Fear Of Fainting, Flight And Cheese: One Man's 'Age Of Anxiety.'

January 6, 2014

Guest: Scott Stossel

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross. I don't know about you, but my anxiety levels tend to rise with the new year, after the holidays are over, and the pace of life speeds up again, which maybe makes this the perfect day for an interview about anxiety. My guest, Scott Stossel, is the author of the new book "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind."

The book is part memoir; he has just about every anxiety and phobia I've ever heard of, as well as some that I'd hadn't. The book is also a history of how the medical profession and the pharmaceutical industry have dealt with anxiety, and it offers a glimpse into cutting-edge research about the neurochemistry of anxiety.

Stossel says he wrote the book to help him understand and find relief from or redemption in anxious suffering. Stossel is a very high-functioning anxious person. In fact before this book, most of his colleagues were unaware of his problems. He's the editor of The Atlantic magazine. The new edition's cover story is adapted from Stossel's book.

Scott Stossel, welcome to FRESH AIR. You have an extreme case of anxiety, and you're also a journalist and a great writer, which makes you the perfect person to have written this book. So first I want to thank you for using yourself as a case study to illustrate some of the anxiety-related issues that you write about, and of course you make connections historically there, too.

Let's start the way your book does with a kind of inventory of some of your anxieties and phobias. I'd like to ask you to do a short reading from the book.

SCOTT STOSSEL: Sure.

GROSS: And this reading picks up right after you've described how you nearly collapsed at your own wedding because of all the anxiety you were experiencing, not over the choice of getting married to the right person but just the anxiety of what?

STOSSEL: Of being in front of every - all these people and having to perform kind of in a public setting, which often provokes acute anxiety, physical anxiety that can lead to all kinds of symptoms like sweating, shaking, nausea and just general feeling of impending collapse.

GROSS: Right, OK. So you want to pick it up from there in the reading?

STOSSEL: Sure. My wedding was not the first time I'd broken down, nor was it the last. At the birth of our first child, the nurses had to briefly stop ministering to my wife, who was in the throes of labor, to attend to me as I turned pale and keeled over. I'd frozen, mortifyingly, onstage at public lectures and presentations, and on several occasions I have been compelled to run offstage.

I have abandoned dates, walked out of exams and had breakdowns during job interviews, on plane flights, train trips and car rides and simply walking down the street. 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 and been beset by nausea, vertigo, shaking and a panoply of other physical symptoms.

In these instances I have somehow been convinced that death, or something somehow worse, was imminent. Even when not actively afflicted by such acute episodes, I am buffeted by worry about my health and my family members' health, about finances, about work, about the rattle in the car and the dripping in my basement, about the encroachment of old age and the inevitability of death, about everything and nothing.

Sometimes this worry gets transmuted into low-grade physical discomfort - stomach aches, headaches, dizziness, pains in my arms and legs - or a general malaise, as though I have mononucleosis or the flu. At various times I have developed anxiety-induced difficulties breathing, swallowing, even walking. These difficulties then become obsessions, consuming all of my thinking.

I also suffer from a number of specific fears or phobias. To name a few: enclosed spaces; claustrophobia; heights, acrophobia; fainting, asthenophobia; being trapped far from home, a species of agoraphobia; germs, bacillophobia; cheese, turophobia; speaking in public, a subcategory of social phobia; flying, aerophobia; vomiting, emetophobia; and, naturally, fear of vomiting on airplanes, aeronausiphobia.

GROSS: Forgive me for laughing, but you're such a good writer that you manage to make that kind of funny, too. And I think we all have - I know we all have anxiety, some of us more than others, you probably more than most. And I know - I'm familiar with a lot of the anxieties, though probably a lot more low-grade than yours.

But, like, I didn't know that there was, like, a fear of cheese or even a fear of vomiting.

STOSSEL: Yeah, well actually I didn't know there was a name for fear of cheese, and that's one I've had since I was about five, and it's - yeah, I have a fairly acute phobia/aversion to it. As I found in my travels through the literature on anxiety, there's a vast encyclopedia of fears and phobias, and pretty much any objected, experience, situation you can think of, there is a - there is someone who has a phobia of it.

So yeah, turophobia, the fear of cheese, is not - I'm not alone in that. But the fear of vomiting, which for me is one of the sort of most original and most acute of my fears, is actually fairly common, emetophobia it's called, and by some estimates it's the fifth-most-common specific phobia. And I came across some evidence that in fact, you know, there are these online communities where these people seek each other out, and the largest one, maybe larger than the largest fear of flying community, which, you know, one would think would be the predominant phobia.

