MS. JENNIFER GOLBECKFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. I'm Jennifer Golbeck, from the University of Maryland, sitting in for Kojo. We all have anxiety. Some of us get butterflies before getting up before an audience. Some are afraid of flying. Others have more particular phobias. A fear of being too far from home, or of heights, or of spiders.

MS. JENNIFER GOLBECKScott Stossel's all too familiar with anxiety. He's frozen onstage and he nearly passed out at his own wedding. He suffers from all the usual fears, as well as a number you probably never knew existed, including a fear of cheese and of fainting. He decided to research the long history of human anxiety in the hopes of better understanding, a coming to terms with, his own issues. Joining us to discuss this journey is Scott Stossel. He's the Editor of Atlantic Magazine and the author of, "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind." Glad to have you here, Scott.

MR. SCOTT STOSSELThank you for having me.

GOLBECKWhat makes you anxious and what approaches do you use to ease your anxiety? Have you ever been treated for anxiety? You can join us by calling 1-800-433-8850 or email us kojo@wamu.org. So Scott, there's a pretty hefty encyclopedia of phobias. I was looking up a bunch of them before the show today. A number of which you know all too well, but in researching this book, were there any that surprised you?

STOSSELYeah, I mean, I think I've come across that same encyclopedia you have, and it's like 500 pages. And, basically, anything you can think of, any object, substance or situation that you can imagine, there is somebody who has a phobia of it. I was fascinated to learn, for instance, that the famous actor, Richard Burton, had an acute phobia of honey. And he couldn't be in a room if there was honey, even if it was in a jar, even if that jar was locked in a drawer.

STOSSELSo, as idiosyncratic as some of my own phobias are, there are people who have far worse ones. Lots of people have phobias of mayonnaise. There are much more common ones, like, as you mentioned, rats, spiders, heights, flying. But there are people who have phobias of -- actually, there's a common, somewhat common phobia of people are afraid of collections of holes arranged in a certain way. And there's some theory that there's an evolutionary explanation for all this.

STOSSELLike, if you -- some people can't look at a sponge, because it provokes intense anxiety.

GOLBECKOh, interesting. The internet must make it easier to find these, cause I think, probably five years ago, I had posted on a blog somewhere that I had kind of a phobia of things that were like way, way too small or way, way too big. Like, things that were out of scale. And that's so random, and then I got an email, like a year later, from some guy in England who said he was really -- he had the same thing and he was scared of washing detergent tablets because they looked like really giant Tylenols.

GOLBECKAnd it was exactly the same phobia. So the internet must be a way that a lot of us can connect over things where we maybe think we're the only one.

STOSSELAbsolutely. And I've found that to be the case with a number of phobias, including, you know, one of my longest standing phobias, that I developed when I was a little kid, is what's known at emetophobia, which is this sort of pathological fear of vomiting. And I think most people, sort of reasonably fear it, but for people who are full blown emetophobes, it sort of governs their life. And, as you said, the advent of the internet, I think, there were lots of people and for whatever reason, it's predominantly women. I'm obviously, I'm the exception there, although Matt Lauer, reportedly, of The Today Show, has this phobia.

GOLBECKInteresting.

STOSSELBut I think most people thought they were the only ones who had it. And now, because of the internet, academics who look into this now think that emetophobia may be the most fifth common phobia there is. Because if you compare bulletin boards for things like flying phobia and claustrophobia, things like that, the fifth largest, in terms of number of members, is emetophobia message boards.

GOLBECKInteresting. And so, how does this manifest itself, because you talk in the book that this also actually connects to part of your anxiety about flying.

STOSSELYeah. Again, my sort of earliest and most acute and longest standing phobia is the emetophobia, and it does intersect and kind of augment some of my other phobias, such as, you know, I have a -- you know, lots of people -- fear of flying and fear of public speaking are usually the most, two most common recited phobias. Both of which I have, to some degree, at varying times of my life. And in my own case, it's compounded by -- I'm not just afraid of crashing or the feeling of claustrophobia that people who have fear of flying have. I'm also afraid that I'll get motion sick and feel nauseas and feel sick.

