Personal Health

What Are You Worried About? The Fascinating History of Anxiety

Nervousness has always been a part of our lives. But is it worse than ever?
Excerpted from My Age of Anxiety by Scott Stossel.Copyright © 2013 by Scott Stossel. Excerpted by permission of Knopf, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. This excerpt was previously published in Psychotherapy Networker.


In April 1869, a young doctor in New York named George Miller Beard, writing in the Boston Medical and Surgical Journal, coined a term for what he believed to be a new and distinctively American affliction, one he had seen in 30 of his patients: neurasthenia (from neuro for “nerve” and astheniafor “weakness”). Referring to it sometimes as “nervous exhaustion,” he argued that neurasthenia afflicted primarily ambitious, upwardly mobile members of the urban middle and upper classes—especially “the brain-workers in almost every household of the Northern and Eastern States”—whose nervous systems were overtaxed by a rapidly modernizing American civilization. Beard believed that he himself had suffered from neurasthenia but had overcome it in his early 20s.

Born in a small Connecticut village in 1839, Beard was the son of a Congregational minister and the grandson of a physician. After attending prep school at Phillips Academy in Andover, Massachusetts, he went on to Yale, where he began to suffer from the array of nervous symptoms that would afflict him for the next six years and that he would later observe in his patients: ringing in the ears, pains in the side, dyspepsia, nervousness, morbid fears, and “lack of vitality.” By his own account, Beard’s anxious suffering was prompted largely by his uncertainty about what career to pursue—though there is also evidence that he anguished over his lack of religious commitment. (Two of Beard’s older brothers had followed his father into the ministry; in his diary, he chastises himself for his indifference to spiritual concerns.) Once he decided to become a physician, however, his doubts left him and his anxiety dissipated. He entered medical school at Yale in 1862, determined to help others plagued by the anxious suffering that had once afflicted him.

Influenced by Darwin’s recent work on natural selection, Beard came to believe that cultural and technological evolution had outstripped biological evolution, putting enormous stress on the human animal—particularly those in the business and professional classes, who were most driven by status competition and the burgeoning pressures of capitalism. Even as technological development and economic growth were improving material well-being, the pressure of market competition—along with the uncertainty that took hold as the familiar verities fell away under the assault of modernity and industrialization—produced great emotional stress, draining American workers’ stock of “nerve force” and leading to acute anxiety and nervous prostration.

Beard believed that constant change, combined with the relentless striving for achievement, money, and status that characterized American life, produced rampant nervous weakness. “American nervousness is the product of American civilization,” he wrote. The United States had invented nervousness as a cultural condition: “The Greeks were certainly civilized, but they were not nervous, and in the Greek language there is no word for that term.” Ancient cultures couldn’t have experienced nervousness, he argued, because they didn’t have steam power, the periodical press, the telegraph, the sciences, and the mental activity of women: “When civilization, plus these five factors, invades any nation, it must carry nervousness and nervous disease along with it.”

By the turn of the century, the language and imagery of neurasthenia had permeated deep into American culture. If you yourself didn’t suffer from it, you surely knew people who did. Political rhetoric and religious sermons addressed it; consumer advertisements offered remedies for it. Magazines and newspapers published articles about it. Theodore Dreiser and Henry James populated their novels with neurasthenic characters. The language of neurasthenic distress (“depression,” “panic”) crept into economic discourse. Nervousness, it seemed, had become the default psychological state and cultural condition of modern times. Disrupted by the transformations of the Industrial Revolution and riven by Gilded Age wealth inequality, the United States was rife with levels of anxiety unmatched in human history.

Or so Beard claimed. But was it really?

According to the latest figures from the National Institute of Mental Health, some 40 million Americans, or about 18 percent of the population, currently suffer from a clinical anxiety disorder. Recent editions of Stress in America, a report produced each year by the American Psychological Association, have found a badly “overstressed nation,” in which a majority of Americans describe themselves as “moderately” or “highly” stressed, with significant percentages of them reporting stress-related physical symptoms such as fatigue, headache, stomach troubles, muscle tension, and teeth grinding. Between 2002 and 2006, the number of Americans seeking medical treatment for anxiety increased from 13.4 million to 16.2 million. More Americans seek medical treatment for anxiety than for back pain or migraine headaches.

