet Emily Dickinson suffered from severe anxiety. In her series of poems, Part 1, Life, XCVIII, she writes: While I was fearing it came, But came with less of the fear, Because that fearing it so long, Had almost made it dear. I took her lyrics from this poem and used them as the basis for a rock song

about anxiety. Its called Fearing, and is appears on the second CD by my band, The Amygdaloids. Our songs, which are mostly original works, are about mind and brain and mental disorders. Here is a music video of Fearing that includes two mini lectures on the pathological states such as those suffered by Dickinson.

January 28, 2012: An Appointment With Dread

By ALISSA NUTTING Across the waiting room in the doctors ofce, a woman is generously showering each page of last months Newsweek with wet coughs. Her expression is a dutiful one, like that of a priest sprinkling holy water upon his congregation; occasionally she ips back to bestow a second layer where the rst might have been too thin. My rst thought of the day: I love my dog. My second: His death is inevitable. The man sitting next to me is browsing a copy of Mens Health. When the nurse calls his name he smiles and offers me the magazine. I recoil. Touching its communal pages would be the equivalent of having unprotected sex with multiple strangers in a Port-a-John. I manage a terse, No thank you, then immediately begin to worry he thinks I refused it because Im illiterate. Perhaps he thinks Im not simply illiterate but also stupid, that I thought illiteracy was actually a medical condition and that instead of going to an adult education center I came to the doctors ofce. Next time someone offers me a magazine in a doctors ofce, I decide, Ill decline by saying, Ive already read that one. When the man is gone I stare at the magazine there on the chair, thinking about how some poor soul who wants to sit down is going to have to pick it up and irrevocably compromise his immune system. At any moment, I expect its pages to erupt with scarab beetles and y around the room. A few minutes later, my name is called. I give a small jump and follow the nurse back toward the examination room, trying to avoid eye contact with the other patients and staff. Its hard not to be aware of how vulnerable I am now following a strange woman down an unfamiliar hallway and consensually stepping into a room I have never seen, where anyone or thing could be lying in wait. Although this feels like an emergency, when we pass a re extinguisher I do not break the glass. I would like to, though. I would like to activate an alarm and run.

You can have a seat on the table, the nurse says. Really? I want to ask. Then can I stick my arms inside an aquarium of scorpions? The thin paper sheet drawn across its vinyl is a laughable barrier against germs. They are sending me into a pathogenic hurricane with only a cocktail umbrella for protection. Because its socially unacceptable to say so aloud, I telepathically send her a request for an aluminum-shell hazmat suit to wear, but she does not seem to receive it. She leaves me alone in the room. I want to get up and try the doorknob, just to be sure that it isnt locked from without. But I really dont want to touch it. When the doctor enters, I sit up with a jolt. Whoa, there, he says. Weve got a live one! I pick a corner of the ceiling to stare at so I dont have to see his ngers. He has a habit of walking them across the page as he reads my chart. They move far too quickly, at a speed I associate with undesirable insects. I nally summon the courage to look directly at him and notice his eyes staring at my foot, which Im bouncing up and down. I stop. Soon his eyes move to my hands, which Im wringing. Still feeling pretty nervous, huh? He looks down at my chart, then looks back at my hands and whistles. You are tolerating a whopping amount of benzos. He says this with an air of respect and selfpride, like this is a great accomplishment we are both responsible for. Incredible, he adds. I feel like an exhibit at a fair, an overgrown gourd with two warty protuberances atop its crown that just happen to make a shadow resembling Mickey Mouses head. But like the image of Virgin Mary appearing on a piece of burnt toast, this miracle isnt quite what it seems. Theres a simple reason the pills arent working, no matter how high he ratchets the dose: Im not taking them. ~~~ I initially visited the doctor lets call him Dr. Blank in order to get some

sedatives for an airplane ight. Why does ying make you nervous? hed asked. Id tried to explain that if he didnt give me drugs, I would likely spend the rst 20 minutes of the ight focused on how at any moment the plane could crack apart like a metal egg in the sky and drizzle a long yolk of passengers out into the ocean, and how I would then urinate in my pants at 30,000 feet before spontaneously passing out, vomiting, then choking on my vomit. It was then that Dr. Blank went on to ask me all sorts of questions that had nothing to do with ying and everything to do with anxiety. Whats one of the ways this worrying impacts your life? he asked. I shrugged. I guess with driving. His eyebrows power-lifted a thick row of forehead skin up to his scalp. What happens when you try to drive? That feeling was hard to explain, too. I might compare it to being trapped inside a metal laundry chute while several hundred people bang on its outside with baseball bats. I feel a little panicked, I told him. I have to pull over a lot when it seems like Im having a heart attack. Then we talked drugs. Sedatives, he explained, were only a small part of the anxiety-relieving buffet and not a very nutritional one. What I needed was a staple that would help me feel less anxious all the time, and help my panic attacks to decrease in frequency. A panic attack was like a spoiled child at Chuck E. Cheese, he explained: if it really freaked out, sure, just throw cake at it so it doesnt cause a scene. Let it eat the desserty sedatives until it has its temporary ll. But this doesnt x the problem. Soon the kid will be screaming again. He prescribed me a tampon multipack-style combination therapy. Always Id wear the protective liner of Lexapro, an antianxiety-antidepressant selective serotonin reuptake inhibitor (SSRI), adding in a small dosage of Xanax for the light days, a

stronger dosage for predictably tense situations, and heavy-ow sublingual lozenges for panic attacks. He stressed that Lexapro, the daily component, was the most critical. In tandem with cognitive behavior therapy, my need for the other drugs would gradually lessen, perhaps even someday disappear. But I dont want the Lexapro, I wanted to protest. I only want the euphoriainducing abusable controlled substances. Even those I didnt want every day. They made me very sleepy, and also made it easy to eat entire pies without noticing. I just needed something to take the edge off when I ew on planes, and other highadrenaline scenarios. Like waiting in line for a bagel. I told him I would follow his regimen, but I had a secret plan. I would not take the Lexapro, only the Xanax sporadically, then return to the unbearable appointments again and again for prescriptions until Id stockpiled enough Xanax that I didnt have to go back for years. After each appointment, I returned home from the pharmacy cradling the prescription bag, whispering pet names to it like Gollum did his golden ring. This went on for a few months until a good friend needed a ride home from the airport. I thought I was going to die at least seven hundred times during the halfhour trip. I arrived at baggage claim with soaked hair and a Rorschach-blot of sweat staining the front of my shirt. Did you run here or drive here? my friend asked. That night in bed, I began to wonder what it would be like to drive while feeling relatively normal. My fear in taking an SSRI was that it would transform me into a Disneyed Alissa, one who could only see sunshine and oddly friendly birds whose facial expressions were anthropomorphized versions of Katie Couric at her morning espresso zenith. I didnt want to feel lied to. Terrible things happen all the time for no good reason worrying has always been my way of displacing my rage at this truth. I focus on the possible events themselves instead of the answerless query as to why they must happen. I did this, in fact, the very next morning. I woke to my dog licking my face. My rst thought of the day: I love my dog. My

second: His death is inevitable. Would an SSRI mean that I didnt have such macabre thoughts upon waking? Maybe blissful ignorance and denial wouldnt be so bad. Before swallowing my rst pill, I decided to try thinking the exact opposite of my fears just to see what a chemical brainwash might be like. You are an immortal being who will outlive world apocalypse, I said to my dog. He leaned back and began licking his bottom. In the weeks that followed, I was both relieved and disappointed to nd that the drugs did not in fact Disneyfy me. But they didnt cure my anxiety either. What they did do was replace the swords of its hands with sporks, put it in a helmet and kneepads, and reduce its farsighted vision. Combined with behavioral therapy, I can now drive in a normal fashion. Somewhat. An acquaintance at work recently stopped me in the hallway. I was behind you in the tunnel the other day, he said.You were going like 20 miles under the speed limit and doing Lamaze breathing. Im sure that wasnt me, I said. He shook his head. Im sure it was.

Part II

FEBRUARY
4 February 05, 2012: A Thief in the House.

By JOE FRANK The series is featuring occasional works of ction. This is one. ~ ~ ~ One afternoon, when I was 8 years old, I went into my parents bedroom and found a coin in the top drawer of their bureau. It was very heavy and had ancient markings written in Arabic or Hebrew or Chinese. I thought it was beautiful and stole it and hid it in the steamer trunk in the back of my closet. And that was the beginning. Whenever my parents were out, Id go into their bedroom and rummage through their drawers and closets. I stole my mothers gold arrow pin, a glass statuette of a unicorn, a money clip with my fathers initials on it, a very small pair of old rimless reading glasses and a ceramic thimble with a picture of a blue rabbit. Sometimes my mother would ask, Did you see my beaded necklace? Or my father would say: I cant seem to nd my blue striped tie. Do you know where it is? I felt they knew I was stealing from them but were reluctant to confront me. Then one day I found, in the bottom drawer of my fathers desk, a red silk pouch with a gold braided drawstring. Inside were small black-and-white photographs. Using the magnifying glass from my stamp collection, I studied these old pictures in which I appeared as a small child but did not recognize any of the people around me. In one, wearing a sailors suit, I was with a group of bearded men in dark coats, big hats and stern faces standing in a forest.

In another, three people were gathered together in the snow, one holding me in his arms and standing with his foot on a frozen dead cow, smiling at the camera. In another, I was harnessed to a babys highchair in the company of a group of people sitting at a table in an outdoor cafe. They were sipping coffee and laughing and waving at the camera, while the cafe behind them was on re. The last photo was taken in a dimly lit nightclub. A man, sitting at a white piano, wearing a bandanna, was accompanying a couple dancing the tango in a very sexually provocative way. On the far wall, I observed a large mural of the baby Jesus. The face of the Christ child bore an uncanny resemblance to the face of the child in the other photos, and I wondered why Id been chosen to represent Christ in an Argentine dance club. But I couldnt ask my parents about the pictures, because it would have revealed that Id been stealing from them. Meanwhile, I began to notice that some of my own possessions were disappearing bit by bit a toy soldier, a harmonica, my favorite pair of beat-up sneakers, a boxcar from my electric train and my autographed baseball cards of Bo Hoskins and Victor Kessel. As more of my things disappeared, I became even more compulsive about stealing from my parents. I stole pendants, lockets, coffee cups, two miniature landscape paintings, a few small cushions from the couch, four incandescent bulbs from the ceiling track lighting and little beads of glass, one by one, from the chandelier in the living room. Over the course of a few months, the walls in the apartment grew barer and the furniture seemed more exposed, and the house became darker. It happened so gradually that my parents didnt seem to notice. At the same time, more of my own things continued to disappear. For everything I took away, something was taken from me, as though an undeclared war was in progress. As we sat at the dinner table talking about the days events, my father would stare at me with his brow furrowed, looking around the room to see if anything else was

missing, while my mother twirled her hair and drummed her ngers on the table. There seemed to be an unspoken sense of suspicion, fear, rage, betrayal, the feeling of an imminent explosion, as if we were teetering on the brink of violence, but none of us could confront the other; and in this atmosphere, I still managed to slip the pewter saltshaker into my pocket. Then, when I returned to my room, I found that my bicycle was missing. By this time, I had taken to wearing a shing jacket with multiple pockets, in order to stash even more items, and by the end of the day Id have books, gurines, shoes, socks and gloves, and the steamer trunk in the back of my closet was so crammed with contraband that it seemed about to burst. One evening, I noticed my parents had put up two surveillance cameras, one in the living room, the other in the kitchen, and posted a uniformed guard at their bedroom door. That night, I put my chair and desk against my own bedroom door, boarded up the windows and placed a tripwire attached to a spring-loaded catapult that would hurl a rebomb at the slightest turn of my doorknob. As I waited, I continued to obsess about the pictures of me as a child, taken with members of an unrecognizable family. Finally, I cracked. I marched into the living room, where my mother was dusting a table and my father was sitting on the couch. Why did you leave those pictures of me as a child with people who are completely unfamiliar to me? I said. Was it to suggest that I have no part in your lives? Or were you trying to drive me crazy? And so, there we have it! An admission! my father shouted. You were the one who started this. But Im a child, I said Youre adults. You should have explained to me that stealing was wrong. Instead, you started stealing from me. Now Ill never be able to trust anyone. Im only 8 years old, and my entire way of looking at the world has been

corrupted. Why did you do this to me? Did you think it would make me stronger? Did you think if you exposed me to betrayal, that you were tempering me to be able to face the realities of life? My fathers face reddened, and my mother began to cry. Finally, I came around to the subject that had been haunting me. And why am I the only recognizable person in the pictures you had hidden away? Who are those people? Are you really my parents, or was I adopted? What are you talking about? my father said. What pictures? I went to my room and returned with the red silk pouch. Using my ashlight and magnifying glass, my parents examined the photos. Yes, it is you, my father said. But neither of my parents recognized the other people, either. We all shared a sense of wonder and bewilderment and retired to the kitchen to get something to eat. But the refrigerator was empty because Id stolen everything in it, and there was only one chair left in the dinette. None of us had eaten for three days, so we decided to go to a restaurant around the corner. We felt a sense of hope that together, as a loving family, we would solve the mystery.

Part III

MARCH
5 March 11, 2012: The Mountain Man.

By THADDEUS RUTKOWSKI The series is featuring occasional works of ction. This is one. ~~~ I walked to the post ofce to pick up my familys mail. When I opened the swinging doors, I saw that the dusty room was empty. Presently, the postmistress came out of her living area and stepped behind the counter. While she checked a pigeonhole for mail, I looked at the wanted posters on the wall. They showed fugitives faces and described their crimes. Some of the men were armed and dangerous; others were extremely dangerous. I tried to memorize what they looked like, in case I saw one of them. If I did see one there wasnt much I could do, because I had no weapon. I would just have to run as fast as I could in the opposite direction. The postmistress handed me a roll of mail, and I went out through the heavy wooden doors. * On my way home, I saw a couple of hunters outside the hotel bar. They were wearing plaid wool coats and eece-lined boots. As I walked past, I saw a dead deer in the back of their pickup truck. The deer had no antlers it looked like an illegal kill.

In the truck cab, a gun rack held two ries. Both of the guns had scopes and shoulder straps. I could imagine the hunters marching through the woods like soldiers, guns slung over their shoulders, barrels pointing into the air. One of the men noticed me and asked, Doing any hunting this season? I shook my head no and walked on. * At the dinner table, my father spoke while my brother and sister and I listened. Theres a mountain man on the loose in Shade Gap, he said. He kidnapped a teenager. The F.B.I. went after him with a dog. First, he shot the dog; then he shot an agent. That man has courage. All these guns, my mother said from her post by the stove. He was lonely, so he took her, my father said. Theyll never catch him. He knows the mountains and the hollows, just like I know the land around here. Why do you need to know it? my brother asked. If they come for me, my father said. Ill know where to go. What will you do for food? my sister asked. Ill be armed. Ill hunt for food. I saw a deer without antlers on a truck, I said. Enough! my father shouted. Ive had enough of you kids for a while. My siblings and I nished our meal in silence. * After dinner, my father left the house. While he was gone, my siblings and I watched television and did our homework. At a late hour, my mother picked up the phone and made a call. I could tell she was talking to the bartender down the street. She said my name and handed me the phone.

Come down here, my father said. There are a couple of guys who want to talk to you. I had to get partly dressed in order to go out sweat pants, shoes but no socks, a coat but no shirt. When I walked into the hotel bar, I saw the same two hunters Id seen earlier. My father introduced me by saying, This is my son. Soon to be my drunken son. You know, one of the hunters said, we didnt poach that deer. No, said the other. The deer jumped in front of the truck. If you want poachers, the rst said, go up the road. Those guys cut wood in the day and poach at night. Have a drink, my father said. I was too young to drink, so I had a soda. When I was nished, my father showed no sign of leaving the bar. I left by myself. * During the night, I woke to the sound of my fathers voice. I couldnt make out most of what he was saying. Among the sharp sounds, I heard, I cant make art with kids around. I go into my workroom, and soon enough I get interrupted. I have to stop what Im doing and entertain children. They learn from you, my mother said. My oldest kids a candy-ass. Hell never amount to anything. Id give him a dollar to be good, but hell be good for nothing. When he started talking about me, I tried to stop listening. * A couple of days later, my family and I watched a news report on television. The Mountain Man had been on the run. Wherever he went, he took the teenage girl with him. The two of them had climbed stony ridges and hiked through valleys. They

stayed a step ahead of the authorities. Finally, they were spotted as they passed a farmhouse. An F.B.I. agent was stationed there. A boy who lived on the farm and the agent both shot at the kidnapper. One of the bullets killed him it turned out to be from the agents gun. The teenage girl had a chain around her neck, but she was unharmed. After the report, my father said, The F.B.I. goes after a lot of people, but why did they have to shoot the Mountain Man? * The next day, my father took me and my siblings with him to a beer distributor. He pulled his car into the loading area, under a large sign that read Discount, and opened the car trunk. An attendant lifted two cases and put them down, and my father paid. Im set now, he said as he drove home. I dont need your company. I can drink on my own. * I went to my room to write some letters. The problem was, I didnt know who to write to. I had some relatives on the other side of the world my mothers family but I didnt have their addresses. Worse, I didnt know their language. I looked around and saw a coupon on a cereal box. I could write away for a prize, a plastic ring with a hidden compartment, but I had no money to pay for it. So I went to the post ofce empty-handed. As the postmistress checked for my familys mail, I looked around the room at the other offerings. There was penny candy for sale at the counter, two loaves of bread next to the candy, and cigarettes on a shelf out of reach. Next to the mail window, there was the sheaf of wanted posters. Some of the criminals were murderers, others were kidnappers. The Mountain Man hadnt been on the loose long enough to make it onto a poster. The faces meant nothing to me.

* At dinner, my mother served a new food. It was the reddest meat Id ever seen. It was so red, it didnt look cooked. Your father brought it home, my mother explained. Its from that deer that was hit by the truck, my father said. The hunters gave it to me. That deer is going to get two families through the winter. He left the room. When he returned, he was carrying a couple of bottles of beer. Im going into my workroom later, he said, Im silk-screening a book about politics. But right now, Im going to drink to the Mountain Man. * I walked up a dirt lane that led away from town. Shortly, I came to an abandoned house. Its walls were still standing, but its door and windows were missing. The remains of a chimney stood at one corner, and an old millstone lay on the ground. I thought I could live in the house. I wouldnt have heat, but I could build a re at the bottom of the chimney. I could survive on the food Id nd in the elds and woods. Id get lonely, but there was a girl in my class at school who might come with me. If she didnt, I would have to fasten her to the millstone, which looked quite heavy. I would become the Mountain Boy.

March 17, 2012: The Danish Doctor of Dread.

By GORDON MARINO The way we negotiate anxiety plays no small part in shaping our lives and character. And yet, historically speaking, the lovers of wisdom, the philosophers, have all but repressed thinking about that amorphous feeling that haunts many of us hour by hour, and day by day. The 19th-century philosopher-theologian Soren Kierkegaard stands as a striking exception to this rule. It was because of this virtuoso of the inner life that other members of the Socrates guild, such as Heidegger and Sartre, could begin to philosophize about angst. It is in our anxiety that we come to understand feelingly that we are free, that the possibilities are endless. Though he was a genius of the intellectual high wire, Kierkegaard was a philosopher who wrote from experience. And that experience included considerable acquaintance with the chronic, disquieting feeling that something not so good was about to happen. In one journal entry, he wrote, All existence makes me anxious, from the smallest y to the mysteries of the Incarnation; the whole thing is inexplicable, I most of all; to me all existence is infected, I most of all. My distress is enormous, boundless; no one knows it except God in heaven, and he will not console me. . . . Is there any doubt that were he alive today he would be supplied with a rellable prescription for Xanax? On virtually every third page of Kierkegaards authorship some note about angst is scrawled. But the adytum of Kierkegaards understanding of anxiety is located in his work The Concept of Anxiety a book at once so profound and byzantine that it seems to aim at evoking the very feeling it dissects. Perhaps more than any other philosopher, Kierkegaard reected on the question of how to communicate the truths that we live by that is the truths about ethics and religion. In the

process, he devised a method of indirect communication, which involved the use of pseudonyms. Writing in The Concept of Anxiety under the guise of Vigilius

Haufniensis (watchman of the harbor), Kierkegaard observes that anxiety is altogether different from fear and similar concepts that refer to something denite. He continues, Anxiety is a sympathetic antipathy and an antipathetic sympathy, a simultaneous feeling of attraction and repulsion. Kierkegaard explains: In observing children, one will discover this anxiety intimated more particularly as a seeking for the adventurous, the monstrous, and the enigmatic. Deeper into this text, it becomes plain that the ledge that we both want and do not want to look over runs along the abyss of our own possibilities. In some of his most immortal lines, the watchman of the inner world notes: Anxiety may be compared with dizziness. He whose eye happens to look down into the yawning abyss becomes dizzy. But what is the reason for this? It is just as much in his own eyes as in the abyss . . . Hence, anxiety is the dizziness of freedom. (The Concept of Anxiety) Many philosophers treat emotions as though they were merely an impediment to reason, but for Kierkegaard there is a cognitive component to angst. It is in our anxiety that we come to understand feelingly that we are free, that the possibilities are endless, we can do what we want jump off the cliff or, in my case, perhaps one day go into the class I teach and, like Melvilles Bartleby the Scrivener, say absolutely nothing. Inquiries about our inner lives and emotions are more complicated than conversing about things in the external world. We can triangulate on objects like rocks, examine them together with various senses and from different perspectives. Not so with the emotions. It could be that what Kierkegaard meant by anxiety is different from the experience we bomb with pills but I dont think so. Writing in different key, Kierkegaard registered this journal entry: Deep within every human being there still lives the anxiety over the possibility of being alone in the world, forgotten by God, overlooked among the millions and millions in this

enormous household. A person keeps this anxiety at a distance by looking at the many round about who are related to him as kin and friends, but the anxiety is still there. In something approaching a Freudian notion of defense mechanisms, Kierkegaard argues that we have ways of trying to deect and defang our anxieties. I might remind myself that there were many friends at the New Years Day brunch and that I have the love and support of my family, but assurances or no, I still harbor that deep anxiety about being all alone. In the age of Big Pharma, we have, of course come to medicalize such thoughts not to mention just about every other whim and pang. When I once conded with a physician friend that one of my children seemed to overheat with anxiety around tests, he smiled kindly and literally assured, No need to worry about that, we have a cure for anxiety today. On current reckoning, anxiety is a symptom, a problem, but Kierkegaard insists, Only a prosaic stupidity maintains that this (anxiety) is a disorganization. And again, if a speaker maintains that the great thing about him is that he has never been in anxiety, I will gladly provide him with my explanation: that is because he is very spiritless. Kierkegaard understood that anxiety can ignite all kinds of transgressions and maladaptive behaviors drinking, carousing, obsessions with work, you name it. We will do most anything to steady ourselves from the dizzying feeling that can take almost anything as its object. However, Kierkegaard also believed that, Whoever has learned to be anxious in the right way has learned the ultimate. In his Works of Love, Kierkegaard remarks that all talk about the spirit has to be metaphorical. Sometimes anxiety is cast as a teacher, and at others, a form of surgery. The prescription in The Concept of Anxiety and other texts is that if we can, as the Buddhists say, stay with the feeling of anxiety, it will spirit away our nite concerns and educate us as to who we really are, Then the assaults of anxiety, even though they be terrifying, will not be such that he ees from them. According to

Kierkegaards analysis, anxiety like nothing else brings home the lesson that I cannot look to others, to the crowd, when I want to measure my progress in becoming a full human being. But this, of course, is not the counsel you are likely to hear these days at the mental health clinic.

March 25, 2012: Finding Clues in the Fearful Brain.

By JOSEPH LEDOUX A few weeks ago I wrote in this series about the difference between fear and anxiety. In simple terms, I described fear as a response to an immediately present stimulus and anxiety as a worry or rumination about something that has yet to occur, or may never occur. These are normal, adaptive processes that have evolved in the brain because they help animals, including humans, survive and thrive. But as we know, fear and anxiety can also become harmful. They play a central role in anxiety disorders, which include phobias, panic, post-traumatic stress, generalized anxiety and obsessive-compulsive disorder. While the line between normal protective states and disorders can blur, most people agree on a basic guideline: When fear or anxiety begin to interfere with daily life, an anxiety disorder exists. Problems with fear and anxiety also are co-conditions in many other psychiatric disorders, like depression, schizophrenia and autism, as well as in most major medical problems. As many mental health professionals would tell you, the complicated and often elusive array of factors contributing to pathological fear and anxiety make these conditions challenging to diagnose and treat. Still, of all the various psychiatric disorders, fear and anxiety are probably the most tractable scientically because they are based on alterations normal brain functions that are beginning to be well understood. Indeed, scientists are making progress in understanding the brain mechanisms underlying both normal and pathological fear and anxiety, and these ndings are pointing the way to better treatments. We know a lot more about fear than anxiety because the former is simpler and easier to study and relate to brain mechanisms. Indeed, given that fear is a response to a stimulus, the task of nding out how the brain does fear is pretty straightforward. All you have to do is follow the stimulus through the brain from the sensory system

that receives it (say, the auditory or visual system) to the motor system that controls the expression of the fear response. This is easier said than done, but much has been learned, and the basic results derived from studies with rats have been shown to apply to humans. Fortunately, the brain mechanisms of fear and anxiety seem to overlap, so progress in understanding fear also helps understand anxiety as well. So, how does fear work? In a nutshell, the representation of the fear-arousing stimulus say, the sight of a snake or a mugger travels from the sensory system to a brain region called the amygdala. There, the threat symbolized by the stimulus is detected, and responses that will help protect the rat or person from the threat are initiated by outputs of the amygdala to motor neurons, which control behavioral responses and other changes in body physiology. Much of what we know about fear in the brain has come from studies that utilize Pavlovian conditioning. When a stimulus, like an auditory tone, occurs at the same time as a painful or otherwise aversive event, the tone comes to be associated with the pain and thereby acquires the capacity to trigger a protective fear (defense) response on its own. The association is formed in a small and very specic part of the amygdala by neurons there that receive sensory information simultaneously about the tone and the pain. This neural meshing triggers chemical processes in the amygdala cells that allow the tone to later activate the cells and trigger the defense responses singlehandedly. Techniques for studying the human brain cannot reveal brain mechanisms with the same degree of precision possible in animal studies. For example, brain imaging techniques can tell you that the amygdala responds to tones or visual stimuli that have been paired with pain, but cannot reveal the exact areas or mechanisms involved. Still, such results reveal that at least to a rst approximation the same basic mechanisms are at play when a human or a rat responds to a tone that has been associated with pain.