STOSSELAnd same thing with public speaking. I mean, a lot of, you know, typical symptom of all kinds of anxiety is that you get butterflies in your stomach or gastric distress. And so, you know, my worst fear is sort of that, you know, the, if I'm in a public speaking situation and my stomach starts to hurt, then I start to focus on that. And you kind of head off down this terrible, vicious cycle where all you can think about is the anxiety, rather than the task you're supposed to be focusing on, which is whatever you're trying to communicate at that moment.

GOLBECKRight. Yeah. So, do you have any phobias? Have you found ways to connect with people to talk about those? You can join us by calling 1-800-433-8850 or get in touch with us through Facebook or tweet at kojoshow. So you discuss, in your article in the Atlantic, and then in the book, that your anxiety involves physical symptoms, and panic attacks are really part of that package. So, for those of our listeners who are fortunate enough never to have experienced a panic attack, can you talk about what your experiencing when you're going through something like that? Or even an event that's particularly anxiety inducing.

STOSSELSure. I mean, in both cases, it's awfully similar. And whether it's a sort of spontaneous onset panic attack, as they call them, or acute anxiety provoked by a phobic stimulus, you know, something that's making you really anxious. The sort of sequence of emotions and physical reactions can be the same, and it's almost like -- I mean, basically, what a panic attack is is sort of a fight or flight reaction, which is an adaptive, evolutionary adaptive response to being in danger.

STOSSELBut when you're having a panic attack, it's sort of misfiring. And so what you feel is, you know, first of all, sort of racing thoughts and feelings of impending doom. And then, a whole slew of physiological responses that can range from everything, including, you all, all of them at any given moment. But, you know, intense sweating, shaking, trembling, you know, feeling like your chest is constricting. Gastric distress, dizziness, tingling in your hands and sort of in your extremities.

STOSSELAnd for people who don't know what they're going through, oftentimes, they think, oh my gosh, I'm having a heart attack. And they'll end up in emergency rooms. People like me, who are more familiar, you tend to know what it is when it's coming on, and sometimes can sort of rationalize it or use deep breathing techniques or something to head it off at the pass. But even, you know, equipped with all of my, sort of, hard won scholarly knowledge gained in working on this book, there are times when the anxiety just sort of becomes overwhelming and, as I say, sort of hijacks both your sort of cognitive system, so you can't -- you know, you're thinking terrible thoughts.

STOSSELAnd your physiology, and suddenly, you're off to the races.

GOLBECKAnd then, that physiology, having those reactions, even though you know better, actually makes you feel more anxious about the anxiety itself.

STOSSELExactly. And, I mean, that's what's sort of the infernal thing about being an anxious emetophobe, that oftentimes, there's stomach symptoms with it. And you start focusing on those, and suddenly, you're, you know, maybe the thing that triggered the anxiety was you're in an airplane or up on a height, but suddenly you're worried about your stomach, and then you almost feel like your brain is kind of turning inside out. It's not pleasant when it happens.

GOLBECKIt's a vicious thing.

STOSSELYeah.

GOLBECKSo, you've written that you found what works for you, for specific situations. And I loved the description that you had about preparing yourself to go up and speak in public. So, can I ask what you did to prepare for this interview?

STOSSELI get that question a lot. I took, I mean, I'm on my -- I regularly take a sort of low level dose of a antidepressant, which is -- builds up in your system, and there's some evidence that that can be effective at reducing levels of anxiety. But I did take a Xanax, which is a benzodiazepine that kind of slows down what's known as your gabaergic system, and basically, in laymen's terms, kind of slows down the firing of neurons in your brain. And for some people, that doesn't work at all.

STOSSELIf you take too much of it, it can make you sleepy or not coherent. But if I'm able to titrate the dose to just the right level, the combination of being made anxious by the anxiety provoking situation gets your adrenaline flowing, and then that can sort of be balanced out by some level of medication that keeps you on an even keel.