Surveys by the Anxiety and Depression Association of America find that nearly half of all Americans report “persistent or excessive anxiety” in their daily work lives. (Other surveys find that 3 out of 4 Americans believe there’s more workplace stress today than in the past.) A study published in the American Psychologist found that 40 percent more people said they’d felt an impending nervous breakdown in 1996 than had said so in 1957. Twice as many people reported experiencing symptoms of panic attacks in 1995 as in 1980. According to a national survey of incoming freshmen, the anxiety levels of college students are higher today than at any time in the 25-year history of the survey. When Jean Twenge, a professor of psychology at San Diego State University, looked at survey data from 50,000 children and college students between the 1950s and the 1990s, she found that the average college student in the 1990s was more anxious than 85 percent of students in the 1950s and that “‘normal’ schoolchildren in the 1980s reported higher levels of anxiety than child psychiatric patients in the 1950s.” The baby boomers were more anxious than their parents; Generation X was more anxious than the boomers; the millennials are turning out to be more anxious than Generation X.

Rates of anxiety seem to be increasing all around the world. A World Health Organization survey of 18 countries concluded that anxiety disorders are now the most common mental illness, once again overtaking depression. Statistics from the National Health Service reveal that British hospitals treated four times as many people for anxiety disorders in 2011 as they did in 2007, while issuing record numbers of tranquilizer prescriptions. A report published by Britain’s Mental Health Foundation in 2009 concluded that a “culture of fear”—marked by a shaky economy and hyperbolic threat-mongering by politicians and the media—had produced “record levels of anxiety” in Great Britain.

The Price of Progress

Given the “record levels of anxiety” we seem to be seeing around the world, surely we must today be living in the most anxious age ever—more anxious even than George Beard’s era of neurasthenia.

How can this be? Economic disruption and recent global recession notwithstanding, we live in an age of unprecedented material affluence. Standards of living in the industrialized West are, on average, higher than ever; life expectancies in the developed world are, for the most part, long and growing. We’re much less likely to die an early death than our ancestors were, much less likely to be subjected to the horrors of smallpox, scurvy, pellagra, polio, tuberculosis, rickets, and packs of roving wolves, not to mention the challenges of life without antibiotics, electricity, or indoor plumbing. Life is, in many ways, easier than it used to be. Therefore shouldn’t we be less anxious than we once were?

Perhaps in some sense the price—and surely, in part, the source—of progress and improvements in material prosperity has been an increase in the average allotment of anxiety. Urbanization, industrialization, the growth of the market economy, increases in geographic and class mobility, the expansion of democratic values and freedoms—all of these trends, on their own and in concert, have contributed to vastly improved material quality of life for millions of people over the last several hundred years. But each of these may also have contributed to rising anxiety.

Until the Renaissance, there was scarcely any concept of social, political, technological, or any other kind of progress. This lent a kind of resignation to medieval emotional life that may have been adaptive: the sense that things would always be as they were was depressing but also comforting—there was no having to adapt to technological or social change; there were no hopes for a better life in danger of being dashed. While life was dominated by the fear—and expectation—of eternal damnation, medieval minds were not consumed, as ours are, with the hope of advancement and the fear of decline.

Maybe anxiety is, in some sense, a luxury—an emotion we can afford to indulge only when we’re not preoccupied by “real” fear. (Recall that William James made a version of this argument in the 1880s.) Perhaps precisely because medieval Europeans had so many genuine threats to be afraid of (the Black Death, famine, dynastic turmoil, constant military conflict, and death, always death—the average life expectancy during the Middle Ages was 35 years, and 1 out of every 3 babies died before reaching the age of 5), they were left with little space to be anxious, at least in the sense that Freud, for example, meant neurotic anxiety—anxiety generated from within ourselves about things we don’t really have rational cause to be afraid of. Perhaps the Middle Ages were relatively free of neurotic anxiety because such anxiety was a luxury no one could afford in their brief, difficult lives. In support of this proposition are surveys showing that people in developing nations have lower rates of clinical anxiety than Americans despite life circumstances that are materially more difficult.

Moreover, political and cultural life in the Middle Ages was largely organized to minimize, even eliminate, the sorts of social uncertainties we contend with today. “From the moment of birth,” the psychoanalyst and political philosopher Erich Fromm observed, “[the medieval person] was rooted in a structuralized whole, and thus life had a meaning which left no place, and no need, for doubt. A person was identical with his role in society; he was a peasant, an artisan, a knight, and not an individual who happened to have this or that occupation.” One argument for why 21st-century life produces so much anxiety is that social and political roles are no longer understood to have been ordained by God or by nature—we have to choose our roles. Such choices, research shows, are stressful. As sodden with fear and darkness and death as the Middle Ages were, Fromm and others argue, they were likely freer of anxiety than our own time is.