Why should we care about a tone paired with a painful stimulus in a rat or a human? People seldom are afraid of stimuli as simple as a tone. The important point is that the way the human brain detects and responds to threatening stimuli is similar regardless of whether the stimulus is a pure tone or an angry, aggressive person. And the responses that occur are similar in rats and people as well, regardless of the exact nature of the stimulus muscles tense, blood pressure and heart rate rise, stress hormones are released. What about pathological fear? Patients with anxiety disorders like phobias, panic and post-traumatic stress tend to have heightened amygdala activity in the absence of threats and sometimes further elevations when threats relevant to their disorder are presented. For example, arachnophobics are very attentive and responsive to spider-related stimuli pictures of spiders, words or sentences related to spiders but not to stimuli related to snakes; snake phobics have the opposite tendencies. Given that pathological fear seems to involve elevated amygdala activity, an important issue is whether that activity normalizes after successful therapy. While such studies are just beginning, data so far supports this conclusion. Rat research has also helped in the development of new therapies for problems related to fear and anxiety. For example, a standard treatment for phobic disorder is exposure therapy. In this treatment, the patient is exposed to the phobic stimulus repeatedly in a safe context. Over several sessions, the fear elicited by the stimulus weakens, and the patient can live fear free, or at least with less fear. However, it is well established that life stress can reactivate phobic fears that were successfully treated. As a result, treatments with more persistent effects are being sought. Researchers found that exposure therapy in rats (also called extinction learning) was more resistant to recovery if it was combined with a drug called d-cycloserine. It appears that the drug achieves this effect by making extinction learning stronger, and thus less susceptible to relapse in the presence of stress. When tested in humans, the same result was found more persistent therapeutic effects.

Another important nding is that the effectiveness of extinction in learning to diminish fear can be improved by carefully spacing the timing of the stimulus exposures. This seems to work by optimizing the timing of chemical processes in amygdala cells in relation to the stimulus presentations. If the presentations are too frequent the processes are unable to achieve their maximal effect. Studies of patients with fear disorders are underway. Research on rats also suggests that learned fear can be reduced by dampening the memory on which fear is based. This approach takes advantage of the fact that memories become unstable when they are recalled, and unless the memory is stored afresh it is either eliminated or made inaccessible. Rats that are made to fear a sound associated with pain stop responding fearfully to the sound if the re-storage is blocked with a drug. Similar results have been found in some studies of healthy people. Particularly important is the fact that the participants remembered the experience cognitively (they remember being conditioned with the sound and pain), but the sound no longer elicits the learned fear response. This approach offers the hope that the emotional impact of traumatic memories might be dampened in this way. However, the jury is still out as to whether emotional memories of complex life experiences can be manipulated in this way in patients suffering from traumatic stress. Folk wisdom tells us to take a deep breath when feeling anxious. It turns out that this is scientically sound advice. When the amygdala detects danger, not only do behavioral defense responses occur but also changes in body organs that provide physiological support for the energy about to be expended in defending yourself. These physiological changes produce sensations that you perceive as a key part of feeling anxious and stressed. Taking a deep breath (or several) jump-starts the body system that normally allows the body to recover from a fear arousing or anxious event. Controlled breathing, when done properly, relieves anxious symptoms without medication. The latter point is especially important. Learning simple tricks to

self-regulate our emotions can be quite effective. These should probably be taught to children at an early age before they develop fear or anxiety disorders since bouts of fear or anxiety can sensitize one to further problems. Science does not and may not ever have all the answers to questions about what fear is, how it works, how it relates to anxiety, how pathological fear and anxiety emerge from the normal processes and how the pathological states might be treated. But that shouldnt stop mental health professionals and patients alike from putting to use what we know while scientists continue trying to meet the challenges of guring out what we dont.

March 31, 2012: Panic in Paradise.

By KARA BASKIN When friends ask about my Maui honeymoon, I tell them that Brian and I didnt leave our hotel. Wink, wink. You must have had a really great time! everybody chuckles. I want them to imagine that we enjoyed a tantric Hawaiian escapade, frolicking like soap stars in 600-thread-count sheets. I actually spent my vacation in sweat pants, eating room-service burritos from a Styrofoam tray while propped on pillows, stufng myself like some deranged queen, watching The Golden Girls reruns while my husband paced from my bedside to the balcony that overlooked a golf course. Every morning, hed unlock the hotel-room safe, look at our plane tickets and wander outside. I am going backward. I am almost underground, and I am almost un-alive. We can leave right now if you want to, hed say, golf course in the distance. We could get a refund. The trip was the pinnacle of years of panic attacks Id fended off with anti-anxiety drugs that never quite seemed to click. In Hawaii, they climaxed in agoraphobia, a common offshoot of panic. Since panic can happen anytime and anywhere, the urge for shelter and familiarity is natural. Sadly, I was far from home, and my sense of familiarity came from Bea Arthur. Panic attacks are little deaths. A panic attack is not getting worked up about a meeting or antsy before a blind date. A panic attack offers the kind of slow-motion inevitability that I imagine a heart attack might, or drowning. Your heart pounds, your chest tightens, you sweat and gasp as dread sets in. Its like looking at the world from inside an aquarium: Everyone is moving so languidly, so infuriatingly unaware while youre rattling around inside yourself on speed wondering where your next breath might come from, or if it will come at all. Maybe the Maui incident shouldnt

have been a surprise. Just before our wedding, commuting home on the Washington Metro, I suffered my worst attack to date. I became absolutely convinced somewhere beneath the Potomac that the tunnel was closing in on us. I frantically ed the train several stops early and agged a cab. And in a twist of spectacularly bad timing, my future in-laws visited that night. We went to a Mexican restaurant. Our table was set above the rest of the dining room from there I could see every exit. I spent the rst half of dinner plotting escape routes. Halfway through the meal, my heart uttered. Then it uttered again. Then I had a kind of out-of-body sensation, the notion of hovering above my cactusleaf margarita. Someone was ordering another drink. Didnt they know what was happening to me? I nudged Brians elbow. I need to get out of here, I hissed. He was mid-chew and looked so deliciously unfazed. What? he whispered back. Theres something wrong with me, I hissed again. I need to go to a hospital. Brian dutifully abandoned his family and sped me to Alexandria Hospital, where a ruddy doctor who smelled like gin administered an echocardiogram. Theres nothing wrong with you, he told me. Probably nervous about your wedding. Go home and go to bed. But there was something wrong with me. My heart wasnt working. My lungs werent working. I returned home, tiptoed past my sleeping in-laws camped out on the living room oor, and lay in bed until sunrise, feeling alone and unheard. I made it through my wedding without incident; adrenaline and the risk of appearing insane in front of 120 guests does wonderful things for the psyche. Boarding a plane bound for Hawaii in a fragile state does not. Midway down the aisle, I stopped, causing a velour-clad honeymooner to crash into my back. Brian turned around. Whats wrong? he asked. I dont think I can do this, I said. I turned to look at the line of happy brides ready to sit down, some with their hair still in up-dos. It was easier to just keep walking.

I truly dissolved at the Maui Hyatt. At dinner, I shivered in the hot breeze, convinced that there was poison in my sushi. I returned to the hotel and rifed through our welcome packet, ipping to the Emergency Services section to conrm there was a resort doctor on duty. I mapped routes to hospitals. I left our room approximately ve times. Our longest outing was a luau, which I endured by guzzling four cocktails in an hour. Poor Brian. He spent most of the trip bringing me food and ipping the remote. Back home in Washington, logic and emotion, which often work at cross purposes, dictated the same solution: I needed to hide. Logically, I was terried of having another panic attack in a public place. If I could have a panic attack someplace as peaceful as a Hawaiian island, whos to say I wouldnt lose control in the supermarket? Or at work? What would I do, pass out in the cereal aisle? Collapse in my ofce? My emotions were more plaintive: Who would rescue me? So I triangulated my world: bathroom to bedroom to couch. There I could hide, and there I could sleep. Inside my little apartment, suitcases barely unpacked, I could just about cease to exist. I called in sick, and I called in sick again. Agoraphobia infantilized me, reduced me to sleep and soft food. My couch and bed were wombs. I lay in the fetal position, battered and terried, under several blankets even though Washington in September is unspeakably humid. I ate baby foods yogurts, purees while Brian scrounged up a few more vacation days to care for me. Even going to the bathroom was an expedition. We had a garden apartment, and the bathroom window was at ground level. I remember standing at the sink, looking out the window, eye level with the grass. I thought: I am a baby; I am going backward. I am almost underground, and I am almost un-alive. Brian and I visited a psychiatrist together. He was a European with wild hair, famous in forensics. At this point, I resembled the late-stage Amy Winehouse. My bones, my clothes, my hair everything hung limp. I slumped in a chair and picked

at my manicure. You must take these! he yelped, gesticulating wildly. Zoloft! For your anxiety. You are an animal in the woods. A frightened, terried animal! It was the rst time that anyone had acknowledged my primal sensations of terror. And Valium! To relax. To sleep! You need to sleep! Otherwise we will hospitalize you! At this point, I hadnt slept more than a couple of hours at a time for three weeks, and my biorhythms were dictated by Nick at Nites programming schedule. I was reluctant to take the medicine, of course. Thats the cruel irony: When youre at psychological odds, the last person you can rationalize with is yourself. I was scared to feel different; I was scared to feel anything at all. Id irted with other antidepressants in the past, off and on in college, and at worst they made me feel dead inside and at best they made me gain so much weight that I resembled a yardsale sofa. Brian, whom I met when I was 20, had seen me through it all, diligently playing the role of the tolerant, even-keeled boyfriend who did his best to understand. And so I felt I owed it to him to try again. Maybe the Zoloft would actually work. I thanked the doctor and returned to my garden hovel; Brian scurried to ll the prescriptions. I choked down that rst Valium like an obedient child, and I slept. Everyone at work was very nice about my time off. (This is a benet of working in magazines: People are very tolerant of neuroses.) Brian returned to work after Columbus Day weekend. He drove me to New England so I could stay with my parents, in my childhood bedroom, so I didnt have to be alone. I was afraid that my mother would force me to break free of myself and do things. Brian treated me gingerly. To him I was still a mystery, a new wife. I was not a mystery to my mother. She might want me to accompany her on errands, ostensibly for my own good. She had a cardiologist appointment in Boston, and I rode with her. Youll feel better if you get some air, she said. I hadnt been in a car in weeks, except to visit the psychiatrist. I fell asleep on the ride, at noon on a sunny Tuesday. Everyone at work was probably walking to lunch

while I was driving through my hometown with my mother, half asleep. Pathetic. We got home, and I just wanted to lie down and die. When I was little, I got stomach pains sometimes. Id stretch out on my belly across the dining room oor, and my mother would step on my back to press them out. I walked to the dining room. I lay on my stomach, and I began to sob into the carpet. I wanted my mother to push me back down into the ground so that it could swallow me up and make the pain go away. She came up the basement stairs from the garage. Whats wrong? I dont know, I cried. I just dont know. Please make this feeling end. I began shrieking now, howling like an animal shot in the woods with no beginning and no end, no home. She called my father at work. I think you should come home, she said. Karas on the oor crying. When my father did get home that night, we watched Jeopardy in the den. Id go home the next morning back to my hidey-hole in Washington. I lay on their couch for hours, while my father sat reading in his leather recliner. I dreaded the moment when he would click off the lamp, put on his slippers, and go upstairs. It would mean that morning was closer. I pressed myself into the cushions and listened for his breath, and fell asleep. My parents drove me to a rest stop in Connecticut, where Brian met us. Weeks earlier, my father had given me away at my wedding. Now here he was, handing me over to Brian again, a grim greasy girl holding US Weekly instead of a bouquet, someone elses problem now. Brian bundled me off and drove me home. I set myself little tasks, like a bored housewife. Every morning, after apportioning my pills, I would walk outside for two minutes. Breathe deeply. Touch the grass. The next day, Id walk to the corner. Id head back when my breath turned shallow it reminded me of the old days and promise myself that tomorrow, Id round the bend. A week or so in, I made it to the end of the street.

Then, about a week later, my medication took hold. It was sudden and intense. I awoke seized with energy, like Id snorted cocaine off the coffee table. I grabbed a rake, hustled outside, and began sweeping leaves from our patio like a madwoman. It was imperative to me that this patio, still coated in margarita splotches from a summer cookout, look spotless. I spent hours out there sweeping, sweeping again, breathing, moving, moving some more, making my heart beat, then beat harder, pushing the dead leaves aside until the patio gleamed, willing myself to the real world because I didnt want to go back inside.

Part IV

APRIL
9 April 09, 2012: Tattoos for the Terried.

By FRANK LESSER If youre worried that youre not cool because you dont have a tattoo, and also worried about everything else, here are some stress-free suggestions for getting inked (after youve researched the ink to make sure it isnt carcinogenic). ~~~ A heart with Mom written inside, beneath the words In case of emergency, contact. A cocoon. Why would a buttery ever want to leave the security of home? A Harley Davidson motorcycle helmet. The name of the person youre dating, and also the names of ve other people. (What if youre making a huge mistake?) Wings on shoulder blades, captioned Not actually a bird in case a hunter sees it. A chubby toddler. It would have been an angel, but heaven is merely a construct to distract us from the inevitability of death. Tub of Ben and Jerrys Chubby Hubby. To calm you down when you start thinking about whether heaven is merely a construct to distract us from the inevitability of death. Teardrop tattoo. It will distract everyone from your nervous crying (see above). Plus people might think you killed a guy in prison so they wont mess with you by making eye contact.

 A mole thats irregularly shaped. At least you know this ones benign. Tattoo of someone elses face over your own. Hopefully this other person will be better prepared for lifes disappointments. A Memento-style tattoo with a list of all the prescription medication youre taking and their side effects. Another Memento-style tattoo reminding you not to watch Memento. That movie is so intense! A portrait of Marilyn Monroe, back when she was Norma Jean and faced less pressure. Stars, but only two and a half of them. You also have self-esteem issues. A mermaid wearing a life preserver. Shes not taking any chances. Anchor. Not a tattoo, an actual anchor. You never know when a tidal wave might sweep you out to sea. Thats probably what happened to that mermaid. The Chinese character for Regret.

10

April 16, 2012: In the Arcadian Woods.

By GEORGE MAKARI Often I sense its electric energy during the initial phone call. Anxiety is like that. It leaps from you to me then back again like some unruly spirit. But that faint buzz reveals surprisingly little else about the being on the other end of the line. Who is not at times worried, nervous, troubled, frantic or even panicked? Anxiety may be an omen of vast import, or not much at all. Like the robot in the television series Lost in Space who proclaims Danger, Will Robinson, this primal alarm sends out its warning, but of what? As a psychiatrist, it is part of my job to nd out. After scheduling an appointment, my prospective patient has something new to worry about: me. For years, the press has been lled with stories of doctors who whip out their prescription pads after but a few minutes, or conversely, psychotherapists who turn up their noses at any quick x that doesnt plumb the deepest meanings of dread. Am I one of those caregivers who consider anxiety to be one thing only, always requiring my favorite remedy, be it based on neurotransmitters, attachment theory, or exposure and response prevention? If so, my caller should be afraid. For the possible causes and meanings of anxiety are so varied that any one predetermined answer is sure to be often wrong. Consider the many histories stuffed inside this little word. In pre-modern, Western Christendom, the Latin anxietas signied unease that often took its shape within a framework of sin, redemption and eternal judgment. Many who paced about with darkened brows had a ery future ashing before them. Treatment for those anxious ones was available from physicians of the soul, Catholic priests who offered confession, among other consolations. The Reformation tore at this fabric and emphasized a Protestants private communion with the Lord. Thus, individuals were left to manage their own bad consciences. Even those endowed with an iron will like Oliver

Cromwell nearly collapsed from the gnawing, unshakeable terror that they might forever burn. Kierkegaard and then the existentialists would riff on this theme of a dread that attends individual freedom and responsibility. Modern medical descriptions of anxiety developed in the 17th century. The Anglican divine, Robert Burton, in his 1621 compendium The Anatomy of Melancholia, worried about the burdens of the soul, but he mostly concentrated on describing natural varieties of alarm and unhappiness. He observed that those sick with anxiety simmered for long periods, then suddenly the foul end of fear caused them to turn red, pale, tremble, sweat, it makes sudden cold and heat come over the body, palpitation of the heart, syncope, etc. Thus, a man or woman could become astonished and amazed with fright. For Burton, these signs betrayed the presence of another disorder. His view transposed nearly four centuries in time still may hold: guilty ruminations and panic attacks can be symptoms of an underlying depression. After 1800, anxious experiences began to be considered in and of themselves. And now our grisly parade truly commences. A series of descriptive medical terms emerged within different cultures. The French wrote of angoisse, a species of tortured misery that bordered on anguish. Germans adopted the term Angst, which referred to a terrible foreboding, a grave fear of some future event. The Spanish spoke of a freaked-out breathlessness they called Angustia. And in 1879, a British doctor distinguished worry from panic, a term derived from the story of the Arcadian god Pan, who was said to make noises in the woodlands that inspired unbridled terror. This menacing menagerie may be of little interest to my patient, who will urgently desire some understanding of why he or she suffers. In 1866, the Frenchman Bndict-Augustin Morel suggested severe anxiety was due to a dysfunction in the autonomic nervous system; others followed his lead and set out to examine problems in the brain, heart and lungs. From this perspective, Will Robinsons robot was on the blink, and sometimes that is surely so. A few decades later, Sigmund Freud, who rst considered anxiety purely physio-

logical, revised himself and put forward the theory of signal anxiety, in which small doses of anticipatory discomfort generated a cascade of self-protective responses. Later psychoanalysts like John Bowlby pursued odd or unceasing distress that emerged from experiences like abandonment or trauma. For these doctors, a troubled mind had grown quick, too quick, to misread benign stimuli as threats. Rather than being something to simply pacify, that worry became a thread that led back to psychic burdens, long accommodated but, in a inch or a startled reaction, not fully forgotten. As I step into my waiting room, I prepare to grapple with these knotty issues and more. Anxiety disorders are now associated with complex epigenetic models, the transgenerational transmission of trauma, a neuroscience for fear conditioning, and even a pediatric infectious illness that triggers auto-immune mechanisms and results in obsessive compulsive disorder. To be open to all of this, I must be willing to enter a realm where most dare not tread. For anxious troubles are quintessential mind-body phenomena. They implicate a possible symphonic interaction of DNA, hormones, neurons, anticipatory fantasies, memories and thoughts, as well as the constraints and opportunities of our culture. And so, in the end, there may be no one answer for my expectant patient, for not surprisingly, our diagnostic system can not accommodate such complexity. Instead, present medical classications offer up a smorgasbord of disorders variously dened by the quality of nervousness, the object of terror, or its source. It is a broad, messy, forgiving schema, in which a number of anxious states remain difcult to cram inside only one box. Given our state of knowledge, thats as it should be. In my experience, these generalities provide important guidance, but often, critical particularities must be discovered with each individual. And so, I start by assuming only this. A signal of danger has arrived in consciousness. This ominous messenger, as in some Samuel Beckett play, takes the stage and says nothing. Who is he, what does he want? It is the stuff of epics, mysteries and horror stories, for the news may alter lives irrevocably, or it may

signify nothing more than a branch snapping in the Arcadian woods.

11

April 23, 2012: Prelude to a Kiss.

By ALISSA NUTTING The house I grew up in was ordinary in most ways a small stucco two-story in suburban Florida at the end of a block lined with more of the same. One thing did set it apart, though: it was outtted with an advanced security system of 57 crucixes. The crosses were strategically hung throughout the house: the moment you left the gaze-range of one Christ, you walked straight into the radar of another. There were no blind spots, not even in the bathroom. I understood and even admired their ubiquity. There was no place in the house where I could hide from scrutiny. It was checkmate. At times I felt a sympathy for the keepers of this vigil. I often looked at the carved, pained expression of one of the living room Christs when my father stalled the television remote on something particularly dull episodes of that PBS do-it-yourself remodeling program come to mind and thought, Havent you been through enough? In the presence of the bathroom Christs, though, I avoided eye contact. Still, it happened from time to time. Id give a pained smile as I sat down, cringing as the porcelain echo broke the silence, then quickly ush and wash my hands. Thanks for listening, Id say apologetically by which I meant, Im sure you have better things to do than preside over the excretion of my liquid waste. It was through this pre-Keanu matrix I had to pass in order to arrive at my rst date. ~~~ I was 15 years old and knew very well the sexual developmental markers my peers were hitting and rapidly passing. If I didnt kiss a boy soon, Id be abandoned, exiled to roam the dry wastelands outside the dome-city of Adolescent Pheromones where

the unforgiving sky rained S.A.T. vocabulary ash cards and lunches were eaten alone in the girls bathroom handicapped stall. Since the Catholic devotion of my parents fell somewhere between that of Mary Tudor and John Paul II, unsupervised dating prior to marriage was discouraged. I had therefore asked my father to drop me off at a friends house; just before leaving home I would call my date with instructions to rendezvous at the departure point in 20 minutes. I would walk around the house and enter her backyard, wait until my father drove away, then wait for my date to arrive. And how did I adorn myself for this personal scavenger hunt for French kissing? I wore a turtleneck, of course, because nothing says open for business like concealing both your wrists and upper chin. This was not kin to the tight-tting turtlenecks of ski lodge playmates but rather a sacklike bag that couldve successfully hidden any number of surprises, ranging from an additional limb to a third-trimester pregnancy to a Remington Long Rie. I suppose I hoped it would, in some odd Victorian sense, heighten my dates interest. Perhaps hed be so curious as to what was hidden beneath the muumuu cut of its hemline that hed feel me up for his own peace of mind. His intentions didnt matter, after all. Only the physical outcomes did. My attire had another benet. When my father nally dropped me off at my friends house neither he nor the omnipotent belly-buttons of the Christ-cams had seen anything that might indicate foul play. And so I waited behind the fence, vigilantly peeking between its boards with a nervous eye. At one point I nearly fainted as heavy footsteps approached I was sure her parents had come home early. Then a pair of blue Postal Service shorts and black knee-high compression stockings came into view. Only the mailman. Soon my dates well-used car pulled up. I realized Id been so nervous about getting to the date that I hadnt yet worried about the date itself. He spoke rst: Did I want to go to a movie? I nodded too quickly and he began to drive. He was a friend of a friend, as all outliers are. And he was older the fact that

hed offered no particular age likely placed him upward of legal drinking age. I didnt know much about him, but the few stats I had were not rosy. He was in town to stay with relatives for a while (hiding from the law?) His graduation status was dubious. In his one month stay he had already been red from a job at McDonalds for allegedly taking $20 from the register (he maintained his innocence but did not attempt to get the job back). Then there was the most damning fact of all: he was willing to take me out on a date. My stomach turned as I took in the details around me. Is my driving scaring you? he asked. I looked into the side mirror. My bulging eyes appeared to be oating several centimeters ahead of the rest of my face and my mouth had opened to a degree normally reserved for the facilitation of wisdom tooth surgery. Everythings ne, I said. It was an attempt at self-hypnosis. I repeated this statement a few times as we pulled into the theater. I have absolutely no recall of what movie we went to see. I was too busy trying not to vomit and fantasizing about all that could go wrong. Would we crash on the way home? Had my parents already somehow found out where I was? Would all the Christs descend down from their crucixes in the middle of the night, form a Lilliputian army, and tie me to my bed to await punishment when the sun rose? At one point during the movie, my dates hand moved from my shoulder to my side. Id never had a boys hand on the side of my body. Millions of confused neurotransmitters started to riot, breaking furniture and punching walls. I began to shake, not demurely, but rather seizing up like an antiquated washing machine connected to a diesel engine and lled with several yards of industrial-grade carpet. I kept telling myself that perhaps he wouldnt notice my convulsions. Are you cold? he asked. I shook my head no. But youre shaking. Oh? I stuttered casually.

I like to think that I ceased rattling before the credits rolled, but I cant be sure. Did you like it? he asked me on the way out. Everythings ne, I responded. We went to Wendys, and even at 15, the parallel meaning of the assembly-line consumerism of the place was not lost on me. I was there in that moment because I wanted to have had my tongue inside the mouth of someone else, because all my friends had already done this long ago, because we all needed to be the same and we needed it right now. The guy didnt matter, the circumstances didnt matter; I didnt (or rather, couldnt) demand anything to be special. My peers were lifting off all around me, passengers on shining aircraft of sexual discovery. Id been granted no such ticket. But I could make out with this guy tonight in his used car. I had him drop me off several blocks from my parents house. He stopped the car and turned to me. Suddenly it was all in reach, his mouth the ag I needed to capture. I didnt know when or if Id get a second chance, so I didnt want to risk anything to subtlety. I had to be sure that it counted. I stuck my tongue inside his mouth and violently moved it around as fast as I could: two angry, epileptic eels in a collision to the death. I kept my eyes wide open the whole time. As soon as it was over, I ed the vehicle. Dusk had fallen. ~~~ When I entered the door at home, I felt the heat of the crucixes stares. It was dark but I could sense the location of each onethey hung on the wall like strung lanterns, each connected to the next through a telepathic wire of all-knowing. I turned the light switch on and tried to act normal, but I knew what they knew. My tongue felt infected and swollen, too-hot to the touch. I went to the bathroom and brushed it with the rough disdain of a zookeeper scrubbing a cage. I had to do it, I said to the crucixes; I didnt like it any more than you did. And to myself, I said, but for different reasons. Then I dimmed the lights, watched the shadows lengthen

across their painted eyes like closing lids, and put the Christs to sleep. A few nights later he called me at home, when my parents were already asleep; luckily I caught it on the rst ring. This time he showed his age; he wanted to come pick me up. It was 11 p.m. on a school night. I cant go out this late, I explained. Sneak out, he pressed. But I was rm. I only sneak out in broad daylight amidst a nest of supporting details and a cover story, I reported. It was the last time we spoke.

12

April 30, 2012: Up in Smoke.

