How Much Should I Suffer For My Anxiety?

A month after I took my last anti-anxiety pill, I was dying. It was a real death, just not outside my head. It started with a thin blue line in the crook of my left knee, a barely hatched varicose vein floating beneath the surface like a dead worm. “That’s nothing,” my doctor quacked, kicking up her leg like a can-can dancer to show off the purple underground map on the back of her gam. But my mind knew better. That pearly-blue vessel signaled the blood clot that I was sure had swum up my thigh and through my trunk and set up shop in my head. The big fat hemoglobin bomb would languish on top of my brain like the smiling storm cloud sleeping atop that house on the cover of the children’s book my mom used to read me—The Dark, by Robert Munsch—until it exploded.

Every day I wasn’t dead was another day I might as well have been for how convinced I was that I would be, which isn’t to say I didn’t try to cheat death. I used everything in my therapeutic arsenal to override that inevitability, except the one thing that had always worked: medication. I practiced relaxation, I learned controlled breathing, I imagined myself on an island. I took yoga, I ate organic, I ran. Nothing calmed me. In the midst of it all, I took a turbulent nine-hour flight across the Atlantic—and had a nine-hour anxiety attack. A family of three formed a snoring pile to my left as I curled up like a fetus and breathed from bump to bump. My boyfriend watched helplessly at 35,000 feet as I continuously shook and hyperventilated. My parents watched helplessly too, and my best friend, and my brother.

“My distress is enormous, boundless; no one knows it except God in heaven, and he will not console me,” wrote Kierkegaard in his notes for The Concept of Anxiety. For 15 years, my God had been meds: Prozac, Zoloft, Cymbalta. They had consoled me. But it was a cheap consolation, I repeatedly told myself. “If I take drugs now it’s like saying I’ve failed,” I quavered in between crying bouts in the head office of a local anxiety clinic I eventually visited. Had Scott Stossel, the editor of The Atlantic and author of the best-selling My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, been in my pocket, I might have spoken more eloquently. His cover story in this month’s Atlantic, entitled “Surviving Anxiety” felt to me like he’d virtually transcribed my thoughts.

“I would try to resist whatever the latest drug was, feeling that this resistance was somehow noble or moral, that reliance on medication evinced weakness of character, that my anxiety was an integral and worthwhile component of who I am, and that there was redemption in suffering,” he wrote.

Neither Stossel nor I came out this way. No one does. While countless prescription drugs have been questioned over the years for their efficacy and their long-term effects, few of them have been as consistently morally deconstructed as psychiatric meds. When Oliver Sacks plied his catatonic patients with the controversial drug L-Dopa—only to have them relapse—he became a movie star. Are the rest of us not allowed our own awakenings?

No, it seems, not when the question remains whether we are, in fact, asleep. In 1952, philosopher Paul Tillich defined anxiety in The Courage To Be as “the state in which a being is aware of its possible non-being.” It’s a fitting description for a condition—organically evasive unlike encephalitis lethargica, for instance—that is often accused of non-being itself. Mood disorders like anxiety and depression are diagnostically slippery, relying largely on subjective diagnosis. With no means of entirely objectively testing these so-called “diseases,” psychiatrist Thomas Szasz denounced his field with a flourish, publishing The Myth of Mental Illness in 1961. The anti-psychiatry movement has since borne the likes of Will Self, who recently argued in The Guardian that depression and anxiety and hyperactivity are the result of disease mongering by “big pharma” and psychiatrists, and that people like me simply exhibit “socially unacceptable behaviors.” In other words, at its worst, anxiety is nothing more than bad table manners of the mind. Fixing a faux pas with a pill? How gauche.

My psychiatrist, on the other hand, doesn’t care so much about looking bad as feeling bad. “I don’t think we get brownie points for suffering,” he said. Well, he’s the only one. People around here don’t get brownie points for taking meds, they get it for taking punches. It’s a Western phenomenon so pervasive that in the 19th century philosopher Friedrich Nietzsche named it: slave morality.

In On the Genealogy of Morality, Nietzsche argued that our values were originally defined by the elite who decided being good meant being happy meant being wealthy, healthy, and powerful. Being bad meant being enslaved meant being poor, sick, and weak. He called this master morality. You would think medication that restores mental health would be celebrated in such a climate, but our moral code is not so clear. According to Nietzsche, Western society is torn between master morality and slave morality, which was established in response to the elitism of the former. A more Christian brand of evaluation, slave morality posits that “the suffering, the deprived, the sick, the ugly are the only pious people, the only ones saved, salvation is for them alone.”

