My Anxiety, and Yours

Welcome to Uneasy Going, a newsletter about living with anxiety disorders.

I met with a therapist for the first time in 2011. His name was Thomas. He had an office in the West Village and he looked like a flustered single dad in a 90s movie, which I found soothing. Thomas* had a PhD in clinical psychology, and when I told him that I struggled with anxiety, he said that therapy could help me feel better. Sometimes we would both take the tiny, coffin-like elevator one floor down after our sessions, each of us staring discretely at the opposite wall.

Freud called anxiety a “riddle whose solution would be bound to throw a flood of light on our whole mental existence.” Thomas and I were unable to illuminate the riddle of my anxiety, despite his many probing questions about my childhood. Next I tried Jacqueline, another PhD. Jacqueline was a psychological terrorist who I wish I could report is now dead, though I can see from her website that she continues to operate on the Upper West Side.

After that, I spent one summer going weekly to a gloomy industrial loft to see Francine, an LCSW whose unsparing questions and assessments actually seemed to impact my anxiety. She didn’t take insurance though, so a month of sessions with her was close to the cost of rent. After Francine I saw Tamar, who referred me to Pam, a doctor whose office decorations were limited to a commemorative cup from the restaurant Medieval Times, and a scale.

Together, Pam and I tried over a dozen SSRIs, SNRIs, and benzodiazepines. We also tried an off-label medicine for people suffering from hives, and one drug that doubles as a sedative for cats. My anxiety raged on, so I supplemented therapy and psychiatry by reaching for journals, yoga classes, meditation apps, adaptogenic seltzers, and tiny amber vials of CBD tinctures sold in witchy stores by affable cannabis bros.

In the late twenty-teens I was drinking so much of this CBD soda that I went alone to a Recess pop-up in a lower east side shoe store with a DJ and a standup comedian. I wandered alone, stowing free Recesses in my dingy New Yorker tote.

Anxiety is a normal part of human life, but my anxiety did not reach normal levels. Clinicians debate what it means for anxiety to become abnormal, and even whether there is even such a thing as an “anxiety disorder.”** But, to summarize the Diagnostic and Statistical Manual’s criteria for Generalized Anxiety Disorder, my anxiety did not cease to feel excessive, uncontrollable, and distressing. Here and there a pill worked, or a therapist got through to me. I became more functional, but I did not feel free.

My story feels to me like a unique and rare experience of suffering, but it is increasingly ubiquitous. At least one in five adults in the U.S. has an anxiety disorder. A review published in the Lancet that looked at data from 204 countries found a 25% increase in anxiety disorders following the pandemic. There is a sense that the entire world has tipped towards anxiousness, that the very air we breathe is suffused with anxiety. Either you are haunted by an anxiety disorder, or your daughter is, or your brother is, or your neighbor.

My experience of seeking treatment for my anxiety disorder is also common: I pursued treatment that sometimes curbed the symptoms, but never sufficiently. Anxiety is rising, stigma has fallen, and more options for help have materialized, but a clear, accessible path for viable treatment has not appeared. Instead, a marketplace of treatments has expanded, with high price tags, dark alleyways, and streets that loop back on themselves, littered with promises of tranquilizing anxiety or harnessing it.

In the absence of a robust network of mental health services or radical societal change or a breakthrough in pharmacology, each clinically anxious individual has been deputized to search for their own cure. Treating anxiety disorders is a nearly $12 billion business in the U.S., and the wellness industry is closer to $500 billion. When you decide to treat your anxiety, you become a customer sitting in the intersection of the wellness industry, the medical industry, and the pharmaceutical industry.

This piece, by Bay Area artist Lola, hangs in a cafe near my apartment. The great myth about anxiety is that it has been destigmatized, and now everyone has a therapist and is on Lexapro and loves “boundaries.” Ask a friend who lives outside of a coastal city if they can find a therapist, or leave work midday for therapy, or if their kid’s insurance covers more than 12 sessions of therapy…good luck!

People suffering from mental health conditions are often told that we should start by asking for help. We’re rarely encouraged to ask about the help—why is it being offered, why does it cost so much money, why am I doing it alone, how long will it take? And if this is so treatable, why aren’t I getting better?

This newsletter is an attempt to publicly ask those questions. It is part of a book project I am working on with the same goals. I will report on anxiety remedies both mainstream and obscure to try to help you and me understand what we’re being sold, whose interests are really being served, and why it feels so hard to get effective treatment for such a condition that is considered treatable and destigmatized.

Anxiety disorders are a devastating blight on human prosperity. They are also a little bit funny. If comedy is tragedy plus time, anxiety disorders stretch themselves over decades, reducing your quality of life just slowly enough to allow you to lol at the fact that you are being haunted by a fear that sometimes presents itself as “What if my whole family dies in a car crash today?” and other times as “Are people mad at me for the way I coughed just now?”

Kierkegaard, who was tortured by anxiety, wrote: “My distress is enormous, boundless; no one knows it except God in heaven, and he will not console me; no one can console me except God in heaven, and he will not take compassion on me.” This still hits. Anxiety makes you very mindful of the fact that you are going to die. The real risk, of course, is that anxiety won't allow you to live. I don’t want you and me to subsist, I want us to live. I am searching for a way, one medicated bubble bath at a time.

* All names have been changed except Jacqueline’s. She really was a villain.

** For example, in the popular 2021 book Unwinding Anxiety, psychologist Judson Brewer writes:

“I’m a bit hesitant to label things as disorders or conditions myself, because as you’ll see shortly, a lot of this stuff shows up simply from a slight misalignment of one of our brain’s natural (and generally helpful) processes. It’s like labeling ‘being human’ as a condition.”

I find this unhelpful. When I leap up and scream at the sight of my own shadow, it doesn’t do much for me to remember that I am “being human.” I am human, but I am also malfunctioning. I think Brewer might respond, though, that he wants patients to realize that they aren’t permanently disordered, and they can learn to realign their cognitive processing.