GOLBECKSo, so I'm not as scary for you as being in front of a group of big people?

STOSSELWell, yes. Exactly. That's true. It depends how big the people are, I guess, but yeah.

GOLBECKSo you weren't sure about the wisdom of putting all of this into a book. What were your concerns that went with that?

STOSSELI mean, I had a lot of ambivalence, because I've spent -- you know, I'm 44 years old, and I'd spent most of my life keeping all of this under wraps. I mean, I've been in and out of various kinds of psychotherapy and on many medications for, you know, 34 of those 44 years. And all but my family and a few of my closest friends, really had no inkling of the depth of the anxiety that I was wrestling with, which is actually a fairly common phenomenon. I mean, in particular, people with panic disorder and some other forms of anxiety -- sort of, they tend to be very good at projecting an outward appearance of calm and competence, where they're churning within.

STOSSELAnd so my fear was sort of several fold. One was that stigma still attaches to mental illness, of which, anxiety disorders are -- they're categorized as mental illnesses. And so I was reluctant to be subjected to that stigma, but I also, as it were, coming out as anxious, I thought, this might be a way to help reduce the stigma. I also worried, you know, would I be compromising my professional standing, because, again, I've somehow managed to build up a reputation for great competence and calm. And if somebody, I say in the book, that someone once described me as human Xanax.

STOSSELBecause I'm able to calm people down. I think that's probably because I can relate to anxious people. And probably because I'm so conscious -- you know, much of the time, I'm so, sort of, internally flapped that even when there's a real crisis situation, I can sometimes appear unflappable, because I'm used to that all the time. But there's -- there was a great quote I came across in researching the book, that there were these signs post on gun installations in Malta during World War 2.

STOSSELAnd it said, if you are a man, you will have the self respect not to reveal an anxiety neuroses, or fear. And I feel like that for men, in particular, but for all men and women, that there's still some perception of weakness or vulnerability or stigma, as I say, attached to mental -- so, that gave me great kind of ambivalence about coming out with this stuff.

GOLBECKBut you have said a lot of people have started responding to you by sharing anxieties that they have and feeling like they can talk to you about it. And we have a lot of those callers on the line. So I think we'll take some of those. Let's go to Paul in Alexandria. Paul, you're on the air. Go ahead.

PAULHi. Yeah, great show. Thanks for hearing me.

GOLBECKThanks for calling.

PAULYeah, my anxiety is -- if I'm watching a TV show or a movie, I get anxious over kidnappings or rape scenes, or any kind of tension that director's trying to give us a good show, but I start pacing. And I'll ask my friends, what's the ending? What happens? And even if they don't know, they'll tell me, it's gonna be OK. And it creates like a panic attack.

GOLBECKInteresting. So thrillers are not for you.

PAULNo, not at all. And even this is -- it's a little tough calling you all, and I guess a lot of callers have that same problem. But it's that when you're with your friends, you should be calm, and I don't know if other people have that. I don't know if it's a common thing.

GOLBECKI, so, it's interesting. Is there some story of that being elevated to the point of a true, kind of, phobia, because I certainly have that kind of tension, and I've flipped to the ends of things before. So, Scott, what do you think about that?

STOSSELI haven't come across that in the literature, and, I mean, in fact, a lot of -- I have read research that -- the one reason that people like horror movies and thriller movies is precisely because it gives this sort of vicarious fear that they, at some level, you know, you know is not real. But as phobias that I've heard of go, yours sounds like actually quite easily to cure it. Just stop watching those movies.

GOLBECKThat's an easy one to avoid. So we'll continue our conversation about anxiety with author Scott Stossel after this short break. You're listening to "The Kojo Nnamdi Show." I'm Jen Golbeck sitting in for Kojo.

MS. JENNIFER GOLDBECKWelcome back. I'm Jen Goldbeck from the University of Maryland sitting in on "The Kojo Nnamdi Show." I'm talking with Scott Stossel about anxiety today. You can join us at 1-800-433-8850, by email at kojo@wamu.org or check us out through Facebook and send Tweets to @kojoshow. So we were talking over the break about anxiety-related health issues. And so I'd like to bring a couple callers in because we certainly have some with things to share. Let's go to Mark in Rockville. Mark, you're on the air. Go ahead, please.

