Is pathological anxiety a medical illness, as Hippocrates and Aristotle and many modern psychopharmacologists would have it? Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it? Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes once had it? Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? Or, finally, is it—as W. H. Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?
The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts). The origins of a temperament are many-faceted; emotional dispositions that seem to have a simple, single source—a bad gene, say, or a childhood trauma—may not. After all, who’s to say that Spinoza’s vaunted equanimity, though ostensibly a result of his philosophy of applying logical reasoning to irrational fear, wasn’t in fact a product of his biology? Mightn’t a genetically programmed low level of autonomic arousal have produced his serene philosophy, rather than the other way around?
I don’t have to look far to find evidence of anxiety as a family trait. My great-grandfather Chester Hanford, for many years the dean of Harvard College, was in the late 1940s admitted to McLean Hospital, the famous mental institution in Belmont, Massachusetts, suffering from acute anxiety. The last 30 years of his life were often agonizing. Though medication and electroshock treatments would occasionally bring about remissions in his suffering, such respites were temporary, and in his darkest moments, in the 1960s, he was reduced to moaning in a fetal ball in his bedroom. Perhaps wearied by the responsibility of caring for him, his wife, my great-grandmother, a formidable and brilliant woman, died from an overdose of scotch and sleeping pills in 1969, a few months before I was born.
My mother, Chester’s granddaughter, is, like me, an inveterate worrier, and, though she enjoyed a productive career as an attorney, she suffers from some of the same phobias and neuroses that I do. She assiduously avoids heights (glass elevators, chairlifts), and tends to avoid public speaking (when she has to talk publicly, she takes beta-blockers in advance) and risk taking of most kinds. Like me, she is mortally terrified of vomiting (and has not done so since 1974). As a young woman, she suffered from panic attacks. At her most anxious (or so my father, her ex‑husband, says), her fears verged on paranoia: just after I was born, while suffering from postpartum depression, she became convinced that a serial killer in a yellow Volkswagen was watching our house. (Today, my mother and father, now divorced 15 years, disagree about the severity of the paranoia: my mother says it was negligible—and that, moreover, there really was a serial killer afoot at the time, a fact that research confirms.) My only sibling, a younger sister who is a successful cartoonist and editor, struggles with anxiety that is different from mine but nonetheless intense. She, too, has taken Celexa—and also Prozac and Wellbutrin and Klonopin and Nardil and Neurontin and BuSpar. None of them worked for her, and today she may be one of the few adult members of my mother’s side of the family not currently taking a psychiatric medication.
On the evidence of just my mother’s side of the family (and there is a separate complement of psychopathology coming down to me on the side of my father, a respected research physician who drank himself unconscious many nights throughout much of my later childhood), it is not outlandish to conclude that I possess what Sigmund Freud called “the hereditary taint,” a genetic predisposition to anxiety and depression.
But these facts, by themselves, are not dispositive. In the 1920s, my great-grandparents had a young child who died of an infection. This was devastating to them. Perhaps this trauma, combined with the later trauma of having many of his students die in World War II, cracked something in my great-grandfather’s psyche. Perhaps my mother, in turn, was made anxious by the fussy ministrations of her worrywart mother; the psychological term for this is modeling. And perhaps I, observing my mother’s phobias, adopted them as my own.
Or maybe the generally unsettled nature of my childhood psychological environment—my mother’s constant anxious buzzing; my father’s alcoholic absence; their sometimes unhappy marriage, which would end in divorce—produced in me a comparably unsettled sensibility. Both my mother and father were well intentioned and loving, but between them, they combined overprotection and anger in a way that may have been particularly toxic for a child with an innately nervous temperament. On many occasions, my screaming bouts of nighttime panic would awaken the whole family, and my father would lie patiently with me, trying to calm me down enough to sleep. But sometimes, exhausted and frustrated, he would lash out at me physically. My mother dressed me until I was 9 or 10 years old; after that, she picked out my clothes for me every night until I was about 15. She ran my baths until I was in high school. Any time my sister and I were home while my parents were at work, we had the company of a babysitter. By the time I was a young teenager, this was getting a bit weird—as I realized the day I discovered, to our mutual discomfort, that the babysitter was my age (13). My mother did all of this out of genuine love and anxious concern. And I welcomed the excess of solicitude: it kept me swaddled in a comforting dependency. But our relationship helped deprive me of autonomy and a sense of self-efficacy.
Still, in most respects my parents maintained a safe, loving, and stable suburban home; many people grow up in circumstances far more traumatic than mine and don’t develop clinical anxiety. Ultimately, it’s impossible to disentangle nature and nurture—my anxiety is surely the result of both, and of the interaction between the two. For instance, it’s possible that my mother’s anxiety while pregnant with me—having endured two miscarriages followed by difficulty getting pregnant again, she says her already high level of worry was inflamed by the fear that she wouldn’t carry me to term—produced such hormonal Sturm und Drang in the womb that I was doomed to be born nervous. Research suggests that mothers who suffer stress while pregnant are more likely to produce anxious children. Thomas Hobbes, the political philosopher, was born prematurely when his mother, terrified by a rumor that the Spanish armada was advancing toward English shores, went into labor in April 1588. “Myself and fear were born twins,” Hobbes wrote, and he attributed his own anxious temperament to the ambient turmoil of his gestation. Maybe Hobbes’s view that a powerful state needs to protect citizens from the violence and torment they naturally inflict on one another (life, he famously said, is nasty, brutish, and short) had its origins in utero, as his mother’s stress hormones washed through him.
Or do the roots of my anxiety lie even deeper and extend more broadly than the things I’ve experienced and the genes I’ve inherited—that is, in history and in culture? My father’s parents were Jews who emigrated from Weimar Germany. My father’s mother became a nastily anti-Semitic Jew—she renounced her Jewishness out of fear that she would someday be persecuted for it. My sister and I were raised in the Episcopal Church, our Jewish background hidden from us until I was in high school. My father, for his part, has had a lifelong fascination with World War II, and specifically with the Nazis; he watched the 1973–74 television series The World at War again and again. In my memory, that program, with its stentorian music accompanying the Nazi advance on Paris, is the running soundtrack to my early childhood. Jews, of course, have millennia of experience in having reason to be scared—which perhaps explains why some studies have suggested that Jewish men are more likely to suffer from neuroses than are men in other groups.
My mother’s cultural heritage, on the other hand, is heavily WASP; she is a proud Mayflower descendant who until recently subscribed to the notion that there is no emotion and no family issue that should not be suppressed.
Thus, me: a mixture of Jewish and WASP pathology—a neurotic and histrionic Jew suppressed inside a neurotic and repressed WASP. No wonder I’m anxious: I’m like Woody Allen trapped inside John Calvin.