And it's one of these things where, you know, the age of the Internet has allowed a lot of these people who may have thought they were the only people with these particular phobias to find each other online. So there is a fairly active - several active communities of emitophobes, of which I am one very acutely.

GROSS: Is the fear of cheese and the fear of vomiting maybe slightly related, since some very ripe cheese smells a little bit like vomit sometimes?

STOSSEL: I think that's almost certainly the case. And there is actually - you know, year ago, I mean, I started - my anxieties blossomed at a fairly young age. And when I was 10 or 11 I started going to a psychotherapist regularly. And he had a theory, which had a certain plausibility to it. So when I was about five years old, I was getting ready to fly to my grandparents' house with my father, and my mother and my sister had taken us to the airport to drop us off.

And my sister, who was three, picked up a piece of cheese that someone had left on the floor, and she ate it. And my mom, who shares my emetophobia, the fear of vomiting and also a fairly obsessive germ-phobic, made a big deal about how this was a terrible thing, and said my sister should not have eaten the cheese.

And then sure enough, we fly to Chicago for a day, come back the next day, and my sister threw up on the living room floor right in front of me. And I - it's not inconceivable to think that at that moment, these two things, the cheese and her getting sick, were linked. I can't prove that that's the case, but I have these two phobias, and I have that fairly vivid memory from age five, so...

GROSS: So of that long list of anxieties and phobias that you inventoried for us, which caused you the most suffering?

STOSSEL: I would say both in terms of the duration of the time that I've suffered from it and its intermittent acuteness, the emetophobia. And it infects, or inflects I should say, many of my other fears. So for instance, you know, the fear of vomiting, you know, it makes me afraid to travel because I'm afraid I'll vomit far from home. It makes me afraid of flying - not for the conventional because I'm afraid the plane will crash, although I also have that - but I'm afraid I'll get motion sick and get nauseous and get sick from that.

The fear of germs is obviously directly tied to that, and the horrible kind of self-fulfilling, vicious cycle of emetophobia is that if you are prone to acute anxiety and nervousness, as I am, it often manifests itself with stomach symptoms. So say I was nervous about coming to talk to you here today. That might manifest itself as sort of butterflies in my stomach, and then rather than - and then I start getting nervous about gee, my stomach hurts a little bit.

And then I get nervous about that, and then all of a sudden I'm not only nervous about having to, you know, talk on the radio in front of a national audience, but I'm also worried about what's going on in my stomach. And so you simultaneously have two thought processes, which are hard enough to kind of keep track of when you're only dealing one of them. You've got two going at once.

So the emetophobia is kind of infernal in that regard. So that - the short answer to your question is that's by far the worst.

GROSS: Even though you rarely vomit.

STOSSEL: That's the irony. Yeah, I haven't since - and I'm not knocking on wood because I think this is a Formica table but...

(SOUNDBITE OF KNOCKING)

STOSSEL: Since 1977, September - March 18.

GROSS: So - which proves that anxieties aren't always rational.

STOSSEL: Exactly, and, you know, with the rational part of my brain, I realize how completely irrational this is. I mean, I spend - you know, the amount of time since I was seven years old that I've spent worrying about something, as I say in the book, that I have spent zero percent of the last 30-some-odd years doing, it makes no sense.

And I know it makes no sense, and yet here I am.

GROSS: Right, not helpful to know that it makes no sense.

STOSSEL: Well, it is a little helpful, and I can sometimes - when, you know, I can sort of engage my neocortex, the part of my brain that, you know, is rational, I can kind of calm down the amygdale, which is the sort of seat of fear-based emotion and can convince myself, you know, there's nothing to worry about.

But then when I'm actually confronted with a phobic trigger, you know, someone in my family gets sick, or I'm feeling a little queasy, all rational ability becomes sort of irrelevant, and my fight-or-flight response revs up and I'm powerless to do anything about it and I'm often running into full-blown panic.

A lot of times I can sort of talk myself into what's known as a limited-symptom panic attack, where I'll have some of the symptoms, whether I'm sweating or having a little bit of stomach distress or what have you, but I can kind of keep myself from going into the full-blown, all-consuming, you know, mind hijacked by panic, and I can do that with sort of self-talk and, you know, armed with the knowledge that I have about how panic attacks work.

GROSS: If you're just joining us, my guest is Scott Stossel. He's the author of the new book "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." He's also the editor of The Atlantic magazine. Let's take a short break, and then we'll talk some more about anxiety. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: If you're just joining us, my guest is Scott Stossel. We're talking about his new book "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." And it's part memoir and part a history of the medicalization of anxiety. And he's also the editor of The Atlantic magazine.

Now that you've inventoried some of your anxieties and phobias, just do an inventory for us of some of the therapies that you've tried, pharmaceutical and otherwise.