MARKHi. Thanks for taking my call. I just also wanted to acknowledge you, Jen, for a great talk you gave at the (word?) lab about semantic technology.

GOLDBECKThank you.

MARKIt was very illuminating. I believe I have a condition called vasovagal syncope. I hope I'm pronouncing that correctly. And basically the symptom is, if I think about blood too much -- and I could do this purely by thought -- my blood pressure goes down and in some cases I can faint away. My understanding is that this affects men much more than women. And I'd like to ask Scott Stossel if he happens to know if this is more physiological or more psychological anxiety related or is it both?

GOLDBECKYeah, go ahead, Scott.

STOSSELNo, very good question. And, no, you've identified a true phenomenon, which is also known as, you know, within the anxiety sort of categories as blood injury phobia. And for me it was interesting. Well, I've had some limited experience with this because I had back trouble when I was about 30 years old and same thing. I went in and I was going to have to get some cortisone injections in my back. And they look -- if you're a male they look at your muscle tone and say, have you ever fainted before? Because apparently there are -- men are more predisposed to this reaction. But then it can become a phobia called blood injury phobia.

STOSSELAnd, as I was saying earlier, you know, all of these anxiety responses -- severe anxiety responses are often sort of misfiring or over firing versions of an evolutionary adaptive response. So people talk about the fighter flight response. And that tends to program you to either be able to run away from danger, to fight danger, but there's actually a third response which you see in the animal kingdom which is to faint. Because A. fainting can -- if you're an animal in the wild kingdom, your predator may think you're already dead and ignore you. And if you've had an injury and you're bleeding, having your blood pressure drop severely actually is adaptive because it means you'll be slow at bleeding out.

STOSSELBut for me, I'd never heard of this. And with my tendency to, you know, excessive worry and particularly to health anxiety, as I was researching this book I learned all about blood injury phobia. And I'd never had any particular fear about having my blood drawn or getting shots. And once I learned about it, I started having that fear because I have this fear of fainting. And so now, you know, when I go in to get my blood drawn, I have to lie down. So I think it is actually substantially a physiological problem, but it can acquire a psychological component to it.

STOSSELAnd it is, in certain ways, adapted but not, you know, if you're thinking yourself into passing out, you know, while you're walking down the street thinking about your blood.

GOLDBECKSo it's interesting. You actually had the anxiety of fainting before and not the anxiety of the blood. But once you've realized that the blood anxieties could lead to the fainting, that became...

STOSSELIt's almost -- it became a self-fulfilling prophecy. So clearly there's a psychological element to it because literally I was -- this was a sort of rare area of non cowardice for me. You know, yeah, I can get my -- my kids are afraid of having shots. I was like, oh no big deal. And now I'm always worried that I'm going to pass out. And interestingly, again, evidence that this has some physiological component, redheads are much more susceptible to this. Don't know why, but redheaded men and women are more susceptible to that particular phobia.

GOLDBECKSo that does suggest some kind of genetic component.

STOSSELThere's something in having red hair and, you know, the genotype of having red hair co presents with a susceptibility to that kind of vasovagal response that the caller is referring to.

GOLDBECKSo we'll talk a lot more about this nature and nurture component later on in the show. But I have a few callers here that I'm going to bring in who are interested in talking about ways that they've overcome problems that they've had. And I think that'll let us talk about some of the potential solutions that work and don't work. Let's start with Vanessa in Mount Airy. Vanessa, you're on the air. Go ahead.

VANESSAHi there. Can you hear me okay?

GOLDBECKI can.

