JOHN DONVAN, HOST:
This is TALK OF THE NATION. I'm John Donvan in Washington. There is a lot to be anxious about. Maybe you've got an upcoming job interview or a big game you're preparing for, or perhaps you're on edge about a deadline at work. We've all been there. But for 40 million Americans, anxiety can be much more than nervousness, it can be a debilitating condition with severe physical and mental effects.
Daniel Smith suffers from a kind of anxiety that results in panic attacks and thoughts of existential ruin. He documents his experience with anxiety in his new book, which is called "Monkey Mind," and it sheds light on many of the layers of his condition and how he has learned to live with it.
So if you suffer from anxiety, or if you treat those who do, what would you like the rest of us to know? Our number is 800-989-8255. Our email address is firstname.lastname@example.org. And you can also join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.
Later on in the program, the latest shift in America's values, what we have faith in and what we don't. But first living with anxiety. Daniel Smith is the author of "Monkey Mind: A Memoir of Anxiety." He holds the Critchlow Endowed Chair in English at The College of New Rochelle, and he joins us now from our bureau in New York. Daniel, welcome to TALK OF THE NATION.
DANIEL SMITH: Hi, thanks for having me.
DONVAN: Did I pronounce Critchlow correctly?
SMITH: You did, yes.
DONVAN: All right, thanks very much. I was told about 40 seconds ago that you weren't actually ready to go, and it caused me a burst of anxiety.
SMITH: Well, you and me both.
DONVAN: So what was happening on your end?
SMITH: That - what was going on with the engineering here?
DONVAN: Yeah, oh, OK, so you had some technical problems.
SMITH: Yes, we did.
DONVAN: So, just as I was reading that, I got a message, a note in my ear: He may not be ready, stretch. And so I read very slowly. So we're both a little bit slightly wired at this point. So I want to talk to you, though, about your book. And, you know, we're asking our listeners to tell us what is it that the rest of us should know.
And in a sense, you wrote a book doing that, telling the world what you wanted them to know. But what is the bottom line. Why write a book about anxiety? Why - who did you want to address, and what did you want them to understand?
SMITH: Well, I mean, I had experienced anxiety my entire life, and I encountered many books about anxiety, books that touched on the clinical experience of anxiety, that gave advice on how to deal with anxiety. But I had never encountered a book that talked about what it's like to live in a body that's hardwired for systemic doubt.
What does it feel like in real time to go through life like this? How does anxiety interact with relationships or interact with work? How does it interact with education? And so I set out simply to tell that story and to tell it with some humor because to my mind, anxiety is the only funny mental illness in existence.
You can't really make a joke about schizophrenia or serious depression, but anxiety is so absurd that it lends itself to humor.
DONVAN: You've had a lot of peaks of anxiety, and you mentioned work relationships and education. Let's talk about education. In the book you talk about when you went off to college at Brandeis, that that was a terrible start for you. What happened to you there?
SMITH: Well, it was like being thrown into the mouth of a volcano, at least that's what it felt like. I had been dropped off at school, and all of a sudden, I was just - there was just an explosion of panic. I've thought a lot about it ever since, and I suspect that a lot of my fellow students were experiencing the same exact thing.
But all of the sudden a college student, a freshman in his undergraduate or her undergraduate years, is faced with freedom for the first time, the ability to make choices.
DONVAN: And we're supposed to like freedom.
SMITH: We are supposed to like freedom, but freedom is also a very frightening and painful thing. Freedom means that you can make a mistake. Freedom means that you have obligations and responsibilities. Kierkegaard wrote the first book exclusively about anxiety, it's a completely unreadable book. I don't even think Kierkegaard scholars have read this book.
Some people think - it's so hard to read, some people think it's a joke itself. But he says that anxiety and fear are inextricably bound - I'm sorry, anxiety and freedom are inextricably bound, that the more freedom you have, the more anxious you're going to be.