STOSSEL: Yes, the list is long, so starting with psychotherapy, you know, individual talk therapy, sort of psychoanalysis-style psychotherapy; group therapy; acceptance and commitment therapy; cognitive behavioral therapy; hypnotism; EMDR, which is eye movement reprogramming something, where you move your eyes back and forth and it's supposed to make new connections across the two hemispheres of your brain; all kinds of pharmicatherapy.

I've taken antipsychotics, major sedatives, benzodiazepines like Valium, Ativin, Klonopin. Early antidepressants like MAO inhibitors such as Nardil; various tricyclic antidepressants such as imipramine and desipramine; and then SSRI and SNRI medications, those are selective serotonin reuptake inhibitors; and serotonin and norepinephrine reuptake inhibitors such as Effexor, Cymbalta.

The SSRI is the most - first and probably most famous is still Prozac, but you've got Paxil, Celexa, Lexapro and many, many more.

GROSS: Yeah, we get the point.

(LAUGHTER)

GROSS: And you write here's what worked: nothing. But they've all helped a little maybe?

STOSSEL: Yeah, I mean and I say that sort of jokingly that nothing worked. I mean, nothing has cured me. There are things that have helped a lot, various medications among them at different times, you know, going back to when I was a kid in seventh grade, a combination of thorazine, imipramine and sometimes Valium, you know, basically kept me in school when otherwise I probably would have had to be institutionalized.

That was when it was at its most severe. Since then there have been times when in the late '90s I took Paxil, which was highly effective for a little under a year. And benzodiazepines like Xanax and Klonopin actually are, for me, and you know, as with all drugs, some drugs work for some people very effectively some of the time, and some don't work at all for some people.

But I have generally found that the benzodiazepines are highly effective on a limited basis.

GROSS: I find this really fascinating. You write in your book that people think of you as calm and that one colleague described as human Xanax, so it was just like calming to be in your presence. How do you explain that since you have such a long list of anxieties and phobias yourself?

STOSSEL: I think it's a couple things. I mean, one is - I mean, some people say that, you know, in stressful situations I can seem unflappable, and I think that's partly because I'm always kind of internally flapped, and so, you know, I'm able to actually, when something - there's real to be concerned about, it's actually less anxiety-provoking than these rational things.

But it's also fairly typical, I now know from all of my reading, certain kinds of anxiety disorder sufferers, particularly people with panic disorder, are exceptionally good at hiding it. They're able to convey an impression of competence and calmness and confidence, which is maybe substantially real, they may actually be competent and in some ways confident. But there's an internal fear, and it's sometimes in fact that gap, trying to protect the inner view of yourself, or to hide the inner view of yourself as frightened, anxious, vulnerable, the gap between that and this façade, where people see you as competent and effective, you're always afraid of being exposed, which is itself anxiety-producing.

One of my more recent therapists calls this phenomenon impression management, and impression management is not only a symptom of anxiety, because you're worried about being exposed, but it's also a cause because you're constantly worried that the house of cards that is your outward image as an effective, confident person is going to be - come crashing down.

GROSS: But you write you think anxiety makes you conscientious because you're afraid of screwing things up. So you want to make sure you've got all your bases covered.

STOSSEL: That's true. There are ways in which anxiety can be a positive thing. It makes - Jerome Kagan, who's a professor emeritus of psychology at Harvard, studied the psychology of temperament for 60 years, and he talks about - he has categories called inhibited temperament, which is a category of personality that sort of lends itself - is more susceptible to developing anxiety disorders.

And then there are uninhibited temperaments, who tend to be more relaxed, have lower reactive physiologies. And he says he, by the end of his career, would hire only inhibited temperament workers because they tended to be more conscientious, they were more careful, they didn't make mistakes, they wanted to get things right.

So it can be a motivating factor. In fact, you know, too little anxiety can be a huge problem too. There was a famous study in 1908 by two Harvard psychologists, Yerkes and Dodson, and they developed what's known as Yerkes-Dodson Law. So if you picture a bell curve and it's running from left from right, and on the horizontal axis there you've got levels of anxiety, and on the vertical axis you have performance, you know, and the higher you are up on the vertical axis, the better you are at performing.

So if you're too far out on the right side, if you're too anxious, performance is inhibited, you're unable to perform because you're so anxious. But if you're too far toward the left and not anxious enough, you'll actually also perform poorly because you're not engaged, your adrenaline's not pumping, your physiology is not activated enough to be at peak performance.

So really where you want to be is sort of a moderate amount of anxiety, and that'll put you at the top of the bell curve, where your performance will be at its peak.

