Books

How Anxiety Can Help You Flourish, According To 'The Power Of Different'

by Gail Saltz, M.D.

March 21, 2017

The following is an excerpt from The Power of Different: The Link Between Disorder And Genius by Gail Saltz M.D., out now from Flatiron Books.

David Sedaris has channeled his perfectionism and desire for control into his own writing. As a child, he felt compelled to lick lightbulbs. As a young man, he had to clean the house on a certain day at a certain time. When he began writing and making art, he put himself on just as compulsive a schedule, much to his benefit. “Everything — everything, everything had its schedule. And so writing had its schedule, or when I was doing visual artwork, that kind of fell into its schedule, too, until it just became— until it just became who I am. I don’t have to force myself to sit at my desk anymore, I just get up in the morning and I just go right there and do it. I don’t have to force myself to do 500 sit-ups every morning, I just do it.”

Sedaris’s diligence and obsessiveness didn’t only contribute to the quantity of his output, but also positively affected its quality. He was 27 years old when he returned to finish college and found himself in writing classes with 18 year olds. He’d look around the class and find himself shocked at how relaxed the other students were. Very often, they’d written their stories the night before they were due. “And I remember thinking, You didn’t write it 17 times? What kind of a person are you? I mean, I figured that out pretty early. You just understand from the very beginning that a first draft is just a first draft and you don’t want anybody to see it, because it’s not worth being seen.”

The Power of Different by Gail Saltz, M.D., $13, Amazon

The other ingredient in Sedaris’s success was sheer determination. “I really cannot believe that anybody ever wanted it more than me. That’s all I ever fantasized about. In junior high school and high school I would walk for hours, or I would ride my bike for hours and hours, and that’s all I ever thought about, was being somewhere and having somebody say, ‘Wait a minute, aren’t you?’ Or, you know, having people come up and get their book signed. I’ve been practicing for that all my life, you know?”

Sedaris acknowledges that a significant element in his drive to succeed is the desire to prove himself to the naysayers—in particular, his own father, who attempted to make Sedaris conform by wearing him down. “I wouldn’t trade my father for anyone. I’m so grateful to have the father that I did, because he was just there for me to work against all my life. You know, he would give me a piece of advice and I would just do exactly the opposite. When I was growing up he must have said to me one hundred thousand times — ‘Do you know what you are? A big, fat zero.’ He said it over and over. ‘Everything you touch turns to crap.’ And I would just think, ‘I’ll show you.’’

Not long ago, Sedaris was talking to his father about a college fund that his father wanted to establish at a local Greek church. He asked Sedaris to contribute, and by way of explaining why he wanted to set up the scholarship, Sedaris’s father said, “You know, when I die, the name dies with me.” In response, Sedaris said, “Well, speak for yourself, my name is on 10 million books.”

It felt good for Sedaris to be able to say that. Even better for Sedaris is the knowledge that he’s “celebrated for being exactly who I am. Not for hiding, not for lying, not for molding myself into anyone else’s idea. I remember when I started on the radio, my father would say, ‘Why do you have to talk about that for?’ And nine times out of 10, what he was talking about was— you know, ‘Why do you have to say the word “boyfriend”?’ Or, you know, he was embarrassed because I had talked about cleaning apartments and he didn’t want his friends knowing that that was my job. And I remember thinking, Well, it’s working. I am being me. I’m not hiding anything. I am exactly who I am, and people like it.”

There is an inherent risk in pointing out the positive elements of any brain difference — namely, that in doing so one minimizes the considerable pain and suffering of the negative symptoms. With anxiety disorders, it can be particularly difficult to see upsides. It’s not as if one can look at a brain scan and see exactly where a talent or acuity correlates with the experience of anxiety. Moreover, as with all difficult-to-treat chemical disorders, the unchecked symptoms can wholly take over one’s existence. David Adam, who suffered for years due to his irrational fear of contracting HIV, is hard-pressed to see a direct correlation between OCD and any particular strength that he possesses. In fact, he says that prior to that switch being flipped in his brain, he considered himself fairly calm and even-keeled. Even he, however, has found that there has been one benefit, “if you want to call it a benefit— it’s that I like doing things that quiet the chatter in my head. And one of them is public speaking. You know, lots of people get very anxious about standing up in public, whereas I really enjoy it, and that’s because I have to really concentrate on what I’m doing. And so those intrusive thoughts about HIV tend not to bother me while I’m doing that.”

