The Fear Factor

Life is better for longer for more people than ever before - so why are fear and worry so commonplace?

Worry is on the increase, despite our greater longevity and quality of life. Oivind Hovland
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Scott Stossel is a very, very anxious man. We know this because Stossel, the editor of venerable US magazine The Atlantic, has surprised colleagues and readers alike by confessing all in an intellectualised version of the classic misery memoir.

In My Age of Anxiety – Fear, Hope, Dread and the Search for Peace of Mind, Stossel describes a nameless and persistent terror so all-encompassing that there is almost nothing about modern life that doesn't reduce him to a sweat-drenched wreck.

“On ordinary days, doing ordinary things – reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis – I have thousands of times been stricken by a pervasive sense of existential dread,” he writes.

And Stossel is not alone. My Age of Anxiety, which spent weeks on The New York Times bestseller list after its release in January, seems to have struck a chord in a modern western society in which anxiety has become not only normal but almost fashionable.

Despite our affluence, good health and high levels of disposable income, we are living, it seems, in anxious times. Anxiety, as Psychology Today has noted, is "one of our modern plagues" – though one, it has to be said, that has proved rather more amenable to monetisation than, say, the Black Death.

On Amazon, there are currently more than 2,500 books offering self-help solutions to anxiety, with hundreds published in the past three months alone. Anti-anxiety apps abound.

According to the Anxiety and Depression Association of America, some 40 million adult Americans suffer from anxiety disorders, with 6.8 million – more than 3 per cent of the population – in the grip of Generalised Anxiety Disorder (GAD), characterised by “persistent, excessive and unrealistic worry about everyday things”.

Life in the United Kingdom is, apparently, no less stressful. There, according to the Mental Health Foundation, GAD “affects between 2-5 per cent of the population”, accounting for “as much as 30 per cent of the mental health problems seen by GPs [general practice doctors]”.

So what exactly is it that we are all so anxious about?

Once upon a time, life in what is now the comfortable, affluent, well-fed and largely healthy developed world was, in the words of the 17th-century English philosopher Thomas Hobbes, nasty, poor, brutish, and short.

But today gone are the obvious sources of anxiety – the wild beasts, famines, uncontrollable diseases and (since 1945, at least) the global wars that once scythed us down on an industrial scale.

Indeed, the greatest threats most of us now face are largely of our own design – lifestyle choices such as driving too fast or smoking, drinking and eating far too much, which we do as though nostalgic for a time when 40 was considered a reasonable lifespan.

According to the World Health Organisation, a child born today in the most affluent countries in western Europe – such as Switzerland, France, the UK, Germany and Sweden – can expect to live 80 years or more, with most of those years spent in good health.

The high-end parts of the Middle East aren’t far behind: a life in the GCC countries, including the UAE, will last for up to 78 years on average, though unsurprisingly life expectancy in troubled countries such as Egypt, Iraq and Syria lags about 10 years behind.

But, in a very real sense, most of us have never had it so good. So what is it about modern life that has got so many of us down in the dumps?

Anxiety itself is, of course, nothing new.

As early as the 1920s Sigmund Freud, the father of psychoanalysis, had recognised a mental state of general anxiety he termed “expectant fear” or “anxious expectation”, which existed as a less intense form of anxiety neurosis, which he grouped with the true neuroses. General anxiety, he said, was “a condition of free-floating fear … ready to attach itself to any appropriate idea, to influence judgment, to give rise to expectations, in fact to seize any opportunity to make itself felt”.

Those in its grip “always prophesy the most terrible of all possibilities, interpret every coincidence as an evil omen, and ascribe a dreadful meaning to all uncertainty”, but in Freud’s view they could not be said to be ill.

“Anxiety is the first effect,” says Dr Stephen Costello, director of the Viktor Frankl Institute of Ireland. “It comes into the world with the asphyxia of birth.”