By DAVID KRAMER I am an artist. Believe it or not, it is a pretty anxiety-provoking career. After 20 years of juggling my art-making with my money-making Ive nally started to make money from my art. Still, it is a dicey way to make a living. Recently I got a call from my French art dealer. He asked me to go to France to do some work. As soon as I got off the phone with my dealer I sent a text to my wife: I am going to Paris. My wife is great. She is a cracker-jack lawyer in a public defenders ofce in Brooklyn. We have been together for 19 years and she has always been right there with me through lots of ups and downs. I found it very interesting that I didnt get a response to the text for almost four hours, though I admit it wasnt a surprise. My wife would often tell me to go out and start smoking again, as she couldnt bear to watch me fall to pieces. These trips to France are always a tricky business. Over the past three years my career seems to be really happening over there a lot of shows and visits. Still I am never comfortable there. I cant speak French. Ive lived in Manhattan for almost all of my life. When you go to Paris, you realize right away that you are not in Kansas anymore. The French have a lot of rules. I dont know half of them. I conded in my French dealer and explained that I was desperately trying to learn the language and the norms, but he told me, Dont bother. You will just ruin everything. When I have a show in Europe my anxiety level goes through the roof. I spend weeks preparing work in my studio in Brooklyn, then get involved in all of the logistics of getting them overseas, crating up elaborate projects into boxes and hoping everything makes over there in one piece. I am usually invited to go along and will often spend a week or two in a city where I dont speak the lan-

guage, working non-stop, all the while drinking and smoking at fever pitch to keep the energy level going. When I return home I usually nd myself looking to clean up a bit. It is during these times that I get to the gym and stop smoking and seem to keep my anxiety at a steady, low-level purr. ~~~ I have always used substances to cope with my anxiety. At different moments in my life, I have become completely lost in food, drugs, alcohol or cigarettes. Sometimes it seemed that survival would have been impossible without them. But after ve years in therapy I can now admit that I probably would have been ne without the substances. What really makes my anxiety go away is time and distance. But heres the thing: part of me doesnt want it to go away. I actually thrive on and revel in the heart pounding and discomfort, and I enjoy it even more when I am dumping booze or cigarettes on the re that is burning in my heart and brain. Of all the vices I have overindulged in, smoking is the only one I will admit has an addictive spell over me. Only cigarettes or the lack of them have changed my personality and taken my body and mind out of my own control. When I was younger and tried to quit, I had horrible physical responses to the nicotine deprivation. Tunnel vision, anxiety attacks, general numbness would take over my body. My wife would often tell me to go out and start smoking again, as she couldnt bear to watch me fall to pieces. Since then, quitting has been a constant project with me. I quit all the time. But often, when I am overwhelmed with work, I nd it almost impossible to not light up. I know, I know. . . Its an excuse. But when I am lled with anxiety I simply nd it so much easier to feed the beast. Trying not to smoke takes way too much effort. ~~~

I made it to France and back. But socializing with dealers, gallery owners, collectors and other artists is a big part of the job. I am often surrounded by drinks and drugs and cigarettes, and often indulge to move things along. Not the healthiest of lifestyles, I admit, but as far as my mental health goes, it is during these business trips that I am at my best. When I returned I went to see my doctor for an annual visit. He was surprised and upset to nd that Id gone back to smoking. I told him that my problem is that I love to smoke and I know it is terrible for me, but whenever I nd myself in the throes of a project quitting or staying quit seems to go right out the window. As things have gone better and better for me in my career, the anxiety levels ratchet up faster and more often. It comes in waves: I become very introverted and detached. I have trouble dealing with people around me. I become controlling and passive at the same moment, stressing about minor details while often losing sight of the situation at hand. My heart races and everything seems to move super fast. I also become funny. I jab out of my shell using humor and jokes and non-sequiturs. Like a pressure valve letting off steam. When I am drinking or smoking, the edge seems to come off. I can be more present. The jokes roll out easier and help establish a tone. I can be much less worried about controlling things and enjoy the moment with some uidity. But of course my doctor was concerned about my smoking and wanted to help. He told me about an antidepressant (Bupropion) that had an interesting side effect: it seemed to make cigarettes totally unpalatable. I had never taken antidepressants before. Even with all of the anxiety and stress I have in my life, depression has never been an issue. Whenever I do get into a downward cycle, I tend to work myself out of it very quickly. I like to joke that the reason I dont get mired in depression is because I have such a short attention span. The doctor told me that the pills would make me not want to smoke, but there were side effects. On the one hand I might nd myself feeling a certain spark in my

life, an increase in energy and vitality. The antidepressant would be basically doing its stuff, same as it would for a depressed person. But there were possible side effects, like the remote chance that the drug would make me a bit suicidal. Well, since I tend to be an overwhelmingly undepressed person, I decided to take the drugs. Hopefully Id quit smoking, and get that lift. I was really excited about this x-all. I was nally going to kick my smoking habit once and for all. So I started to take the anti-depressant. My doctor told me it would take some time to ramp up in my body and that I should begin to take the pills, slowly getting up to three or so a day, while establishing a quit date for about seven days away. I was feeling pretty great and for the rst few days. I was in heaven, really. Taking what seemed to me were essentially uppers and smoking away all the while thinking I was doing something really good for my body and overall physical health. My quit day was still a couple of days away. About the fourth or fth day it all began to change. I lit up a cigarette and it had to be the most revolting feeling and taste that I had ever felt in my life. My whole body cringed. I felt like I had sewer water running through my veins. I tried again later with another cigarette and it was the same all over again. I was suddenly turned off to cigarettes, completely. I was happy about this, disgusted by cigarettes and moving on, although I have to admit that I did feel a little ripped off having given up the smokes a day and a half prior to my quit date. I didnt get the chance to say goodbye. Not long after, though, something else changed. Biking home from work across the Williamsburg Bridge or riding the subway Id start to have these horrible thoughts about what would happen if I threw myself in front of a train or down into the river. In the studio I was using power tools and thinking about cutting my hand off. It was really freaking me out. My mind was spinning out these very full, detailed and dark narratives, which I was simultaneously watching happen from another, walled off

perch in my brain. One day I was coming home from work and my wife was out on Long Island and I sent her a text message saying that I wanted to kill myself. This time she responded right away. I had experienced plenty of stress and anxiety in my life, but I had never been down in such a deep and dark place. She called the next minute and directed me to see my doctor, who I found in his ofce that afternoon. He told me to stop taking the drugs immediately. It would take a week or so to get the residue out of my system. The experiment was over. For the next ve days or so I continued to feel much the same. A dark cloud hung over my head. The drug had not only made me feel horribly suicidal, but also had completely taken away my sense of humor. I was walking around in a deep funk and feeling very little relief. On the morning of the sixth day, though, I woke up feeling fantastic. I was back. My joy and spark had returned. Everything seemed to be getting back to normal. I went to my studio and started to work my way out of the terrible stuff that I had been making over the past couple of weeks of the experiment. I found an old pack of cigarettes lying around and I decided to have one to see if it would be as disgusting as the last. It was not. The cigarette tasted just as good as all the others Id had before taking the drugs. I laughed out loud to myself and thought, No wonder I wanted to kill myself. I wasnt smoking! I had my sense of humor back. All was right again with the world. I could live with my anxiety, as long as I had my vices to help me through.

Part V

MAY
13 May 07, 2012: Cycle of Fear.

By TIM KREIDER Like many people, I like to set aside a few hours every day, generally between 3 and 6 a.m., to lie quietly thinking about everything that could go horribly wrong with my life and all the ways in which I am negligent and reprehensible. I have spasms of panic over things I shouldnt have written, or, worse, things I should have; I regret having spent all the money and wonder where more money might ever conceivably come from; I wish Id kissed girls I didnt, as long ago as 1985. Im suddenly convulsed with remorse over mean things I did in middle school (I am sorry, Matthew Reeve); I force myself to choose my least favorite death (drowning). I suspect that if I am killed while biking, the state of mind in which I am likeliest to die is extreme annoyance. Its worth noting that the order in which these items preoccupy me is more or less the inverse of the order in which I ought to be worrying about them. I tend to obsess over the least pressing problems, the ones over which I have the least control. Some people have suggested that I should stop worrying about things I cannot control. These people are no doubt hardheaded, competent C.E.O.s of the Fortune 500 of La-La Land. Of course its the things I cant control that I worry about. Worry is not productive; its a kind of procrastination. I like to pretend worry is passive, something your brain does when its trapped and helpless, but its more often a way to avoid taking some direct action that would be frightening, difcult, inconvenient or boring, like drawing up a monthly budget or doing sit-ups or nally just summoning

up the nerve to ask someone What, exactly, The Deal Is. Worrying can turn into one of those problems that prevents itself from getting solved, the way that pornography can if youd rather stay home watching it than go out and meet somebody. Natural selection has made us hypervigilant, obsessively replaying our mistakes and imagining worst-case scenarios. And the fact that weve eliminated almost all of the immediate threats from our environment, like leopards and Hittites, has only made us even more jittery, because were now constantly anticipating disasters that are never going to happen: the prowler/rapist/serial killer lurking in the closet, a pandemic of Ebola/Bird Flu/Hantavirus, the imminent fascist/socialist/zombie takeover. The disasters that do befall us are mostly slow, incremental ones that seem abstract and faraway until they suddenly blindside us, like heart disease and foreclosure. So we go about our days safer and more comfortable than human beings have been in ve million years, constantly hunched and growling with a low level of ght-or-ight chemicals in our bloodstreams. My doctor assures me that this is the cause of most of our chronic back and neck problems; my dentist says nocturnal tooth-grinding became so endemic in New York after 9/11 it actually changed the shapes of peoples faces by enlarging their masseter muscles. He sells a lot of night guards. Which is why its such a relief, an exhilarating joy, to break the clammy paralysis of worry and place yourself at last in real physical danger. Even though its the time when I am at most immediate risk, riding my bike in Manhattan trafc is also one of the only times when I am never anxious or afraid not even when a cab door swings open right in front of me, some bluetoothed doofus strides into my path, or a dump trucks fender drifts within an inch of my leg. At those moments fear is a low neurological priority that would only interfere with my reaction time, like a panicky manager shoved aside by competent, grim-faced engineers in a crisis. I doubt that the victims of sudden violent accidents die terried; theyre probably extremely alert, brains gone pretty much blank while their galvanized bodies try to gure out what to do. I dont think our minds are designed to accept that theres no way out. Based

on my own close calls, I suspect that if I am killed while biking, the state of mind in which I am likeliest to die is extreme annoyance. And at least it wont be by drowning. The fear gets released later on, while Im falling asleep and near-misses replay themselves in my minds eye like an endless computer game fraught with constant hazards, in which Im a disembodied Steadicam hurtling through busy city streets at the same speed something falls, pedestrians appearing out of nowhere, the broad at fronts of busses expanding with terrifying suddenness in my peripheral vision. Occasionally I jerk briey awake just before being obliterated. These are the dreams that make dogs twitch and snarl. Before I moved here, I imagined that I would be far too terried ever to ride my bike in New York City. I am not whats called a thrill-seeking personality: I am too scared to go on carnival rides and can only imagine that if I were ever to go ziplining, bungee jumping or skydiving I would turn instantly to stone with terror, a shortlived meteor. The actual danger of biking is incidental; its only an external condition that forcibly focuses my concentration, the same way that the violence of war can serve as an occasion for valor. If youre anything like me, you probably spend the majority of your time either second-guessing the past or dreading the future, neither of which actually exists; having to navigate those teeming streets narrows the beam of my consciousness to the lasers width of the instant I actually inhabit. When Im balanced on two thin wheels at 30 miles an hour, gauging distance, adjusting course, making hundreds of unconscious calculations every second, that idiot chatterbox in my head is kept too busy to get a word in. Ive heard people say the same thing about rock-climbing: how it shrinks your universe to the half-inch of rock surface immediately in front of you, this crevice, that toehold. Biking is split-second fast and rock-climbing painstakingly slow, but both practices silence the noise of the mind and render self-consciousness blissfully impossible. You become the anonymous hero of that old story, Man versus the Universe. Your brains glad to nally have a real job to do, instead of all that trivial busywork. You are all action, no de-

liberation. You are forced, under pain of death, to quit all that silly ideation and pay attention. Its meditation at gunpoint. Im convinced these are the conditions in which we evolved to thrive: under moderate threat of death at all times, brain and body fully integrated, senses on high alert, completely engaged with our environment. It is, if not how were happiest were probably happiest in a hot tub with a martini and a very good naked friend how we are most fully and electrically alive. Of course we cant sustain this state of mind for too long. People who go through their whole lives operating on impulse tend to end up in jail. We are no longer purely animals, living only in the moment; we are the creatures who live in time, as salamanders live in re, prisoners of memory and imagination, tortured with dread and regret. That other, extra-temporal perspective is not the whole reality of our condition. Its more like the view from the top of the Empire State Building, of people as innitesimal dots circulating ceaselessly through a grid. Eventually we have to descend back to street level, rejoin the milling mass and take up our lives; you lock up your bike and become hostage to the hours again. But its at those moments that I become briey conscious of what I actually am a eeting entity stripped of ego and history in an evanescent present, like a man running in frames of celluloid, his consciousness ickering from one instant to the next.

14

May 14, 2012: Meltdown in Motherland.

By ELIZABETH ISADORA GOLD When Clara, my daughter, turned four months old, my husband Danny and I celebrated the end of the fourth trimester. From here, the books had said, things would get easier. I began to look forward to tting into old clothes, my C-section incision no longer hurting, attending parties, readings and concerts. Id already gone back to my day job tutoring teenagers eight weeks before (freelance artists dont get maternity leave), but I missed my real work writing. Now, the new, post-baby version of my beloved internal life could begin. Id write and read, while producing milk and cuddling my girl. But something was wrong. I was so tired. Commuting on the subway rendered me nauseated and dizzy. The effort of bumping Clara down my Brooklyn stoop for a stroll in the winter sunshine was insurmountable. How would I make it around the block without something terrible happening? When my mom friends held our rst night-out-without-babies, I was too nervous to show up. On the street, faces grimaced and swelled into malevolence. Car alarms, sirens and unexpected footfalls made me jump. I pushed through my worry and sleep deprivation by writing. For a long month, I worked on an essay for an anthology about Madonna and celebrity baby obsession. But Clara would cry as soon as I opened my computer. Id pop her in her swing (which our baby book called a mechanical mommy), shed conk back out and Id frantically type until she screamed again. The sound of the swing became the rhythm of the essay; I became the topic. Had Madonna ever had to time her dance rehearsals between naps and pumping? People magazine never mentioned it. At night, when Clara woke to nurse in her bassinet beside me, wed both always fallen easily back to sleep, but now I lay awake, heart thumping, fearful heat rippling

my skin. Danny is a chronic insomniac, but now I was the one buzzing, waking him to ask what I should do to fall asleep. This didnt feel right, but Id never had a baby before. Did every new mother lay awake alone in the dark? After a few weeks, Danny went out of town for two nights. Id been looking forward to my rst solo with the baby, proving I didnt need my husband so much, that I wasnt scared to be left with my child. I dont know how much I slept the rst night he was gone. After reading all of Bridget Jones Diary, I closed my eyes and counted down from 100 until I nodded off. Clara must have sensed my disturbance because she woke more than ever. The next day, I was so tired I felt sick. I needed another adult body in the house, but all my friends either had new babies, taxing jobs, or werent the types to burden with my vulnerability. Putting aside any semblance of pride, I called a friend I hadnt spoken to in years, begging her to come sleep on my couch. When she arrived, I was so relieved I started shaking as hard as I had when my epidural hit. The next day, my parents arrived from Philadelphia. Youre just a little freaked out, honey, my dad said. You have what you always wanted, but youve been through hell. When Danny got home a few hours later, we hoped the worst was over. But my sleep worsened, my fears mounted and my fathers words looped through my head. Danny and I had been through hell. In May 2009, a year and a half before Claras birth, I was overjoyed to see a second line on a home pregnancy test for the rst time. Eight weeks in, at my ob-gyns ofce I asked, Can we see a heartbeat yet? The doctor paused. Im sorry, she said. I turned 35 the day after she declared my pregnancy nished, and we spent the rest of the summer watching the The Wire, pausing to cry or ght. I tested positive again in October, but by Thanksgiving. . . Between miscarriages, I went to acupuncture, worked out, and set myself a daily writing word count. It helped, but what I yearned for (besides a baby) was to talk about my body and mind, to nd comfort in the verbalization of this nightmare. Ive

spent much of my adult life on the therapeutic couch, but I refused to see a professional. Instead, I wanted my friends and family to make me feel better. People dont like to talk about death, and miscarriage is a confusing version of mortality. Its sex and blood, and not in the easy horror movie sense. Everyone apologetically responded with the same platitudes: once you have a baby, you wont remember. Statistics say youll have a healthy child soon. Reduce your stress. When I got pregnant for the third time, in February 2010, we rationed our hope. After seeing not only a heartbeat, but also ultrasounds of feet and hands, and then our daughters brain and face, we relaxed a little. Until I began bleeding. On the way to the emergency room, I announced that if this one didnt stick, wed take a trip and get a dog. Thankfully, Clara (wed known her name since the rst pregnancy) was still perfect, my bleeding benign. At the beginning of my third trimester, I was diagnosed with gestational diabetes, a pregnancy complication so common as to be almost banal except I had to prick my nger with a mechanized lancet ve times a day, swear off ice cream, fruit and lemonade during the hottest summer in New York history, and surrender my plan for a natural delivery. Clara was a healthy seven pounds at birth. Still, my dutiful single slice of sevengrain bread a day, my weekly ultrasounds and non-stress tests, didnt prevent 36 hours of labor, followed by a C-section. When we brought Clara home, Id been in some version of pregnancy or recovery from pregnancy for a year and a half. Ill never know how that affected me hormonally. It certainly set me at odds with my body. A few weeks after Claras birth, bedridden and weepy, I took an online assessment test for postpartum depression, but didnt qualify; I wasnt sad enough. As I got to know Clara, I forgot how terried Id been. Now the worry was back. On the night I fell asleep at 1:30, waking an hour later as if for the day, I called the doctor. Actually, three: my ob-gyn, my new mommy cohort who happens to be a psychiatrist, and my pediatrician aunt. You need medicine and

help, they said. My shrink friend referred me to a psychiatrist who diagnosed me with postpartum anxiety. I lled his prescriptions for anxiety and insomnia meds, as well as an antidepressant. My parents came back into town to help, offering cash so we could hire more babysitters. I found a wonderful therapist who specializes in postpartum issues. We moved Clara out of our bedroom, and into Dannys home ofce. He bedded down on the couch and took the night feeds for months so I could have unbroken rest. For weeks, I hovered between panic attacks, waiting for the anti-depressants to kick in. Postpartum anxiety often includes intrusive thoughts of harm coming to the baby, but I knew she was thriving; I was worried about myself. Leaving the house for the day, Id run home after a few blocks, weeping and apologizing to Danny and Clara, gulping down a pill. Then Id go to bed and cry more, until the medicine put me to sleep. Then there was breastfeeding. Clara was so little, and I wasnt willing to give up nursing. When I took an anti-anxiety pill, I couldnt feed her for four hours. Watching her scrunch up her face and scream, I wondered if I was the worst mother in the world. Eventually, the antidepressants took effect and I did get better. These days, I often write in a local coffee shop at the same time as a new moms group. The babies are tiny, the moms bodies are still soft and swollen. I watch them select pastries, listen to them talk too loud, and with too much detail. Theyre exchanging freshman year condences, telling their most basic stories along with anecdotes about naps. I want to tell them it might get worse before it gets better, but theyre enjoying their cappuccinos and chocolate croissants. Ive come to believe that our obsession with birth acts as a scrim for our lack of attention to what happens after. More than one in 10 women experience a postpartum mood disorder, but theres no DSM category for them, so my psychiatrist had to list

major anxiety as my insurance diagnosis. My post-labor ob-gyn appointment took place before my symptoms manifested, and while my excellent, progressive doctor warned me that postpartum depression could appear any time in the rst year, she never mentioned insomnia or anxiety as separate issues. Nor did the gestational diabetes specialists who saw me every week for months when I was pregnant. I discovered that gestational diabetes and miscarriage are risk factors for postpartum the way I found most of my information on the Internet. A year past my diagnosis, I havent had a panic attack in months, though a particularly bad night of sleep or too much work can still make me worry that a normal mother wouldnt need this much childcare or protein, or so many naps. Acknowledging how my condition must have affected my loved ones shuts me down a little, and I will always grieve that I dont know who I am as a mother without this. That is parenthood: changes and mistakes, the integration of fear and love. A few days ago, Clara said home for the rst time. Im not taking the symbolism of that too seriously.

15

May 21, 2012: Control.

By DOMINICK BROCATO and DW GIBSON In the summer of 2011 the writer DW Gibson set out across the country to speak with Americans who had lost their jobs. The following account is adapted from Mr. Gibsons July 12, 2011, interview with Dominick Brocato of Kansas City, who had been red nearly two years before from his position with DST Systems, where he had worked successfully for 20 years. The full interview, and more than 70 others, are collected in the forthcoming book and documentary lm Not Working. Mr. Gibson describes Mr. Brocato: He is 58 and has lived in Kansas City all his life. His shirt is pressed and tucked. His hair is denitely not gray, nor do I think Dominick would allow it to become so. He carries a notepad encased in a leather pouch. His appearance is immaculate and I can conrm it is not easy to remain so well turned out in the July humidity that grips this city, wringing composure from those who are exposed to it. The Editors

Both my grandparents came from Italy. Palermo. My dad was a mechanic. It was very much a Ward and June Cleaver kind of environment. My mom stayed home all day and cooked, and she came home and wore the aprons. My mom died when I was 15 and it was devastating for me. My dad had no idea what to do. I immediately took charge of the family and started doing all the things that needed to be done to keep the family together. My mom kind of trained me and taught me some of those kinds of things. And I think that just kind of carried on. I always wanted to be a protector, and I think thats why I was always successful in the roles that I was in, because people trusted me. Ive been in human resources for many years, and one of the things about hu-

man resources is that youre always there for other people, and youre always trying to help their lives and help them to see things in a different manner, and I guess Ive always been good from that standpoint. I didnt want people to be scared. I wanted to create an environment where you look forward to going into work, and you dont feel pressured and you dont feel scared or intimidated that, to me, is my responsibility. Ive worked for DST Systems for the past 20 years. The chief operating ofcer who was retiring left in December [of 2009], and at the rst of the year the new chief operating ofcer went to the board of directors, and he convinced them that the company needed to go through this reorganizing and restructuring. It was kept quiet somewhat, but I could tell that something was changing. I knew something was going on. It was hard through the holidays to know this stuff; I didnt say anything to my family, because I didnt want them to be worried about it but yet, deep down, it was hard to be happy knowing I was going to be out of the picture. I would say that probably during that November time period until it actually happened in February were some of the harder times in my life. My actual date was February 4^th of 2010. It was a Thursday. I still remember it very well. They had started on that Monday, and they had said that if you survived until Friday, that you were safe with this rst round of layoffs. And so I got my call at 9:30 a.m. to come into a conference room. It was low-key. They just said, Because of restructuring, your position now has been eliminated. They did it in a very effective manner, I have to say. It was very pleasant. I felt that I was very professional in the process. I still have the utmost respect for the company and for the president of our company. The new chief operating ofcer, he doesnt know me. He doesnt know who I am. All he knows is a name and tenure and what I was making, and Im guessing those were the reasons that decisions were being made. I kept hinting to my wife that something is probably happening, but her being

the type that worries about everything, I was just kind of very subtle with it. And she honestly did not know until the day I came home at 10:30 in the morning with the box. She was just quiet because you know, my last son was graduating from college. I put three kids through college. We were thinking, Finally, now, were going to be able to live and travel and do stuff just for us, and I know she was sad thinking through that, realizing we nally got to this point and now this happens. I said, Hey, Im starting outplacement on Monday, and were going to work through this. I was positive. And I felt that I had enough skills that it was going to be fairly quick for me to nd another position. I knew that now was time to start a new beginning, and I still try to have that feeling. But its hard after 17 months to keep realizing that maybe something will never happen. Ive been part of job clubs. I went back to school. I got an advanced certicate in employment law. Im doing everything that Im told to do, that Im trained to do, but yet, for whatever reason, its not happening. And you still keep looking back at yourself, thinking, Am I saying something wrong? Am I saying too much? You keep trying to psychoanalyze everything to the point where you can drive yourself nuts. Between April and August I have lled out and put in resumes for about 380 to 390 positions. I probably had 45 to 50 different meetings that I would just initiate on my own, asking someone, Can we just go have coffee, or just go to lunch? I spent a lot of money doing that. The majority of people, where I would say, Can we just go to coffee? . . . I didnt get a lot of response. If Id say, Hey, lets go to lunch; Ill buy lunch, I got more takers. And that was O.K., if I thought it was going to work to my benet. Sometimes I would say, You pick the place. I did that a few times, and after a $40 lunch I realized this isnt going to happen anymore. This is not fair. I guess I was really shocked that people would allow me to go ahead and pay knowing theyre working and theyre with a company, but again, I made the offer, and I was willing to do that. And Id always try to end every meeting saying, How can I help you?

