Richard M. Restak, M.D.

Poe's Heart and the Mountain Climber

Introduction  

Daily life in twenty-first-century America provides a steady diet of anxiety-provoking events.  On more days than we care to count, we awaken to television newscasts of riots, violent protests, and killings occurring at various locations throughout the world.  Over breakfast, we read about infectious diseases that might evolve into a modem-day plague; additional power outages resulting from our outmoded energy delivery systems; computer worms and viruses with the potential to destroy our most secure databases; and escalating levels of drug use and violence both in large cities and small towns.

And it gets even more up close and personal.  Upon our arrival at the office, we learn that the CEO has made yet another change in employee health insurance coverage, thus requiring us to choose yet another new doctor.  While driving home from work, we flip from station to station on the car radio in search of information about potential terrorist threats, all the while reviewing in our mind various disaster scenarios that could conceivably befall us.

Anxiety has become such an integral part of our lives that Americans reported higher levels of anxiety in the 1990s than they did in the 1950s, the so-called Age of Anxiety.  Among children, the situation is even worse.  Starting in the 1980s, normal children experienced higher anxiety levels than adult psychiatric patients in the 1950s!

Media pundits and gurus have cited several possible reasons for this increase in anxiety.  For one, near instant communication technology provides us with vivid video depictions of anxiety-provoking events occurring thousands of miles away, events that otherwise often bear little relevance to anything happening or likely to happen in our own lives.  What's more, government officials, media marketers, and even scientists have learned an important principle: If they want to get our attention, they have to arouse our anxiety-if you doubt this, just watch the nightly newscasts or read your morning paper.  Over the last decade or so, they've discovered (principally via the process of trial and error) that most of us pay more attention to those who speak to us of the terrible things that may happen than we do to people who assure us that everything is all right.

As a result of these converging influences, we're now exposed to information about innumerable nerve-racking calamities that might occur.  To make matters worse, anxiety tends to be a cumulative emotion: If we become anxious about something today, then our anxiety will resurface whenever we encounter that same event or situation in the future.  And since each day provides any number of anxiety-provoking events, the triggers for anxiety arousal increase over the years.

In response to escalating personal and communal anxiety, increasing numbers of us are falling prey to anxiety-associated illnesses.  At the moment, more than 19 million Americans suffer from some form of anxiety dysfunction.  Ask any primary care doctor and he or she will tell you that anxiety is the underlying cause for the majority of patient complaints.

Because we are collectively feeling increasingly threatened, vulnerable, and helpless-that our lives are determined for us by forces outside of our control-our individual and community anxiety levels are on the increase.  In response, we take various attitudes toward managing that anxiety.

For example, consider an article I encountered in the New York Times entitled "A Nice Place to Live if You Can Live with Terror." It described the attitudes of several wealthy Colombians living in Bogota in February 2003, two days after terrorists detonated a 330-pound bomb in the parking garage of an exclusive sport and social club, killing 32 people and wounding at least 160.  The statements of several of the interviewees are typical of different responses to anxiety, in this case the anxiety provoked by the uncertainty and risk associated with living under threats of terrorism.

"Six children died in there; how can that be?" asked the father of a thirteen-year-old who often played squash or miniature golf in the bombed structure.  "It is absurd, so absurd." "This march today is a march of fury for the loss of our countryman," shouted a famous Colombian actor during a demonstration protesting the bombing.  "If they want to stop us they will have to kill all 40 million Colombians." "Now all of us are worried because we could be in their sights," commented a retired surgeon while on a putting green at his Bogota golf club.

"I will do the same things I did before but I will be more careful," said a retired engineer.  "I will not go to risky places, to certain restaurants, or take long car trips, or go to shopping malls on certain days." "This is still a nice place to live," responded another retired engineer.  "If you take precautions, you can live very, very well.

You cannot just abandon that." Notice the progression of attitudes expressed by these quotes (which I've presented in a different sequence than in the Times article): disbelief and a sense of absurdity, followed by rage and defiance, then worry, then the determination to make a lifestyle change, and finally acceptance.

A similar progression is occurring within our entire society.

Our initial reaction to the terrorist attacks on the Twin Towers and the Pentagon was one of horrified disbelief and unreality the sensation of entering a nightmare, as President Bush commented on his visit to New York in the immediate aftermath of the attacks-followed by rage, and then anxious worry.  In response, many people at various times have contemplated some kind of lifestyle change.  Here in Washington , dinner-party conversations always eventually drift onto the subject of whether it's time to relocate.  After the Pentagon bombing, the anthrax scares, the sniper episodes, and the daily fluctuations in the threat levels of terrorist attacks, many people seriously contemplate moving elsewhere.