And so that first experience of college, that first flush of freedom, a lot of people feel deeply anxious. At the same time, unfortunately it's confusing because you're also experiencing the opposite of freedom. You're used to having, if you're lucky, your own room, and you're with your family, and now all of a sudden you're thrown in a room with strangers, and you have to shower in communal showers and go to the bathroom next to people and brush your teeth next to each other.
And there's this necessity to act like you're cool and calm and you have it all together while at the same time dealing with these complex emotions. So its like this perfect recipe for anxiety.
DONVAN: So you were at college, the first weeks were terrible, you experienced what I think you described also as homesickness, which you talked about as a form of anxiety, and you wept a lot. And you...
SMITH: I did weep a lot, yeah.
DONVAN: And you called your mom, and she and your dad came up. And read a section for us from the book when your mother basically had put her arms around you, she knew that you were a wreck, she'd seen it before, and she'd had her fingers crossed that college was going to work out and at the beginning wasn't.
So what happens? What does she say to you? And you can read from the book.
SMITH: Sure. Yeah, we had taken a walk across the city of Boston and wound up in front of the New England Holocaust Memorial, which is this really harrowing monument. And we sat down, and she said: (reading) Oh Daniel, she said, stroking my back between my shoulder blades. You're not crazy. Honey, you're going to be OK. You're just anxious. You have severe anxiety, like me. It's a mental disorder, that's all.
You just need some help to get you through it: therapy, some medication. You have a condition, a treatable condition.
DONVAN: And why did she know what she was talking about?
SMITH: My mother had experienced anxiety throughout her entire life, and her anxiety had been very serious. She found it debilitating. She was able to raise her kids and work, but it was extremely hard for her, and it was so hard for her that it pushed her into a new career, and she became a therapist who specializes in the anxiety disorders.
So by that time, not only was my mother speaking from experience as a sufferer, but she was speaking as a clinical expert and someone who has treated, successfully, many, many dozens of patients. This was very difficult for her to try to balance being a mother and being a therapist. She can't be my therapist; she's my mom. And yet of course she wants to impart this knowledge.
DONVAN: And was it a relief for her to give it a label, a diagnosis?
SMITH: I think it was. I think it's a relief for lots of people to give their distress a label. I personally have some problem with it. I don't use the word anxiety disorder, or my own personal diagnosis, generalized anxiety disorder, all that much in the book because to me, that pathologizes it. And although anxiety can be a disorder when it becomes debilitating, it's a universal emotion. It's something that everyone can understand, even if it doesn't restrict their ability to live day by day.
And if you give it a label, it sort of cuts off that wide expanse of experience related to anxiety that isn't pathological but that we all know about.
DONVAN: Let's bring in some callers. And I want to continue your story - the story unfolds throughout the book, and I want to visit that from time to time, but I'd like to bring in some listeners who want to share their stories with you, as well. So let's go to Ray(ph) in Jacksonville, Florida. Ray, you're on TALK OF THE NATION. Oh, I think I've made...
RAY: ...cautionary tale.
DONVAN: Ray, I'm sorry, I made an error and cut off your first couple of sentences. Can you start again?
RAY: Certainly. I believe my thoughts run more along the line of a cautionary tale. I have, for practically all of my life, been self-employed. And within the last years started experiencing increasing levels of anxiety. On Sunday nights, I'd start worrying about Monday to the extent that I was just a miserable, miserable person.
And the years of stress led to or were a part of irregular heartbeat or atrial fibrillation. And the combination of the A-fib and the generalized anxiety disorder over time manifested into congestive heart failure. And I am now still self-employed. I lost my health insurance a year or so before I really, really needed it, after having paid tens of thousands of dollars.
So the reality of my circumstance has worsened. I take a great number of pills each day. My personal financial circumstance does not allow me to see my cardiologist anywhere nearly as often as he would prefer. And I think it goes back to: if you have feelings of uncertainty, go and talk to somebody right away. Don't pretend that it's - that it's just stress manifesting itself.