Jerome Kagan, among others, has argued that historical changes in the nature of human society have led to mismatches between our evolutionary hardwiring and what modern culture values. Qualities such as excessive timidity, caution, and concern with the opinions of others that would have been socially adaptive in early human communities are much “less adaptive in an increasingly competitive, mobile, industrialized, urban society than these traits had been several centuries earlier in a rural, agricultural economy of villages and towns,” Kagan writes. In preliterate cultures, all members of a community generally shared the same values and sources of meaning. But starting sometime around the 5th century BCE, humans have increasingly lived in communities of strangers with diverse values—a trend that hyperaccelerated during the Renaissance and again during the Industrial Revolution. As a result, and especially since the Middle Ages, “a different kind of uncomfortable feeling was evoked by reflection on the adequacy of self’s skills or status and the validity of one’s moral premises,” Kagan argues. “These feelings, which were labeled anxiety, ascended to the position of the alpha emotion in the hierarchy of human affects.” Perhaps the human organism isn’t equipped to live life as society has lately designed it—a harsh zero-sum competition, where the only gains to be had are at the expense of someone else, where “neurotic competition” has displaced solidarity and cooperation.

One of the earliest uses of the word anxiety in English associated it with chronic uncertainty: the 17th-century British physician and poet Richard Flecknoe wrote that the anxious person “troubles herself with every thing” or is “an irresolute person” who “hovers in his every choice like an empty Ballance with no weight of Judgment to incline him to either scale. . . . When he begins to deliberate he never makes an end.” (The first among the Oxford English Dictionary’s definitions of “anxiety” is “uneasiness about some uncertain event.”) Recent neurobiological investigations have revealed that uncertainty activates the anxiety circuits of the brain; the amygdalae of clinically anxious people are unusually sensitive to uncertainty. “Intolerance of uncertainty appears to be the central process involved in high levels of worry,” Michel J. Dugas, a psychologist at Penn State, has written. Patients with generalized anxiety disorder “are highly intolerant of uncertainty,” he says. “I use the metaphor of ‘allergy’ to uncertainty . . . to help them conceptualize their relationship with uncertainty.” Between 2007 and 2010, there was a 31 percent increase in the number of news articles employing the word “uncertainty.” No wonder we’re so anxious.

Except maybe we’re relatively less anxious than we think. Because if you read far enough back into the cultural history of nervousness and melancholy, each successive generation’s claim to be the most anxious starts to sound much like the claims of the generations that preceded and followed it. Trying to directly compare levels of anxiety between eras is a fool’s errand. Modern poll data and statistics about rising and falling levels of tranquilizer consumption aside, there’s no magical anxiety meter that can transcend the cultural particularities of place and time to objectively measure levels of anxiety—which, like any emotion, is in some sense an inherently subjective and culturally bound thing. But if anxiety is a descendant of fear, and if fear is an evolutionary impulse designed to help prolong the survival of the species, then anxiety is surely as old as the human race. Humans have always and ever been anxious (even if that anxiety gets refracted in different ways in different cultures); some relatively fixed proportion of us have always been more anxious than others. As soon as the human brain became capable of apprehending the future, it became capable of being apprehensive about the future. The ability to plan, the ability to imagine the future—with these come the ability to worry, to dread the future. Did Cro-Magnons suffer nervous stomachs when predators lurked outside the cave? Did early hominids find their palms getting sweaty and their mouths dry when interacting with higher-status members of the tribe? Were there agoraphobic cavemen or Neanderthals who endured performance anxiety or fear of heights? I imagine there were, since these proto–Homo sapiens were the products of the same evolution that has generated our own capacity for anxiety, and they possessed the same, or very similar, physiological equipment for fear.

Which suggests that anxiety is an abiding part of the human condition. “In our day we still see our major threats as coming from the tooth and claw of physical enemies when they are actually largely psychological and in the broadest sense spiritual—that is they deal with meaninglessness,” Rollo May wrote in 1977 in the foreword to his revised edition of The Meaning of Anxiety. “We are no longer prey to tigers and mastodons but to damage to our self-esteem, ostracism by our group, or the threat of losing out in the competitive struggle. The form of anxiety has changed, but the experience remains relatively the same.”

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