"With anxiety disorders, it can be particularly difficult to see upsides. It’s not as if one can look at a brain scan and see exactly where a talent or acuity correlates with the experience of anxiety."

Moreover, Adam says, “I don’t look for reasons to be miserable now, because I know that they can be thrust upon you.”

When the symptoms of anxiety are severe, we don’t have the luxury of contemplating what our strengths are. In fact, even those who have experienced moderate and isolated bursts of panic know that no other thought is possible in those moments. The idea that the panic might end, that some rational thought process can be applied to end the anxiety— that simply does not compute. The first step, therefore, in ensuring a better, more fulfilling, more productive life with anxiety is to seek treatment.

According to Barbara Milrod, the average amount of time before the person with anxiety seeks treatment is 10 years. This is extraordinary, considering how prevalent anxiety is. However, there is a big difference between saying that one is stressed —which, in fact, we are all expected to be if we are working hard enough — and saying that one’s stress is unmanageable. The latter feels like failure. This is unfortunate, not least because anxiety is so treatable.

"...there is a big difference between saying that one is stressed —which, in fact, we are all expected to be if we are working hard enough — and saying that one’s stress is unmanageable. The latter feels like failure."

Contrary to the assumption that drugs are almost always required to alleviate symptoms, in fact, in the majority of cases, cognitive behavioral therapy alone can make all the difference. A meta-analysis of 56 effectiveness studies that was published in the Journal of Consulting and Clinical Psychology found that the contrast between pre- and post- therapy testing was large and positive. This is why I strongly recommend that patients try at least eight sessions of cognitive behavioral therapy (CBT) prior to seeking a prescription. CBT is a structured therapy whereby the therapist incrementally and repeatedly exposes the patient to the feared situation or object so that the conditioned fear (and its associated response) can be extinguished. Drug treatment of a phobia—for example, a tranquilizer for someone with a fear of flying—simply throws a blanket over the problem, muffling it but not making it go away. However, CBT works with the brain’s plasticity to truly sever that connection between the stressor and the individual’s emotional response. That said, those who suffer from OCD, which can have a biological component, often do require a combination of medication (typically the class of drugs known as SSRIs) and cognitive behavioral therapy.

Multiple studies suggest that aerobic exercise has real and measurable positive impact on stress levels — both in protecting the body from the harmful effects of stress and in boosting physical and emotional resilience to stress. Other self- help measures such as meditation and getting the proper amount of sleep have been shown to have positive impact. There is also some clinical evidence, though mixed, that acupuncture can have concrete benefits. Indeed, because anxiety spurs the fight-or-flight response, anything that naturally relaxes the body can be beneficial. For those who have difficulty reaching a meditative state (which is not always easy for those who have obsessive thought patterns), muscle relaxation can be beneficial. Simply lie down and tighten, then relax, each muscle group, one by one.

Mentally, there are a few exercises that can help with symptoms. While the person in the throes of an obsessive thought (such as checking that the front door is locked) can feel that the impulse will never pass, in fact most obsessive behaviors don’t last. One of the most effective forms of CBT is simply to instruct the patient not to do the thing that they feel compelled to do for just fifteen minutes. With repetition, that can help break the cycle of magical thinking (the thoughts that make the individual believe, If I do this, then disaster won’t occur). The student who suffers from test anxiety can similarly break negative patterns by reminding herself at moments of panic that she can never be 100 percent sure that she will pass the test. This kind of self- talk is about learning to tolerate the anxiety, rather than convincing oneself that there is some predetermined amount of studying that will take all the risk away.