GROSS: I found this really interesting. Someone you know who's a war correspondent, and she has anxiety problems, but she says she's calmer when being shelled in a war zone than she is at dealing with a lot of ordinary things in a safe area. Is that something that you think is fairly common in certain people?

STOSSEL: I think it is. I mean often if you are sort of internally consumed with anxiety, when you are distracted by actual things to be afraid of, like bombs possibly dropping on your head, you don't have the luxury of being anxious about neurotic things. So that's fairly common.

There were these studies I came across from World War II during the Blitz, where people who were diagnosed with various sort of neuroses and anxieties found themselves becoming less anxious during the Blitz. And partly it was because I think they had other, you know, real things to be afraid of. They were running around worried about bombs dropping on their head.

And partly, you know, they could see that everyone else was as nervous as they felt all the time anyway. And so actually this had a sort of de-pathologizing effect on their anxiety. And Freud says, you know, that often threats from within, perceived threats to within, to self-esteem, to your image of yourself, are more anxiety-provoking than threats from without, whether that's a tiger that's chasing you or, you know, somebody who's got you pinned under fire in a war zone.

GROSS: You say that pharmaceutical companies have played a role in defining some of the categories of anxiety. Basically when they come up with a drug that addresses a problem, then they name the problem and it becomes an official disorder. Can you give us an example of that?

STOSSEL: Sure, a classic recent example is Paxil and social anxiety disorder. In 1980, social anxiety disorder was formally inscribed into the DSM-III, but almost nobody was diagnosed with it for about 17 years. And by today you have millions of people who are diagnosed with it.

What changed? Well, it was FDA approval of Paxil, which is an SSRI antidepressant. It was the first drug to be approved specifically for the treatment of social anxiety disorder. And the drug company launched a multi-million dollar marketing campaign, and suddenly you went from almost zero diagnoses to hundreds of thousands and then millions.

And in fact if you look in the literature, there were very few citations even of social anxiety as anything in the mainstream press until Paxil came along, and then suddenly there were hundreds of thousands. So here's a case where a drug came along and basically created a category that hadn't existed before, and the diagnoses exploded.

GROSS: And I guess maybe in a way doctors have to give that diagnosis in order to prescribe the medication.

STOSSEL: That's right. I mean, they have - you can do what's called off-label prescribing, but for the most part, unless, you know, a drug has been approved by the FDA for a given disorder, most doctors aren't even aware that they're able to do that or what they're used for.

So often you'll have a drug come online, and that will suddenly lead to an inflation of the diagnostic category. And again, that doesn't mean that the disease doesn't exist in nature. It doesn't mean that the drug companies are completely, you know, are malign and inventing things. They really are trying to create drugs that relieve distress from anxious, depressed, whatever people.

But oftentimes, you know, the marketing can kind of get ahead of the science, and people who may not need the drug end up getting prescribed it.

GROSS: Scott Stossel will be back in the second half of the show. His new book is called "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." He's the editor of The Atlantic magazine. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross back with Scott Stossel, author of the new book, "My Age of Anxiety." It's both a memoir about the many anxieties and phobias that afflict him, and a history of how the medical profession and the pharmaceutical industry have treated depression.

Stossel also reports on new research into the neurochemistry of anxiety. Stossel is the editor of The Atlantic magazine. The current edition's cover story is adapted from his book.

You write a little bit about genetics and anxieties, as anxiety - severe anxiety - an inherited problem. And you have a family history of anxiety. Maybe you could just run through some of the anxiety in your family tree.

STOSSEL: Sure. Well, going back - and it goes back even before this, when I dipped into the kind of the family archive - I found evidence of great, great-grandparents who have had to sort of retire from some successful careers to move to the countryside because that was the only thing - they couldn't deal with people. But the first, the relative of mine with whom I sort of most identify and did the most research into was my great-grandfather, Chester Hanford, on my maternal side. And he, in the 1940s and '50s, had been dean of Harvard College, very successful esteemed man and basically underwent a series of nervous breakdowns, provoked by severe anxiety that led to multiple hospitalizations, electroshock therapy, all kinds of drug therapy.

His granddaughter, my mother, suffers from many of the same phobias and neuroses that I do. She also has fear of public speaking, fear of flying, acute emetophobia. My sister has a set of anxieties that are actually overlapped with some of mine. She will not fly. She hasn't flown for many years. She has an acute fear of thunderstorms, and she has fairly severe social phobia. I have other relatives on my maternal side who have been on and off various SSRI medications. So the family tree is sort of stippled with people who have anxiety - which is quite common in the literature.