In a church like this, medication is not a salve, it’s a sacrilege. Only those who suffer for their well-being—Goopy detox, anyone? Epidural-less birth?—are redeemed. This puritanical knee-jerk morality is etched into the American Dream: Hard work leads to prosperity. Climb up on that cross and the only way out is up. The same belief inspired 18th-century British Quaker William Tuke to respond to asylums—where medicated patients were often kept in inhuman conditions—by founding a community in which the mentally ill engaged in manual labor; no drugs, no medics, just good clean toil. The name of this treatment? Moral therapy, of course.

When psychotropics came along, laboring for one’s sanity no longer seemed necessary. You could prosper without the slog. For the mentally ill, it was a dream. For everyone else, the old dream lingered. To this day, people believe there is no mind disorder that a brisk walk through nature cannot neuter. After being placed on an involuntary psychiatric hold, bipolar comedian Maria Bamford was advised by a “spiritual” friend to visit Big Sur instead of languishing in the “negative” atmosphere of her psych ward. “Right?” Bamford responded, “So I can jump off a cliff or go slowly into a cold body of water.”

I have had anxiety for two decades. It started out as a stomachache (with a heavy side of paternal loading) and by the time I was in my mid-teens I had visited every gynecologist in the city, convinced I had AIDS. At 16, I learned cognitive-behavior therapy (CBT) for the first time. Each session I listened to my heavily accented therapist advise me to go “limp, loose, and eh-slack” as I invariably fell asleep. I didn’t believe CBT worked, so it didn’t. At 20, I became so socially anxious I stopped attending university. That’s when I took my first anti-anxiety drug. That worked. Whether or not it did because I believed it would, I don’t know. But the social anxiety only reappeared a few years later when I briefly went off it. So I stayed on.

But I was sleepy. All the time. And I started getting cavities, a lot of cavities. The drugs gave me med mouth, gums so dry that over the years my teeth grew riddled with holes. And though I may have cried relentlessly when I went off the drugs, I never got dry—and I hardly slept. Everything was wrong, but those two things were finally right. And was everything wrong, really? The Atlantic called anxiety America’s “most common mental illness” (one in six adults reportedly suffers from it). In the wake of Stossel’s piece, the publication continues to publish countless readers’ experiences with the illness. Before that, the New York Times devoted an entire blog to anxiety.

Anxiety was not always pathologized, though it was moralized. “Saint Augustine believed fear is adaptive because it helps people behave morally,” wrote Stossel. “The novelist Angela Carter has called anxiety ‘the beginning of conscience.’” In The Meaning of Anxiety, existential psychologist Rollo May argued that my strained bowels were in fact essential to my experience as a human being. Anxiety allows me to act with courage, he claimed, rather than letting me drift into the lazy land of the comfortable. Daniel Smith, who last year published the memoir Monkey Mind about his own anxiety, recalled May in his final installment in the Times’ anxiety blog. He wrote, “Toss aside the bath water of anxiety and you will also be tossing aside excitement, motivation, vigilance, ambition, exuberance, and inspiration, to name just several of the inevitable sacrifices.”

So I dunked myself in. And I very nearly drowned. Without meds, I became so ill I was unable to focus on getting well. “Everyone forgets why they started taking meds until the moment they stop,” a friend and fellow anxiety sufferer reminded me. In a sort of psychological Catch-22, my anxiety got in the way of my anxiety treatment. Having anxious thoughts is like being in an enclosed batting cage with dozens of balls thrown at you at once. CBT is like the bat you use to hit them. It works, sure, but if you’re too anxious, for every ball you hit you get pummeled with dozens more. Anxiolytics reduce the number of balls coming at you so your success rate improves. Eventually, minus the medication, those balls may proliferate, but hopefully by then you know how to play the game.

“Originally un-egoistic acts were praised and called good by their recipients, in other words, by the people to whom they were useful,” Nietzsche wrote. I cannot say whether psychiatric meds are moral or immoral, only that they have been useful to me. Their value is not absolute, but individual. As ridiculous as it is to compare a minor hairline fracture to a broken back, mental illness varies in intensity. While drugs may be “chemical straitjackets” to Self, anxiety is the same thing to me. I believe its hold can be loosened, if not eliminated, by a combination of cognitive restructuring, meditation, and breathing. But without popping pills, I would be unable to do any of those things. Drugs form the bed upon which my anxiety can be laid to rest, and that’s good enough for me.