And quite a few would take me up on that. I wrote out personal thank you notes, sent cards, had cards made with my name on the front. So I did all those things that I dont think the average person does. Ive always been in the role of helping others, so, you know, why cant you help yourself? Ive always been in control. So I always feel like I have to work everything out internally, just like when my mom died, I had to work that out. Again, back then, you didnt go to counselors, nor could we afford to do that, but me and my brothers and sisters, we needed that. Why would someone who has four kids die at 36? We needed to work through that. And I dont think we ever honestly did. So I havent. I read a lot of books, self-help and that sort of thing. You just try to gure out, there must have been a reason. Just like when someone dies, there must have been a reason. Ive run into people, Ive run into guys that are selling shoes at Dillards and so forth, and just thinking, That cant happen to me. Thats never going to happen to me. And now Im realizing, with some of these guys that have been unemployed now for two years, that Im getting close to that date. And how is this happening? How is this happening when Ive been in such control? Ive learned in some meetings Ive been in that companies are asking that recruiters and headhunters not even present them people that are 50 or older. They are not interested in people that have been unemployed for six months or longer because they feel something must be wrong with them. They also have made requirements that if someone has been in their job for 15 or more years, theyre not interested in seeing them either, because they feel that theyre set in their ways, and they havent updated or learned new skills. So again, a lot of the things that we were brought up with a lot of the ethical things that we thought were going to make us successful and that we did to show our dedication to a company are now used against us. Were having a new Trader Joes coming in, and when I found out that you have

benets even if youre a part-time employee, I thought, O.K. Let me try this. Of course, I did. I called, and they said, Well, youre at the bottom of 800, so well call you as soon as we go through the other 799 above you. I thought, Wow. I dont know what those next steps are going to be, and like I say, for someone who has always been in control and educated and so forth, you never imagine that these times are happening. But they are. For the last two months, Ive. . . I dont want to say Ive given up, but Ive just kind of taken a break from all the stuff that Ive done before, thinking I need to regroup. I need to get my head straight. I need to clear everything out. And so thats what Ive done for the last two months, but yet everyday you feel guilty: I should be doing this. I should be calling. But then you get to the point where you run out of people to call. Thats kind of where Im at right now. We both have old cars. Ive cut my cable and those sort of things. Obviously with the air conditioning and so forth, you kind of change the thermostat. This was the rst new house that we lived in we bought and built three and a half years ago. Next month the other house that we left wouldve been paid off. So of course, you constantly think of that stuff. I have friends who keep telling me that I should try to apply for food stamps and so forth. I may get to that point, but right now, I cant force myself to do that yet and I dont know why. Theres just something about it. Even going to unemployment. It was very difcult for me. Im self-conscious when I go. I dont even know what you do to get food stamps and that sort of thing but Im really hoping I dont have to get to that point. The other negatives that Im nding, at this point too, has to do with benets. I have been going through trying to nd insurance, and Ive hired two different brokers. I have been denied insurance coverage by every major company within Kansas City because I had a pre-existing condition. In September, 2007, I learned that I had a rare form of cancer [extraskeletal myxoid chondrasarcoma] in my left leg. This type of cancer usually leads to amputation. It had been growing in my leg for about

a year. Unfortunately, it was malignant and I had 30 radiation treatments. I went four and a half years clean, then it showed up in my left lung. Part of my upper left lobe was removed. And companies will not insure me. And thats devastating. Now Im realizing that possibly starting in August, I will not have medical coverage. And for someone thats always been in control, always tried to do the right things, always paid to have coverage and do the things that are appropriate, now were in this position of not even being able to be protected. I talked to the one doctor that I go to and said, O.K., so starting in August, if I cant pay, how is that going to affect my still coming here to see you? This was a conversation we had two weeks ago. He was very silent. He didnt answer me. I always used to tease my wife, because all she ever wanted to do was watch Leave It to Beaver and The Andy Grifth Show, and Id say, Why is that all you ever want to watch? Theres so many things on TV. And she said, Life was so simple, and you didnt have to worry about everything that we have to worry about today. And she said, I just want to pretend Im back in that time again. And after she said it, I nally realized what she really meant.

16

May 25, 2012: Control. An Update.

By DOMINICK BROCATO and DW GIBSON Last weeks Anxiety post, Control, featured an interview with Dominick Brocato, conducted and transcribed by DW Gibson, the author of the forthcoming book and documentary lm, Not Working. Many readers who commented wanted to know how Mr. Brocato was managing his various challenges unemployment, illness and a lack of medical insurance among them since the interview, which took place in July 2011. To provide that update to readers, Mr. Gibson contacted Mr. Brocato by e-mail and phone earlier this week. DW Gibson writes: When I contacted Dominick, I learned that hed had surgery on his right knee (unrelated to his cancer) just the day before. I immediately suggested we talk later but he ignored the offer. True to my memory of him, he was at attention, instantly composed and engaged. His own words I am still a vital and vibrant person still echo in my head. The update below is composed of Dominicks words from our e-mail correspondence this week and a follow-up conversation over the phone. The Editors

In 2011, after I found out that the cancer I had in my left leg had moved to my left lung, I had a malignant tumor removed with a partial lung resection. In the weeks to follow, my 23-year-old son had an apparent stroke and was later diagnosed with multiple sclerosis. It was at this point when I really wanted to give up. I kept asking myself why I am being punished. I still cry even thinking about my sons new challenges. With adversity you can only hope that something good will come to ease your pain. My rst grandson was born last summer, and after holding him, my spirit was renewed. Although they live in California, Ill do everything in my power it to see

him grow up. Many have asked about insurance and said that it is the law that we cannot be denied insurance. Much of this is true starting in 2014 if the law stands but today in Missouri, one of our answers is the Missouri State Pool. They had to offer me insurance and it was $1812 per month. Five days before my COBRA was ending, I called my prior employer and asked if there was anything they could do to help me. In this conversation I learned, for the rst time, that the company paid for any of us who could not get insurance to be offered private health insurance. This medical coverage for me alone is $1400 per month. This is what I have today. I am grateful I have it, but it is another monthly nancial drain on my 401k did I mention that many of us are also getting penalized for early 401k withdrawals? My 401k savings is what I use just to survive and I realize most Americans may not have this as an option. Sadly, my kids know I will have nothing left to leave them or my grandkids. I have now applied for and been denied jobs at Macys as a sales clerk, a bakery assistant for $7.75 an hour, three security guard positions from $8 to $10.85 per hour (and yes, I always wanted to carry a bullet in my shirt pocket like Barney Fife), three entry-level positions at a local casino, an entry-level job at two grocery stores, an entry-level job at Quick Trip, and at Costco applied three times just to mention a few. Many companies do not offer health care benets, especially if the position is part-time. If you take a new job and it does not work out for whatever reason, you have to go through underwriting again, and then go six months without insurance before you are given the opportunity to get back into the State Pool insurance, or the private insurance I have today. Keep in mind this is assuming you are accepted back into a program. After many months of ongoing pain on my left side, in March of this year, I learned I had a herniated lung. Since I was told after my surgery it would take 6 to 8 months to feel close to normal, I accepted the daily pain not thinking something was still wrong. Apparently, after my surgery in June 2011, a piece of my lung had pushed

through the rib cage and was pressing against my spine. This was repaired on March 16 of this year and I am doing much better. The positive and the negative to my story is that after all of this, I was nally approved for medical disability. You would think I would be happy, but this seemed like a chapter in my life I did not want to open. I want to work. Although I have had my medical challenges, I am still a vital and vibrant person. Im still trying to nd a part-time position but truthfully I feel shackled by the disability rules. I dont mean to sound ungrateful; I just want to work. I still want to make a difference, but if I do work, I cannot make more than $700 a month or I will lose my disability. Do I risk it?

17

May 25, 2012: Do the Jews Own Anxiety?

By DANIEL SMITH Lets say that, on a whim, you decide to form a baseball franchise made up of historys greatest anxiety sufferers a sort of neurotic all-star team, like the 2004 Red Sox, only too debilitated to make it out of the dugout. What would you call the team? Last Rosh Hashana, I asked a group of friends this question, and the answers I got suggested that the team would be exclusively . . . Jewish. Responses included but were not limited to the following: the Los Angeles Kvetches, the Brooklyn Nazi Dodgers, the Kansas City Mohels, the Chicago Schlubs, the Miami Meshugeners, the Westchester Rhinoplasties, the Hollywood Indigestives and my favorite, a late entry from my brother Scott the Upper West Side Ativans. We, the Jews, have encouraged the world to think of us as anxious. The results of my informal survey were admittedly overdetermined. As JewishAmericans, the participants were highly susceptible to the kind of ironic, self-deprecatory ethnic pride that many American minorities not just Jews like to indulge in. (To dispel any suspicions: although my last name isnt Jewish, my family and ancestry are; our name was said to be changed from Gomolski to Smith by a clerk at Ellis Island.) Ask a Korean-American or a Greek-American or an Italian-American or an Arab-American who the nuttiest, most nervous, most irreparably self-conicted people in the world are, and he will invariably point to the members of his own tribe. And yet who could dispute the fact that, when it comes to unabashed, even triumphalist declarations of collective neurosis, the Jews have had the market locked down for a long time so much so, in fact, that they are the only ethnic group I know of that members of other ethnic groups will unabashedly declare to be suffering from collective neurosis. The relationship between the Jews and nervousness is by now so

widely accepted that it barely registers. The Chosen People, at least in the American consciousness, are the very image of anxiety. But there is a fundamental problem here: it isnt true. That anxiety all-star team, were it actually to be assembled, would contain at least a couple of Jews Moses at third, say, and Franz Kafka in right but plenty of gentiles would make the cut, too. As the self-appointed general manager Id offer contracts to Charles Darwin, who suffered from debilitating insomnia and panic attacks; to Emily Dickinson, who lived on Dread and almost never left the house; to William James, who spent a decade paralyzed by uncertainty, and his sister Alice, a nervous invalid (Id put them at second and shortstop, respectively, so they could talk to each other); and on the mound, Soren Kierkegaard, who made anxiety not only a way of life but also a central philosophical concept, declaring (with suspicious exaggeration), The greater the anxiety the greater the man. In short, the Jews dont own anxiety and never have. So why do so many people think otherwise? The answer to this question, I think, is that we, the Jews, have encouraged the world to think of us as anxious. Weve done this by propagating the gure of the Neurotic Jew our hysterical clown. When you think about the personication of anxiety think quickly, without reection whom do you think of? If you are anything like me, what jumps rst to mind are the great fretful Jews of American ction and lm: the harmless Tevye, portly shtetl hero of Fiddler on the Roof, foreshadowing decades of New World pathology to come with his Talmudic indecision (On the other hand . . . on the other hand . . . on the other hand); Philip Roths Alexander Portnoy, the son of doting Newark Jews, raging to his analyst about his inability to reconcile his id and his superego, begging for help (. . . it hoits, you know, there is pain involved, a little human suffering is being felt . . . ); the Coen brothers Barton Fink, a nebbish idealist with a paralyzed will, nightmarishly unnerved by the conict between his artistic ambitions

and the vulgarity of Hollywood; and of course, above all, Woody Allen, in almost any of the 40-plus movies he has appeared in. This We are the champions pose that so many Jewish artists have struck in regard to anxiety has been, to some, a strange and upsetting project, mainly because the Neurotic Jew gure bears a close resemblance, at least supercially, to the Jew of the anti-Semitic imagination. He might not bake Christian blood into matzos or conspire to control the global means of production, but he is, when compared with those around him, awed weak-willed, ill at ease, quavering and chronically maladjusted. In a word: inferior. Or, to be more precise about the concerns of a certain group of Jewish detractors, he can be seen as inferior. There is a strong possibility that his exquisite sensitivities will be interpreted by the world at large as a kind of congenital defect like hook noses or Tay-Sachs. Such maestros of the character as Roth and Allen couldnt be more aware of this risk, or its reward: the contrast between the Neurotic Jew and the rest of the world, its manners and muscularity of action, is precisely what makes the character exciting, poignant and funny. Thats why Roth, for example, has Portnoys Complaint culminate in a confrontation between Alex and a representative of the one class of Jew that the Whats best for the Jews? contingent likes to point to as psychologically and morally superior to the gentiles, namely the Israeli: By dawn I had been made to understand that I was the epitome of what was most shameful in the culture of the Diaspora. Those centuries and centuries of homelessness had produced just such disagreeable men as myself frightened, defensive, self-deprecating, unmanned and corrupted by life in the gentile world. It was Diaspora Jews just like myself who had gone by the millions to the gas chambers without ever raising a hand against their persecutors, who did not know enough to defend their lives with their blood. The Diaspora! The very word made her furious.

The Neurotic Jew is perceived as inferior not just by the representatives of American rectitude and power but by the members of his own beloved species, who have allegedly evolved beyond him, toward mental clarity and physical courage and a bracing, unselsh submission to the commonweal. He is derided and disparaged, the poor man, both outside and inside his ethnic group. Hes a weakling, a vulgarian, a schmendrick, a schlemiel. But heres the twist: hes a schlemiel on top. Other people may see his anxious thrashing as a mark of inferiority not the least of his anxieties is that he tends to agree with them but simply by virtue of where he has been made to stand in comparison with everyone else he cant be inferior. Its a technical impossibility. He isnt some craven, venal caricature with horns and cloven hooves. He isnt a side thought or a scarecrow or a bogeyman. He isnt even an object of moral ambiguity, like Shylock. Hes the hero of the tale, the most complex, vibrant, fully ensouled, attention-worthy human being in the dramatic universe he inhabits. And since he is dened above all else by his tendency toward anxiety, that tendency inevitably takes on the quality of a heroic trait a virtue, like Achilles bravery, Socrates wisdom, Jesus compassion or George Washingtons honesty. This is all very weird and topsy-turvy because anxiety isnt a virtue. Or if it is a virtue its an unpleasant and problematic one. Which raises an important question: If anxiety is so painful, why celebrate it? Jewishly speaking there are, I think, two reasons or actually two and a half. First, the purveyors of the Neurotic Jew gure recognize they feel in their bones that Jewish anxiety isnt a genetic afiction or even so much a consequence of histrionic parenting as it is the nontransferable cost of being born Jewish. As a Jew born since, say, A.D. 200, you are forced to live in a world in which you are for perplexing, unfathomable reasons not only the object of a widespread psychotic rage but also, as the very consequence of that rage, urged and expected to associate all the more strongly with your heritage. Indeed, you are urged and expected to act as a kind

of personal repository for nearly 6,000 years of collective memory and as a bearer of an entire peoples hopes for surviving into the limitless future. You dont want to be anxious? You dont want to be neurotic? Tough. You were born into anxiety. Second, celebrating anxiety exhibits pride. Anti-Semites stereotype Jews as hopelessly head-bound and urbanized, lacking in old-fashioned pastoral virility, and a lot of Jews spend a lot of time and energy trying to put the lie to that stereotype. But for centuries being Jewish has also meant a willingness to question, discuss, scrutinize, interpret, dissect and argue over every last niggling aspect of human existence. Exegesis endless, mind-numbing exegesis is the soul of the Jewish religion. The corollary to this reason two and a half is the current of self-attery that runs through the Jew-as-anxiety-hero trope. Because if anxiety is rooted in excessive intellectual activity, then it is also rooted, by association, in excessive intelligence. When a Jew says hes a member of the most neurotic tribe in existence, its a backhanded way of saying hes a member of the smartest tribe in existence, the tribe of Spinoza and Marx and Freud and Einstein and Roth and Allen. Its a way of claiming mental power. Which says as much or more about anxiety, I think, as it does about Jewish identity. There are people who argue that mental illnesses are outgrowths of noble faculties that, for example, depression is related to emotional depth and schizophrenia to the fertility of the imagination. But no one could argue sensibly that it is nobler to be depressed or psychotic than not. No one could argue that depression and psychosis are desirable. Whereas lots of people Kierkegaard foremost among them have made this argument about anxiety. Theres a whole history of claiming that anxiety, for all the pain it causes, is a sign that the person who struggles with it exists in a higher state of being than those who dont that they are more alive to lifes contradictions, more receptive to the true nature of things, that they have sharper vision, more sensitive skin. That they are more conscious than other people. And I am here to tell you: this is a really dangerous position to accept.

Part VI

JUNE
18 June 02, 2012: Cancer on the Brain.

By DAVID ROPEIK I got a call from a friend last year. He had prostate cancer and wanted some help thinking through what to do. He had gone to his doctors for the details about his physical condition. He was calling me for help dealing with the other condition he knew he was facing excessive fear of this dreaded disease that sometimes does more harm than good, what some have called cancer phobia. 1 He knew that, like many cases, his prostate cancer had been detected when it was still asymptomatic, and was the slow-growing kind unlikely to ever become symptomatic or to kill him given he was an otherwise healthy man in his 50s before old age did. He also knew about the occasional side effects of treatment urinary incontinence, rectal bleeding, sexual impotence risks that thousands of men take each year not so much to remove from their bodies something that might harm them, but to remove from their minds the fear of living with cancer. Nonetheless, he said he was leaning toward treatment, and recognized that his emotions were making it hard to think rationally about the clinical medical evidence. I gently suggested that the perception of risk is so often based more on emotion than just the facts, and the roots of the fear of cancer are so broad and deep, that understanding these anxieties might not help much. But I offered what I could. Physical risks, I told him, have psychological characteristics that make them feel scarier or less scary, regardless of actual probability or evidence. And cancer triggers a couple
The concept of cancer phobia was rst coined in 1955 by Dr. George Crile Jr. in an article in Life magazine, A Plea Against Blind Fear.
1

of the most powerful of these emotional alarms. Research by experts in the eld of decision and risk, like Paul Slovic of the University of Oregon and Baruch Fischhoff of Carnegie Mellon, has found that the more pain and suffering a risk involves, the more fear it causes. Many forms of cancer involve a great deal of pain and suffering. We are also more afraid of risks we cant control and, despite great medical progress, most people still feel they have little control over cancer either getting it or ghting it. Many people still assume that a diagnosis of cancer is a death sentence. I also told my friend that cancer has been stigmatized. In the psychological sense this means that as soon as we hear the word, subconsciously all sorts of bad and frightening associations go off which frame how we think and how we feel about anything else we then learn. This aspect of cancer phobia is rooted in the perfect storm of conditions in the 1950s and 60s when cancer rst fully blossomed into public consciousness. The atomic bombings of Japan, and the Cold War, seared into our psyche the tangible existential threat of nuclear annihilation, a deep dread that was closely linked with fear of radiation from the fallout from atmospheric nuclear weapons testing. The health consequence of radioactive fallout the reason to fear it was cancer. Evidence rst started reaching the public in the 1950s about the carcinogenicity of smoking. An issue of Readers Digest in 1950 featured an article titled Cancer by the Carton. And as the modern environmental movement got going in the 60s, it used the threat of cancer as a central rallying theme. Rachel Carsons classic cri de coeur, Silent Spring, featured a whole chapter on cancer, warning that we were living in a sea of carcinogens. To drive home those fears, she regularly compared the danger of industrial chemicals to the risks of radiation. Given how this conuence of events magnied the innately frightening nature of cancer, it was no wonder that when the National Cancer Act passed in 1971 the introduction declared cancer to be the major health concern of Americans today. It still is.

A recent Harris poll found that cancer is the most feared disease in the United States; 41 of those polled listed it at the top, with Alzheimers next, at 31 percent. The benet of all this fear, of course, has been a body of laws and regulations, and changes in individual behavior, that have signicantly reduced the risk of what is indeed a group of horrible diseases. It has given rise to medical progress that has made many once-fatal forms of cancer treatable, and in some cases even preventable. But the costs of cancer phobia have also been signicant. One example of the impact it has had at the policy level can be seen at the National Institutes of Health, which spends more than twice as much researching the molecular biology of cancer ($5.4 billion a year) than on guring out the mechanisms of heart disease ($2 billion a year), which kills more people. 2 Its a fair to suggest that more people might be alive or healthier if those investments were proportional to the risk. The health damage from cancer phobia has been signicant in many ways at the individual level, too, and not just with prostate cancer. In Overdiagnosis in Cancer doctors at Dartmouth classied 25 percent of breast cancers detected by mammography, 50 percent of lung cancers detected by chest x-ray or sputum tests, and 60 percent of prostate cancers detected by the prostate specic antigen (PSA) test, as overdiagnosed. The authors describe how these overdiagnoses often lead to medically unnecessary treatments, sometimes involving radical surgery, that have major impacts on the patients quality of life. The authors of that study are careful not to ascribe this to fear. But a panel of experts on prostate cancer convened by the National Institutes of Health was pretty clear that our dread of cancer contributes signicantly to the harm that it does. So much so that for slow growing prostate cancer they recommended: Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be
2

A full list of what the N.I.H. spends its money on.

given to removing the anxiety-provoking term cancer for this condition.3 I didnt get into all those details with my friend. But I did tell him that the fear of cancer can contribute to chronic stress, which raises blood pressure and increases the risk of cardiovascular disease, and which weakens the immune system and increases the likelihood of all sorts of health problems. (A weakened immune system increases the likelihood of getting cancer in the rst place, and makes it harder to ght off once you get it.) 4 ) So unless he could deal with the fear of living with cancer, cancer phobia alone might make him sick. My friend was in a tough place. Cancer, in many of its forms, is a terrible disease. Ive had it. Ive lost relatives and friends to it. But cancer is also a frightening disease, and that fear, and the harms it can do, are no less real than the disease itself. Cancer phobia is powerfully rooted in the deep instinctive ways we perceive and respond to risk, and like many forms of cancer itself, hard to overcome. My friend thanked me, and said that just knowing all that gave him a reassuring sense of control and helped him put things in perspective as he faced his difcult choice. A year after our conversation my friend and his wife treated me to dinner at a ne restaurant. Hed decided to have radiation treatment to eliminate the cancerous cells, and was at peace with his decision, even though the treatment left him with at least one permanent side effect. He had to go to the rest room three times over two hours to urinate, something this 50-ish year-old man will have to deal with for the rest of his life a price he was willing to pay not so much to cure a physical disease, but to cure the powerful fear he just couldnt face.

The report Role of Active Surveillance in the Management of Men With Localized Prostate Cancer was released in 2011. 4 For more on the relationship between stress and cancer, see Psychological Stress and Cancer: Questions and Answers.

19

June 18, 2012: Toasted.

By THADDEUS RUTKOWSKI When I leave our apartment, I cant remember if Ive turned off the toaster oven. The appliance doesnt go off automatically. If it is on, you have to turn the knob to the left or unplug the whole gadget. I have a picture in my mind of the heating elements glowing red and the food crumbs catching re inside. I know this can happen because Ive seen it. Ill be toasting something, and Ill see a ickering yellow light through the ovens small window. If I do nothing, the re will continue unabated. If I open the oven door, the inow of air will feed the ames. The re inside the appliance could spread to the plasterboard wall. The cardboard layer is ammable; a high temperature will set it off. A painting of mine hangs near the toaster. Its a harmless still life on canvas stretched over wood. Are there any better materials than canvas, wood and Sheetrock to fuel a re? Maybe the painting deserves to be burned. But even if it does, I dont want the entire apartment turned to ash. I smell smoke, either from my burning apartment or from a vehicles exhaust pipe. I cant tell. In any case, the sensation puts me on alert. I know what can happen. The smoke will turn into ame. What should I do? Return and check the toaster-oven knobs, or continue on my way? If I keep going, maybe something else will grab my attention and Ill forget about the toaster. Maybe Ill arrive at my workplace and discover that an e-mail I was supposed to send hasnt been sent. When I realize what has happened, it will be too late. Someone else was supposed to take the e-mail and reformat it. That person needed me to send the raw material. I remember making some revisions. I remember seeing the le name on my computer screen. I remember attaching a document, something about a proposal, a proposed law, new coverage. But I dont remember highlighting the recipients name and clicking the

send button. Maybe the work problem will take my mind off of my burning apartment. Maybe Ill realize whats done is done theres nothing else I can do. Either Ive set re to my building or I havent. Anyway, it doesnt matter, because if I dont start the re, someone else will. Many of my neighbors have appliances with electric heating elements, and as I see it, they dont care as much about safety as I do. One time, when I was living alone, I was awakened by the smell of smoke. The source was somewhere outside my apartment. I opened my entrance door and saw that the hallway was lled with smoke. I went back in and looked out my window. On the street, a reghter shouted through a bullhorn: Dont leave your apartments! Stay inside and keep your doors shut! I opened my door again and saw a woman run out of the apartment next to mine. She had nothing but the clothes she was wearing and her cat, in a carrier. She ran down the stairs, through the spray of the sprinklers, and onto the street. I looked out my window and saw her on the sidewalk. She and her cat were soaked, but they were safe. I followed instructions and stayed inside. From where I was, I could hear reghters walking on the stairs. As they arrived at each apartment door, they pounded. If no one answered, they struck the doors with their axes. I could hear the sound of metal against metal. When they got to my place, I opened the door before they struck. Good, one of them said. We wont have to pop your lock. The next day, I learned that my rst-oor neighbor had turned on an electric heater and let some bath towels fall over it. Then she went to sleep, and the towels started to smolder. Her place became a bath-towel furnace, and the building turned into a smoky sauna. No one was harmed, but I coughed up smoke particles for the next few days. I imagined that my neighbors and their pets were similarly aficted. Bottom line: If my neighbors dont set a re, our child will. Our daughter doesnt know how to work the Toast and Heat buttons on the toaster oven. She thinks

that once the timer stops ticking, the oven is off. But if the control knob is still turned to high heat, the oven is on. I picture the toaster switched off while the oven is set to 450 degrees. Thats hot enough to ignite anything burnable. A solution, of course, would be to clean the toaster oven and move it away from the wall. That way, there would be nothing to burn. But these steps are beyond me, mainly because I never think of them while Im in the apartment. I think of them only as I walk away from the building that will shortly become a cinder. Now, as I walk away from home, I could call someone who is still inside to see if the appliance is off. I could use my cellphone my question is urgent. But I dont think anyone is home. Even if anyone were there, all they would tell me is that the place is engulfed in ames. I make the call. Someone answers, but I dont know who it is. This is Daddy, I say. Daddy? No, not Daddy, I say. This is not your daughter, my spouse says. Can you do me a favor? I ask. Can you check to see if the toaster oven is off? Hold on. I hold, and as I hold, I imagine my spouse batting at the ames that are licking the walls.

20

June 11, 2012: Survivors.