Sidney’s mother, Lisa, has learned that her daughter reacts much more positively when she doesn’t try to fix her problems, but rather simply listens to them. (This is good advice for any parent, or spouse, for that matter.) Sidney will say to her mother, “‘I just want to tell you about this. I don’t want your advice.’ And I’m like, ‘All right. Okay. It’s hard. But okay.’ ” From a clinical perspective, Sidney and her mother are on to something. John Walkup points out that many young adults who have been highly protected by their parents are smacked with their first experience of serious anxiety when they head off to college. Certainly being off on one’s own for the first time is stressful for anyone, but some kids react to it better than others, and often the difference is in how emotionally prepared they are to cope with anxious feelings. We learn by doing— and if every anxious moment is eased away or medicated, adolescents never have the opportunity to develop those habits of resilience.

There is a right amount of anxiety that can spur us to action, that can keep us financially solvent, that can even keep us going to the doctor for annual checkups. A blithe belief that everything will turn out all right might be pleasant, but it’s not realistic— not for us, and not for our children. As Barbara Milrod pointed out, wouldn’t you rather have the child with a healthy degree of anxiety behind the wheel of the car, rather than the unworried risk- taker? The trick is in finding the right notch on the dial for us, the level that keeps us on our toes and doesn’t freeze us in our tracks.

There is a right amount of anxiety that can spur us to action, that can keep us financially solvent, that can even keep us going to the doctor for annual checkups.

Dan Harris says, “it’s like titration, and I’m constantly tweaking it, because, you know, I screw up.” He had an experience recently that brought this home to him. After a gunman attacked the Canadian Parliament in 2014, he was sent to Toronto to cover the story. “Normally, when breaking news happens, I go into this high alert.” This time, though, he didn’t. “And I was kind of patting myself on the back for being pretty calm. I was really kind of telling myself a story— you know, I’m so evolved now. And I got there, and I did my story. Afterward, I got a note from my boss, Ben Sherwood, who is featured prominently in my book as somebody who likes to kick my ass— and he’s like, ‘Ya know what? You were pretty flat tonight. Your manner did not capture the urgency of the story.’ And he was totally right. And so, the next day, I got it right. I mean, I wasn’t out of my mind the way I used to be.” He was examining all the angles, ensuring that his competitors didn’t have anything that ABC News (his employer) didn’t, but only “to the extent that I thought that it was useful. And you know, we got a lot of great elements, we had the appropriate urgency, and we did it right. And I wasn’t a jerk to anybody, and I didn’t make myself more miserable than I really needed to be. So, I am not here to tell you that I am perfect. I am constantly learning and failing.”

In his highly regarded book My Age of Anxiety, longtime journalist and magazine editor Scott Stossel writes:

"Even if I can’t fully recover from my anxiety, I’ve come to believe there may be some redeeming value in it. . . . My anxiety can be intolerable. It often makes me miserable. But it is also, maybe, a gift—or at least the other side of a coin I ought to think twice about before trading in. Perhaps my anxiety is linked to whatever limited moral sense I can claim. What’s more, the same anxious imagination that sometimes drives me mad with worry also enables me to plan effectively for unforeseen circumstances or unintended consequences that other, less vigilant temperaments might not. The quick social judging that is allied to my performance anxiety is also useful in helping me to size up situations quickly and to manage people and defuse conflict."

Stossel’s assessment of his gifts speaks directly to the anxious individual’s ongoing quest for a sweet spot between misery and complacency. We can all occasionally fear that if we lose even a bit of our — or our child’s — perfectionism, then mediocrity is sure to follow. Similarly, we can fear that grappling with anxiety means that we simply can’t hack it, that like one of Charles Darwin’s inadaptable creatures, we’re not cut out for surviving this world. In truth, the very opposite is true: these qualities of worry and hypervigilance and perfectionism can be the source of our greatest contributions.