And in my research, you know, not just into my own family, but in sort of reading through, I mean I've come to the conclusion that there is a rather large genetic component to one's underlying temperament. That doesn't mean that you're doomed to grow up to be, you know, have an anxiety disorder or be, you know, nervous all the time, but you will be sort of disproportionately prone to being - developing an anxiety disorder. And nothing is ever purely genetic. You know, there are identical twins - one of whom will develop panic disorder, you know, and then the other is much more likely to develop panic disorder than a random person in the population, but they're not guaranteed to do it - which is sort of proof that it can't be wholly genetic because what they have the same genome.

GROSS: This is really interesting. Your young daughter has emetophobia - the fear of vomiting. And you kept that from her. You never told her that you had that fear. So your mother had that fear, you have that fear, and without any prior knowledge of that in your family, your daughter developed that fear. It seems so improbable that there would be a genetic underpinning of such a specific and what I thought was really unusual phobia.

STOSSEL: Yeah. I was - when my daughter developed this when she was 6 or 7 -which as it happened, was the exact same age when I developed mine - I was both flabbergasted, heartbroken and fascinated, because exactly as you say, you know, how could something as idiosyncratic as emetophobia - fear of vomiting - be transmitted from generation to generation? And I had always sort of assumed that I had picked up mine from watching my mom, who had fairly severe emetophobia, you know, I thought via modeling - as the psychologists call it - I might have learned it from her. But I took care to hide it from my daughter. And my wife does not have these anxieties at all.

Now it's possible in some secret unknown way I transmitted this to her subconsciously, but I don't think that's the case. So I talk in the book about how, you know, is it possible that you could have a gene or a set of genes for emetophobia. It's more likely that there's probably a set of genetic predispositions that make you likely to become anxious in certain ways and maybe have a fear of a loss of control, which tends to be something that's common to emetophobes.

GROSS: So how do you try to calm your daughter down? When she first developed this when she was 6, since you have it, you know it, you understand it. And you also know that nothing's helped you overcome it. And that rationally knowing that like you haven't thrown up in decades doesn't help. So what did you tell your daughter in the hopes that it would, you know, end that anxiety?

STOSSEL: Well, I was a little bit torn at first because I didn't know whether to tell her - do I tell her, you know, Maren, you don't have to worry about this, I've gone more than 30 years without doing it, you might be able to get away with that too. Or was that in fact the, precise wrong thing to tell her because that's not realistic? And so we actually put her into therapy with a cognitive behavioral therapist who was actually very, very effective. And, you know, there was a moment when it seemed like - as had been the case with me, you know, my emetophobia sort of metastasize into a whole range of other fears and phobias. My daughter still has the fear and, you know, my wife jokes that, you know, if either my daughter or I hear the word or anyone referring to a stomach virus, our heads will snap around. It's almost like we're on, you know, DEFCON 4 alert all the time, you know, scanning the environment for evidence that there's danger. But we have, you know, her fears are limited to just that one phobia, and it's less acute than it was. And I mean I'm proud of her, it's less acute than mine. She still worries about it, but she's not debilitated by it in the way that I am.

GROSS: There's something else that you did in part as research for your book, is that you did your genome. And you were looking specifically for what are sometimes called the Woody Allen genes? What are those genes?

STOSSEL: Well, interestingly, there's a whole bunch of different genes that the media over the years have called the Woody Allen genes, so I could've picked a number of, you know, so-called candidate genes. But the two that I was able to get tested for were what's known as the COMPT gene - which some people call the warrior-worrier gene, you know, depending on which variant of it you have. Having one of them makes you more of a worrier, sort of scanning the environment and probably, you know, in the state of nature more evolutionarily well-equipped to avoid danger. And then there's the warrior gene, which it means you're not doing that. You're more likely to end up in danger. But once you're in a stressful situation, you're probably better able to perform with kind of, you know, in effect, grace under pressure.

And then there's another one called the SERT gene or the, it's basically the serotonin transporter gene, which probably is the gene that's had the most research applied to it. And so on the COMPT gene I have sort of a mixed variant of it. I actually don't have the pure warrior gene or the pure worrier gene. It's sort of in between, which there is less data about what that actually means. On the serotonin transporter gene, I have the one with two short alleles, which means based on some of the studies that have been done, I should be more prone to acting neurotic when presented with a certain amount of stress. But interestingly, you know, a large portion of the population has this gene - this particular genome - and there is evidence that it actually may equip you to thrive in certain circumstances where you're not under stress.

GROSS: Has it been helpful to get this information about your genes?

STOSSEL: Yes and no. I wondered in advance of doing it whether I would, you know, I was actually in some ways worried that what if I got the results back and show that I had all the genes for resilience and resistance to anxiety? And I thought boy, you know, I managed to squander an excellent genetic inheritance. And in some ways I feel like now I can point to something and say see, you know, it's not, I'm not just a malingerer, I've got it right there in my genes that shows I've got anxiety woven into my genotype.