DONVAN: I also find it, Ray, interesting that you're talking about this physical manifestation of it because again, Daniel, you talk about your brother Scott(ph) suffers from anxiety but that his is a more physical, a more physical experience than yours, which is more purely cerebral and thought processes.
SMITH: Right, well, Scott is a hypochondriac, whereas my anxiety is far more cerebral. But this point about anxiety being a - having physical manifestations is true across the board. I don't - I haven't struggled with physical problems the way that the caller has, and I sympathize with that greatly, but I certainly can feel the anxiety in my body, and I feel it in the form of tightness in the chest and intestinal problems and profound sweating.
Anxiety always is tied into these physical feelings.
DONVAN: And Ray also raises the point if you're having these feelings not to wait, and I'm just - isn't it difficult to know - go ahead, Ray.
RAY: It's human nature, especially - I believe it's gender-biased, but it's human nature, usually allows us to procrastinate.
DONVAN: Right, that's what I was going to say, Ray, is when do you know that it's really a problem and that, you know, you might ask yourself I'm just being weak, or this is going to pass?
RAY: Well, if for most of your life you have not felt that way, and then you start having these unreasonable feelings of anxiety over relatively mundane issues, then it's time to speak to a health care professional and to go on some medication, which is just the opposite, I think, of what most men do.
DONVAN: Ray, I have to cut you off because we're coming up to a break, but thanks for sharing those thoughts. We'll be back with Daniel Smith in just a moment. The book is titled "Monkey Brain," and if you suffer from anxiety, give us a call, 800-989-8255. I'm John Donvan. This is TALK OF THE NATION from NPR News. [POST-BROADCAST CORRECTION: The book is titled "Monkey Mind: A Memoir of Anxiety"]
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DONVAN: This is TALK OF THE NATION from NPR News. I'm John Donvan. We're talking with the author of the new book "Monkey Brain: A Memoir of Anxiety," and in it, Daniel Smith tells the story of one therapist who, after treating him for some time, asked actually to videotape him because he wanted to show it to a class he taught. And Daniel said no to that.
But the experience convinced him of two things: One, he was anxiety personified; and two, that he is more than qualified to write this book. You can read more in an excerpt of a chapter titled "Why I Am Qualified to Write This Book," and that's at our webpage, at npr.org.
So if you suffer from anxiety, or if you treat those who do, what would you like us to know? Our number is 800-989-8255. Our email address is email@example.com. And Daniel, why is it called "Monkey Brain?" What's a monkey brain?
SMITH: Well, it's not, actually, John. I'm getting a little anxious here.
DONVAN: "Monkey Mind." "Monkey Mind."
SMITH: Yeah, it's called "Monkey Mind," that's right. Well, the term monkey mind is a Buddhist term that refers to the state of consciousness when you can't control your own thoughts, when your thoughts are bouncing around like monkeys in trees and screeching and swinging from vines. And Buddhist practice is, of course, designed to calm those monkeys down.
There isn't a great deal about Buddhism in this book, although I do sometimes meditate, not often enough, but it seemed like such an evocative term. I love - I thought it described what a person who suffers from anxiety struggles with so beautifully that I wanted to use it as a title.
DONVAN: Ray mentioned this point about knowing when to ask for help, and I was pushing back, you know, how do you - when do you know what you're having is garden-variety anxiety and something that's more debilitating. And you talk about, you make a distinction between fear and anxiety, and explain how fear and anxiety are not the same thing. And fear has a place, and anxiety might have a place, but not in extremes. So what's the difference between fear and anxiety?
SMITH: Well, the traditional view of fear and anxiety going back to Freud and perhaps before is that fear is a primitive alarm in response to a present danger. So fear is located in the present, whereas anxiety is a state of nervous vigilance that's oriented toward the future, some threat to your well-being that's located in the future.
And this is useful, but I prefer a distinction that fear is an appraisal of danger, whereas anxiety is a feeling state that's evoked when fear is stimulated. I like this because it suggests that fear and anxiety are both linked, that they both have to do with thought, which I think is very true, that both fear and anxiety occur because you've thought, oh, there's something that's causing me risk, that I'm at risk, causing me to be at risk.
