Joy, Guilt, Anger, Love (16 page)

One piece of advice from cognitive behavioural therapy is to recognize these distorted cognitions, localize our fears, evaluate them from a distance and identify all the reasons why some do not make sense, ungrounded as they are in reality. In other words, it teaches us to give fear the reasons, if any, that it is looking for. If the thought of the gunman prevents us from going to our regular café, a therapist will encourage us to overcome that irrational fear and to observe and experience the safety of the action of entering the café. By asking us to replace old and negative behaviours with new ones, and to practise novel actions, therapists are encouraging us to use the plasticity of our brains. With the help of a skilful and knowledgeable consultant, psychotherapy digs deep into our brain like a neurosurgeon. We leave the therapy room renewed. Not only because of acquired awareness about our past and present behaviour patterns, but also because that awareness is underlined by ongoing chemical transformation in our brain.

Trips into tranquillity

In summer 1958, visitors at the convention of the American Medical Association in San Francisco were confronted by the gaze of a 20-metre-long wormlike creature made of parachute silk, that regularly ‘breathed’ as to mimic the movement of a caterpillar. This was an installation created by Salvador Dali, that was designed to be viewed on the inside as well, where there were four human figures. On first walking into the caterpillar’s interior, visitors saw an emaciated man who held a staff capped with a black butterfly. For Dali, this depicted human anxiety. Next was an almost transparent woman who also carried a staff topped with a moth. The third figure was a maiden with a head full of flowers, whom Dali called the ‘true butterfly of tranquillity’. Finally came another maiden who skipped rope towards serenity.

The caterpillar creature, which was not calming at all, was an artwork commissioned by the Wallace Laboratories, the manufacturers of Miltown, a drug discovered by accident in 1955 (first intended as a muscle relaxant) that was to become one of the most consumed minor tranquillizers in the early history of psychopharmacology.

The eccentric surrealist artist, well versed in portraying the mind and particularly the subconscious, named his creation
Crisalida
: ‘The outer structure of Miltown is that of a chrysalis, maximum symbol of the vital nirvana which paves the way for the dazzling dawn of the butterfly, in its turn the symbol of the human soul.’
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It seems Dali was sufficiently familiar with the experience of human anxiety to visualize it with confidence and represent the drug as a journey through the interior of a seemingly disturbing and terrifying creature. The journey began in anxiety and ended with the arrival at a place of harmony. According to the narrative of
Crisalida
, Miltown paved the way to an ataraxic state of mind distant from the turmoil of anxiety. When
Crisalida
was shown, profits from Miltown had already reached incredibly high peaks. Those were
anni mirabiles
for drug companies, which found fertile ground in a society needing to cope with the stresses of modern life.
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Later on, another class of anti-anxiety drugs, the benzodiazepines, were introduced into the market. These achieve their calming effects by binding to the brain’s GABA receptors, which, like the Htr1A receptor mentioned above, have inhibitory transmission activity. They slow your racing heart and rapid breathing almost instantly and they act fast to pacify your anxious thoughts. They are effective and relatively cheap to produce. These drugs were marketed to target a specific portion of the population. Some of the promotional material directed at doctors portrays ordinary individuals who seem to be in need of the advertised drug to overcome worries arising from a variety of everyday hurdles and difficulties in social or interpersonal contexts.
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The range of characters depicted encompasses the housewife who cannot cope with daily household chores, the person who cannot make friends and the manager or high-finance banker who, like Robert, is under pressure at work. A frequently recurrent figure is a woman troubled by tension and anxieties arising from difficulties in her household. Males are more often portrayed in their working environment, dealing with a multitude of business-related challenges demanding high standards of performance, multi-tasking skills and a range of social and interactive skills – for clinching important deals and for a successful integration in the office. The press started to label the drugs with catchy terms that gave readers and potential consumers an idea of what to expect of them. They were, for instance, ‘Peace of Mind Drugs’, ‘Aspirin for the Soul’, ‘Happiness Pills’, ‘Mental Laxatives’ and even ‘Turkish Bath in a Tablet’.
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However, soon after their commercialization and wide dissemination, the minor tranquillizers had become regarded as both an opportunity and a danger for society. The pharmaceutical industries were accused of practising ‘mystification’, in presenting problems that form part of normal human existence as conditions requiring medical attention.
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Benzodiazepines never disappeared from the market. Nowadays, they are still amongst the most widely prescribed medications. You can meet people who gulp down a Xanax before boarding a plane, or before an important interview. I have never taken Xanax or the like. Whenever anxiety has knocked on my door, like that night when my friend Robert called me, I have resorted to different kinds of remedies. I have tried yoga, camomile tea, alcohol or a chat with a friend.

I don’t have any strong objection to the use of medications in principle. A world without synthetic drugs is unthinkable. Anti-anxiety drugs are indeed effective in helping you manage anxiety in the short term. Perhaps I have never used them because I have never felt my anxiety reach a level that I could not manage alone. Or maybe it is because, stoically, I have been under the conviction that I should work through my feelings without intervention, or that any perturbation in my mood should be first faced by trying to find the inner causes for it. Pills are attractive. When everything else fails, they are a ready alternative. And, for sure, anti-anxiety drugs have become easily accessible, the only hurdle being to obtain a doctor’s prescription. However, they can generate dependency, too. If you benefit from the use of an anti-anxiety drug in a particular difficult situation, each time that same type of situation arises, you will be tempted to take the drug. It will give you relief on that occasion, but it won’t prevent a recurrence of anxiety.

What remains disputable, however, is whether medications should be prescribed to people whose anxiety is not such as to render their lives dysfunctional: just the regular, all-too-familiar anxious edge that afflicts almost everyone and for which boundaries of diagnosis and treatment are extremely murky. This is the type of anxiety that affected Robert, and that regularly affects you and me. It is the type of anxiety that in our current society has been labelled ‘generalized anxiety disorder’ and is so widespread.

