When panic attacks!

America is the most anxious country on the planet. So will I ever learn to live with my fear, racing heart and disaster scenarios?

Published June 12, 2008 10:43AM (EDT)

I'm sitting at my desk, pretending to work. I dial my wife's cellphone. Again. She doesn't answer. Again.

Katrine's out of town, and we had a plan to talk two hours ago. Eleven years into blissful domestic partnership with a certified Anxious Person (A.P.), Katrine knows all too well the price of violating such a plan. I glance at the clock for the 23rd time in the past 127 -- make that 129 -- minutes. I'm not imagining this. Something's wrong.

My mouth goes dry. My heart starts pounding. Good thing I took that Managing Your Anxiety class when my anxiety suddenly, inexplicably, peaked last winter. If I hadn't learned to "interrupt my automatic thinking" and "substitute coping statements," I'd be freaking out right now.

I close my eyes and take a deep "settling breath": in-in-in through the nose, out -- whoosh! -- through the mouth. I check my voice mail, in case I missed Katrine's call. "You have no new messages," the robo-voice says. Who needs new messages, I think. I have plenty of old ones. Whatever can go wrong, will. Good news is bad news's way of catching you off-guard.

The phone rings in my hand. "My cell ran out of juice," Katrine says, "and I couldn't get to my charger."

She waits for me to say what she, or any other normal person would say -- words in a language I do not speak. Instead I burst into tears. "I thought you were dead!" I wail.

Not for nothing do I make my living writing stories. The darkest ones with the unhappiest endings -- those are the ones I save for myself. As a journalist and an anxious person, I'm driven to know why. So I decide to embark on a little investigation of trepidation, agitation, consternation and palpitations.

The first thing I learn: As the New Age gurus say, I am so not alone. Misery loves company, but anxiety draws a crowd. Turns out that anxiety disorder -- a spectrum that includes panic, obsessive-compulsive disorder, post-traumatic stress, phobias and the catch-all, generalized anxiety disorder -- is now the most prevalent mental health problem in the world.

Like Burger Kings and Botox clinics, A.D. is disproportionately prevalent in the U.S. According to the most recent World Mental Health Survey, Americans are the most anxious humans on earth. Forty million of us -- that's 28.8 percent -- suffer from the ailment that the National Institutes of Mental Health defines as "an excessive, irrational dread of everyday situations"; William James called "a horrible dread at the pit of my stomach"; and Anaïs Nin called "love's greatest killer."

I call Dr. Leslie Rokoske, a psychiatrist at the Ross Center for Anxiety and Related Disorders in Washington, D.C., and ask her why. "It's the pace of life," she says. "Everyone's very stressed out, trying to keep up." Rokoske adds that she and her colleagues have noted an, um, surge in anxiety in response to 9/11 and the war in Iraq. "We had an attack on our own country, which is a collective trauma," she says. "And now we've got our military coming back with head trauma and PTSD."

But some people (me) seem unable to handle that anxiety as well as others (Katrine). "There's a definite linkage between genetics and anxiety disorders," Rokoske says. "Nine out of 10 of our anxious patients have a family history of anxiety."

I'm doomed, I say, recalling the nights I fell asleep as a child, listening to my father pacing the floor.

"Anxiety is a good thing to have in a dangerous situation," Rokoske says soothingly. "It's the original caveman fight-or-flight response. When the adrenal gland senses danger, it sets off neurotransmitters in the brain -- cortisol, norepinephrine, serotonin -- to help the body cope."

Turns out, my fellow Americans are high on cortisol. We're nine times more likely to be anxious than the Chinese laborers who assemble our children's toys, whose working and living conditions would make us run screaming for a Xanax IV. And 94.4 percent of Mexicans -- bone-crushing poverty and barbed-wire borders notwithstanding -- have never experienced a major episode of anxiety or depression. But move a Mexicano north of the border, according to a study in the December 2004 National Institutes of Health News, and his mental health will deteriorate faster than you can say "Campesinos sí, NAFTA no."

To find out why, I call on Patricia Pearson -- novelist, anxious person and author of "A Brief History of Anxiety (Yours and Mine)." The book is a genre-busting page turner: a portrait of Pearson's lifelong struggle with anxiety, melded with a journalistic investigation of what ails her, and me and us. "Mexicans have stronger family ties, deeper connections to their community, greater involvement in collective rituals through their churches and unions and schools," Pearson tells me. "And there's less onus on the individual in Mexico to achieve material success."

So, I muse aloud, if I invite my adult kids to move back into their old rooms, join my local pagan coven and take the iPhone off my must-have list, Katrine will stop calling me "psycho" and start calling me "honey" again?

Pearson laughs. "We live in one of the most anxiety-provoking cultures on the planet," she says. "That's why we have this neurotic need to be plugged into our iPhones all the time."

Pearson had her first anxiety attack at age 7. Now, at 44, she's still doing things like stocking her basement with cases of freeze-dried vegetables to prepare for the next flu pandemic. I ask what she does, besides shopping online at Survival Acres, to keep her demons at bay. Her answer is a page from my Managing Your Anxiety workbook. "I do cognitive behavioral therapy to help me recognize patterns of behavior that made my anxiety worse," she says. "I spend time with my family and friends. And, with great reluctance, I get my butt to the gym."

I'm on the Managing Your Anxiety drill, too, but I don't know whether it's my modified behavior, or the little yellow pill I take each night, that's improved what passes for my equilibrium.

