The anxieties you describe in your book sound crippling yet you have managed to build not only a successful career as an author and editor but a happy marriage with two children. How so?
Anxiety can be a spur to achievement as well as a barrier. Picture a bell curve with extreme anxiety on the far right and extreme lack of anxiety on the far left. If you're too anxious to the point where it's physically and mentally debilitating, then your performance suffers. If you're not anxious enough, if you're not engaged and slightly activated by anxiety, as it were, then your performance also suffers. So in some ways it does hold me back but in others there is a redeeming value to it.
Do you find it easy to hide your anxiety?
I won't say it is easy to hide. Most of the time it is very hard to hide. But I think for the most part I am pretty successful at hiding it. I've had a number of colleagues coming in after reading the book and offering to give me a hug – which is sweet but also a little uncomfortable – and expressing great surprise about what I've written, because it is so much at odds with their view of me as this calm, rational human being.
What is your most debilitating phobia or anxiety?
Emetophobia, which is a fear of vomiting. That is the phobia that lies at the core of all my anxieties. To people who don't have it, that must sound bizarre. Nobody likes stomach viruses but fear of them does not consume their existence. But for me, going back 30-plus years, half of the dreams I've ever had are nightmares about vomiting, even though I've not actually been sick for more than 35 years. All my other fears connect to the emetophobia: my fear of flying, while in some ways a conventional aerophobia, is also a fear of getting motion sickness; my agoraphobia comes from being afraid of getting sick far from home; public speaking engagements are terrifying because I'm afraid my anxiety-symptoms about speaking will be so intense they will make my stomach hurt and then I'll be afraid of vomiting.
What works best to treat your anxiety, drugs or psychotherapy?
There have been acres of words written about the evils of Big Pharma. I'm not in that camp. There is no denying drugs are way overprescribed and have serious side effects, many of which we're not properly aware of, but I do think that for people who are severely anxious or depressed, like me, the modern drugs really, really do work. Having said that, there is a lot of evidence emerging about cognitive behavioural therapy, which suggests that it can be very effective in getting patients with anxiety and phobias to reframe their cognitions and change their maladapted thought patterns. Studies show it can be as effective as the relief offered by medication, with none of the side effects. New brain-scanning techniques have also shown that regular meditation can be extremely effective. It actually works to shrink the size of the amygdala, which is the part of the brain involved in anxiety.
Your great-grandfather had electroshock therapy to combat his chronic anxiety, and it is a form of treatment that is gaining renewed respect in some circles. Would you ever submit yourself for ECT?
If things got bad enough, yes. The movie depictions of it, like the scene where Jack Nicholson receives it in One Flew Over the Cuckoo's Nest, have made people think it is barbaric, understandably so. It isn't pleasant. But for people who have been severely depressed and anxious it can prove pretty effective. It seemed to work for my great-grandfather. I sometimes wonder if I would have had to have recourse to ECT before now if it hadn't been for the modern drugs, the SSRIs and benzodiazepines that I've had access to but were not around in my great-grandfather's time.
Do you think we are more anxious today or is anxiety simply a part of the human condition?
The short answer is both. I do think that anxiety is woven into the human condition, and I think a lot of it is hard-wired into the genes so your relative capacity for anxiety is pretty much pre-determined. Having said that, I think there are certain eras that might be more anxiety-producing than others, and the one we're living through now is one of those. The reasons are obvious: economic fears, fear of unemployment, fear about dropping out of the middle class – all these things are anxiety-inducing. We also have so much more choice than ever before: more political power, more freedom to choose our own jobs, our partners, the way we dress – all of which is good but also incredibly anxiety-producing. We have so many decisions to make! We are also working more and sleeping less. For all of those reasons the modern age could lay claim to being the most anxious ever.
Your young son and daughter are already exhibiting symptoms very similar to your own. How do you feel about having passed on your anxieties to your children?
Rotten in some ways. But there is evidence that by intervening early you can limit the odds of children developing a full-blown anxiety disorder, and that's what my wife and I are hoping for. When I started struggling with anxiety as a kid, my parents didn't know how to handle it, even though my mother had suffered from it herself. We are probably much better equipped than they were because I have not only experienced it myself, I have also done a lot of scholarly research. So we have been able to do more early intervention. My daughter has the emetophobia but aside from that her general level of temperamental anxiety is much reduced from what it was a couple of years ago. With my son, who is six, it is still a big issue but we're hoping that we will be able to head him off at the pass.
In the last line of the book you say you are hoping that the act of writing and publishing it will be empowering and anxiety-reducing. Has this proved to be the case?
The jury is still out. It varies from hour to hour and day to day. There are moments when I think, what have I done? I've let the genie out of the bottle, I can't put it back in. One of the things that prompted me to write this book was my acute anxiety about the book tour surrounding my last book. So I wrote this book and now here I am rewarded with another book tour. I've revealed a lot about myself in the book, which is not my natural tendency, so I feel quite a bit of anxiety around that. But I'm hopeful that in the fullness of time it will prove to be liberating and empowering.