Viktor Emil Frankl, a Viennese psychiatrist, neurologist and philosopher, developed the form of therapy known as existential analysis just after the Second World War – and this was a man who knew the true meaning of anxiety. His bestselling 1946 book, Man's Search for Meaning, was published shortly after his wife, mother and brother were murdered in Auschwitz and following his own liberation from a Nazi death camp.

“We must,” says Costello, a philosopher and logotherapist in the Frankl style, “distinguish between ontological and psychological anxiety.”

The first relates to "our very being in the world" – the existential angst described by the Danish philosopher Søren Kierkegaard in his 1844 book The Concept of Anxiety, and perhaps best summed up by one line from Samuel Beckett's absurdist 1957 play Endgame: "You're on Earth, there's no cure for that!"

In other words, says Costello, “we’re stuck with it, as death represents absolute anxiety for us”.

The inevitability of death aside, however, Costello believes that “psychological anxiety has certainly increased, probably due to a more uncertain world, less long-term job and financial security, less long-term emotional security, more technology and our helplessness and frustration in the wake of it, globalisation and modernity in ­general”.

Research published a few years back in The Canadian Journal of Psychiatry found that reported levels of anxiety had risen "alarmingly" since the Second World War, to the point where "anxiety disorders constitute the most prevalent mental health problem around the globe, afflicting millions of people".

One possible cause was “the ever-­increasing pace and demands of modern life”. But there was, said the authors, more evidence that the anxiety epidemic had more to do with “a prevailing social ethos that teaches people that anxiety-related symptoms are a socially and medically legitimate response to life in the modern age”.

Human psychological priorities were catalogued in a 1943 paper by the American psychologist Abraham Maslow, whose “hierarchy of needs” presented basic physiological requirements – eating, drinking, sleeping – as the base of a pyramid. As we develop and grow physically more secure, so our needs evolve, rising through safety, love and belonging and esteem to the top of the pyramid and what Maslow called “self-actualisation” – our concern with realising our potential.

In other words, by that stage, "we have the 'luxury' to worry", says Alison Bonds Shapiro, an author and motivational coach who delved into the issue of existential anxiety in her 2009 book Healing into Possibility, the story of her own recovery from two brainstem strokes. These days, she says, "we do have much more opportunity to concern ourselves with things other than immediate needs for safety, security and food".

The stiff upper lip of our forebears, in other words, is a thing of the past. The rise of mindfulness, talking therapies and what Time magazine has described as the narcissistic "me me me generation" have not only swept aside stoicism, but replaced it with an almost obligatory requirement to wear our minds on our sleeves.

But while it is true that these days “people do in general talk much more about their emotions and about fear and anxiety”, says Nicky Lidbetter, chief executive of the charity Anxiety UK, at the same time “we are facing ever more stressful times with the requirement to do more for less and to be achieving more – and to be constantly switched on”.

The charity recently conducted research with the University of Salford on the impact of social media on anxiety.

“We found it does increase people’s anxiety because of the expectation that you should be doing certain things and you can’t switch off. You are constantly on devices, constantly plugged in, and it is literally information overload.”

This type of lifestyle, says Lidbetter, “flies in the face of approaches like mindfulness, which is very much about being in the now and not constantly feeding your mind with information and looking back or looking forward but just being in the moment”.

Some neuroscientists believe technology-enabled multitasking is directly responsible for inducing anxiety. The multitasking that so many of us pride ourselves on achieving is a myth, writes psychologist Daniel Levitin in his most recent book, The Organised Mind.

All we are doing when we try to attend to email, Facebook, news streams and Twitter simultaneously, he says, is “frantically switching from one task to another” – inefficiently.

Asking the brain to do this, says Levitin, professor of psychology and behavioural neuroscience at Montreal’s McGill University, causes the prefrontal cortex to burn up oxygenated glucose, the very fuel it needs to stay on task. This in turn “leads to compromises in both cognitive and physical performance”, boosting production of the stress hormone cortisol and, in the absence of the safety valve of the vestigial fight or flight response our bodies were once programmed to execute, making us anxious.