VANESSAOh, wonderful. Yes. I was diagnosed with fibromyalgia about three years ago. Up until that point I had always suffered from symptoms of fibromyalgia, but never knew that it was anxiety-related. And when my uncle contacted me about curing his fibromyalgia 20 years earlier, he notified me that it's actually an anxiety disorder. And it's your body physically reacting to your emotions, like blushing or having butterflies or, you know, back pain. And my rheumatologist was pressuring me to get on medication. But when I realized it was anxiety-related, I didn't want to treat the symptom. I wanted to treat the problem.

VANESSASo it's been about two -- it was about a two-year quest for me to not do meds but fix the anxiety issues. And I've overcome fibromyalgia for about a year now. And so what I've been dealing with the past year is what caused the fibromyalgia in the first place, which for me was childhood trauma. But I am type A. I don't deal with pressure very well. I had long term trauma, PTSD. And a lot of people that have FM have those traits as well. And...

GOLDBECKSo Vanessa, is this something that you've been working through say with a therapist or a psychologist, psychiatrist?

VANESSAI had been in therapy for about 20 years. I'm 28. And when I was eight I went into therapy. It didn't work for me. It just opened wounds but there was no closure. So actually what he did was he suggested two books for me. I don't know if I'm allowed to say them on air but one was about back pain and how it's caused mentally usually. And the other was actually a five-week workbook that explains fibromyalgia. And there was actually a five-week program. And I went from couch-bound for six months to trying out for a cheerleading team and making it to the cheerleading team within four weeks.

GOLDBECKWow. So that's a pretty dramatic turnaround. We also have -- oh, sorry, I think we lost her there. But I would like to also bring in Brenda who has another story for us overcoming her anxiety problems. And then, Scott, we can talk a little bit about all of these options that they've looked at. So Brenda, you're on the air. Go ahead, please.

BRENDAYeah, hi. I had really debilitating anxiety after just an unbelievable amount of stress in a short period of time, like one of my best friends dying and unemployment and you name it. So I kind of had a breakdown and I was put on antidepressants. And they really did help for a while. And then it just basically wore off and I had ten extra pounds on my body. So I just -- I got off that and I tried a lot of alternative things, and they also helped.

BRENDABut then I found something that I have not had a panic attack since I started doing it. It's called the healing code and it's basically something -- you kind of hold your hands in position and you say an intention. And like -- you could liken it to meditation, but it's pretty specific and you can find it. And I have to tell you, I just was amazed because nothing else was really working. And I would love to share that with people who might suffering out there.

GOLDBECKSo this is interesting. So we're getting, you know, some callers who have done kind of a therapy route. You know, we've just had some interesting solutions there. We also got a tweet from someone who had a fear of vomiting and said that it ended after she had morning sickness. So, Scott, that's something that you could think about trying.

GOLDBECKI've been trying to get pregnant for years and it just hasn't worked.

GOLDBECKSo can you talk about, either from your own experience or things that you researched as part of the book, kind of what's the arsenal for helping people deal with these issues? And what's most successful? I know it depends on person to person but...

STOSSELWell, yeah, I mean, there's a huge range of possible approaches. And just to address, in succession each of the previous two callers comments, I'm not an expert on fibromyalgia specifically. But I do know -- I suspect the book she's talking about about relieving back pain through sort of psychological means, maybe this book by Dr. Sarno. And what increasingly something that eastern medicine has recognized for a long time, western medicine is now coming to terms with in a more empirically grounded way about, which is the relationship between mind and body. And that, you know, everyone from Freud on has talked about how psychological issues, you know, whether it's trauma or psychic conflict, can get refracted into the body.

STOSSELAnd sometimes you don't even necessarily feel emotionally anxious but you're having all of these physical symptoms. And there's evidence that if you can sort of bring the underlying psychological conflict to the surface through talk therapy or hypnotism or whatever, that you actually relieve the physical symptoms. And it does sort of sound like the first caller was able to achieve something along those lines. For Brenda, the second caller, there's something called the Holmes Rahe scale which ranks kind of life events on the degree of stress they cause for the individual.