But before anybody calls in the moving vans, he or she should reflect on the experience of Wilmer McLean.  In 1861, at the beginning of the Civil War, Wilmer became sufficiently anxious to flee his home in Manassas , Virginia , and move farther south to the comparative safety of Appomattox Court House.  Four years later, on April 9, 1865, General Robert E.  Lee and General Ulysses S.  Grant signed the final documents of Confederate surrender in Wilmer's front parlor.  Sometimes-and this, too, is one of those times-there just isn't any refuge that offers guaranteed safety.

If flight isn't an option-and after we've successfully maneuvered beyond disbelief and feelings of absurdity and rage-then we're left with a limited number of options.

Ponder for a moment that last quote by the retired engineer:

"If you take precautions, you can live very, very well.  You cannot just abandon that." Then answer the following multiple choice question.

Do you believe the quote reflects: 

1.  An unrealistic and overly confident feeling that taking precautions-assuming one even knows what precautions to take-will prevent one from being killed or injured?

2.  An expression of denial that evades any emotional response to possible pain, injury, or death?

3.  A healthy expression of the humility we all should feel in response to the little control we all have in regard to what can happen to us from moment to moment?

The best answer to that question, it seems to me, is "all of the above." While it's true that no amount of precautions will ever guarantee safety, we can't allow our anxiety about an uncertain future to goad us into jettisoning our most cherished values and living in denial: shutting ourselves up in our homes or apartments without televisions, radios, or links to the Internet, and simply hoping for the best.  What's demanded of us in the face of terrorism and other contemporary sources of anxiety is a major psychological realignment in our attitude toward anxiety itself.  In a world where total security is impossible, we must learn to accept the fact that anxiety is going to remain a permanent part of our inner landscape.

"In an open society, there are simply too many threats, too many openings and too many interactions that are built on trust.  You can't even begin to secure them all without also choking that open society.  Which is why the right response, after a point, is not to demand more and more security-but to learn to live with more and more anxiety," wrote columnist Thomas Friedman.

Learning to live with increasing levels of anxiety means learning to take it in stride, becoming comfortable with the concept that feeling anxious is a "normal" part of living.  Our attitude should be similar to that of the cancer survivor who learns to savor every moment despite the realization that however favorable the doctor's prognosis, the cancer may return.

What's needed is a new, more empowering approach that involves thinking in counterpoint.  The New Shorter Oxford Dictionary defines musical counterpoint as "the art or practice of combining two or more musical parts in accordance with definite rules so that they are heard simultaneously as independent lines." Thinking in counterpoint involves simultaneously processing one stream of thought (our activities, goals, and concerns at the moment) while at the same time neither avoiding nor panicking at the secondary thought that we live in dangerous times in which total security is impossible.

As with the cancer survivor who thinks wistfully back to the time prior to diagnosis, our lives, too, have been irrevocably changed: We cannot return to the world that existed before September 11, 2001.  The question is, are we going to build up our tolerance for anxiety-adjust our anxiostat, so to speak-and get on with our lives, or are we going to allow our anxiety to overwhelm us?

In Poe's Heart and the Mountain Climber, we will explore anxiety at every level from the molecular to the behavioral.

Along the way, we will address such pivotal questions as these:

How does anxiety differ from fear and stress? Which areas of the brain are associated with anxiety? Can animals become anxious? If so, how does animal anxiety differ from ours? And if we were free of all anxiety, would that be a good thing, or do we actually need a certain level of anxiety in order to be creative and live life to the fullest? Along the way, I'll provide some guidelines on how to manage anxiety, how to make it a positive rather than a negative influence on your life.

After interviewing many experts on anxiety, and reflecting on my own years of experience treating anxious patients, as well as experiencing more than a few anxious moments myself, I've organized this book around one principle: The best way to manage anxiety in these anxious times is to learn about it and put that learning to practical use.

While not intended primarily as a self-help book, Poe's Heart and the Mountain Climber contains suggestions I've received from experts on anxiety that, if you apply them, will enable you to manage anxiety in your own life.  Thus, Poe's Heart and the Mountain Climber involves both information and its practical application.  And although our exploration of anxiety will sometimes involve complex topics and principles, I've tried to temper scientific precision with clarity and a user friendly approach.  As a first step, let's take a close look at two factors contributing to our anxiety: the deficient probability estimating power of the human brain, and the increasing attempts by the media and others to influence our behavior by arousing our anxiety.