And in this age of global connectivity, the collective consciousness evoked in 1893 by the French sociologist Émile Durkheim has never been more real – nor more easily manipulated en masse.

Thanks to the internet and our smartphones, we are connected 24/7 to the often ill-founded thoughts, opinions and fears of millions, not to mention a media adept at transforming every passing problem, from Ebola and obesity to aircraft disasters and volcanic ash clouds (remember Eyjafjallajökull?) into a global catastrophic risk of existential proportions.

We are in danger of evolving into single nodes in a gigantic, global neural network feeding on a constantly changing diet of fear and fads.

It is, as an article on The Huffington Post noted last month, "nearly impossible to turn on the TV, open up a web browser, or scroll through Twitter without being assaulted with notifications of a new world disaster … The world isn't falling apart, but it can sure feel like it."

Addicted to our connectivity, we have become the gullible victims of a modern, technological version of the butterfly effect – the element of chaos theory mooted in 1969 by US mathematician and meteorologist Edward Loren.

He speculated that a minor incident anywhere in the world might have a disproportionate effect on an apparently unconnected event elsewhere: a butterfly in Brazil flaps its wings, causing a tornado in Texas several weeks later.

Today, we are all so well connected with each other that the strangest memes, fads and fears can flash effortlessly across now-meaningless national and intellectual boundaries and into our consciousness.

Being persuaded to dump a bucket of icy water over your head, as many were by last year’s internet sensation, the Ice Bucket Challenge, is one thing. But there is evidence that our connectivity can have far subtler, and potentially far more dangerous, outcomes.

In 2010, computer science researchers at the University of Illinois set up what they called an Anxiety Index, a “metric of anxiety, worry and fear” designed to monitor and classify 20 million posts by members of the LiveJournal community.

To their surprise, they found a predictive correlation between the collective mood of LiveJournal posters – discussing everything from K-Pop idols to the weather – and movements on the Standard & Poor 500 stock market ­index.

The findings, they wrote, “show how the mood of millions in a large online community, even one that primarily discusses daily life, can anticipate changes in a seemingly unrelated ­system”.

The stock market is a handy, data-rich yardstick against which to measure effects, as another paper, published in the Journal of Financial Economics the same year, demonstrated.

It was, wrote the authors, already well recognised that “negative sentiment driven by bad mood and anxiety” affected investment decisions and the value of assets. But they went a step further and took a closer look at the effect of aviation disasters on stock prices.

There is nothing like flying to bring out our primal fears. We have no wings, which tells us deep down that flying is unnatural. When something goes wrong, no matter how far from our flight path, it cuts right to the heart of our existential angst.

That, in their measured academic speak, was what the authors concluded after finding astonishing evidence of what they called “a significant negative event effect”.

Whereas the actual estimated loss of any air crash was no more than about US$1 billion (Dh3.67bn), on average every such disaster temporarily wiped more than $60bn off the markets because of an irrational increase in perceived risk.

Modern nameless anxiety “is an atmosphere”, says Dr Rob Fisher, former head of philosophy at Westminster College in Oxford, the founder of and one of the organisers of Fear and Anxieties in the 21st Century, a multidisciplinary conference that will take place in Oxford this July. “It has been largely manufactured for us and we have come to live it, breathe it, absorb it.”

For a start, he says, fear and anxiety are now political tools: “For example, the recent Netanyahu visit to Congress, the pushing of Iran as a nuclear threat coinciding with his election and the Republican political agenda.”

In Britain, “‘terrorism’ is the fear trigger which enables both the passing of bills on surveillance curtailing our freedom – what a small price to pay when the bearded stranger in our midst wants to kill us – while setting the political agenda for the next election”.

And the media, he says, have also learnt to peddle fear and anxiety, from “the present obsession [in the UK] with children – innocence – and paedophiles – the monsters hidden among us”, to “the majority of modern advertising [which] is premised on fear or anxiety; making people afraid of it in order to provide the solution for it”.