STOSSELAnd almost all of us -- I mean, there are some very, very lucky people who are so psychologically strong that they have almost, you know, complete resilience or resistance to any kind of emotional breakdown. For the rest of us, you know, most people in the middle there is some, you know, quantity of stress under which they will simply break down. The human body's only equipped to deal with so much. And then for those of us like myself who have anxiety disorders, the, you know, amount of stuff that can pile up is maybe less than for average.

STOSSELBut in terms of, you know, overall -- you know, there are -- in the kind of therapeutic professions there are those who advocate, you know, for medication very strongly. There are those who are anti-medication and say you need to do sort of talk therapy. One of the -- we were talking in between segments about how cognitive behavioral therapy or CBT, there's a lot of evidence suggesting that that may be, you know, as effective or more effective than drugs with fewer side effects.

STOSSELAnd basically what that is, is kind of a form of talk therapy where in a very concentrated way you deal with whatever the thing that is making you anxious or depressed and try to reframe your thinking about it in a more positive way. And there's a lot of evidence that that can work very effectively in a short period of time. And I will say too that ever since, you know, the excerpt of my book came out in The Atlantic and then the book itself, I've been inundated with, you know, many, many people. Some of them have not found a cure but many who have. And, you know, there's all kinds of things from diet to exercise to getting more sleep to strange gadgets that you hook up to your back to, you know, send electromagnetic waves.

STOSSELThere's a lot of things that work for different people and probably no single thing that works for everyone.

GOLDBECKYeah, as long as it works.

STOSSELAs long as it works, yes.

GOLDBECKOkay. Let's take a call from Rachel in Silver Spring. Rachel, you're on the air. Go ahead.

RACHELThank you for taking my call. Back in 1981 when I guess college students weren't told about things like this, I had a panic attack and it lasted almost a year. And I had no idea what was going on. It started in class. I just sort of got up quietly and went into the restroom and looked at myself. I didn't look any different but I thought -- as you said before, I thought I was dying. And I had no idea. But the first thing I did was call the campus therapist and go down there. And it was just the strangest thing because he described it to me as if it was something that, I mean, everybody knew about. And, you know, I should know what's going on.

RACHELBut I had to drop out of school at that point a year, going to therapy twice a week just to calm down to the point where I could function. And I didn't go out except to go to therapy. And I was, you know, just on edge all the time. And the only thing that could make me calm was to go to sleep. And that was, you know, more than 25 years ago. I haven't had an anxiety attack since. But I'm very glad that this is a subject that's out in the open now because honestly, you know, I described to a couple of people what was going on while I was at school. And they all were just like, what? How horrible for you. But, you know, nobody really knew.

GOLDBECKYeah...

RACHELAnd therapy helped -- therapy was what helped me. They didn't have the medications that they have today. And it worked and I hope that whatever works for other people works for them.

GOLDBECKThanks for your call, Rachel. And this brings up a point that you raise in the book, that anxiety is really the most diagnosed mental illness in the United States. It's very common. At the same time there is still this stigma associated with it. And that can affect people like Rachel who then start having some of these symptoms and don't recognize them for what they are.

STOSSELWell, I think she said it struck her in 1980. And actually, it's not surprising then that she wouldn't have heard of it. Because what's interesting is that the sort of terms and definitions that we use to describe the experience we now call anxiety or anxiety disorders have had many different names over the last, well, thousands of years, but even in modern psychiatric history over the last 50 or 60 years. And so panic disorder as an official disorder didn't actually exist until 1980 when it was written into the third edition of the DSM, which is the Diagnostic and Statistical Manual, which is sort of the Bible of American psychiatry.

STOSSELAnd so before that you might've called it like anxiety neurosis, but it's not -- you know, these days millions of people are diagnosed with panic disorder. It's sort of part of the popular culture. I mean, Tony Soprano was -- had panic attacks. So I think if you were to succumb to that now, you'd be much more familiar. But it is -- you know, the evidence suggests that as many as one in six American adults at some point will suffer from some kind of anxiety disorder, whether that's generalized anxiety disorder or panic disorder or a specific phobia.

