none of these treatments have fundamentally reduced the underlying anxiety that seems woven into my soul and hardwired into my body and that at times makes my life a misery. As the years pass, the hope of being cured of my anxiety has faded into a resigned desire to come to terms with it, to find some redemptive quality or mitigating benefit to my being, too often, a quivering, quaking, neurotic wreck. (View Highlight)
Anxiety and its associated disorders represent the most common form of officially classified mental illness in the United States today, more common even than depression and other mood disorders. According to the National Institute of Mental Health, some forty million Americans, nearly one in seven of us, are suffering from some kind of anxiety disorder at any given time, accounting for 31 percent of the expenditures on mental health care in the United States. According to recent epidemiological data, the “lifetime incidence” of anxiety disorder is more than 25 percent—which, if true, means that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetimes. And it is debilitating: Recent academic papers have argued that the psychic and physical impairment tied to living with an anxiety disorder is equivalent to living with diabetes—usually manageable, sometimes fatal, and always a pain to deal with. A study published in The American Journal of Psychiatry in 2006 found that Americans lose a collective 321 million days of work because of anxiety and depression each year, costing the economy $50 billion annually; a 2001 paper published by the U.S. Bureau of Labor Statistics once estimated that the median number of days missed each year by American workers who suffer from anxiety or stress disorders is twenty-five. (View Highlight)
A recent paper in The Journal of the American Medical Association observed that clinical anxiety is the most common emotional disorder in many countries. A comprehensive global review of anxiety studies published in 2006 in The Canadian Journal of Psychiatry concluded that as many as one in six people worldwide will be afflicted with an anxiety disorder for at least a year during some point in their lifetimes; other studies have reported similar findings. (View Highlight)
epidemiología ansiedad evidencia
“The real excitement here, both in the study of anxiety as an emotion and in the class of disorders,” says Dr. Thomas Insel, the head of the National Institute of Mental Health, “is that it’s one of the places where we can begin to make the transition between understanding the molecules, the cells, and the system right to the emotion and behavior. We are now finally able to draw the lines between the genes, the cells, and the brain and brain systems.” (View Highlight)
The cognitive-behavioral therapists’ antecedents can be traced to the seventeenth-century Jewish-Dutch philosopher Baruch Spinoza, who believed anxiety was a mere problem of logic. Faulty thinking causes us to fear things we cannot control, Spinoza argued, presaging by more than three hundred years the cognitive-behavioral therapists’ arguments about faulty cognitions. (If we can’t control something, there’s no value in fearing it, since the fear accomplishes nothing.) Spinoza’s philosophy seemed to have worked for him; biographies report him to have been a notably serene individual. Some sixteen hundred years before Spinoza, the Stoic philosopher Epictetus anticipated the same idea about faulty cognitions. “People are not disturbed by things but by the view they take of them,” he wrote in the first century; for Epictetus, the roots of anxiety lay not in our biology but in how we apprehend reality. Alleviating anxiety is a matter of “correcting erroneous perceptions” (as the cognitive-behavioral therapists say). The Stoics, in fact, may be the true progenitors of cognitive-behavioral therapy. When Seneca, a contemporary of Epictetus, wrote, “There are more things to alarm us than to harm us, and we suffer more in apprehension than in reality,” he was prefiguring by twenty centuries what Aaron Beck, the official founder of CBT, would say in the 1950s.* (View Highlight)
But Plato and his adherents, for their part, believed that psychic life was autonomous from physiology and disagreed with the idea that anxiety or melancholy had an organic basis in the body; the biological model of mental illness was, as one ancient Greek philosopher put it, “as vain as a child’s story.” In Plato’s view, while physicians could sometimes provide relief for minor psychological ailments (because sometimes emotional problems are refracted into the body), deep-seated emotional problems could be addressed only by philosophers. Anxiety and other mental discomfort arose not from physiological imbalances but from disharmony of the soul; recovery demanded deeper self-knowledge, more self-control, and a way of life guided by philosophy. (View Highlight)
In our postindustrial era of economic uncertainty, where social structures are undergoing continuous disruption and where professional and gender roles are constantly changing, is it not normal—adaptive even—to be anxious? (View Highlight)
According to Charles Darwin (who himself suffered from crippling agoraphobia that left him housebound for years after his voyage on the Beagle), species that “fear rightly” increase their chances of survival. We anxious people are less likely to remove ourselves from the gene pool by, say, frolicking on the edge of cliffs or becoming fighter pilots. (View Highlight)
Do these shifting interpretations represent the forward march of progress and science? Or simply the changing, and often cyclical, ways in which cultures work? What does it say about the societies in question that Americans showing up in emergency rooms with panic attacks tend to believe they’re having heart attacks, whereas Japanese tend to be afraid they’re going to faint? Are the Iranians who complain of what they call “heart distress” suffering what Western psychiatrists would call panic attacks? Are the ataques de nervios experienced by South Americans simply panic attacks with a Latino inflection—or are they, as modern researchers now believe, a distinct cultural and medical syndrome? Why do drug treatments for anxiety that work so well on Americans and the French seem not to work effectively on the Chinese? (View Highlight)
I have spent much of the past eight years reading through hundreds of thousands of the pages that have been written about anxiety over the last three thousand years. (View Highlight)