Scott Stossel first saw a psychiatrist aged 10. Since then, he has tried 27 medications and many different kinds of therapy in an attempt to assuage his anxiety-related problems. This book is an account of his own experiences, together with a history of anxiety-related disorders that stretch back as far as Hippocrates in the fourth-century BC, and takes in Plato, Spinoza, Kierkegaard, Darwin, Freud, and many eminent 20th-century authorities on the way to the present day.
Stossel takes the reader through the various hypotheses about the cause of excessive anxiety. These include postulates about genetic inheritance of the propensity, and modelling based on the behaviour of family members. Although abnormal levels of neurotransmitters in the brains of the anxious have formed the basis of many new drugs used in anxiety and depression, most notably the serotonin reuptake inhibitor class of anti-depressants, the psychiatric world is far from unanimous in believing that low serotonin levels, or any other neurotransmitter disturbance, is responsible.
Stossel mixes his first-hand account in with the historical and scientific data, so the latter does not become turgid. He describes many studies, such as functional magnetic-resonance imaging, which has shown that anxiety is mediated via a part of the brain called the amygdala, and that anxious people tend to have increased firing of neurones here; and numerous fascinating theories and experiments such as those from John Bowlby and Mary Ainsworth, which investigated the link between cold mothering style and anxiety in the offspring.
His personal account is unflinchingly honest and written in an accessible style and a self-deprecating tone. There is a hilarious anecdote about flooding a bathroom in the Kennedy family's villa with raw sewage, having to strip off, and trying to make a dash to safety without being intercepted; another about receiving a drug to make him vomit to try and overcome his fear of vomiting, and lying on the floor of a public toilet heaving for hours with his psychiatrist and a nurse in tow.
This is a courageous, entertaining, and well-researched book about a condition that is thought to currently affect 15 percent of people in the UK. I have one tiny quibble: Stossel says adrenaline is also known as norephinephrine, but adrenaline (UK term) is epinephrine (US): norepinephrine is noradrenaline.
Perhaps the last word on the multi-factorial causation of anxiety should go to a quote from the author Carl Elliott: "Just because I can explain your depression using terms such as 'serotonin reuptake inhibitor', doesn't mean you don't have a problem with your mother."