By PATRICIA PEARSON The other day, I came across a tin of powdered butter that Id stored in my basement ve years ago as part of an emergency cache. All I needed to do was add 27 cups of water and voila! Id have a huge amount of peculiar-tasting buttery substance with which to adorn my bread and Kraft Dinner while I waited out an inuenza pandemic in a pristine state of self-quarantine. Not that one ever materialized. But it might have. There is nothing inherently irrational about vigilance. Disasters happen. In 2006, as you will probably not recall, the U.S. Department of Health and Human Services issued a bulletin via a Web site called pandemicu.gov (now, the less menacing u.gov), advising the citizenry to stockpile six to eight weeks worth of supplies. Just in case. You never knew. There might be a global pandemic at any time, and if there was, then inuenza could what? level the sales staff at Trader Joes, and there would be no one left to sell you your food. This was before Steven Soderberghs movie Contagion came out, and made it thoroughly, unnervingly obvious to all that a mutated u virus could spark a global disease catastrophe necessitating prolonged self-quarantine. In 2006, none of my friends had the faintest apprehension that a time of great peril was approaching. They hunkered down with their proven pleasures American Idol, Jazzercise while I, alone, stood guard. Anxious people can get their timing wrong, Ill grant you, but, still, we act as scouts along the periphery of the human campre, scanning for threats in the darkness. We are the watchers. Scoff if you will. Some of us are self-appointed and others are professional. Our vigilance can be critical, in some instances, to everyones safety. It can also be wildly and hilariously irrelevant. The special magic trick is to

know which is which. There is nothing inherently irrational about vigilance. Disease outbreaks, climate disturbances, nuclear Armageddon all are entirely plausible scenarios. A whole class of paid worriers must go about the thankless task of monitoring such scenarios: oceanographers watching sea levels, anti-terrorism experts trawling the Internet, geologists keeping an eye on the super volcano under Yellowstone National Park that has the potential to erupt and kill us all. The calamitous prospects are legion, which was very likely the calculus of producers at Spike Television, who have just announced a new reality show called Last Family On Earth. Survivalists will compete for the prize of a furnished, underground bunker in an undisclosed location. (You could also win this prize by becoming vice president, but you wouldnt get to skin a squirrel.) Many will receive this news with arched eyebrows, but really: are the burgeoning number of American preppers wrong to be getting prepared? Are the anxious wrong to be scouting? In this culture, that question is never comfortably settled. The challenge, I think, has less to do with anticipating the threats than with shaping a healthy and judicious response. At some point, in preparing for the 2006 u pandemic, I began to realize that I was coping with anxiety through a process that the Italian psychologist Maria Miceli has called hypothetical analytical planning. This is where you lie in bed at night and run through as many prospective scenarios as you can imagine, and then rehearse them backwards, or in Spanish. Its obsessive. Ones power over events is closely dependent on ones power to foresee, Miceli, of Romes Institute of Cognitive Sciences and Technology, has written about this kind of anxiety, because if I cannot foresee, I cannot act. It is, in essence, a kind of magical thinking that masquerades as rational. Indeed, we value it highly in certain work settings, such as airport security. The anxious person proceeds in the laborious task of formulating various hypotheses

about all the possible courses that events could take. The trouble is that since those courses are pretty much innite, the anxiety is never quelled and simply deepens, like grooves being laid down in vinyl. Thus I would nd myself, late at night, compiling my order list from a Web site called Survival Acres and wondering: What if I cant t the powdered butter and dehydrated dinners into my car, along with our dogs and children? Will we stay here, in the basement, rather than ee to the country? If the dogs need to go out, how will they come back in without bringing the virus into the house on their feet? What if they step in bird feces? Shall I purchase booties? It is the conviction that all every single angle must be foreseen that can turn heightened vigilance into a dizzying cognitive spiral. There is no reason to assume that institutions and professions are any more exempt from the spiral than individuals, which is how we wind up with infants on no-y lists, and people being patted down due to pacemakers. Last week, a friend of mine who has been fretting about changes to space weather, alerted me to a planning conference in Washington on June 5th, organized by the Ofce of the Federal Coordinator for Meteorological Services and Supporting Research. My friend (and presumably the conference attendees) has been keeping abreast of solar storms and other features of space weather for several years now, and is increasingly concerned that civilization is about to be destroyed by a lick of ame from the star that has always sustained us. But what can he do? What, really, can anyone do about that? He mused briey about moving his family to Cape Breton, a sparsely populated island off the coast of Nova Scotia, where one assumes there will be fewer post-apocalyptic gangs. How much control does he have, though, I found myself asking him, and what is it that hes trying to assert control over? Everything? Every conceivable turn of events? That is a very, very difcult question for anxious people and societies to solve in a satisfactory way.

All the food I ordered from Survival Acres proved useless when my father and sister died two years later from, respectively, heart disease and cancer. Yes, I had persuaded my sister to stockpile a natural anti-viral syrup derived from blackberries that Id read about on the Internet when I was doing all this planning for the u. And yes, it was still in her kitchen cupboard when we had her funeral. A few months after Dad and Katharine died, I contracted the H1N1 virus, which I used as a very good excuse to stay in bed.

21

June 25, 2012: Haunted Heart.

By GORDON MARINO I grew up in a house that shook with rage a couple of times a week. Maybe it was the frays, genes or both, but I have always been haunted by the sense that something terrible was just about to happen. Of course there were times when I was dead right, like when my warring parents turned the house upside down in the middle of the night, or more recently, when a doctor left a message on the phone that I needed to call back as soon as possible. The sick heart is not like a bad shoulder. You can always feel it ticking away. For as long as I can remember, I have dealt with my angst by punching it out at the boxing gym and by working out. You cant fret about what is going to happen next week when a left hook is sailing your way. Indeed, I have even been known to preach to students and friends who make regular visits to the medicine cabinet for nerve balms: Are you getting enough exercise? Youll always feel better after a workout. It moves the energy around. Amen. Last August I took my anxiety out on the track. After about a quarter of a mile, there was a persistent squeezing pain in my chest. Soon, I was burping continually. Indigestion, salted with anxiety, I gured; it would fade after a couple of miles. But it didnt. I walked in, and the ache subsided. A bad sign. The next day I was feeling the jitters. Again I put on my running shoes, and again the chest pain ran along with me. I can remember coming around one corner of a loop in the country it was humid and gray, the foliage seemed to be sweating, and the sad thought was dripping: Your life is about to change, and not for the better. Even for the simplest of matters, I go to the doctor as one going before the hanging judge, acutely aware of the fact that I might be going from being full square in the moment to nonexistence. One minute youre out playing home run derby with your

20-something sons. The weather is perfect. It is just the three of you, hooting as one son hits 10 in a row over the softball fence. Ten! And then blam just like a ball hitting a bat, youre told you have two months to live. ~~~~~ I was given a stress test. I stood atop a treadmill in a darkish room, tethered to a full metal jacket of monitors and wires, and started walking . There were two nurses. Stupid half jokes and nervous laughter oated up. So far my chest was quiet. Kierkegaard, the rst philosopher to attack the problem of anxiety, described it as a kind of foreboding. As I padded along and they ramped up the speed and elevation, the foreboding was there. Something was following me. Jocular and stoic as I tried to be, I was desperately hoping that the paramedics wouldnt let me know if they saw anything but I could feel it coming. Then one nurse, gruff and near retirement, nger toward the monitor, loudly whispered to the other, Theres something here. That was it for me. There have been many times when I have been examined, prodded and released as innocent, but this time a guilty verdict came back. I needed an angiogram. My attitude was, O.K., in a couple of weeks. But it was Friday and my cardiologist a lithe, tanned, stiff woman in her 40s insisted: You have to come into the hospital on Monday. And nothing strenuous between now and then. Nothing! Over the weekend a doctor friend who lived 1,000 miles away assured me that an angiogram is just a day at the ofce for these guys. But once I arrived for the procedure, I was informed about a dozen times that it could be nothing, but then again I could be in need of a stent or bypass. I had two friends who vanished in bypass operations. I had recently been alongside parents going over the falls. My wife had just been through breast cancer. I understood why my Italian nonna preferred death to the hospital. At the time, I felt as though I couldnt deal with the harrowing machine