But I also want to emphasize, it's something that, you know, I need to emphasize to myself, that, you know, genes are not destiny. And there's, you know, as much as we now know and the information is proliferating all the time, they're still far more that we don't know. And the way that, you know, all these genes interact is so complex and, you know, they're starting to find interesting correlations. But the reality is that you can always, you know, neural plasticity, the ability to kind of carve out new neural pathways, continues throughout your entire life and in fact, even your genome can get affected by the environment - certain genes get turned on and off. And you don't want to fall prey to a kind of genetic determinism where you sort of lie back and say well, I'm you know, look, I'm doomed, I've got the neurotic gene, I'm going to be neurotic. No. You can overcome that.

In fact, a lot of the research these days is on a psychological trait called resilience - which basically, you know, people who are particularly resilient recover from trauma more quickly, they're more resistant to anxiety and depression. And the thing is, you know, resilience is clearly partly genetically determined, but it can also be learned and developed with practice. And that's something that, you know, I am trying to learn to do better and that, you know, anyone struggling with an anxiety you can become more resilient and resilience is really the key to overcoming your ailment.

GROSS: Do you think there's a neurochemical basis for resilience? Are doctors, you know, scientists looking into that?

STOSSEL: Yes. They definitely are. And in fact, there's a lot of fascinating research into her a neurotransmitter called neuropeptide Y or NPY. And what's fascinating about this is that, so they've done studies of Navy SEALs and Army Rangers, you know, who go through these incredibly hard obstacle courses as part of the training in order to get admitted into the Navy SEALs and the Army Rangers. And it's a test of your physical endurance and resilience and your psychological resilience and endurance. And basically the test is designed to try to break you, because if you can't be broken, then you're Navy SEAL material. And there are studies that show that you can predict in advance who will complete the course and who will not based on the levels of neuropeptide Y that they have in their brains. Neuropeptide Y is evidently directly positively associated with resilience.

And there's a separate research that shows that the amount of neuropeptide Y you have is genetically determined. So it may be that, you know, so and actually, I think there is now drug research into could you come up with some sort of synthetic NPY or a way of augmenting those in your synapses to in effect engender chemical resilience. And then separately meditation, mindfulness meditation. People who are really, really good meditators, and even those who aren't good, some who are novices, with just a little bit of meditating, if you do it properly, your brain will actually change. The connections in your neo cortex, where irrational thoughts take place, become stronger and more interconnected and your amygdala, the seat of fear, becomes smaller. And the people where you see those effects on the anatomy of the brain report that they are less stressed and happier. So there are multiple ways that you can build resilience in a way that actually has, you know, physiological correlates that you can see in the body.

GROSS: If you're just joining us, my guest is Scott Stossel. He's the author of the new book "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." It's part memoir but part a history of how everybody from philosophers to psychiatrists, psychologists and the pharmaceutical industry have defined and dealt with anxiety.

Let's take a short break here, then we'll talk some more. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: If you're just joining us, my guest is Scott Stossel. We're talking about his new book "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." It's part memoir and part history of how philosophers, psychiatrists, psychologists and the pharmaceutical industry have defined and dealt with anxiety of all sorts.

Because your book is part memoir - and I should mention here, you're the editor of The Atlantic magazine, which is a pretty high power position. So even though you have every anxiety in the book, you function at a super high level. But, you know, you write in your book that revealing all these anxieties within the book might be, you know, a professional hazard. Which made me wonder, how much do your colleagues know that your readers now know?

STOSSEL: They didn't know any of it. And I was actually surprised - I didn't know as I started to circulate advance galleys of the book, I had a parade of colleagues coming into my office, many of them saying they wanted to give me a hug - which was very nice and somewhat uncomfortable.

(LAUGHTER)

STOSSEL: They all - others coming in and saying - apologizing retroactively for, you know, have I ever done anything that caused you anxiety, and others just sort of expressing surprise saying, you know, gee, there's a lot going on in there. And this was interesting to me because I never really knew, you know, I thought that was pretty good at concealing it and it turned out that I was as good as I thought I was. And several people said, you know - and this is my, one of my big fears - they say, you know, no one's ever going to look at you the same way again. And, you know, this is why in some ways I had, you know, great ambivalence about writing the book in this way. I mean I never intended to write a straight memoir. I mean I don't, my life isn't even that interesting to me and I didn't think, you know, on its own it was that interesting to other people. But I did think because of my struggles with anxiety it was useful as a kind of case study to illustrate various aspects of anxiety.