The aspiration to a carefree or tranquil state of being, the idea underlying Dali’s
Crisalida
, is perhaps intrinsic to the human condition. We dream of an anxiety-free existence, or at least intervals of careless living. Those who suffer from anxiety and those who work to alleviate its burden, be they laboratory or clinical researchers or drug companies, are all focused on obtaining relief. However, what this attitude does is to load anxiety with negative connotations and depict it as an undesirable condition. Anxiety is portrayed as an unwanted and avoidable psychiatric condition that requires intervention. At some point in
The Age of Anxiety
, the poem which I remembered back in that early-morning bar, Auden describes anxiety as a bad smell that haunts ‘the minds of most young men’, under the illusion ‘that their lack of confidence is a unique and shameful fear which, if confessed, would make them an object of derision to their normal contemporaries’.
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Anxiety is still flagged as something to be avoided, even to be ashamed of.

A fundamental problem with psychiatric categories is their dependence on social context. Whatever their nature and whatever name they are given, you cannot divorce them from the context in which they arise.

The French historian of science Georges Canguilhem (1904–95) formulated a general framework by which to explain this constant tension between the disorder itself and the meaning attributed to it, which also helped him come up with a distinction between normality and pathology. He believed that every organism, and therefore every individual, comes with its own set of properties and functions – its own general physiology, if you like – which allows it to function in the world and adapt to the environment. This for him constitutes the intrinsic vital normativity of an individual. From this perspective, even impairment in the regularity of the body constitutes the normativity belonging to that individual, as part of his or her vital norms. But outside the organism, in society, exist other norms that deem certain kinds of behaviour unacceptable or problematic. This constant tension between vital norms on one side and social norms on the other underlies the emergence of new psychiatric conditions, the labelling of normative aspects of our physiology as lamentable disorders.
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Contemporary societies, especially in the Western world, with their reverence for values such as self-sufficiency, initiative, achievement, relentlessness and efficiency, have become less tolerant of anxious states, both disruptive and mild, and have transformed our expectations of individuals. There is neither time nor patience for anxiety. These values act as a norm against which differences or deviations, such as lack of energy, low mood or resignation, and individuals displaying them, are judged as pathological. Hence the growing efforts to eradicate anxiety, as reflected in the relentless rise in prescriptions of anti-anxiety medications and the search for new and even more effective drugs.
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So, ironically, we live in a society that generates anxiety but overlooks its existentially positive role. Moreover, it is our efforts to rid ourselves of anxiety that may propagate a culture that keeps on producing it.
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Coda

Robert eventually did lose his job as a banker. It wasn’t at all easy for him at first. During his period of unemployment I met him several times to try to help him figure out the next steps. In our full-ranging conversations about science, philosophy and life in general, we agreed that whilst we are powerless to affect the larger economy we can certainly change our reactions to it.

Occasionally, we found ourselves pondering what life would be like if these current years in our young adulthood were not affected by the crisis. With resignation, we wondered whether we were perhaps born too late. But then, even if we bow to the fact that we may live in an age of greater and disproportionate anxiety, there is truly not much we can do. These are the times we live in and we need to make the best of it.

Except in the case of a blatantly serious traumatic experience leaving a lasting mark in our memories, most of our anxieties actually reside in our constant desire to change our identities and in the realization of the impossibility of finding any
definite
guidance for our actions. Anxiety is being unable to cope with uncertainty, and in severe cases the experience can be terrifying.

But isn’t life nothing but uncertainties?

Despite the world’s attempt to stigmatize anxiety, we should cherish it. We need anxiety in order to make an objective assessment of our existence and, thereafter, to make a significant change, strive for something positive. Anxiety is our amber light: an opportunity to make the right choices and to identify the goals and actions that we consider worth pursuing if we are to live authentic lives, or at least lives that have meaning for us. These goals will, of course, vary. But whether you long for a large family, a job in sales, a career as a musician or the perfect body, you need to be determined. So, when the howling wind of anxiety blows, we need to be robust enough to remain rooted in our aspirations, but flexible enough to attune to the types of change we need. Anxiety is an opportunity to make the indefinite into something more certain, vagueness and dimness into precision and clarity. If you can do that, then anxiety will fade and more positive emotions will set in.

To my joy, Robert bravely used part of his retirement savings to start a new business, a café and bookshop in the heart of Soho. Having always dreamed of owning such a shop, he seized the opportunity the recession gave him to nurture his passion for books. Now, whenever he or I need to exchange views on life, I go and visit him there.

Several among those who lost their competitive jobs in high finance during the recession came up with creative ideas for an alternative occupation, rediscovering some of their old, long-repressed passions and dedicating themselves to them. Who knows if Robert’s café will sustain him through the economic crisis. Yet his triumph is to have accepted that life is all about uncertainties. Fear and bravery are two sides of the same coin. Bravery is to go ahead with your actions despite the fear, and to turn corners without knowing what lies ahead.

When I need to remind myself of this, I evoke a beautiful text written by the Austrian-Bohemian poet Rainer Maria Rilke. It talks about the ‘fear of the inexplicable’, a phrase which in itself encapsulates the meaning of anxiety. He says:

 . . . fear of the inexplicable has not alone impoverished the existence of the individual; [ . . . ] it is shyness before any sort of new, unforeseeable experience with which one does not think oneself able to cope [ . . . ] For if we think of this existence of the individual as a larger or smaller room, it appears evident that most people learn to know only a corner of their room, a place by the window, a strip of floor on which they walk up and down. Thus they have a certain security. And yet that dangerous insecurity is so much more human . . .
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