of the ward again. With its combination of urine scent, ice chips for those oating down the River Styx, chirpy nurses, squeaking shoes, elevator bells, Monet reprints and daytime talk-show blather cascading from high on the wall, the hospital world always seemed to me to be a vertiginous combination of Holiday Inn and funeral home. Registered, checked over and wrist taped, I was wheeled down the hall toward the courtroom of the body with its screaming surgical lights. R.E.O Speedwagon blared as they moved my limbs around like something in an auto-body shop. The nurses were amped up and chattering about the weekend, occasionally checking in with a kind touch on the arm . How ya doin sweetie? Fine. Fine thanks, I answered. The procedure was done by a heart surgeon and former Rhodes scholar who seemed as focused to me as a ghter pilot landing on an aircraft carrier in a storm. Since general anesthesia is not used during angioplasty, I was awake for it all. The process is reasonably safe these days; then again, it is the heart, the engine room of individual existence they are poking around in. Just in case, I was trying to make my peace, but with the hard rock music and locker room banter it seemed absurd, until in a ash and a quick grin, I grasped it: this was all life, the perfect admixture of the sacred and the profane. Somewhere in the befogged process, it became clear that my forebodings knew what they were talking about. The nurses were slipping a stent up my arm through my wrist. I had a complete blockage of the left anterior descending artery. In recovery, there was juice, gentle hugs and kisses on the forehead from family, and assurances from the staff that they had xed the problem. For a few hours there was the delicious feeling that I had escaped, but then plink, plink, plink, I started to think about the genes, my father and grandfathers numerous heart attacks, and with my wife sleeping tenderly at my side, I began to feel that the verdict was not entirely benign. I had marginally high blood pressure, high cholesterol and a bad cardiac inheritance.

~~~~~ The next afternoon, when the nurses were checking me out for release, my blood pressure started climbing. I was sternly informed that they werent opening the gates until the needle came down. Of course, it soared even higher. As though to calm me down, one paramedic marched in, handed me a little bottle of nitroglycerin, looked me in the eyes and lectured: Never go anywhere without this. It can save your life. Get an amulet-like bottle and wear it around your neck. The blockage you had was the widow maker. It was very close. Dont ever be without the nitro. Ah, there it was, the dark pronouncement that my anxiety was eager to form itself around. The nurse marched out. I snuck a sleeping pill under my tongue and within half an hour I was packed onto the elevator, but now with the cynical feeling of a released prisoner who knows hell be back behind bars soon. In a couple of weeks, I was in the classroom again, professing about the good life, and the place of courage within it. I have always espoused the view that the way we deal with anxiety and fear plays a large part in determining the content of our character. And in order to nurture courage we need to get in the ring with these unsettling feelings. Now I was getting plenty of practice. There is a kind of fear that gets so loud that it almost becomes a feeling of certainty. For years now, I have pictured death as a balloon popping. Poof, youre gone you disappear, but only after a splinter of a split second, enough time to watch the world move on as you seep out of existence. It is an unnerving thought to have hovering over ones head like a cartoon caption, and now its there all the time. The heart is not like a shoulder. You can always feel it ticking away. Some angst and it starts uttering like a sparrow, and then an awareness of the uttering and it starts to gallop. Often times, Ill be in mid-sentence and my telltale heart will start throbbing. Ill draw a deep breath and keep the conversation going, all the while

feeling, Here comes the pin to the balloon. My old man had four major heart attacks, and though he never talked about his quiet terror, I now understand why he used to sit in his chair watching television with this vulnerable look on his sad countenance and the tips of his right hand tenderly touching his heart as though he had an itch.

22

June 30, 2012: The Busy Trap.

By TIM KREIDER If you live in America in the 21st century youve probably had to listen to a lot of people tell you how busy they are. Its become the default response when you ask anyone how theyre doing: Busy! So busy. Crazy busy. It is, pretty obviously, a boast disguised as a complaint. And the stock response is a kind of congratulation: Thats a good problem to have, or Better than the opposite. Its not as if any of us wants to live like this; its something we collectively force one another to do. Notice it isnt generally people pulling back-to-back shifts in the I.C.U. or commuting by bus to three minimum-wage jobs who tell you how busy they are; what those people are is not busy but tired. Exhausted. Dead on their feet. Its almost always people whose lamented busyness is purely self-imposed: work and obligations theyve taken on voluntarily, classes and activities theyve encouraged their kids to participate in. Theyre busy because of their own ambition or drive or anxiety, because theyre addicted to busyness and dread what they might have to face in its absence. Almost everyone I know is busy. They feel anxious and guilty when they arent either working or doing something to promote their work. They schedule in time with friends the way students with 4.0 G.P.A.s make sure to sign up for community service because it looks good on their college applications. I recently wrote a friend to ask if he wanted to do something this week, and he answered that he didnt have a lot of time but if something was going on to let him know and maybe he could ditch work for a few hours. I wanted to clarify that my question had not been a preliminary heads-up to some future invitation; this was the invitation. But his busyness was like some vast churning noise through which he was shouting out at me, and I gave up trying to shout back over it.

Even children are busy now, scheduled down to the half-hour with classes and extracurricular activities. They come home at the end of the day as tired as grown-ups. I was a member of the latchkey generation and had three hours of totally unstructured, largely unsupervised time every afternoon, time I used to do everything from surng the World Book Encyclopedia to making animated lms to getting together with friends in the woods to chuck dirt clods directly into one anothers eyes, all of which provided me with important skills and insights that remain valuable to this day. Those free hours became the model for how I wanted to live the rest of my life. The present hysteria is not a necessary or inevitable condition of life; its something weve chosen, if only by our acquiescence to it. Not long ago I Skyped with a friend who was driven out of the city by high rent and now has an artists residency in a small town in the south of France. She described herself as happy and relaxed for the rst time in years. She still gets her work done, but it doesnt consume her entire day and brain. She says it feels like college she has a big circle of friends who all go out to the cafe together every night. She has a boyfriend again. (She once ruefully summarized dating in New York: Everyones too busy and everyone thinks they can do better.) What she had mistakenly assumed was her personality driven, cranky, anxious and sad turned out to be a deformative effect of her environment. Its not as if any of us wants to live like this, any more than any one person wants to be part of a trafc jam or stadium trampling or the hierarchy of cruelty in high school its something we collectively force one another to do. Our frantic days are really just a hedge against emptiness. Busyness serves as a kind of existential reassurance, a hedge against emptiness; obviously your life cannot possibly be silly or trivial or meaningless if you are so busy, completely booked, in demand every hour of the day. I once knew a woman who interned at a magazine where she wasnt allowed to take lunch hours out, lest she be urgently needed for some reason. This was an entertainment magazine whose raison dtre was obviated when menu buttons appeared on remotes, so its hard

to see this pretense of indispensability as anything other than a form of institutional self-delusion. More and more people in this country no longer make or do anything tangible; if your job wasnt performed by a cat or a boa constrictor in a Richard Scarry book Im not sure I believe its necessary. I cant help but wonder whether all this histrionic exhaustion isnt a way of covering up the fact that most of what we do doesnt matter. I am not busy. I am the laziest ambitious person I know. Like most writers, I feel like a reprobate who does not deserve to live on any day that I do not write, but I also feel that four or ve hours is enough to earn my stay on the planet for one more day. On the best ordinary days of my life, I write in the morning, go for a long bike ride and run errands in the afternoon, and in the evening I see friends, read or watch a movie. This, it seems to me, is a sane and pleasant pace for a day. And if you call me up and ask whether I wont maybe blow off work and check out the new American Wing at the Met or ogle girls in Central Park or just drink chilled pink minty cocktails all day long, I will say, what time? But just in the last few months, Ive insidiously started, because of professional obligations, to become busy. For the rst time I was able to tell people, with a straight face, that I was too busy to do this or that thing they wanted me to do. I could see why people enjoy this complaint; it makes you feel important, sought-after and putupon. Except that I hate actually being busy. Every morning my in-box was full of e-mails asking me to do things I did not want to do or presenting me with problems that I now had to solve. It got more and more intolerable until nally I ed town to the Undisclosed Location from which Im writing this. Here I am largely unmolested by obligations. There is no TV. To check e-mail I have to drive to the library. I go a week at a time without seeing anyone I know. Ive remembered about buttercups, stink bugs and the stars. I read. And Im nally getting some real writing done for the rst time in months. Its hard to nd anything to say about life without immersing yourself in the world, but its also just about

impossible to gure out what it might be, or how best to say it, without getting the hell out of it again. Idleness is not just a vacation, an indulgence or a vice; it is as indispensable to the brain as vitamin D is to the body, and deprived of it we suffer a mental afiction as disguring as rickets. The space and quiet that idleness provides is a necessary condition for standing back from life and seeing it whole, for making unexpected connections and waiting for the wild summer lightning strikes of inspiration it is, paradoxically, necessary to getting any work done. Idle dreaming is often of the essence of what we do, wrote Thomas Pynchon in his essay on sloth. Archimedes Eureka in the bath, Newtons apple, Jekyll & Hyde and the benzene ring: history is full of stories of inspirations that come in idle moments and dreams. It almost makes you wonder whether loafers, goldbricks and no-accounts arent responsible for more of the worlds great ideas, inventions and masterpieces than the hardworking. The goal of the future is full unemployment, so we can play. Thats why we have to destroy the present politico-economic system. This may sound like the pronouncement of some bong-smoking anarchist, but it was actually Arthur C. Clarke, who found time between scuba diving and pinball games to write Childhoods End and think up communications satellites. My old colleague Ted Rall recently wrote a column proposing that we divorce income from work and give each citizen a guaranteed paycheck, which sounds like the kind of lunatic notion thatll be considered a basic human right in about a century, like abolition, universal suffrage and eighthour workdays. The Puritans turned work into a virtue, evidently forgetting that God invented it as a punishment. Perhaps the world would soon slide to ruin if everyone behaved as I do. But I would suggest that an ideal human life lies somewhere between my own deant indolence and the rest of the worlds endless frenetic hustle. My role is just to be a bad inuence, the kid standing outside the classroom window making faces at you at your desk, urging you to just this once make some excuse and get out of there, come

outside and play. My own resolute idleness has mostly been a luxury rather than a virtue, but I did make a conscious decision, a long time ago, to choose time over money, since Ive always understood that the best investment of my limited time on earth was to spend it with people I love. I suppose its possible Ill lie on my deathbed regretting that I didnt work harder and say everything I had to say, but I think what Ill really wish is that I could have one more beer with Chris, another long talk with Megan, one last good hard laugh with Boyd. Life is too short to be busy.

Part VII

JULY
23 July 09, 2012: Two-Way Mirror. Facing a Daughters O.C.D.
By BETH BOYLE MACHLAN Twice a week, my daughter Lucy and I take the F train from Brooklyn to see her doctor on Park Avenue. The ofces are lush and airy; children op on the colorful couches or surf the net on Macs. We rarely have to wait long. My own psychiatrist usually has at least ve twitchy people in his vestibule at any given time, and he sees them for 10 minutes, tops. Lucys appointments are 45 minutes, and most of them run longer. In a way, I envy Lucys anxiety, its organized concordance of fears and behaviors. When she was 8, Lucy started humming and could not stop. I have struggled with depression and bipolar disorder for most of my life, so I knew there was a good chance my children might inherit some form of mental illness; a neurological condition like Tourette Syndrome wasnt even on my radar. I was relieved to learn that mild cases of Tourettes are treatable with behavioral therapy, and some children even age out of their tics completely. One year later, the condition had started to seem like just another one of Lucys activities: tae kwon do, lmmaking, ice hockey. Then one night, just before her bedtime back rub, she whispered that she had something to tell me. What is it, bunny? You know how Ella Enchanted had to do things even if she didnt want to? Sometimes I feel like I have to do things, too.

I tried not to panic. What kind of things? I have to count things. Or line them up. I feel like if I dont do that, something bad will happen. What will happen, sweetie? Something bad, she repeated rmly. To you or Daddy. I knew immediately that Lucy was describing obsessive-compulsive disorder, or O.C.D., a condition that often arises alongside Tourettes. Her allusion to Ella Enchanted, a character in a contemporary fairy tale who must do anything she is told, suggested that she knew her fears werent real. At the same time, they were obviously bothering her to the point where she needed to ask for help something Lucy usually hated to do. I called the doctor the next morning and he t us in that afternoon. We had barely exchanged greetings when his orescent ofce lights revealed something else I hadnt noticed. Honey, what happened to your eyebrows? Lucy is blond and her eyebrows are even blonder, which I guess is why it took me so long to notice that they were almost gone. I pulled them out, she told me. I started to feel sick. In response to her doctors gentle questions, Lucy described a set of behaviors and associated fears. Objects needed to be in order to protect me and her father from unspecied deaths. The sliding mirrors on the bathroom medicine cabinet had to be lined up just right, or a witch would jump out of the wall. She had to be sure her dolls eyes were closed or her stuffed animals faces turned away when she went to bed, or they might kill her in her sleep. Youd think that a mother with 25 years of psychiatric treatment behind her might handle a childs mental illness better than a terminally-sane parent, but that was not the case for me. I have experienced hypomanic episodes and debilitating depressions, but I have never pulled out my hair or believed that the safety of my loved ones relied on the position of my pencils. I had hoped that, if my daughters ever ex-

perienced depression or mania, I would be there to guide them and make them feel safe. But Lucys disorders were new and frightening to me, and I had nothing to offer. Lucy didnt seem afraid; she seemed genuinely relieved to have shared her anxieties, and eager to address them. Clark, her doctor, gestured toward his desk, which was a mess. See those papers? he asked Lucy. Do you want to straighten them? Lucy shrugged. A little. Between 1 and 10, how strong is your urge to straighten those papers? In Tourettestalk, the feeling that creates the need to tic is called an urge. When Lucy feels a tingle in her throat telling her to tic, she is supposed to begin a competing response, or a non-tic behavior, that she practices until the urge subsides. In this context, however, Clark seemed to be trying to incite the urge instead of abate it. Maybe a 2 or a 3. Clark gathered the papers and, watching Lucy intently, dropped them on the oor. How about now? Lucy pointed to the paper closest to her, on top of the pile. What I really want to do is scratch that one. O.K., lets work on that. Hold your nger directly above the paper, but dont scratch it. I have a question, I began, but, Clark cut me off. Hold on a second. He positioned a timer on his desk so that it faced him. Lucy, how strong is the urge? I couldnt see Lucys face; she was sitting cross-legged on the oor, dangling her nger over the paper. Its a 9. I stared at her. Nine? In all the time wed been working with Clark, shed never had an urge this strong or, as far as I was concerned, this weird. Good! O.K.! Clark leapt up and began to graph her responses on a whiteboard. Finally, he acknowledged me. Mom, you had a question? Yes. I gazed at Lucy, who was still focused on her nger. I can understand why its a problem if Lucys afraid of the bathroom mirror. But is it really such a big deal

if she wants to scratch a piece of paper? Clark turned to Lucy, as if shed prepared remarks on just this topic. Lucy, do you know why this is important? I still couldnt see her face, but I heard her loud and clear. Its not only the paper, Mom, she told me. Sometimes I want to scratch the blackboard at school, or peoples coats. I thought, not for the rst time, Why didnt you tell me? But I didnt say anything. How strong is the urge now? Still 8. Lucy plucked at her eyebrows with her free hand. How had I never noticed that before? Try not to touch your face, Clark said gently. She stopped with her eyebrows and started chewing on her wrist. I tried to make a joke. Eating your hand wont help, I told her. It distracts me, Lucy responded, in an unfamiliar voice that sounded both wise and tired. She still didnt look at me. It hit me that, for her, I wasnt actually there not in any useful way. Unlike Lucy, I never associated my anxiety with any behaviors or numbers. My fear seeped and rose like dark, relentless water; because it was attached to nothing, nothing could make it stop. What the doctors called anxiety didnt feel like anxiety to me. It felt like terror. Clark must have been listening to me more closely than I thought, because he took me into an adjoining room. There, I could cry without upsetting Lucy, who I watched through a two-way mirror gripping her own hand as if trying to cling to someone who was trying to leave. In a way, I envy Lucys anxiety, its organized concordance of fears and behaviors. If my doctors had asked me to assign my anxiety a number between 1 and 10, I would have said a thousand, a million, innity. Perhaps O.C.D. will shield her from the shapeless dread that characterized my own depression. Perhaps she we are

lucky after all. Clark says something funny through the intercom, and Lucy laughs. The urge is still an 8. Youre doing great, sweetie, I tell her. I know its hard. Lucy smiles into the mirror, right at me. She knows Im there.

24

July 15, 2012: Jokers Wild.

By PAUL VANDEVELDE Even if I live to be a thousand years old I wont forget my rst panic attack, that rst surreal journey into the paranormal dimensions of my cerebral cortex. Decades later, the memory is all white heat and jagged edges. Psychologists call these acute anxiety episodes little deaths, but victims of them will tell you there is nothing little about them. Next to a panic attack, death, when it nally comes, will be skipping through tulips. It was a sweltering July day in 1980 and I was sitting in a Manhattan restaurant a few blocks from the Plaza Hotel with 70 carats of emeralds in my pocket. The stones were fresh from the infamously lethal Muzo mine in Colombia, and as a favor to a good friend who had smuggled them into the country, Id own to New York the day before to meet with a gem dealer, the father of a college friend from Brooklyn who had connections. Drinks with friends until 3 a.m. the night before was not the best idea, and the pitcher of black coffee I poured down my throat in the Palm Room a few hours later ooded my central nervous system with Jamaican voodoo and highvoltage insults. So after a testy morning of bickering over occlusions and color and squinting through jewelers loupes, I was a little on edge when the gem dealer invited me to lunch. I heard a mufed linguine Alfredo, and thats when the lm snapped. I rst noticed the seizures in my ngers when we were seated bizarre, neurological twitches that made my digits dance like grasshoppers on the linen tablecloth. A tic in my left eye kept shuttering my vision. The dining room was jammed to the eur-de-lis wallpaper with red-faced white guys in blue suits and harried looking waiters in penguin costumes. Not my crowd. I remember hearing a mufed linguine Alfredo and the clinking of glasses at another table, and then the lm snaps.

This, as Ive come to think of it, was the moment my rst life stopped, where the lm broke and the reel spun around and around, ogging itself. I couldnt move. I was suddenly, inexplicably, paralyzed with anxiety. As researchers would learn years later when they peered into our brains with PET scans, the electrical messaging between the amygdala and the anterior cingulate in my brain had gone Tilt! The sudden storm of impulses surging between these tiny glands lit up my central nervous system like a Christmas tree hit by lightning. A neurological journey measured in milliseconds launched me across a threshold wider than any ocean, from my happy-go-lucky, anything-goes carnival of a life to a place that was scarier than the hospital scene with Heath Ledgers Joker playing Russian roulette. The initial tremor of voltage wormed its way up the back of my neck in a vertiginous rush of heat. Before I could grab the table to steady myself, the snake uncoiled itself inside my head and struck my prefrontal cortex with a ferocity that made my heart pummel my ribs, trying to break out. In a ash, my arms and legs went numb from the elbows and knees down, a band of steel encircled my head, I trembled, sweat poured off my forehead, and the spinning behind my eyes was speeding up. Are you all right? asked the dealer. Get me outta here. I couldnt actually shape the word dying with my mouth, but thats what I thought. Thats what I felt. This was it, the Joker, his hot tongue slobbering all over me. I reached for a glass of water but it ew out of my hand and shattered. I pushed back from the table and stood up and my friend caught me before my legs buckled. As we made our way to the door all I could think about was my wife and our 11-month-old son. They were so far away. I would never see them again; this was curtains. What I couldnt know at that moment was that Id crossed a frontera, a border crossing separating my old life from the new, and there was no way back, any more than I could return to my mothers womb or rewrite my genome. This was the new

me, a verdict with no appeals, no chance at parole. My brain had betrayed me, and in this new life I would have to learn how to function in a suspended state between the deadening banality of the exterior world and the theater of the absurd that tormented me from within. I was now living with an intimate stranger, trapped, it seemed, between two profoundly distorted mirrors with no way out. Once outside, I managed to get my bearings, but the storm raging at the center of my brain was getting worse. Panic deepened with each breath. The dealer took my pulse and blurted an expletive. Can you walk? I know a doctor up the street. Somehow, we got there. The next two hours are phantom memories. My heart was beating so fast 220 beats a minute according to the doctor that very little oxygen was getting to my brain. The doctor, an elderly German with kind eyes and soft, thick hands, laid me out on a bed in his ofce, covered me with blankets, gave me a shot of a barbiturate, and I was gone. When I came around a little while later, he said, You have experienced an acute anxiety attack. I think youre going to be ne, now, but I want you to take one of these if it ever happens again. I took the small vial of pills, thanked him profusely, and got up and left. Thus began my descent into the world of acronyms (EEGs, EKGs, G.A.D.s, LMNOPs), bewildered doctors, frustrated psychologists, and a three-ring circus of pharmaceutical adventures. Years later, after my second stint in a clinical study on depression and anxiety at the University of Arizona Medical Center, I made a T-shirt that read, Lab Rat. I ew home to Montana with a vial of Valium, a few emeralds and a rationalized story that I had gotten a bad oyster. I wanted more than anything to believe that story, but it was only a matter of time before the hair-trigger in my amygdala wasted that fantasy. The second time the Joker struck was on a snowy evening the following November as I was rocking my son to sleep. The attack was ruthless, without warning, another

world-class humdinger of a meltdown. This is not good, I told myself as I waited for the doctor in the emergency room, this will not end well. The attacks came in shorter intervals over the next few years, and I soon learned that I knew more about acute anxiety than most of the doctors treating me. Tests revealed nothing abnormal. Their bewilderment was palpable. My refrain, There has to be an organic source to this, fell on deaf ears and glazed eyes as they scribbled out yet another prescription. Even 25 years ago, before PET scans and other imaging break-throughs, the inner workings of the human brain were an enigma to medical science. My doctors didnt know that their best efforts to control the beast in my head were making the beast more and more uncontrollable. Desperate, I threw myself into my work. Photojournalism forced me to break through the gravitational eld pulling me inward, to turn outward and engage the world through the viewnder. That hope, like so many others, was in vain. Nothing worked. Then one winter evening, a neighbor, a ministers wife, knocked on our door. I cracked it open a few inches and saw her kind, gentle smile. I think I know how youre suffering, and I think this might help, she said. She slipped a blue clothbound book through the slot: Peace From Nervous Suffering, by Dr. Claire Weekes. This is for you. I have my own copy. I read it cover to cover, that night, and then I curled up around that book and wept. Finally, someone understood my living hell. I wasnt alone. As a journalist I covered wars, presidential campaigns, natural disasters, you name it, all with the Joker on my back and that book in my camera bag. Claire Weekes went everywhere I went. She was a brave and brilliant pioneer in the eld of emotional brain physiology, and her fearless insights and calm compassion gave me a ghting chance against the black pit of despair, a place to plant my feet on solid ground when the world all around me was heaving with madness and dissolution. But she, alone, could not stop the attacks. They kept coming, those E-tickets on the Anxiety Express, with varying intensity and varying frequency. You havent explored the far-

thest reaches of the existentially surreal until youve had a grand mal panic attack during an 8.2 earthquake in a war zone in the middle of the night. Alone, in a foreign country. Peak experience. Inevitably, the 10-year-long addiction to Valium led to intense medical detox, including a course of Dilantin to stop the seizures, and a year of mind-bending withdrawals from the benzodiazepine curse. Then came the terror of confronting the world metal-on-metal, without a buffer. This was yet another new frontera, the border crossing into my third life. If you survive this last crossing, youll always have something to laugh at, yourself, and an experience so absurd in its comedic/tragic dimensions that the only possible venue for objective reection is in the funhouse mirror of the everyday. I survived. The Thorazine, imipramine, benzodiazepines, opiates and rivers of alcohol, the serotonin reuptake inhibitors, the uppers and downers, inners, outers, laughers and screamers, are all markers of a distant past. I havent had a panic attack in many years, but theres always tomorrow, or tonight, or 10 minutes from now. Ruthless, unprovoked, no warning. When I paid my 10 bucks a few years ago to see Batman: The Dark Knight, one glance at the hideous feral leer of Heath Ledgers Joker took me right back to that July day in New York City. Ledger was a brilliant, once-in-a-generation talent beset by the emotional anarchy of acute anxiety and one or more of its sinister rst cousins; depression, insomnia, isolation, mania, personality disintegration and O.C.D., and thats just the front row in the family portrait of demons. By the time the lm was released, Ledger had already fallen into the abyss with the help of a cocktail of prescribed remedies, but of this I am certain. His Joker was no illusion, no dark fantasy of his imagination. His Joker, whom he described as a psychopathic, mass-murdering, schizophrenic clown with zero empathy, was the real deal, the mocking personication of the intimate beast trapped between two mirrors in both of our heads. When Jack Nicholson who played the Joker in 1989 was informed of Ledgers death,

he cryptically told reporters: Well, I warned him. Its a shame that our six degrees of separation could not be narrowed to one. Maybe, just maybe, I could have thrown that young man a life ring on a stormy night. Maybe I could have slipped a blue clothbound book through a crack in his door and somehow made a difference. And maybe not. Well never know. The Joker got there rst.

25

July 23, 2012: A Desert Beyond Fear.

By JANA RICHMAN

Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom . . . Bertrand Russell On a cold, sunny day in early March, my husband, Steve, and I layered up and took ourselves out to our backyard: Grand Staircase Escalante National Monument. For a few days we had been spiraling downward through a series of miscommunications and tensions the culmination of my rigorous dedication to fear, or what Bertrand Russell aptly coined the tyranny of the habit of fear. A fresh storm had dropped 10 inches of snow with little moisture giving it an airy, crystallized texture that sprayed out in an arc with each footstep and made a shushing sound, as if it were speaking directly to me. Shush. Shush. Shush. My fear began roiling, slowly at rst, but soon popping and splashing out of its shallow container. Moving into the elegant world of white-draped red rock is usually enough to strip our minds of the qualms that harass us, but on this particular day, Steve and I both stomped into the desert bearing a commitment to hang onto the somber roles we had adopted. Solemnity is difcult, however, when one is tumbling down hills of snow-covered, deep sand and slipping off steep angles of slickrock on ones backside. Still, it took a good half-mile before we were convinced of our absurdity. Such is the nature of the desert. If you persist in your gravity, the desert will take full advantage it will have you falling over yourself as you trudge along carrying your blame and angst and fear; it will mock you until you literally and guratively lighten up and conform to the place. The place will never conform to you. We knew that; thats why we went. Thats why we always go to the desert when were stuck in a cycle of self-induced wretchedness. Fear, Russell writes, makes man unwise in the three great departments of human conduct:

his dealings with nature, his dealings with other men, and his dealings with himself. Mikkel Sommer I can attest to the truth of Russells words. Ive spent many lifetime hours processing fear, and Ive brought fears oppression into my marriage. Because fear is the natural state of my mind, I often dont realize Im spewing it into the atmosphere with my words and actions. The incident that drove us into the desert on that particular day was, in my mind, a simple expression of concern, a few what will happen ifs; in Steves mind, a paranoid rant. Upon reection, I have to agree with his version. A few months prior, Steve and I had decided upon a change in our lives: certainty in the form of a bi-weekly paycheck was traded for joy in the form writing time. It wasnt a rash decision; it was ve years in the making. Yet, from the moment the last check was cashed, my fear began roiling, slowly at rst, but soon popping and splashing out of its shallow container. My voiced concerns regarding homelessness and insolvency went considerably beyond probable, falling to the far side of remotely possible. In my world, thats enough for worry, discussion, obsession, more discussion, and several nights of insomnia. We had parked the truck at the head of the rocks, an understated description of a spot that allows a 360-degree view of red and white slickrock cut with deep gulches and painted with the sweeping wear of wind and water. The Grand Staircase Escalante National Monument is 1.9 million acres of land, much of it devoid of human intrusion on any given day. Before we moved to the small town of Escalante on the Monuments border, we came here from our city home ve hours away alone or together whenever life threatened to shut us down. From the head of the rocks, we followed the old cream cellar road, a wagon trail of switchbacks carved into stone in the early 1900s. We could see our destination about two miles out a smooth, jutting wall with a level run of sand at its base that would allow us to sit with our faces to the sun and our backs against the wall a tting spot. Steve walked behind me in silence, but I knew his thoughts. My fear perplexes and disparages him. His acts of heroism should dispel my anxiety, but it persists beyond the reach of his love. Yet,

his love, too, persists. Knowing Ill pick up and read anything placed in my path, Steve had left on the butcher block where I eat breakfast Russells timeless collection of essays, New Hopes for a Changing World, published in 1951, ve years before I was born. I skimmed the table of contents until I reached three essays entitled, Fear, Fortitude, and Life Without Fear, in which Russell writes about the pervasive and destructive nature of fear. One of the signicant fears Russell writes about a fear close to his own heart is the fear of being unlovable, which, he writes, is self-fullling unless one gets out from under fears dominion. Ive been testing Russells theory for the past eight years. Ive heard it said that all fear stems from the knowledge of our own mortality, and indeed, many of our social systems thrive by exploiting our fear of death and our desire to thwart it. But fear of death has never been my problem. To me, life, not death, holds the promise of misery. When life is lived as a problem to be solved, death offers the ultimate resolution, the release of all fears, the moment of pure peace. By the time we had dropped from the head of the rocks halfway down to the scooped-out basin below, I could feel Steve letting go. His stride had become rhythmic, his foot placement sure. Without surprise, I noticed the same of myself. Steves 64 lanky frame ows effortlessly through the desert. He blends with his environment like a native species skin the color of sandstone, eyes the color of juniper berries. If I turned to look at him, I would see a serene expression on his face, his hands held in front of his chest, the ngertips gently touchinghis walking contemplation pose. When we reached our destination, Steve pulled a space blanket out of his pack and spread it for us to sit on. The warm rock allowed us to discard several layers of clothing before resting our backs on the wall and tipping our faces upward. Steve placed a hand on my leg. In his autobiography, Russell wrote, In general, I nd that things that have happened to me out-of-doors have made a deeper impression than things that have happened indoors. A curious statement upon rst read, but my desert rambles have conrmed that nothing illuminates irrational fear more brilliantly than sun bouncing off slickrock.

My fear is a bit much, I said. Yes, Steve said. The tyranny of the habit of fear, I said, quoting Russell. Yes. Sometimes in the mornings I wake up feeling as if my world is about to y apart, and it takes a few minutes to pull myself back into my bed, my bedroom, my house the one where my kind husband moves around the kitchen making coffee, the one where a sweet, asthmatic cat has taken up the still-warm, vacated space on the bed next to me. I once had a therapist tell me that I likely learned my fear at a pre-verbal stage of life, which means, as I understand it, it got hard-wired in my brain. She called it Armageddon Syndrome. It is the deep nature of my fear that makes it an all-ornothing proposition for me, something that needs to be treated like an addiction. Dabbling in it, however briey, can bring on a full-scale blackout. The only option is letting go entirely one moment at a time. Ive had throughout my life what I refer to as moments of bravado a sudden urge to push myself beyond my fear in some big way. Those are the moments responsible for the signicant changes in my life. They took me from my hometown of Tooele, Utah, to a Wall Street job in New York City, from nance to writing, and from New York City back to the West where I belong. Ultimately, my moments of bravado took me to the deserts of the Escalante, a place so stunning in its grandeur it dees fear. If ever there were a place on earth that allows one to enter and dwell at peace, this would be it. From the outside looking in, my moments of bravado may appear as a connected life a life lived with courage and intent. Yet each moment was taken in sheer terror. In The Courage to Create, Rollo May writes that Kierkegard, Nietzsche, Camus and Sartre all dened courage not as the absence of despair but as the ability to act in spite of it. If I go by that denition, I can technically call myself courageous. Treating my fear as an addiction that doesnt allow wavering often means placing myself in what others see as risky situations: How wise is it, for instance, for a woman whose deepest fear is nancial destitution to quit her job (the one with a good salary

and health insurance!) during the worst economy on recent record? The answer lies in Russells words: Until you have admitted your own fears to yourself, and have guarded yourself by a difcult effort of will against their mythmaking power, you cannot hope to think truly about many matters of great importance . . . Fear is noisy, and it takes up a lot of space. Very little else including matters of great importance can break through. But at times, I can sit long enough to quiet the din of fear. When I do, in the part of my gut that is often churning with anxiety, I know that thoserisky decisions are the only things that do keep my world from ying apart. When I wake up in the swirl of Armageddon, I have two choices: the rst is to lie in bed convincing myself that the media headlines loom near I will soon lose my house, my husband, and what little money I have. I can probably keep the cat, but he and I will be sharing a food bowl. The other choice is the courageous choice: get out of bed, open the blinds, and look to the east where the Escalante River gorge cuts through the sunlit ridge.

26

July 29, 2012: The Song Remains the Same.

By DANIEL TORDAY About 10 years ago, when I was in my early 20s, I started playing bluegrass mandolin in earnest. Days I worked as a magazine editor and drafted a novel I hoped one day to publish. Nights I cultivated a dream that if things worked out right, I might have a band successful enough for me to play full-time. To appear professional enough I bought an expensive Flatiron, F-5 style mandolin. A Hungarian great-aunt who had lived in Upper Manhattan since before the war had left a small sum for me to start up life after college. What I didnt spend on rent and whiskey (not necessarily in that order) in those early years in New York City I spent on this ornate mandolin. I fussed over and doted on it. It was my baby. Soon I got to playing with a band. Many nights we had gigs at places like The Parkside Lounge, The Rodeo Bar and CBGB (so named, despite its punk pedigree, for Country, Bluegrass and Blues). But on Wednesday nights I went to the most established bluegrass jam in the city, at the Baggot Inn, on West Third Street. Vestiges of the 60s folk revival were there: guitarists and ddlers who had played with Doc Watson or Bill Monroe would stop in. At the front of the bar people played Old-Time, a genre distinct from bluegrass in that the same song could go on for 10, 15 minutes, no singing or soloing. At the back was the antic energy of hard-driving bluegrass: people singing tenor harmonies, and