"We've constructed this narrative of ourselves as purely biological beings," Pearson explains. "If we're anxious, we have a chemical imbalance, which can be treated with chemicals. That's a very limiting tale to tell about our lives. We need to know ourselves, rather than simply swallowing capsules of 'Pain Begone.'"

Suddenly I'm awash in the feeling I get when one of those glowing earth mothers starts describing her transcendent home birth, and I hitch my jeans up to hide my Caesarean scar. "Pain Begone is my new best friend," I confess.

"Drugs can be helpful," Pearson allows. "But in my case they never resolved the underlying issues."

How retro, I think. How quaint. Who can afford to care about underlying issues anymore? Not my $450-a-month HMO, that's for sure.

Last winter, when I presented myself to my "caregivers" with my racing heart, dizzy head and inability to eat, sleep, work or smile, they loaded me onto the managed-care mental-health train and sent me rattling down the track.

First stop: a 20-minute audience with "Dr. Do-Little," the psychiatrist who issued me a sheaf of prescriptions and told me to take antidepressants every day for the rest of my life -- all without lifting her eyes from her computer screen. Next stop: two sessions with a behavior modification psychotherapist. The man was as bright as his scuffed, beige-on-beige institutional office décor, but he did succeed in modifying my behavior -- by reminding me why I'd vowed, years ago, never to enter a therapist's office again. Last stop: the HMO's eight-week, $75 Managing Your Anxiety class.

I'd never met a classroom I liked (I was kicked out of high school; that's my mother's anxiety story), but this was my last shot. So the following Wednesday I shuffled into a hospital basement conference room. I was surprised to learn that my 19 fellow A.P.'s -- young and old, straight and gay, black, Asian, Israeli, Palestinian and white -- seemed neither sicker, nor healthier, than I. Despite our differences -- the sallow-faced insomniacs clustered together on one side of the room, trading tips about melatonin and white noise machines; the phobics jittered in their seats on the other; the "generalized anxiety" types like me scattered ourselves indecisively in between -- we bonded over what we had in common. We were the English muffins of post-millennial America, our nooks and crannies dripping with doubt and fear.

Our instructor began each session with a relaxation exercise and then asked us to rate our own anxiety levels from 1 ("Feeling slightly nervous") to 10 ("Panic, fear of going crazy or dying"). She would rise to the whiteboard, clutching a fistful of worn dry-erase markers and pose the question of the day. Week 2, for example: "What are your anxiety triggers?"

"My divorce," said a housewife who'd rated herself a 9.

"Taking off and landing in a plane," an older Asian woman confessed.

The Palestinian man beside her scoffed. "You can get on a plane? I get triggered just hearing a plane in the sky."

By Week 3 we were down to 14 people. By Week 6, we were 10. There were rumors that the man who'd rated himself a 23 each week had been hospitalized. Someone said she'd seen the guy who couldn't stop dreaming about the World Trade Center, and he didn't look well. But we stressed-out survivors plugged away, and after two months I was stunned to discover that I had less anxiety, and more tools in my psychological repertoire, than talk therapy had yielded in 20 years.

A few months after the class ended, though, I began to backslide. And lately, "little" stressors, like my MIA wife, started pulling my trigger again.

I decided to consult with an internationally acclaimed expert, Jerilyn Ross. Disabled by a phobia in her 20s, Ross became a therapist, underwent treatment for her anxiety (in that order) and went on to found the Ross Center for Anxiety and Related Disorders in 1997. She's also president and CEO of the Anxiety Disorders Association of America, a 25-year-old nonprofit.

Ross listens to my story sympathetically. It's clear she's heard it before.

"I've had so many clients come in saying, 'I've spent 20 years in analysis and I'm still afraid of heights,'" Ross says. "Tony Soprano notwithstanding, psychotherapy isn't the treatment of choice for anxiety. The research shows that a combination of cognitive behavioral therapy and medication is highly effective."

I tell Ross that as the months and the refills have gone by, I've felt increasingly ambivalent -- personally and politically -- about my little yellow pills. This wasn't what I meant, in the '60s, by 'better living through chemistry.' Plus, I can't shake my conspiracy theory: that the popularity of the behavioral/pharmaceutical cocktail is driven more by what's good for Big Pharma than by what's good for semi-psychos like me.

"So what if it's a conspiracy? It works," the ever-pragmatic Ross replies. "The psychoanalysts say we're putting Band-Aids on our patient's problems. I say if it stops the bleeding, who cares?"

I was fine with the Band-Aid, I say, but lately I've had a little breakthrough bleeding. "Have you been doing your homework?" Ross asks. "If you had diabetes, you'd need to take your insulin every day. Anxiety is a chronic condition. You have to learn to live with it."

Ross invites me to call her for a tune-up if I hit another "rough spot." I hang up feeling reassured. I head to the kitchen for a celebratory cup of Calming Tea, flipping through today's paper while I wait for the kettle to boil. "Second Freeway Shooting in Two Days." Jesus, that's the freeway my son takes to work, and the victim isn't named. Maybe I should call him, just to be sure.

"Cyclist Killed at Busy Intersection." Oh, swell. I bike every day to calm myself down, and now I have to worry about that killing me, too.

I pour my tea, take a sip, burning my tongue. It's been hours -- OK, minutes -- since I got off the phone with Jerilyn Ross. I wonder if it's too soon to call her back.

By Meredith Maran

Meredith Maran, a frequent Salon contributor, is the LA-based author of 14 books including "The New Old Me" and "Why We Write." A book critic and book editor, she’s on Twitter and Instagram at @meredithmaran

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