And yet anxiety is so expansive, it affects the entire system. It affects you physiologically, it affects you cognitively, it affects you emotionally. It's a real holistic - not to put too nice and calm a word on it - emotion.
DONVAN: We - a fascinating tweet's just come in from Bridget(ph), thank you, Bridget. She writes: The most important thing for people to know about those with serious anxiety is that we know that we are being irrational. We still can't stop, though.
DONVAN: Does that ring true to you?
SMITH: Oh, that rings absolutely true. This is why it's funny. I mean, it's not funny in that it's painful, but there's a level of absurdity to it. We know, we know that we're not going to be eaten by wolves while we sit at a bar in Union Square, and yet we can work ourselves up to believing that, or maybe that's an extreme example, but it's not so extreme.
These fears, these anxieties that we have are often so far off from what's true and from the state of things around us that it has that level of utter irrationality. And what makes it hurt so much, at least for me, is that you know you're being irrational. If you didn't know, it maybe wouldn't hurt as bad, but you know that you're being self-defeating and self-harming.
And I do want to say that Ray is right. I see no reason not to go for help. It doesn't mean you have to go on medication, but if something's causing you distress, why not learn how to train your mind in a more salutary direction?
DONVAN: Let's bring in Melody from Stanberry, Missouri. Hi, Melody, you're on TALK OF THE NATION.
DONVAN: Hi. You can go ahead, Melody, you're on the air with us.
MELODY: OK, yes. Yeah, I just wanted to share my story about how my panic attacks or anxiety attacks oftentimes don't seem to necessarily be the result of a particular stressful situation. I might have something random happen, such as maybe feeling a little bit of a dizzy spell or maybe have a hard time breathing or catching my breath.
A lot of times, my panic attacks would happen at night, when I would wake up and just have a little bit of a hard time breathing, and I would just go into full-blown anxiety attack, panic mode, when my heart would start racing and an overwhelming sense of feeling really hot, and I couldn't breathe. And it was really, really challenging, if not impossible, to talk myself out of that, even though like the author said, I knew. I knew that it wasn't rational, and yet I couldn't talk myself out of it.
DONVAN: You have monkey mind.
MELODY: Yes, exactly.
MELODY: Exactly, I did. Now I have a word for it, so that's good.
DONVAN: Yeah, Daniel, what do you want to say to Melody?
SMITH: That I empathize completely. I can get a panic attack in a light breeze on a beautiful bright day. And it can be unnerving, to say the least, when your anxiety or your panic comes out of the blue, as it were. What is it that causes this thing? And, you know, over the years I've learned to pay close attention to what's going on in my mind, not that I do it often enough, but to be mindful.
And usually there's almost always something that happens just prior to this, a fluttering of the heart or a thought that says all is not right, or I forgot to do this. And we say these things to ourselves so automatically, so habitually that we aren't even aware of them unless we learn to be mindful of the talk.
DONVAN: So Daniel, you alluded to, before Melody called, you alluded to the notion of being mindful and taking steps to manage, to manage your anxiety, and Melody, thank you very much for your call. Thanks for joining us.
MELODY: Sure, thank you.
DONVAN: So what have you done? How did you get to this position where you can sit and at least sound very calm on the radio, which for a lot of people is a really scary thing to do?
SMITH: Yeah, well, you know, I'm a mess on the inside, John.
SMITH: But I've done a number of things over the years. That therapist who you talked about, who wanted to film me, I'd had four therapists before then, and by then I was only 22. None of them had really done any good. And this therapist, whose name was Brian, was a cognitive behavior therapist. I didn't know that at the time, I didn't know it until years later, but this was the first thing that helped me.
And it's very similar to meditative practices, in the respect that it teaches you to be aware of your own thoughts and to put them into words. And this helped enormously. And the reason it helped enormously is because it taught me that I have a certain habit of mind. My anxiety came from years, years, probably from - simply from who I am, from my own temperament, of talking to myself in a fearful and anxiety-producing manner, and that if I wanted to be less anxious I had to foster better habits of mind.