between each verse, a chance for the ddles, guitars, banjos and mandolins to take a solo, or a break, as it is known. I was still learning to play then. The experience of leading a song was nerve-racking. Songs were played at 140 or 150 beats-perminute. All at once the leader had to signal the harmonic structure of a song, sing, nod at a player to take a break and even take one himself all while making sure the double-bass player and at least one guitarist were holding down the rhythm. Early on I would sit at the edge of a large circle, cradling the F-5, picking out melodies as my whole body tightened at the idea of getting up there. Id had no experience to prepare me. Id never acted in a play, not even in elementary school. Just the thought of it made my palms sweat. I was the singer in a cover band in high school we mainly did bad versions of late Nirvana songs. Id written magazine pieces that reached hundreds of thousands of readers, but magazine audiences were an abstraction. No one applauds, boos or throws a half-empty beer can at a magazine article. Within a couple of months I began to lead songs. Its easiest to sing the highest note in your register loudest. I could sing loudly. Mistakes get covered over when you play fast. I could chop hard and in time. But when time came to take a break, I found the ngers of my left hand clutching my mandolins neck so they would barely move. After a couple minutes, pain shot through my shoulder. A couple of months in, my whole left side would knot so tight that if I lifted my hand over my head I could give myself a foot cramp. One night the fastest, loudest picker there, a guitarist with tattooed ames running up his arms, came up to me at the bar. You were clamming up real bad out there, the Tattooed Guitarist said. Clamming up? I said. The phenomenon I was experiencing had a name, known to every experienced picker. When playing in front of people, at speed, one would clench tight, like a clam protecting precious nacre. The harder one tried to undo it, the harder he clamped.

I looked down at the index nger of my left hand. It was bleeding from clutching so hard. Clamming up, I said. Just stop thinking so much, Tattooed Guitarist said, and he handed me a drink. They call it playing for a reason. So go play. Over the months that followed, I talked to Tattooed Guitarist more. I thought less. When I started thinking about taking a break I would look over at him, his long hair pounding against his back, his hands loose. Sometimes Id start taking a break without even knowing I was taking it. I started to clam up less. My ngers developed calluses. But my nights at the Baggot would soon end. I left the city for a graduate ctionwriting program upstate. I got married and bought a house. I found a teaching job in Philadelphia. The Baggot itself ended, too, when it closed its doors for good in 2008. The bassist in a band Id been in back in Brooklyn lived in West Philly. He called his bass a bull ddle. He brewed his own beer in his large basement, grew hops that crawled up and over his three-story row house. We started a traditional bluegrass band. There werent as many venues in the Sixth Borough. We played when we could. My wife got pregnant. When she was 20 weeks along I told the band. We were on the bassists back porch. Were having a baby, I said. I dont even remember sleeping together, our banjo player said. Huzzah! our guitarist said. But I guess thats the end of the band. No, no, I said. It was late fall. Hops crawled all the way over the top of Bull Fiddlers house. Hops growing over a bassists house must be a metaphor for something, I thought. Later

that night, I put my hand on my wifes growing baby bump and felt remarkably calm. ~~~~~ Baby came at the end of March. She was perfect. The midwife let me catch her. I was teaching full-time and I had the summer off to take care of her. My wife was a medical student, working long hours at the hospital, and child care fell to me. I worried I wouldnt nd any time to work on the novel, let alone play music. When she naps, my wife said, you can write. I was deeply invested in getting Baby to sleep. While she sat in one of those bouncy chairs I played her my mandolin or read from Healthy Sleep Habits, Happy Child, which my wife and I began to refer to as the Bible. It gave tips and explained how the babys sleep would progress over time. Id worried I might never get her to sleep, so what it said to do, I did. A Dad-Friend who I knew to be an expert parent came over one day. He explained that my job was to recreate the feeling of the womb. The rst three months of Babys life, he said, were known as the fourth trimester when the infant was out but wanted to be in. He said my job was to hush very loudly in Babys ear while rocking her. Dad-Friend showed me with a football he swung the pigskin like his arms were the Pirate Ship ride at the state fair, and roared like he was trying to get a particularly obstinate hair out of his throat. Dont just whisper it, he said. Its not a game. Dont be afraid to really roar. During those rst months I would stand in Babys room for a half hour or more, rocking her hard and hushing loud until my shoulders cramped. While I rocked Baby I would strain to picture the place on the page where books said to rock, to roar, to remember exactly how Dad-Friend had showed it. My stance was wide. My elbows were clutched. I thought about it. A lot. Babys eyes were wide, too. One afternoon a month into summer, I just couldnt get the nap going. Baby cried.

I was too tired to think. I rocked. I hushed. My mind drifted not to Dad-Friend, or parenting books, but to the scene Id been working on in the novel I was writing last nap time. I entered it, as if in a dream, and got lost. My body moved automatically. I did not think. Suddenly I was just playing, moving less than before, hushing more quietly. When I looked down, Babys eyes were closed, lids shot through with purple vein. She was asleep. As I put her down softly in her crib, my arms were clam shells, just loose enough to show off their shining treasure.

Part VIII

AUGUST
27 August 06, 2012: My Son, Lost and Found.

By DAVID KRAMER My son, who is 12, loves living in Manhattan. He thinks our neighborhood is great. One day last year he told me he never wanted to leave Chelsea. He could live here the rest of his life, he said. I told him he was very lucky to feel this way, but he was going to have to get his own apartment. Despite what my wife may tell you, I am not cruel and inhumane. I am not trying to prematurely push my son out the door. I do, however, see it as at least part of my job as a parent to create an independent, self-sufcient young man by the time this is over. Believe me, I am sad that the hand-holding days will soon end, but Im sure he is going to have much more fun when he is out there on his own.

Lately, I have been encouraging him to try to get out of the house alone. He goes to a school that picks him up in a bus, and so he rarely takes to the streets without a chaperone. He is not quite up for all that independence yet and I respect that. One of his after-school activities is fencing, and even the prospect of walking down Seventh Avenue carrying his sword doesnt give him the condence he needs to be a solo act on the streets of New York. When I was very young my family moved out of the city and up to New Rochelle, N.Y. Both my parents worked in Manhattan and although we had a housekeeper, I rarely remember going anywhere with anyone to watch me. I am not trying to sound like a latch-key kid, but I dont recall doing much more than yelling an approximate destination out loud to no one in particular as I was leaving my house. We kids were all on our own on the streets starting in kindergarten. That didnt seem abnormal at all back then. ~~~~~ All this got me thinking about the day I lost my son at Coney Island. He was 4. At the time it was the most traumatic moment of my life. Wed had some friends in town from Hawaii and wanted to show them what a real beach looked like. So we all trekked out there me, my wife and son, along with our friends and their two pre-teen boys on a stiing hot day. It was the day of the Mermaid Parade, so the place was swarming with every kind of person in every kind of costume imaginable. The kids were having fun on the rides. At some point, my son told me he had to go to the bathroom, so we left the others behind and walked toward the rest station on the boardwalk. The bathrooms were packed and we waited in line. My son went to the urinal rst and I stood behind him. When he nished I told him to step back and wait right there while I took my turn. I remember when I was a boy my grandfather would take me and my sisters to Coney Island. He had cousins living across the street from the band shell off Neptune

Avenue and whenever we went with him to visit the bright lights of the amusement park drew us over there. My grandfather hated the place it was full of Shvartzes, he said. But we would beg him to take us and eventually hed give in. On one of those trips I had an emergency and he took me into the bathroom, which was very crowded, gross and wet. There were no doors on the stalls so my grandfather stood in the doorway to block anyone elses view. But for some reason he did this facing me. So I just sat there for a while. It was not until he turned around that I was nally able to go. Anyway, there I was now, in maybe that very same bathroom, and when I nished and turned around my son was gone. The bathroom was chaotic. Turnover rate was high. People rushed in and out, milled around the lines and changed clothes. I could not nd my son anywhere. Whatever fears I was having about all of these half naked men and boys and closed doors and every bad thing imaginable happening was only being trumped at that moment by the fear of calling my wife to tell her what I had done. I ran around to the other set of toilets around the corner, and then outside, which was even more crowded than the actual bathrooms, with people waiting on their friends. He wasnt out there either. He was gone! I ran back into the bathroom and saw a big guy sitting on a bucket near the door in a Parks Department T-shirt and asked if he saw a little kid. I saw you come in with him, he said. I knew this guy wasnt capable of much further help so I ran circles around the bathroom and out into the crowd, my mind racing What the hell am I going to do? Then, just as I ran out the door, like magic, the crowd seemed to part slightly and there was my son, standing there, oblivious to the fact that hed been lost. I dropped to my knees and hugged him. This would have been the perfect ending scene to a Hollywood movie, if not for the disgusting puddle of water that I was then kneeling in.

I gave my son a stern lecture, but as I said, he had no idea what hed done. When we got back to our group at the amusement park, I spilled the beans to my wife, who I can tell you by her reaction to the news that he was safe, would have killed me if he had actually disappeared. ~~~~~ I am an artist and work in Williamsburg, Brooklyn, where I have a studio. Sometimes, when my son is off from school Ill take him out there to work with me. He loves that neighborhood, too, and he is somehow more condent there than he is in Manhattan and will venture out on his own. There is a doughnut shop nearby that he is nuts about. Sometimes I let him walk over there from my studio alone. He knows the way. On the day of my sons 12th birthday, he was with me all day. I had a busy day planned for myself workwise. I was installing a show at The Boiler, a project space near my studio. In the afternoon I had a meeting back at the Pierogi gallery (which owns The Boiler), a few blocks away. And in between the installation and the meeting, we had to run back to Manhattan to organize a trip out of town the next morning. Not the best birthday for a 12-year-old, but the next day we would be off for the whole weekend. My son who does have a name, but has forbidden me to use it here was totally bored with idea of the return trip to Brooklyn, but on the way there I promised him a doughnut for his cooperation. Once we got back to Brooklyn, we agreed, he would walk to the shop on his own. When we got off the train he told me hed forgotten his wallet and phone. I told him that without his phone hed have to wait for me to get his doughnut but he was having none of that. As a newly minted 12 year-old, he can be very insistent. As most parents know, there is often no way to argue with a kid who thinks he knows everything.

On top of that I was getting stressed and losing patience. I was late for my meeting and now I had this 12year-old telling me what to do. Go, I told him. There is always a lot of pressure when you are installing a show in a gallery. For this one I had made a piece that was unusual for me a small-scale version of Fallingwater, the Frank Lloyd Wright house, complete with a pump and a waterfall of actual running water. Just that morning my son and I had introduced live goldsh into the pond. This piece was for me a tribute to the summer house that I never have the time or the money to buy or even rent for my family. So this was the plan: He would walk to get his doughnut, taking a specic route. If my meeting nished quickly, Id go to the doughnut place and nd him, taking the same route. If he nished rst, he would walk back to the gallery the same way. If we left at the same time, wed cross paths. We said something about the L train station and the gallery, but who cared? He was mad and I was late. I was O.K. with this. To me Williamsburg and Greenpoint have been very safe places. Ive been working or living there since the 1980s. You could get lost and there were always drunks walking around, but I liked the fact that you could almost always see the Manhattan skyline across the water, like an enormous nightlight to guide you. My meeting went quickly so when I was done I started out after him. As I was walking past McCarren Park it occurred to me that he had to be on his way back by now. It cant take that long to eat a doughnut. I was starting to see holes in our plan. We never discussed what side of the street to walk on, and with the cars and people it was hard to see both sides of the street at the same time. There were lots of hipsters and drunks in the park did he know not to talk to them? I kept assuring myself he was too smart for any of that, but with every step I took my panic was rising. I was sure I would see him when I turned the last corner, but I didnt. I began to walk faster now hoping hed be in the doughnut shop. I walked in, gave the place the once-over and turned white.

My mind was racing now. My heart began to pound the same way it did Coney Island years ago. Where could he be? What I would have to tell the police? What would I tell my wife? I was kicking myself for letting him go without his phone, but I kept trying to stay calm: Everything is going to turn out all right. Ill nd him. Just then my phone rang. It was someone from The Boiler. I was hoping that somehow my son had found his way there, but no my piece had sprung a leak and there was water dripping all over the oor. Now I was really a mess. Not only was my son a missing person, but my art career was going down the tubes with him. I ran to the gallery and asked if anyone had seen my son. No. I turned and took off for the L train two blocks away. He wasnt there either, so I turned and ran back toward the gallery when my cell phone rang again. This time it was the gallery. When I answered I heard my sons voice. He was there. When I got to the door he was already standing outside. This time he was really scared. He gotten totally lost and never found his doughnut. We hugged. He told me that he had gotten so lost he cried. He told me how he tried to retrace his steps. I dont know how we missed each other or why but I was so relieved to see him I didnt care. He told me that on his second pass by the gallery he had asked someone to call me. I told him I was proud of his decision making even though he had been so impatient at the beginning. I explained to him how difcult it was to give him directions before he left when he kept insisting he knew what he was doing. And I told him that I wouldnt want to keep all of this from his mother, but that I would leave it up to him to tell her. Back at The Boiler, I emptied out the sh and the water and devised a plan to x the piece later that night. My son never said a word and waited patiently for me to nish. When I was done I asked him if he still wanted that doughnut. He said no. Maybe the getting lost thing took the good doughnut vibes away from him. But I insisted.

We went to the shop and he had his doughnut while I had an iced tea and we relaxed for a few minutes. It was so nice to sit together at the counter while he ate. That evening, when my wife came home, the rst thing my son did was tell her about his getting lost. I left them and went back to x my piece. Riding the train there I remember thinking that when we were kids we had no cell phones and got lost all the time. And I was thinking about my son and how glad I was he was safe at home with my wife, and that maybe somehow getting lost and then found was the best thing that ever could have happened. As much as I want my son to get out the door and feel good on his own, I am not in such a big rush for that to happen after all.

28

August 11, 2012: The Anxious Idiot.

By DANIEL SMITH One day last year, I called my brother Scott in a state of agitation, self-hatred and incipient despair. Scott was at work and short on time. I got straight to the point. Im in a state of agitation, self-hatred and incipient despair! I cried. Tell me more, Scott said. What is it? Im anxious again! Im anxious day and night. I wake up anxious and I go to bed anxious. Im a total wreck. And Im not doing anything to help myself! I know what helps and Im not doing it! Whats wrong with me? Why am I not doing the things I know full well will make me feel better? Oh, Scott said. Thats an easy one. Its because youre an idiot. Then he said hed call me after work. When Scott called me an idiot, I initially took it as a joke a bit of sharp-elbowed levity meant to nudge me out of my morbid self-involvement. As a brother, friend and fellow anxiety sufferer, Scott has license to make such jokes. And they help; they truly do. But the more I think about Scotts comment the more I come to see it as containing real wisdom, as well as the power to explain one of the particular hells of anxiety: its tenacity. Like many people who have been given a diagnosis of an anxiety disorder (and many who have not), I am always braced for the next recurrence. Anxiety, like the

tide, is forever receding and returning, receding and returning. I have been experiencing this pattern for nearly 20 years now, so that my anxiety has come to seem, at times, inevitable and unassailable a fait accompli. My anxiety, Id concluded, is what I am. There is no escape. Thanks to Scott, I am now coming to understand that this is not true. Thanks to Scott, I am now coming to understand that anyone, even the most neurotic of souls, can lessen and even elude anxiety, so long as he heeds a simple dictum: Dont be an idiot. I should dene idiot for our purposes. I dont mean someone of low I.Q. or poor academic abilities. Intelligence as commonly conceived has nothing to do with it. By idiot, I mean exactly what my brother meant when he tagged me with the epithet: an impractical and unreasonable person, a person who tends to forget all the important lessons, essentially a fool, one who willfully ignores all that he has learned about how to come to his own aid. A person who is so xated on the fact that he is in a hole that he fails to climb out of the hole. An idiot, in short, is someone who is self-defeatingly lazy. Laziness: it isnt a characteristic usually associated with the anxious. Hysteria, yes. Clamminess, yes. A shrill speaking voice, often. But laziness? If anything, people tend to view the anxious as more active and motivated than normal, because they are more haunted by the specter of failure. And yet long experience has taught me that it is laziness and not enclosed spaces, social situations or any other countless triggers that is the foremost enemy of the anxiety sufferer, for laziness prevents him from countering the very patterns of thought that make him anxious in the rst place. Its true that the anxious are rarely slothful in any typical sense. Its more that we tend to be undisciplined, or somehow otherwise unwilling to see our anxiety for what it is a habit of mind. To the argument that anxiety is not a habit but an afiction, Id respond that the two are not mutually exclusive. Anxiety may come on like an afiction, but it persists due to habit. Or, to put this another way, just because you are aficted with a mental disorder doesnt mean that you cant apply your conscious

will to mitigating that disorder. Even if you use medication, as I do, to coax your nervous system in a more salutary direction, your will your determination to act in a way that is counter to your nature still factors in. Indeed, I am convinced it is essential to recovery. This isnt to say that being willful is easy. Anxious thoughts the what-ifs, the should-have-beens, the never-will-bes are dramatic thoughts. They are compelling thoughts. They are thoughts that have no compunction about seizing you by your lapels and shouting, Listen to me! Believe me! So we listen, and believe, without realizing that by doing so we are stepping onto a closed loop, a set of mental tracks that circle endlessly and get us nowhere. This makes the anxious habit very hard to break. Over time those mental tracks deepen and become hardened ruts. Our thoughts slip into grooves of illogic, hypervigilance and catastrophe. My own mind, I am fairly certain, will always gravitate toward anxiety. And like many, I will often be disinclined to do anything about it. The reasons for this are no doubt complex and myriad. But it is certain that anxiety is exhausting and demoralizing: in many cases, as you listen to your anxious thoughts you get tired and apathetic. You get depressed. And that hopelessness, inaction and despair can become a sort of cocoon, a protective layer between you and the high-pitched terror of it all, and maybe, over time, even a painful and perverse comfort. But that doesnt mean and here is the good news that there is nothing we can do about anxiety. Indeed, there is plenty a person can do. The promising thing about a habit is that it is not the same thing as a fate. An alcoholic, we are told, is always an alcoholic but not every alcoholic drinks. Similarly, an anxious person will always be at risk of anxiety, but he neednt be troubled by it on a daily basis. He can avoid his own tendencies. He can elude his own habit. To accomplish this, however, he has to work, and work hard. He has to ght every day of his life, if hes got it bad to build new patterns of thought, so that his mind doesnt fall into the old set of grooves. He has to dig new tracks and keep

digging. As for what that digging entails, I have my preferences. Over the course of my anxious life, I have found two reliable methods to keep my anxiety at bay: Zen meditation and cognitive-behavior therapy. Both methods teach, in their own fashion, that ones thoughts are not to be taken as the gospel truth; both foster mindfulness and mental discipline. But you will likely have your own favored methods. You might nd yoga, or exercise, or therapeutic breathing, or prayer are what work best for you. Im not sure it matters what a person chooses so long as he chooses and keeps choosing. So long as he remains dogged. Anything else, as my brother might say, is idiocy.

29

August 20, 2012: Childs Play.

By KARA BASKIN When I left you back in March, it was with the tale of my agoraphobic honeymoon meltdown in Hawaii in 2006, where I was last seen curled atop a starchy bedspread watching reruns while my husband paced to and fro, wondering whether to call a psychiatrist or a divorce lawyer. Readers e-mailed me to inquire after my health. Did I ever shut off the TV? Did my husband leave me once we hit the Lower 48? And how did Roseanne end again? Thankfully, my husband did not bolt, but he did shepherd me into treatment before his tan wore off. Over time, Zoloft centered me, Valium blunted the panic attacks and a very patient psychotherapist helped me locate an inner resiliency that, until then, had come in the form of bad takeout and couch cushions. Eventually, anxiety faded into the background, like a large pet that needed to be fed and patted on the head every so often. In fact, after a couple of years, my husband and I talked about starting a family. He wanted kids. I did too, but I had to wonder was this a good idea? Frankly, I was worried about my past: If I couldnt hack it at the Old Lahaina Luau, what hope did I have at Mommy and Me? I had visions

of succumbing to extreme panic with my as-yet-unborn child bringing me burritos in between Sesame Street episodes. At the time, the only thing I had in common with an infant was the ability to sleep 20 hours per day. The idea of getting pregnant wouldnt have been so jarring, really, if I couldve continued to take my medicine. Yes, there is a happy mothers equal happy children camp that believes SSRIs during pregnancy is protective, but I wasnt willing to run the risk of birth defects. (When you waste hours surng the Internet for ways to convince yourself that death is imminent, courting a legitimate gestational health risk seems insulting.) And so, after months of ferrying from gynecologist to psychiatrist to online chat boards, I opted to taper my medication, secure in the knowledge that Id been healthy for years. Refreshingly, during nine months of drug-free pregnancy in 2010, I felt downright placid save bread-loaf ankles. Maybe it was the hormones. But maybe it was the subconscious certainty that disaster just wasnt an option any more. The fears that were such currency to me, paralyzing loops of worry about death and dying and nancial insolvency, had faded away. On the other hand, immediate concerns regarding crib-shopping and color schemes seemed foreign, simple, and deliciously trivial. I remember thinking as I pre-ordered a set of onesies, trying to decide between blue or yellow: This is what normal people do. Not shockingly, having a baby and quitting my meds did not transform my predilection for worry. Instead, it reframed it. Not long ago in this series, Elizabeth Gold wrote Meltdown in Motherland, which eloquently chronicled her post-partum anxieties in a way that made me slightly, well, jealous. Unlike Gold, my anxiety which returned as surely as my ankles deated has very little to do with being a mother. Were that the case, it might feel more socially acceptable. Instead I fear bizarre, rather non-maternal things like ending up homeless and alone with my toddler in a cardboard box, eating cat food. Sending e-mails accidentally laced with profanities. Not being able to provide for my son because my boss intercepted said e-mails and red me, but not before Tweeting my ineptitude to

the world. There are post-partum groups for people who are depressed or who dont feel affection for their newborn. Ive yet to nd a group for people who feed their babies with one hand while checking their high-school savings account balances one more time with the other. I tried to channel my anxiety in routine ways, trolling Internet message boards like any vigilant rookie mom. Was he eating enough? Filling his diaper with suitable regularity? I joined a new mothers group, where I tried to focus while a proper British instructor guided us in the ner points of newborn massage. I lurked on friends Facebook pages its a law of the universe that once you become a parent, everyone else is one, too and noted the most popular worries. People posted questions about purees and swings. But I couldnt bring myself to get worked up about Andys sleeping schedule or his containment apparatus. I was fairly sure that he would develop as planned regardless of my stroller choices. I harbored few illusions about my aptitude for homemade purees, though I was condent that Gerber could ll the gaps. Here I was, someone who dealt with panic disorder and agoraphobia for years, utterly rational about the most anxiety-producing enterprise imaginable. This isnt to say that creative meals and stroller choices arent important. They are. But theyre also luxurious worries. I had spent years girding against imagined disasters like bankruptcy and death, and I guess maybe I was tired. It was time to get help again. Now, two years into parenthood, I sometimes do sweat the smaller stuff. I consider it a gift. The other day, I found myself fretting, actually fretting, over whether Id cut the crusts from Andys sandwich before sending him off to school. It felt like a victory.

30

August 25, 2012: Drugs, Sweat and Fear.

By DIANA SPECHLER In the fall of 2007, I attended my rst yoga class. For more than four years ever since graduation had dumped me into adulthood Id been leveled by anxiety. My days were plagued with worry. Was I living correctly? What if I died? What if, like in that Twilight Zone episode, the rest of the world died and I lived? Innocuous things I said to people haunted me hours later Was that dumb? Mean? Wildly inappropriate?until Id squirm with shame. Unable to sleep at night, I gobbled Tylenol PM, rationalizing that it was over-the-counter, as if over-the-counter meant nutritious. Id heard that yoga was relaxing. So one Saturday morning, in the spirit of relaxation, I spent 90 minutes contorting my body inside a 100-degree Bikram yoga studio. For your rst class, the teacher said before we began, the goal is just to stay in the room. I looked at the door. It was closed. I was already sweating, my heart pounding. Around me, the other students were sweating, too, but they also looked tranquil, lying on their mats, palms open, gazing softly at the ceiling. I did not feel tranquil. I wanted to scream. But I did what I was told to do: Stay in the room. By the time we nished the opening breath sequence, I was drenched from my hair to my toes. Come back tomorrow, the teacher told me. I was lying in nal savasana. I would

not come back tomorrow. How could I sweat out all the water in my body a second time? I would shrivel like a leaf. I was glad I had tried it, though. Now I could tell everyone, I did yoga in a 100-degree room! and then never again do yoga in a 100degree room. But after class, when I left the studio and felt the cool air on my skin, I oated, as if I were walking home on a moving sidewalk, or even hovering just above one. I was so blissed out, I almost got hit by a car. That night, I slept, Tylenol PM-free, for seven hours. The next day, I bought Shakti shorts (the unofcial Bikram yoga uniform), returned to class and relinquished my earthly possessions (well, my gym membership). I was ready to walk with Bikram. Come back tomorrow, the teacher told me again during nal savasana. And the next day: Come back tomorrow. The Bikram yoga philosophy maintains that if you practice the series every day, youll need nothing else in your life: no drugs, no gym, no situps, no excess food or cigarettes or unhealthy relationships. You wont even need other schools of yoga. Bikram will sustain you. I bought it because for the rst time in years, my thoughts were quiet. At night I slept peacefully. I was in love with the postures, with the joy I felt day in and out, with the way 10 pounds melted off my body, with the coconut water we guzzled after class, with my limbs, stretching as they hadnt since childhood, and especially with the way my mind danced free, the weight of worry lifted. Although Id never met him, I was also half in love with Bikram Choudhury, the charismatic, controversial businessman who arranged his 26 favorite yoga postures into a sequence and named it after himself. I read his book as though it were a religious text. In class, I had epiphanies that made me shiver in the heat. One teacher, after admonishing us for wiping our sweat, said: Stop responding to discomfort by reaching for things. We scratch. We smoke. We drink. Those are temporary solutions. Practice

being still. Even now, whenever I feel jittery, I remember that advice. Theres one particularly grueling posture in the Bikram series that involves balancing on one foot, taking the other foot in your hands, and stretching that leg out in a parallel line to the oor. Grab your foot, the teacher says, and everyone hedges. Grab it! one of my teachers yelled one morning. No ones going to grab it for you. To this day, when a big decision leaves me panicked, that refrain makes me focus. No ones going to grab it for you. A couple of months into my practice my grandmother noted that I was in a state of euphoria. I paused. The characterization unsettled me. A state of euphoria implied impermanence. My anxiety was gone forever, wasnt it? To be sure, I decided to challenge myself 365 yoga classes in 365 days. Come back tomorrow? I was coming! After a year, my anxiety would be an ancient relic. The snag in my plan was that sometimes I traveled, got sick or had too much work and couldnt nd the time to practice. To compensate, I would double up two classes a day. Who cared if that meant waking up at 5 a.m.? Or if the whole experience commuting, two classes, two showers robbed me of ve hours a day? Who cared if I sometimes got so dehydrated, my hand curled into a claw? Bikram yoga was my medicine. But as drugs tend to do over time, it stopped working. My anxiety would creep back an hour or two after class. To sleep at night, I resumed my old Tylenol PM habit. In pursuit of the initial high, I became frantic about how class was run. If the heat in the studio wasnt dizzying, I felt like rolling up my yoga mat and beating it against the wall. I needed that hot room, where, like impurities from boiling water, my anxiety evaporated. If I could just be hot enough, I was sure Id be O.K. In retrospect, I was rejecting the truth, the way I have in malfunctioning romantic relationships engaging in maddening repetition instead of admitting the thing was broken. Then one day, after about 300 classes, I nally let go. I didnt have a profound reason for quitting. My rst book was coming out, and I got busy.

For another year, although I kept practicing Bikram yoga to the exclusion of other exercise, I was disheartened. I was also curious about why the yoga seemed to work for some, but not for me: my muscles, unimpressed by engaging daily in the same workout, had softened. My thoughts were once again the anxious kind dark, nasty creatures sprinting on a treadmill. But many of my classmates were toned and lithe, smiling serenely, sipping SmartWater, executing bow pose to perfection. Had I overdone it? Had I reached some kind of tipping point, like snifng perfume until I could no longer smell? I didnt know. On my rst day back to the gym after more than two years as a Bikram yogi, I walked home feeling not ecstatic, but content. I didnt know it then, but after years of refusing to examine my anxiety, I was only a few months away from opening my eyes. With the prodding of a therapist, I would stop looking for solutions and look instead at myself. Id wanted yoga to save me, to make me feel forever what it had made me feel in the beginning. But relationships dont work like that. You have to grab your own foot. No ones going to grab it for you.

Part IX

SEPTEMBER
31 September 01, 2012: Music of the Unquiet Mind.

By MARGARET LENG TAN

Why do you not do as I do? Letting go of your thoughts as though they were the cold ashes of a long dead re? John Cage ~~~~~ In 1944 the avant-garde composer John Cage wrote Four Walls, a 70-minute work using only the white keys of the piano. It was the music for a dance play in two acts by the dancer and choreographer Merce Cunningham, who would later become Cages lifelong partner. I rediscovered Four Walls, virtually forgotten for four decades, in the 1980s. It has since become one of the most personal works in

my repertoire. Its repetitive, insistent nature struck a deep chord within me. It was as if someone had entered the innermost rooms of my mind and translated their contents into sound. I asked Cage, whom I rst met in 1981, about this compelling musical essay in inquietude. He told me that Four Walls was about the disturbed mind, a subject of fascination for Cunningham and himself during the mid-1940s. Two years after the completion of Four Walls, Cage seriously considered giving up composing to undergo psychoanalysis; he turned instead to Asian philosophy and Zen Buddhism. The music in Four Walls is of a non-narrative nature. Its many silences and static repetitions do, however, contribute to an atmosphere of growing entrapment, inviting the listener to probe the deep recesses of his psyche. Each person brings to the experience what he wishes or, rather, what he is. When Cage and I discussed the piece, he did not elaborate on the nature of the disturbances that had led to its creation. Not only would asking about it have been a trespass, I really preferred not to know. Instead, I would draw on my own experience of the disturbed mind and interpret the work accordingly. I have lived with obsessive compulsive disorder for as long as I can remember. When I was a child it manifested itself in a spectrum of behavioral quirks ranging from an adamant insistence that the bow in my hair be perfectly straight to a perpetual need for reassurance to allay my many fears, largely imagined but painfully real to me. A few years ago I came across the perfect depiction of O.C.D.: an image of a child trapped in a merry-go-round cage while his parents looked on helplessly. My own parents did not know what to make of it all and did their best to cope with my idiosyncrasies. Fortunately for them I insisted on having piano lessons when I was 6, and this became a creative channel for my obsessive energies. One of the classic manifestations of O.C.D. is compulsive counting. Till this day I count the number of steps when climbing a ight of stairs or the number of times I rinse after brushing my teeth. These counting rituals permeating my daily life serve no particular pur-

pose other than to satisfy the need to perform them. That is the nature of O.C.D. Enter music and rhythm: you can imagine how delighted I was to be actually required to count the beats in a piece of music. I could now count to my hearts content in a totally creative fashion! When I was 16, I left my home in Singapore to study at Juilliard. In my 30s, I had the great good fortune to meet John Cage a milestone for me, musically, personally and philosophically. In fact, I still dene my life in two periods, B.C. and A.C. Before Cage and After Cage. Cage was a pioneer in what is now regarded as the American maverick tradition. Like his revered predecessor, the transcendentalist philosopher Henry David Thoreau, Cage was a one-of-a-kind spirit in the way he lived, thought and made art. A towering iconic presence, his writings, most notably the anthology Silence (essentially Cages interpretation of Zen), have had a dening inuence on subsequent generations of artists across all disciplines. Philip Glass and Steve Reich, the progenitors of Minimalism in music, regard it as their bible. Through Cage and his take on Zen philosophy, I have made a truce with my O.C.D. I recognize that it is integral to who I am and have come to accept myself, warts and all. Obsessive-compulsives are, not surprisingly, perfectionists. Yet, I have learned to relinquish the grand illusion of the goal and relish, instead, the unfolding of the process. Cages highly forgiving denition of error, as simply a failure to adjust immediately from a preconception to an actuality, has helped temper my self-judgmental parameters of right and wrong, all or nothing. When I am entangled in an ide xe, one of Cages favorite Zen proverbs, Taking a nap I pound the rice, offers a welcome antidote empowering me to step away and let the unconscious work its magic. O.C.D.s most salient feature is its viselike hold on the mind, imbuing unwanted thoughts with a ferocious, pitiless tenacity. Cages Zen-inspired text Lecture on Nothing is balm to an obsessive-compulsive: Regard it as something seen momentarily, as though from a window while traveling . . . at