GROSS: This is the second book you've written.

STOSSEL: Right.

GROSS: The first was about Sargent Shriver and this is about anxiety - yours and just the whole history of anxiety and its diagnosis. And for your first book tour it sounds like you were really a mess. You are just, you know, pretty overcome with anxieties about the travels and the public speaking. And you were afraid while you were writing this book that you wouldn't get it finished. That was one of your major anxieties - that you wouldn't get it finished, that you would be spending so much time on it, you would be undermining your career as an editor and that everything in your life was going to fall to pieces. It didn't. And you say your doctor pointed out - your psychiatrist pointed out to you that you overcame so many crises while writing this book.

Your wife got ill with a mysterious ailment. A tree fell on your house during a thunderstorm and your house collapsed while you were in it. Your father's company went under. Yet you managed to write the book and I will vouch for the fact that it's really a terrific book. This is the very start of your book tour. Can I ask how the anxiety level is about taking the book into the world and the public speaking involved with it, including just doing this interview?

STOSSEL: Yeah. It can be pretty acute. I was struck by the irony that I actually had the idea - the idea for writing this book first occurred to me while preparing for the book tour for my last book. And in fact, you know, when I went to the Boston University Center of Anxiety Disorders where I went, you know, to try to seek emergency treatment, you know, additional emergency treatment in advance of my last book tour, I sort of actually told them, you know, I'm actually thinking about writing this.

And partly I was saying that because I thought maybe it would get me in for an appointment faster, but that's the moment I thought actually I should write about this. So here we are. You know, we spent - that was 10 years ago. I've spent, you know, much of the last six or seven years working on this book. I completed it, which I'm, you know, very glad about it. People seem to be pleased with the result.

And yet here I am, 10 years later rewarded with another book tour. Which was exactly the thing that prompted my anxiety the first time around. So, no, I am pretty anxious. It varies from day to day and moment to moment. I did take a Xanax before coming in here, just for full disclosure, but I think I'm so far doing OK.

GROSS: You read superhero comics as a kid. Considering all of the anxieties that were besetting you as a child, what did you like about superhero comics? And did you wish for a certain super power?

STOSSEL: I mean, I guess to armchair psychoanalyze myself it would be, you know, the notion that, you know, you have these powers that allow you to transcend scary things. There was no superhero who had the power that I wanted which was, you know, anti-vomit man.

(LAUGHTER)

STOSSEL: That would be the power I most wanted. But aside from that, I suppose, you know, I'm terrified of flying and chair lifts. If I could actually fly myself I could probably ski and get places. But there are a lot of cool ones. Invisibility, obviously. Super speed like the Flash and, you know, I'm not a big fan of the sea but if I were Aqua Man and I could talk to the fish, maybe I'd feel less anxious in the water.

(LAUGHTER)

GROSS: OK. Since you know the exact day that you last vomited, which I think was 1977.

STOSSEL: Yeah.

GROSS: Like 1970-something.

STOSSEL: 1977.

GROSS: 1977. Do you mark that day? Is that any kind of, like, anniversary? Is it a day that you face with some dread or - ?

STOSSEL: I do. Much less than I did in the past. I mean, for the - and it happened to be St. Patrick's Day so it's not an easy day to forget. And so, you know, I'm always aware on the calendar...

GROSS: May I say, it's a day when a lot of people are throwing up because they've drank...

STOSSEL: Yeah, exactly.

GROSS: ...way too much beer.

(LAUGHTER)

GROSS: That's a really bad day for that anniversary.

STOSSEL: Yes.

GROSS: So, anyways.

STOSSEL: But I don't - I don't light a candle or put a notch on the bedpost.

(LAUGHTER)

GROSS: Right.

STOSSEL: Or, you know, sacrifice a goat or anything like that. Although, if I thought that would continue this streak, I would do that.

(LAUGHTER)

GROSS: Absolutely. That would be wise.

STOSSEL: Yeah.

GROSS: Scott Stossel, it's really been great to talk with you. I'm really glad you wrote the book. Thank you so much for talking with us.

STOSSEL: It's been my pleasure. Thank you for having me.

GROSS: Scott Stossel is the editor of The Atlantic magazine. His new book is called "My Age of Anxiety." You can read part of the first chapter on our website freshair.npr.org. Coming up, David Bianculli reviews last night's season premier of Downton Abbey. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

TERRY GROSS, HOST: This is FRESH AIR. Last night, the PBS anthology series "Masterpiece Classic" began importing the latest season of "Downton Abbey," the popular period costume drama set at a lavish but struggling British estate in the 1920s. Our TV critic David Bianculli has waited until the day after to discuss it, to join the next day water cooler conversation, because, he says, it's one of the few TV series that still generates some.