It doesn't matter how you do it, but that's the goal. We all have these pathways that we've set for ourselves, and mine happens to be an anxious pathway. And they'll always - my thoughts will always slip back into those ruts unless every day I try to carve out new pathways.
DONVAN: And it's doable.
SMITH: It is absolutely doable, but it's something that you have to do constantly. I don't think that one can fully recover from anxiety, or even that that's - I'm not even sure that's desirable. Anxiety is a part of who we are; it's a universal emotion. But it is doable that you can carve out a new way of thinking for yourself, and you could foster better habits of mind.
And that is absolutely doable, and in fact it has to be done.
DONVAN: We have a longer email than normally that I'm going to read, it's from Mary. It's three or four short paragraphs: (Reading) I believe the hardest part of my own anxiety is the embarrassment. I am embarrassed when I feel anxious, so often that I take it out on those around me in inappropriate ways.
In attempts to control the environment, I yell or snap at my family. I am also embarrassed when I am looking for treatment. I have been to many practitioners but usually feel self-conscious about what I am thinking and feeling. I am embarrassed to ask for medication because as a nurse, I know the attitude that can be directed toward "drug-seekers," she puts in quotation marks, who often complain of pain.
I also suffer from chronic headaches, as well as anxiety. As a result, I am not getting effective treatment, and it does affect my relationships and functioning. I mean, she sounds - she sounds like she could be an alter-ego of the you that you describe in the book.
SMITH: And of the me that exists. I understand - I mean, I've written a book about anxiety, so the shame has - I've had to banish the shame. But I understand it, and my heart goes out to her. There's no shame in feeling anxiety. One shouldn't feel embarrassment or shame about something that everybody has experienced.
DONVAN: But in the book, you talk about hiding behind rocks so that people wouldn't see you going to see a therapist.
SMITH: Absolutely. Absolutely. I went through years of that, years of embarrassment and shame. And I'm grateful that - to have the opportunity to publish a book on the subject because I've obviated that. There is no - there can't be any shame anymore, and it's a very freeing thing. But more importantly, for someone like the woman who wrote that email - I don't remember her name - she...
DONVAN: Mary. Mary.
SMITH: Mary. For someone like Mary is that the shame and the embarrassment are self-defeating. It's harmful to be anxious. It's harmful for one's relationships. It's harmful for how one is able to be productive with one's work and with one's life, and it makes it hard to love and to live.
And if the cost of feeling better and being able to accomplish the things that you want to accomplish is getting over your shame and going through the embarrassment, I think that's a small cost. I think it's a necessary one. But my heart does go out to Mary and to that predicament.
DONVAN: Emily(ph) in Wichita, Kansas. Hi. You're on TALK OF THE NATION.
DONVAN: Hi. Hi, Emily. You're on the air. You can start speaking. Thanks.
EMILY: Oh. Well, I called in, and I - I am 25 years old, and I started struggling with anxiety when I entered college, probably in my sophomore year, and I experienced my first panic attack at a movie theater. And ever since then, movies have somewhat scared me, and I'm afraid to go there because I'm afraid that I might have an episode again.
But I have really started to overcome the anxiety, and I can relate to how it feels so absurd to struggle with anxiety and how embarrassing that is. But I will say that once I have let my friends know this is what I struggle with, if I seem like I might be panicking, you know, I want you to just be aware. And letting them know and understand what I'm going through, like this is - my heart rate will go up. I feel disconnected from the - where we're at. I see that - it's just - it's not as stressful in that situation if the other people I'm with know that I struggle with anxiety. That's helped me a lot.
DONVAN: All right, Emily. Thanks for sharing that story. I want to bring in Audrey(ph), who is in Sacramento. Is that correct, Audrey?
AUDREY: That's correct.
DONVAN: Hi. You're on TALK OF THE NATION.
AUDREY: Hi. Thanks for taking my call.