any instant, one may leave it, and whenever one wishes one may return to it. Or you may leave it forever and never return to it, for we possess nothing. . . . Anything therefore is a delight (since we do not possess it) and thus need not fear its loss. Fear of loss rules the life of an obsessive-compulsive fear of loss of control, fear of loss in both physical and metaphysical realms (paradoxically, the fear of losing worthwhile thoughts), and the ultimate fear fear over the loss of time when consumed by compulsive rituals; I live in a constant race with time to make up for the time lost to the dictates of the disease. Now, with Cages wise words of counsel I have on occasion triumphed, actually retreated from the precipice of an impending attack and, even more impressively, curtailed a bout in progress. Running like a vein through the writings in Silence, is what Cage liked to call the now moment. Living in the now moment means relinquishing the previous moment and forgoing anticipation of the next. As Cage wrote, Each now is the time, the space. I have recently discovered that this focus on the now moment can counter the grip of an O.C.D. attack. The mere act of stepping outside oneself, even momentarily, can serve as an O.C.D. circuit breaker, which is reinforced by the addition of each successive now moment. This is of course contingent on the severity of the attack; I am always grateful for good days when the distancing process can work its spell. People tell me that I have accomplished a great deal. I dont know if it is in spite of or because of my obsessive-compulsive disorder. I do know that I would not wish this afiction on my worst enemy, and of course I would prefer not to wear holes in the carpet of my mind. But, as Cage said, . . . the important questions are answered by not liking only but disliking and accepting equally what one likes and dislikes. Otherwise there is no access to the dark night of the soul.

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September 09, 2012: On Being Nothing.

By BRIAN JAY STANLEY

Every man looketh that his companion should value him at the same rate he sets upon himself. Thomas Hobbes As a carryover from childhood camps, I still instinctively check my mailbox with excitement. At camp, when I felt homesick, the arrival of mail from family was a reminder that I was not forgotten, that somewhere in the great world, though not here, my existence was written boldly in anothers ledger. Now, despite my Pavlovian reex, browsing my mail is not merely unexciting but depressing. What am I in this world but a pawn of others projects? The utility companies require the payments they are owed. The stores have new products they invite me to come and buy. A speaker has planned a lecture and seeks an audience. I owe taxes to the government for making money, for spending that money, for owning a home, for owning a car to leave that

home. I am not a name but an account number, a social security number, a customer ID, a current resident of this address. Every day, I am sought out by people who do not know me but who want something from me. I matter to the world merely as the owner of a bank account from which others wish to withdraw. Most annoying are subscription solicitations I receive from literary magazines that got my name and address from rejecting work I submitted. They do not want my writing, but might I send them my money so I can read the writers they chose over me? They thwart my project and subsume me into theirs. Not that I can blame any of these solicitors. A store needs customers, a speaker needs listeners, a publisher needs subscribers. I use others as surely as others use me. They are not my enemies but individuals trying to live and succeed, just as I am. Nevertheless, all those individuals added together make up the world, and the world is cruel. At every stage of life, we desire to be noticed and afrmed by others. Infants are born craving affection as much as milk. Children playing do not require the active involvement of nearby adults, but if you try to leave they demand that you watch them play. Adolescents, in their perpetual anxiety to be popular, do not so much look at others through their own eyes as look constantly at themselves through others eyes. Those who are dying worry about being remembered after death, though when dead, how can they care if theyre forgotten? As adults, our successes give us little pleasure unless sweetened by others admiration. If we dress up, there must be others to see us or our work seems wasted no one wears a tuxedo at home. A marvelous gardener once told me (speaking for human nature) that he takes more delight in a single garden visitors compliment than in all the shrubs and owers he has ever planted. What is this craving for anothers eye to rest upon us?

Upon reection, a desire for recognition seems irrational. Since we live in our own minds, why should we care what thoughts are in the minds of others? Is this not like a Canadian fretting about the weather in Mexico? How to explain this need for notice is debatable. Are we so doubtful of our worth that others must attest to it? Conversely, are we so certain of our worth that others must bow down to it? Growing up in a small town, I had an audience. I knew everyone at church, at school, on opposing sports teams. Everyone else knew everyone, too. Thus we were all one anothers audience. This did not always make life pleasant; one had an audience for ones failures as well as ones successes. But it made life meaningful. Everything counted because someone was watching. In high school, the bliss of getting a pretty girlfriend consisted less in having the girl herself than in walking the halls with her on your arm, for others to see. The chief motivation to score goals in sports was not to beat the other team but to impress the fans. To score a goal or get a girl on a desert island would have been a paltry pleasure. Small town life resembled the medieval universe in which saints and angels looked down on the adventures of humankind. Your actions might lead to heaven or hell, but because all eyes were on you, even damnation possessed a certain coziness. A decisive break in my life occurred when I left town after high school. My well-nurtured ego thought of the outside world as the waiting arena of my actions, where all humanity was expectantly assembled for me, yet when I arrived I found that no one knew my name nor wished to learn it; I was a king without any subjects. Arriving at college was like stepping out of the medieval world into the modern. The campus was a chaos of otherness with nothing at the center, least of all me. Unknown students from unknown places lived unknown lives, unconnected to mine. What

did my actions matter anymore, since no one was keeping track of me but me? I studied anomie in my sociology classes and experienced it alone in my dorm room. Though I made friends, I no longer had an audience. I remember lying awake in my dorm bed the rst night I arrived on campus. The thought gripped me that no one on campus or in the city knew I had come or required that I be there in order to function. The local restaurants had been in business for 20 years without my patronage. The dorm where I slept had been housing students since before I was born. If I died tonight, I thought, the city would not miss me or pause from its busy routines except for someone to call my family to fetch my body. I felt frightened to be so unnecessary. The one comfort I clung to was that the college had admitted me and, more importantly, had offered me a scholarship, implying it wanted me. For what is the proof of being wanted except being paid? I began noticing every small sign of my insignicance to others, and minor episodes made deep impressions. One day during my sophomore year, I was issued a $100 citation for parking seven feet from a re hydrant, when the law required 15 feet. I thought the ticket was unreasonable, for although common sense told me not to block a re hydrant, how was I to know the precise distance required, when no one had posted a sign? I appealed the ticket using this argument but was informed in a formal letter that the law does not bend for the ignorant, and I had to pay. Reading the brief, austere sentences from an authoritative stranger gave me a view of myself through the laws eyes, as a nameless citizen. I had duties more than rights; the laws only concern was that the human herd keep inside the fences. Excuses were irrelevant. Some days I feel so insubstantial that I am startled by signs of my visible presence in the world. On a recent afternoon walk, when my thoughts

on these matters had gone somewhat too far, a dog rooting in the grass turned its head and barked at me. I turned my head toward the sound in surprise: I had made the rooting dog look up therefore I did exist. True, the dog hated me, but in its bark I heard a vicious compliment, for it is better to be hated than ignored, hate being a form of acknowledgement, albeit negative. Society is adroit at disillusioning newcomers, and many self-assured children grow up to be bitter adults. But bitterness, instead of a form of disillusionment, is really the refusal to give up your childhood illusions of importance. Ignored instead of welcomed by the world, you fault the world as blind and evil in order not to fault yourself as nave. Bitterness is a childs coddling narcissism within the context of an adults harsh life. Instead, I know that the world only tramples me as a street crowd does an earthworm not out of malice or stupidity, but because no one sees it. Thus my pain is not to feel wrongly slighted, but to feel rightly slighted. There must be a Copernican revolution of the self. Instead of pointlessly cursing the sun to go around me, my chance of contentment is learning to orbit, being the worlds audience instead of demanding the world be mine. If the world is a stage, then everyones an extra, acting minor roles in simultaneous scenes in which no one has the lead. With so much happening, society is poorly made to satisfy pride, but well made to satisfy interest, if we will only let go of our vanity and join the swirl of activity.

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September 15, 2012: Surviving the Pain at the Roots.

By ALEXANDRA HEATHER FOSS I came out of the womb scratching. Mitts had to be put on my hands so I would stop clawing my skin. When I was seven and got mad I would bite myself, raising welts on my arms. This was already well into the time when I would have to touch certain spots on the cabinets, on the sidewalk, with my ngers and toes. At 12, after a seriously traumatic event, I began to pull out my hair. Every day since then, for the past 18 years, the hairs on my body have gone one by one, in the thousands, as I have tried to cope with overwhelming anxiety from a chaotic series of experiences that from birth have made me feel inside as if my very life is at stake if I do not pick and pull and bite and scratch. This is what anxiety does, the anxiety that comes from being a sensitive being in an insensitive world. We are taught when we are young that life will be fair, good guys will win, that if we are well behaved we wont suffer, that out there for each of us is some perfect stranger who will swoop in with armor and save us, some ctional man or woman who will make everything all the assaults and sorrows, traumas

and disappointments O.K. But it is painful to be born, to literally be pushed out from a tiny canal, crushed so that we can live. When we arrive the world is bright and harsh and loud. Strangers fondle our bodies as though we asked them to and then we are given to one, maybe two, people, our parents, who are supposed to love one another and us. Often some part of that equation is lacking and that becomes confusing because when the blind trust between child and parent gains sight and we see things as they really are, when we see the disappointed tears of one parent, hear the screams of another, when the reality starts to come into focus and we realize that what we believed was real never was and that trust is a candy peddled by strangers, it becomes too much to bear. When this happens we have to look elsewhere for the picture of happiness we formed before we saw clearly the underlying thread of sadness inside those we love, all the while doling our light and love out to those lacking as if our supply were endless. Soon we are tired, our lights are dim, but still we give, we try to make things we cannot change different so that the people we love are happy, but the burden becomes great, the task Sisyphean, and those we try to x are never satised. When I realized my family would never be happy as if the daily wars inside the four-walled battleeld of our home were not indictment enough and that I could never be happy in a society where I was from infancy an outsider, teased and picked on in the playground, I desperately searched for a way to t in. My skin felt stolen, like the skin of a selkie, by those who wanted me to be different, be theirs, instead of wholly myself. Even being female in a chauvinistic culture made me feel wrong in some way exploited, objectied, trivialized. As a woman I became an object for someone elses affection, and often times rage. The way I coped with circumstances outside my control was to grab onto something my body, more specically, my hair. I tried to marginalize my pain and dissatisfaction by uprooting the bad things that were making me anxious with tweezers, my ngers, nail clippers, safety pins, whatever tools were available during the des-

perate hours of my suffering. I would pull and pick and the destructive vortex of emotion that was threatening inside to sweep me away from life would stall, would recede, and for a while I could be calm, safe, even though that safety came at a painful price. My obsessions, my compulsions, eventually my hair-pulling disorder trichotillomania gave me an excuse that for years I was ashamed to own. I would say I could not attend a function with kids who picked on me because I was sick with the u. I would be late for a family dinner because I was going to the bathroom, the one place where social convention saved me because it made people afraid to open the door. Shut in there for hours I would at least miss the ghting, the teasing and the violence that was more damaging than my own body attacking itself in order for me to have peace. Instead of the dorky mist, I became the tardy girl, the screw-up, the rebel without a cause. Only I had a cause for my torment. I had many: all the people who made life unsafe, who touched me the wrong way, or teased me mercilessly, who were unkind when all I craved in life was kindness. It was the violent media, the violent words, the abuse as I was raped of my innocence, dragged down a ight of stairs head rst. This is why I am anxious, why I take two pills in the morning and two at night now to bring me from a constant state of ght or ight back to something like a state of balance. I believe that anxiety is the result of a violent culture where abuse has been so normalized it seems insignicant. We are told that to be strong means to suffer in silence, when strength really comes from giving our suffering a voice. The voice my suffering has taken through the years is not a voice lled with words, it is rather my trichotillomania, my O.C.D., the eating disorders I survived in high school, rising from attempted suicide with resilience as I realized on the oor of my room I deserve better. Our culture is not nurturing. We ask each other, How are you doing? but we do

not really want to know. We do not really want that person to say anything other than ne, because that would mean we would have to listen, to really care, something that most of us have not even done with ourselves. We want form responses, people who check all the right boxes, who say all the right things, whether they mean them or not. A rsum for a culture puffed up with lies, that is what we want. And as a result, we have a ne culture that is everything but ne. Medicated smiles, robotic responses, whole lifetimes that pass under the guise of ne when all we really want is for someone to ask and care. How are you? How am I? We want nourishment, not only for our bodies but for our souls. That is what we need to ourish, to feel less anxious. Environments that are safe, loving, relationships that are honest and nurturing. Nobody wants to ght, not really. We are taught to ght ourselves and others, we are taught to be defensive and aggressive, so that we may survive another day. But it seems it should be different. When I look at nature the way a seagull spreads its white wings wide as it hovers just above a meal, the way the tide rushes in bringing shell sparkles and lost treasures, the way the sun rises every morning even when it is cloudy, the way a tree stands proud even when it is wounded, its roots deeper than the trials it endures I see truth, a truth where there is no need for anxiety because things are as they should be. People should stand strong and say what they really feel not what they think others want to hear. They should ow with their emotions, like the tide, whether they be happy or sad. They should rise bright with possibility into every day and hover gently near what they want instead of aggressively taking. I am an anxiety-ridden, obsessive-compulsive hair-puller, but this is not who I am or how I choose to identify myself. I am a survivor. I choose to be honest about how I really feel, who I really am, even if it makes me unpopular, because I would rather be unpopular and be myself than be popular and not really ne at all. I am

grateful for my anxiety and my coping mechanisms. Hair-pulling, touching certain spots on the cabinet these things have saved my life, have gotten me here, able to write from a place of distance about the great strength of character it takes to struggle and survive. I am hardly perfect, I am denitely scarred, but at the core I am myself, anxious and also beautiful, otherwise known as human. What about you? How are you?

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September 22, 2012: America the Anxious.

By RUTH WHIPPMAN

The search for happiness is one of the chief sources of unhappiness. Eric Hoffer As soon as an American baby is born, its parents enter into an implicit contractual obligation to answer any question about their hopes for their tiny offsprings future with the words: I dont care, as long as hes happy (the mental sufx at Harvard must remain unspoken). Happiness in America has become the overachievers ultimate trophy. A vicious trump card, it outranks professional achievement and social success, family, friendship and even love. Its invocation can deftly minimize others achievements (Well, I suppose she has the perfect job and a gorgeous husband, but is she really happy?) and take the shine off our own. This obsessive, driven, relentless pursuit is a characteristically American struggle the exhausting daily application of the Declaration of Independence. But at the same time this elusive MacGufn is creating a nation of nervous wrecks. Despite being the richest nation on earth, the United States is, according to the World Health Organization, by a wide

margin, also the most anxious, with nearly a third of Americans likely to suffer from an anxiety problem in their lifetime. Americas precocious levels of anxiety are not just happening in spite of the great national happiness rat race, but also perhaps, because of it. As a Brit living in the United States, I am acutely aware of the cultural difference between attitudes to happiness here and at home. Thomas Jefferson knew what he was doing when he wrote that pursuit of happiness line, a perfectly delivered slap in the face to his joy-shunning oppressors across the pond. The British are generally uncomfortable around the subject, and as a rule, dont subscribe to the happy-ever-after. Its not that we dont want to be happy, it just seems somehow embarrassing to discuss it, and demeaning to chase it, like calling someone moments after a rst date to ask them if they like you. Evidence of this distinction is everywhere. Blindfold me and read out the Facebook statuses of my friends, without their names, and I will tell you which are American and which are British. Americans post links to inspirational stories, and parenting blogs packed with life lessons. (British parenting blogs tend to be packed with despair and feces.) My American friends post heartwarming messages of support to one another, and often themselves, while my British cohorts updates are usually some variation on This is rubbish. Even the recent grand spectacle of the London 2012 Olympic Games told this tale. The opening ceremony, traditionally a sparklefest of perkiness, was, with its suffragist and trade unionists, mainly a celebration of dissent, or put less grandly, complaint. Still, this back door approach to national pride propelled the English into a brief and unprecedented stint of joyous positivity lasting for the exact duration of the Games. For three weeks I was unable to distinguish my British friends Facebook sta-

tuses from those of my American ones. The transformation wasnt absolute of course. Anyone watching a few minutes of the BBC Olympic cover age would have noticed that the average British person sounds painfully awkward forming the syllables of the phrase hopes and dreams, which trips lightly off the American tongue. Our queen, despite the repeated presence of a stadium full of her subjects urging in song that she be both happy and glorious, could barely muster a smile, staring grimly through her eyeglasses and clutching her purse on her lap as if she might be mugged. Cynicism is the British shtick. When happiness does come our way, it is entirely without effort, as unmeritocratic as a hereditary peerage. By contrast, in America, happiness is work. Intense, nail-biting work, slogged out in motivational seminars and therapy sessions, meditation retreats and airport bookstores. For the left theres yoga, for the right, theres Jesus. For no one is there respite. There is something joyless about the whole shindig. I live in California, where the Great American Search for Happiness has its headquarters. The notice board of the cafe where I write offers a revolving loop of different paths to bliss: Maum Meditation, TransDance, Chod Training and, most oddly, the drinking of wolf colostrum. Customers jot down the phone numbers earnestly, although statistically theyd be better off joining the Republican Party. The people taking part in happiness pursuits, as a rule, dont seem very happy. At the one and only yoga class I attended, shortly after arriving in the United States, the tension and misery in the room were palpable. Which makes sense, because a person who was already feeling happy would be unlikely to waste the sensation in a sweaty room at the Y.M.C.A., voluntarily contorting into uncomfortable positions. The happy person

would be more likely to be off doing something fun, like sitting in the park drinking. Since moving to the States just shy of a year ago, I have had more conversations about my own happiness than in the whole rest of my life. The subject comes up in the park pushing swings alongside a mother I met moments before, with the man behind the sh counter in the supermarket, with my gym instructor and with our baby sitter, who arrives to put our son to bed armed with pamphlets about a nudist happiness retreat in Northern California. While the British way can be drainingly negative, The American approach to happiness can spur a debilitating anxiety. The initial sense of promise and hope is seductive, but it soon gives way to a nagging slow-burn feeling of inadequacy. Am I happy? Happy enough? As happy as everyone else? Could I be doing more about it? Even basic contentment feels like failure when pitched against capital-H Happiness. The goal is so elusive and hard to dene, its impossible to pinpoint when its even been achieved a recipe for neurosis. Happiness should be serendipitous, a by-product of a life well lived, and pursuing it in a vacuum doesnt really work. This is borne out by a series of slightly depressing statistics. The most likely customer of a selfhelp book is a person who has bought another self-help book in the last 18 months. The General Social Survey, a prominent data-based barometer of American society, shows little change in happiness levels since 1972, when such records began. Every year, with remarkable consistency, around 33 percent of Americans report that they are very happy. Its a fair chunk, but a gure that remains surprisingly constant, untouched by the uptick in Eastern meditation or evangelical Christianity, by Tony Robbins or Gretchen Rubin or attachment parenting. For all the effort Americans are putting into happiness, they are not getting any happier. It is not

surprising, then, that the search itself has become a source of anxiety. This is true in my own experience. Even adjusting for emotional openness, my American friends are certainly no happier, and in many ways more anxious than my British ones. For those of us who like their rash assertions to be backed up by meaningless numbers, Britain consistently scores higher on international happiness indexes than the States, although the mental gymnastics required to comprehend a meaningful difference between, say, 74th and 114th place in the world happiness hit parade are probably not a great use of anyones time. So heres a bumper sticker: despite the glorious weather and spectacular landscape, the people of California are probably less happy and more anxious than the people of Grimsby. So they may as well stop trying so hard.

Part X

OCTOBER
35 October 01, 2012: From Hunger.

By SARAH GERARD In September 2007, at the age of 22, I jumped from a moving freight train and landed on my face. The train had originated in Worcester, Mass., and was headed west toward Buffalo, but the path leading up to that event had begun six months before, in Long Island, where I was double-majoring in English and secondary education at Hofstra University, interning at a high school, taking two extra classes and dating a guy who liked to self-medicate. Bulimia and anorexia had reduced me to a skeletal 92 pounds, and Id developed an addiction to diet pills that lled my small off-campus apartment with plastic bottles and bubble-wrapped packages hidden in drawers and crevices where my roommate wouldnt nd them. Every at surface was home to a stack of celebrity gossip magazines full of articles about beach bodies and diets. I had a few friends, but they seldom visited me. I rarely slept and would spend

long nights anxiously staring into the vacuum of my living room, feeling the walls breathe around me, smoking cigarette after cigarette, searching for the peaceful center of my hunger. The day I nally hit bottom, my mentor at the high school found me crying in the supply closet of the teachers lounge with bits of tear-soaked tissue all over my face. I hadnt slept in days, and had just nished throwing up a lunch of edamame beans and Red Bull. As was my ritual, I followed this purge with two Hydroxycut pills to burn off whatever remained in my stomach. I told my mentor that I had just been given a diagnosis of a thyroid disease, hoping, though he never asked, that it would explain why I was so skinny. I could tell he didnt believe me, but he gave me permission to leave for the day. I called my father in Florida from the parking lot, crying hysterically, my mouth tasting of metal and stomach acid. Two weeks later, I checked into an inpatient rehab facility in Tampa, where I would spend the next 60 days trying to learn how to eat properly and how to speak candidly about my feelings. It did not work at least not right away. Two months after my release, I was still not abstinent. Id stopped attending my 12-step meetings for philosophical reasons and began hanging around with a girl Id roomed with in treatment who was worse off than I was. I wasnt starving myself, but we had started shoplifting, and went back to drinking and smoking weed generally causing trouble all over town. A photograph from that period shows us together at a water park in Tampa. She is much taller and heavier than I am, and I remember thinking when the picture was taken that, standing next to her in a swimsuit, I must have looked so small. I am visibly sucking in my stomach, playing it off as comical, but looking back, I know it wasnt. Soon I knew I needed to ee the self-medicating boyfriend, the life I was living in Florida, everything. I had to be where no one could see or nd me. An old friend introduced me to her cousin lets call him Michael who had issues of his own and was looking to leave town. Desperate to escape, we decided to

leave together. Some friends of his had just returned from months of hopping freight trains. Their stories sounded exciting, liberating, exactly what we needed. They told us the nearest hub for freight trafc was Savannah, Ga. From there, we could catch a train north, and then another one west. We could go anywhere we wanted to without documentation. We could live the way we wanted to, free of any rules. We packed our bags with compasses, pocket knives, duct tape, lighter uid: everything we thought wed need to survive as members of the squatter punk subculture. Two weeks later, we were on an Amtrak train to Savannah. Michael and I were out on the road from July to September. I cut off my hair and my sleeves, rubbed holes in my jeans, sewed patches onto my shirts, refused to shower, and gave myself a road name Ema. But even while hitchhiking and hopping freight trains, my motivation was image-centric: I was more concerned with looking the part of the hobo than being one, and anxious not to be exposed as a fake. Sitting next to the Allegheny River one night in the rain with a group of hobo kids, one told me I looked like a model. It was meant as an insult, but I took it as a compliment; I was prettier than all the dirty hobos in the gravel pit that night! I dyed my hair purple in the river with another girl and three days later bleached it blonde in New York City in the apartment of a friend who made us shower twice before letting us sleep in his bed. We took a bus to Massachusetts and caught our last train ride out in the middle of the night. Hunger on a freight train is not the hunger of the anorexic. You know that no one is looking. It is the difference between wanting food and needing it. Michael and I rode on a car with no roof and two narrow strips of sheet metal for a oor. We could see the tracks racing by underneath us. Rain soaked through our clothes and our packs. We ran out of food soon after we left and had no fresh water, and hid beneath the semi truck that shared our car. Pulling into Buffalo some time after dawn, we knew we had to get off. We waited for the train to slow down, but didnt wait long enough.

My last memory is of the gravel rushing toward me. I woke seven hours later to Michael feeding me ice chips on a gurney in the Buffalo hospital. I was starving, but I wasnt allowed to eat because my stomach had to be empty when they stitched me back together. I could stick my tongue through a hole where my tooth was knocked out, and my upper lip was split to my nose; my lower lip down to my chin. My left eye was swollen shut, the eggshell-thin bone behind it cracked, causing me to see double for months. It would be days until I could eat solid food again, and I knew then, asking for more ice, that I would never be beautiful like I wanted to be. Like I had striven to be. Like I didnt want to want to be. My parents paid for both my stay in rehab and the multiple rounds of surgery I would need to recover. They have never asked me to pay them back, but they did ask me to save a picture they took of me in the hospital, with over 150 stitches running down the middle of my swollen face and inside my mouth, to serve as a reminder of what I shouldnt choose to live with anymore. After the accident I returned to Florida a bruised and battered mess, moved back into my old bedroom, and began the slow process of nding a job with little idea of where I should be looking. I knew that I wanted to help people, but I didnt know what I could offer another person considering the state I was in. Who was I to lead anyone? Finally, I came across an ad in the newspaper seeking temporary in-home support for adults with mental retardation. I applied, and got it. A few weeks later, Michaels mother suggested that I apply for an assistant teaching position at the school where she worked, in a classroom for third and fourth graders with emotional and behavioral disabilities. Surely, I was qualied. I applied, and got that job, too. I worked seven days a week, ve of them at the school. Meanwhile, Michael and I looked for apartments. Despite all this, for the rst time in years, I was happy. I felt, nally, like I belonged somewhere. When I wasnt working, I was trying to write a novel. I had decided to be a writer.

Every photograph is a memento mori, an acknowledgment of what Susan Sontag called times relentless melt. A class picture from that year shows me standing next to a pretty white teacher with a small group of black and Hispanic third and fourth graders, my head turned in such a way that, I had gured out, hid the more awkward angles of my face caused by the scar and the underlying tissue. Around this time, an oral surgeon told me that, if I kept throwing up my food, he would refuse to perform the several rounds of surgery I needed to replace the bone I had shattered in my upper jaw, and the gum that had started to recede around it, which was needed to anchor the implant that would replace the tooth I had lost. At the risk of stating the too obvious, an eating disorder is inherently narcissistic. As if looking at a photograph, one has to enjoy climbing outside of herself to see herself as she believes others see her, then commit to xing whats imperfect. Without the admiration of others, her pain loses purpose; while rooted in the delusion of control, her addiction is exposed as something very much out of control; obsessive; devoid of reason or justication. The students in my classroom didnt notice when I was hungry, didnt care when I was tired, cared even less that I was thin. The disabled adults with whom I lived on the weekends, if they could even talk, would tell me that I was pretty no matter how I looked, because to them, I was. Gradually, what remained of my eating disorder stopped working the way I wanted it to; it began to feel silly. Like a waste of time that, since the train accident, suddenly seemed all too precious. When I was working seven days a week, my eating disorder began to feel like a third job that I didnt have the energy to perform. Meanwhile, I had found goals that were far more important than being thin. After a year of living together in an apartment infested with termites where hobo friends came to sleep on our couch and share stories about their ramblings where I had written what I thought was a novel about what little I knew about train hopping Michael and I broke up. He was going back on the road, but I had experienced enough hardship and would not be joining him. In the year and a half that

had passed since the accident, I came to realize that traveling, to me, had been a form of running away from myself. I couldnt decide which road to take, so I didnt decide and, instead, just took any. I wasnt ready to do the work I needed to be a whole person, and there had been nothing in Florida to keep me there no life to speak of, at that time. But I had since learned that becoming whole was a gradual process, and that nding something to keep me there was my own responsibility. I still wasnt completely abstinent; I had starved myself for several days before cheating on Michael with our neighbor, a fact Im not proud of. But I was closer than I had been in years, and would continue to get better. I was going to be a writer, and writing was more important than being beautiful. Rather, I found, being beautiful was writing.

36

October 07, 2012: Brain Scan.

by JOE FRANK I was sitting alone in a booth in a local diner when a sense of profound, almost paralyzing lethargy came over me. Id nished dinner and paid the check, but somehow I couldnt summon the strength to rise from the table. I ordered another cup of coffee and contemplated saying to the waiter, "Excuse me. Im feeling ill. Could you please call for an ambulance?" Then, nally, with considerable effort, I managed to lift myself from my chair and return to my apartment, where I felt so weak I was barely able to undress.

The following day, I saw my doctor. My blood was drawn and an M.R.I. was scheduled. A week later, I returned to my doctors ofce. He told me that blood tests had come up negative, but an M.R.I. revealed a small cluster of nodules at the base of my spine. Holding the picture to the light, the doctor said, "Im going to schedule you for a brain scan and a spinal tap." Startled, I asked him why these tests were necessary. He said he wanted to check my spinal uid for cancer cells, to determine if the nodules were malignancies that had traveled down through my spinal cord from a brain tumor. I left the ofce, stunned. When I returned home, my apartment seemed weirdly and imperceptibly altered. Was this my furniture? Was that my photo collage on the wall? Were those my clothes in the closet? I went into the bathroom, stared at

my reection in the mirror, and tried to make sense of the image before me. I felt like a character in a lm, oddly removed, and at the same time terried. That Friday evening, when I returned from the hospital after the spinal tap and the brain scan, my girlfriend and I attended a small dinner party. I didnt tell her what had happened. The host, a man in his 40s, was a celebrated television commentator. Genial and at ease with everyone, he emanated a sense of relaxed authority. At dinner, my girlfriend was seated next to him while I sat across from them both. He told an amusing story about his prep school days that charmed everyone at the table, but I was barely able to follow the intricacies of his narrative. Instead, I found myself focusing on a drop of perspiration on a mans forehead; the freckles on the back of a womans hand; another mans eyes, weirdly magnied by the thick lenses of his glasses; a womans red ngernail that was much shorter than her other nails; the sagging breasts of an older woman who was wearing a low-cut gown. Id been introduced to everyone at the table, but couldnt remember anyones name, and found it impossible to follow the conversation. And I noticed that the host although he had at the beginning of the evening attempted to distribute his attention equally to all the people at the table - was now becoming more attentive to my girlfriend. I watched, as if from a great distance, as she burst out laughing at something he told her and then became more thoughtful as their conversation turned serious. I noticed that their chairs had moved closer, their bodies almost touching, as he reached over and poured wine for her and they exchanged a meaningful look. Then I noticed him staring at me, as if he was sizing me up, studying me, assessing me, trying to gure out what I was made of, and wondering what she was doing with a man like me. I thought I saw an expression of sympathy come over his face, one that seemed to say he understood me, that we were brothers, but that nevertheless, he would still be compelled to seduce my girlfriend. When we returned home that night, my girlfriend wanted to make love. I suspected her encounter with our host had fueled her ardor, which she was now redirecting at me. I declined, turned off the bedroom light, and in the long silence that followed, I

could feel her frustration and rage. Finally she said, "Whats been going on with you lately? You havent been yourself. You hardly said a word at dinner." I didnt answer. A few minutes later, she got up, packed her overnight bag, and left. When I heard her car pull away from the curb and drive off, I felt relieved. I fell asleep and dreamed I was walking in a city at night when I noticed a street lamp icker and go out as I passed beneath it. Then I was urinating on the oor of a vast shower room, experiencing a profound sense of relief and pleasure, until I woke up with a feeling of warm wetness spreading around my thighs. I jumped out of bed, shocked by what had happened. Was I losing control of my bodily functions? Was this the rst step toward incontinence, toward my own infantilization? I removed my soaked pajamas, stripped the bed and threw everything into the washing machine. Then I scrubbed the mattress with soapy water, made a fresh bed over a thick towel to absorb the moisture from the wet spot, took a shower and changed into clean pajamas. A week later, I returned to my doctors ofce to learn the results of the tests. As I sat in the waiting room, I looked at a book of photographs of weightlifters taken on Muscle Beach in the 1930s and 40s. The men were in a variety of poses to accent their powerful physiques. I imagined how, in the decades that followed, their bodies had deteriorated with age, until now, more than 50 years later, they were either repulsively old or dead. So this accomplishment of theirs seemed an enormous waste of effort. Why not work at something that might last? But then I wondered if, in the overall scheme of things, anything endured. And thats when I heard the nurse call my name. "The doctor will see you now," she said.
Abstract

37

October 14, 2012: Anxiety Art. This Mortal Coil.

By DAVID SANDLIN This comic is from a series Ive been working on since 1999, when my son was born, which has slowly been shaping itself into a book. My father died shortly before I myself became a dad, and both those events started me thinking about relationships and history and the responsibilities of parenthood. Theres all the baggage that one picks up from personal, family connections that you want to lter out for your kid. And then theres the rest of the world you want to be optimistic for the future, but if youve looked at history and are paying any attention at all to how things are going now, its a tough prospect. Really, about all I can do is stay alert and keep a sense of humor!