DAVID BIANCULLI, BYLINE: When you think about what "Downton Abbey" has achieved and is continuing to pull off, it's actually pretty remarkable. In an era when the most acclaimed TV series of the decade is an edgy cable drama about a dying, meth making criminal, "Downton Abbey" draws similarly large audiences on broadcast TV - public TV at that - with an old fashioned soap opera about servants and household staffer and those they serve.

As season four begins on PBS, "Downton Abbey" is the most popular drama in the history of public television. When the whole of the TV universe is fragmenting, that isn't just impressive. It's almost impossible. But here we are. And having seen the first seven hours of the new season, I think I know why.

Julian Fellowes, the creator and writer of "Downton Abbey," has crafted characters so well-rounded, so complicated and so interesting we're drawn to them no matter what the circumstances. The casting is first-rate and in many instances, perfect. The scenery and set design is beautiful to behold. And the many subplots are both rapidly paced and firmly telegraphed.

When new characters or conflicts are introduced, their trajectory seems obvious - yet every so often, Fellowes throws in a twist so unexpected, and often so unsettling, that characters as well as relationships can change dramatically from one episode to another.

This is the point where we begin talking specifics. One of those sudden shifts occurred at the end of Season 3, when a beloved character, Lady Mary's husband Matthew, died unexpectedly in a car crash. Season four begins six months later, with Lady Mary, played by Michelle Dockery, so despondent that she stays hidden behind the walls of Downton, as relentlessly grim and dour as a grown-up Wednesday Addams.

That goes on for a while, but only until Mr. Carson, who runs the downstairs, confronts Lady Mary to urge her to snap out of her misery. It's both dramatic and comical, because Mr. Carson, played with such British reserve by the deep-voiced Jim Carter, is himself like a human Eeyore. At first, Lady Mary pulls class rank, and scolds him for being so bold. But later, she comes downstairs to seek him out privately.

(SOUNDBITE OF TV SHOW, "DOWNTON ABBEY")

JIM CARTER: (as Mr. Carson) My lady.

MICHELLE DOCKERY: (as Lady Mary) I'm sorry to bother you so late. But I think you know why I've come - to apologize.

CARTER: (as Mr. Carson) You have nothing to apologize for. I pushed into your room and I spoke impertinently.

DOCKERY: (as Lady Mary) I suppose you know my grandmother agrees with you.

CARTER: (as Mr. Carson) That doesn't surprise me. So does this mean you've decided to return to the land of the living? Because if so, I'm glad.

DOCKERY: (as Lady Mary) It means that I know that I've spent too long in the land of the dead.

CARTER: (as Mr. Carson) We were very fond of Mr. Crawley, you know, my lady. All of us.

DOCKERY: (as Lady Mary) I...I know.

CARTER: (as Mr. Carson) You cry, my lady. You have a good cry. That's what's needed now.

BIANCULLI: Mr. Carson is one of my favorite "Downton" characters, but there are plenty of others. Downstairs, I enjoy spending time with absolutely everyone, with a special nod to Brendan Coyle as Mr. Bates. Upstairs, there's the defensive stuffiness of Hugh Bonneville as Lord Grantham, who runs the estate but no longer owns it - and there's my most cherished character and performer of all, Maggie Smith as the Dowager Countess.

Fellowes hands her delicious lines in even the briefest scenes, and Smith nails them all, hammering them home with hilarious understatement as here, when she confronts Lord Grantham about his coddling of Lady Mary.

(SOUNDBITE OF TV SHOW, "DOWNTON ABBEY")

HUGH BONNEVILLE: (as Lord Grantham) You must forgive Mary.

MAGGIE SMITH: (as Dowager Countess Violet) I do forgive her.

BONNEVILLE: (as Lord Grantham) She is broken and bruised and it is our job to wrap her up and keep her safe from the world.

SMITH: (as Dowager Countess Violet) No, Robert. It is our job to bring her back to the world.

BONNEVILLE: (as Lord Grantham) Well, I'm afraid that is not how I see it.

SMITH: (as Dowager Countess Violet) Really? Then I can only say that while I will overlook Mary's poor judgment I find it hard to overlook yours. Good night.

BIANCULLI: The parts of season four I've seen have plenty of comedy, plenty of drama, and lots of romance - as well as at least one stunner of a cliffhanger. But I haven't seen the season's final episodes, which is when Shirley MacLaine makes a return appearance, accompanied this year by another American guest star, Paul Giamatti. I can't wait - but in this case, I'm happy to.

GROSS: David Bianculli is founder and editor of the website TV Worth Watching and teaches TV and film history at Rowan University in New Jersey.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.