Fear, he says, also rules the workplace, especially in an age of austerity: “People working harder, for less, because of what might happen if they don’t – being without a job, without money, without status. Because of what might happen to a society built on hard work if you don’t play your part.”

All of this “is nonsense, of course. But if you build the right context for it, then fear and anxiety become tools of manipulation within that context.”

It’s important, says Lidbetter of Anxiety UK, to realise that everyone becomes anxious from time to time, and that anxiety “is a natural, everyday emotion. It’s not about getting rid of anxiety. We say to people on the helpline: you wouldn’t seek to never be angry again in your life, because you know that’s not reasonable or practicable, and the same is true with anxiety.”

Everyone has anxieties – jobs, health, mortgages, relationships – but how can we tell whether our concerns are everyday worries, or symptoms of a serious anxiety disorder? Because if anxiety is only natural, perhaps the extent to which it has been medicalised by the psychiatry business could be described as unnatural.

The cover-all term, Generalised Anxiety Disorder, was coined in the late 1970s by the American Psychiatric Association, which first included it as a condition in the third edition of its Diagnostic and Statistical Manual of Mental Disorders, published in 1980.

The DSM, currently in its fifth edition, has long been widely accepted as the definitive guide to the classification and diagnosis of mental illness, and is found on the shelves of doctors and psychologists around the world.

But the number of conditions described in the DSM has grown exponentially since it was first published in the 1950s, and when DSM-5 was published in 2013 there was widespread concern that the proliferation of mental disorders was getting out of hand.

As part of the professional debate over the revisions for DSM-5, one group of psychiatrists, writing in the journal Depression and Anxiety in 2010, pointed out that Generalised Anxiety Disorder alone had undergone "a series of substantial classificatory changes" since its first inclusion in the manual, driven by "concerns that it may lack diagnostic credibility".

Indeed, according to one leading psychiatrist I spoke to in 2013 for an article I wrote for The British Medical Journal, certain categories of personality disorder described in DSM-5 had been included simply because they were pet theories of psychiatrists working on the American Psychiatric Association's personality disorder group. The APA, he said, was "in danger of medicalising people unnecessarily".

Of course, “unnecessarily” is probably not how the pharmaceutical industry or its shareholders would see it.

A report published in September by US market research company Transparency predicted that by 2020 the global “anxiety disorders and depression treatment market” was expected to be worth US$18.2bn, growing at a steady annual rate of 1.25 per cent from 2014.

The diagnosis of 40 million Americans as suffering from anxiety disorders had “helped the market to transform itself into a billion-dollar ­industry”.

And we are, it seems, all too keen to swallow the line spun by those in white coats that happiness lies in swallowing a pill. Recent research carried out by University College London found that less than half the prescriptions for antipsychotic drugs issued in the UK were being prescribed for the serious mental illnesses for which they were intended. Instead, The British Medical Journal reported in December, a large proportion were being used to treat mild conditions such as anxiety.

Perhaps, as Franklin D Roosevelt told Americans at the height of the Depression in 1933, the only thing we have to fear is fear itself. In the end, says Shapiro, what we need to do is take control of ourselves and become comfortable with uncertainty – and our inevitable demise.

“If you look at people who are contemplative, live in deep awareness of their inner lives and the richness of their own sensory experience, you find people who are comfortable with uncertainty [and] in those circumstances there may be minimum anxiety.”

The practice of meditation, for example, teaches “a direct awareness of uncertainty – specifically including the ultimate uncertainty of dying. In the West we try to hide death. In other cultures, death is more an evident part of the life cycle.”

Having come close to death herself – not once, but twice – Shapiro now works with people who are dying. In the process, she has made an interesting discovery.

“The body is programmed to resist dying,” she says. “That’s our biological imperative. But the mind can become trained to ‘be’ with uncertainty with curiosity and peacefulness.

“When I was close to death I was not at all anxious. My body knew that it knew how to die. When I didn’t die, then I became anxious.”

Jonathan Gornall is a regular contributor to The National.