AUDREY: So I am a marriage/family therapist intern here in Sacramento, and I am also someone who has - I struggle a bit with anxiety myself. In fact, my heart is racing right now. But the thing that I found very helpful, both in my process and for my clients, is the meta-worry. I worry about am I going to be anxious? How am I going to deal with anxiety? Is it going to trip me up? And then I get anxious about being anxious.
DONVAN: Mmm. Yeah, yeah. So it's a big cycle.
AUDREY: Yeah. And so working with my clients on that has really been helpful for them in that it's not about necessarily stopping the anxiety. It's not worrying about it and allowing the process to happen and realizing this is just a part of being human. This is a part of me, and it, you know, it can inform me, and I can move through this.
DONVAN: All right, Audrey. Thanks very much for sharing that.
AUDREY: Thank you.
DONVAN: You're listening to TALK OF THE NATION on NPR News. Daniel, what about that, becoming anxious about becoming anxious? It sounds almost like becoming anxious about becoming embarrassed, that it's part of the same dynamic.
SMITH: Yeah, and it is. And Audrey really nailed the particular hell of anxiety, which is that anxiety is so unpleasant and so frightening and so distressing that once you've experienced it in any acute way, you become anxious about that rearing its ugly head again. And by doing so, you almost immediately hop on this merry-go-round.
It could be very hard to get out of that cycle of worrying and then worrying about worrying, which then, of course, simply increases your anxiety. And there you are. The whole job, after that cycle has started, is to try to find some exit ramp. And when you're on it, it could feel like there isn't any, but there is, but there is. And I would like to give Audrey a hug.
DONVAN: Audrey, thanks for your call. Tony(ph) is in Grand Rapids, Michigan. Hi, Tony. You're on TALK OF THE NATION.
TONY: Hi. I'm married to a woman who has severe anxiety, debilitating anxiety, and it's been a challenge for us because I don't have anxiety. It's been difficult for me to come to terms with what level of debilitation comes as a result of her anxiety.
You know, for instance, we'll have a social engagement - and this has happened hundreds of times - and right up at the last second, she'll say, I can't do it. I can't go. And, you know, plans will have been made, dinner has been cooked, and I'll be the one to call and cancel. And as she sits there and says, I can't go, what I'm thinking or what I had thought in the past is, well, of course you can go. You can physically take yourself to the car and get in, and we'll drive there.
DONVAN: Was all of that evident in the beginning of your relationship?
TONY: No. It became more manifest as we've been married. And I've gained a greater understanding, but I feel like I've accepted it, but I don't fully understand it yet. And so that's why I'm so excited to read this book to gain a better understanding so that I can have better empathy and know how to help her more and understand it for myself.
DONVAN: All right. Tony, thanks for your call. And I want to put what you've said to Daniel this way: What role do people who are not suffering from anxiety have in the experience of those who do suffer from anxiety?
SMITH: What is the difference?
DONVAN: No. What role do the civilians have?
SMITH: What role? Right. Well, Tony presents a really wonderful example. The desire to be empathic and to try to understand it is incredibly admirable. I don't know. I wish I could answer that in a more intelligent way than I think I'm able to because I've never been a civilian, as you say. I know that my own wife has struggled with this, when I am struggling with anxiety and when I'm paralyzed by it.
It can be very difficult for a person's partner, anyone whose lives are affected by that anxious person because, of course, they can do it. They can physically do it, but they're seized by something that feels outside of themselves. The role that they ought to play is to show respect and show empathy because that might soften the person and allow them to actually move past it. Being - lacking understanding is only going to increase the person's anxiety.
DONVAN: Daniel Smith, author of "Monkey Mind: A Memoir of Anxiety," joined us from our New York bureau. Daniel, thanks so much for your time.
SMITH: Thank you so much, John.
DONVAN: Coming up, a new poll shows Americans are more and more cynical yet, at the same time, optimistic about their futures. We'll talk with pollster Mark Penn about what's driving this latest shift in values. I'm John Donvan. It's TALK OF THE NATION from NPR News.
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