STOSSELAnd, I mean, it's somewhat. There are those who dispute, you know, that maybe we're over diagnosing because as these drugs that have come online over the last 30 years and get FDA approved to treat some of these syndromes, the kind of diagnostic categories have expanded. And more people, maybe some of whom aren't really truly clinically ill, are getting, you know, swept up in the nets and ended up, you know, getting treated for stuff that they might not need to be.

STOSSELOn the other hand, I do think that there are still plenty of people who aren't aware of, you know, what an anxiety disorder is. And particularly people in poorer areas don't have access to mental health resources. And so I would say actually just as a public service to anyone who's interested, if they feel like they or someone they know is struggling with these, there's an organization called the ADAA, the Anxiety and Depression Association of America.

STOSSELAnd basically it's a nonprofit that tries to provide resources and information to people who are trying to learn something about their condition or trying to find a therapist. They're completely kind of ecumenical about what they recommend but it's a good resource for those who are maybe struggling themselves.

GOLDBECKGreat. So let's take another call. This is Ken calling from Rockville. Ken, you're on the air. Go ahead.

KENHi. Thank you. Well, I have an anxiety about contaminants in drinking water. And of course, that situation in Charleston, W.V. with the chemical spill drove me nuts. And closer to home now up in Ten Mile Creek watershed up in Clarksville -- Clarksburg, rather, Maryland there's a movement underway by developers to build all kinds of malls and houses that will -- all the science says it will pollute our drinking water. So that's kind of what's on my mind now and I'll take my comments off the air. Thanks.

GOLDBECKSo this has got to be a pretty common phobia that people have of contamination, right.

STOSSELYeah, I mean, he's talking specifically about water contamination. In general, you know, a lot of people with OCD or like me with sort of general germ phobia are worried about contaminants of all kinds. And for the most part these fears are overblown and irrational and interfere with your life. On the other hand, as they say about paranoid people, you know, even some paranoids have enemies. And, you know, as the caller says, you know, you look at incidents like this in West Virginia and sometimes you have legitimate reason to be afraid.

STOSSELI think -- I'm no expert on this, I think most of the time the drinking water is probably safe. But I can definitely relate to the caller, as I'm always worried about, you know, what horrible contaminant has leached its way into whatever I'm consuming at the moment.

GOLDBECKThat's right. So we'll continue our conversation about anxiety with Scott Stossel after this break. I'm Jen Goldbeck and you're listening to "The Kojo Nnamdi Show.

GOLBECKWelcome back. I'm Jen Golbeck from the Human Computer Interaction Lab at the University of Maryland sitting in for Kojo Nnamdi. I'm talking with Scott Stossel about anxiety. If you'd like to join the conversation, you can call 1-800-433--8850. So I'd like to take a couple more calls. We have a lot of people who are interested in talking about this. But we did just get a call from a public utility official. He called to reassure us that the water is safe.

STOSSELGood to know.

GOLBECKThat should make everybody feel better. Let's take Genevieve in Salisbury, Md. Genevieve, you're on the air. Go ahead.

GENEVIEVEHi. Thank you taking my call. I just wanted to mention, just like a previous caller, I too started suffering from anxiety when I was in college and, you know, I had to cut back on the numbers of classes that I took because of it. And, you know, I was prescribed different things over the years, medication, antidepressants, but I found what helped me was natural supplements, and I started hearing about from Dr. Ayman. I know he's had some infomercials on PBS. But I take (word?) regularly, but, you know, every -- different things work for different people, but I was just wondering if Scott could comment on what he's, you know, if he's found anything -- any statistics related to people who have been helped by natural supplements.

GOLBECKThanks for your call. And we did also get an email from someone who said that cutting out caffeine, even though they didn't drink very much, actually had a really big impact for them.

STOSSELYeah. Well, on the second question first, there's no -- and actually I'm saying this with my coffee here on the table, I have to be very careful to take it in very small doses. There's no question that caffeine is an anxiogenic substance. It causes anxiety. And so cutting out caffeine is a clear way to reduce anxiety. As far as statistics about natural supplements, I don't have any based on, you know, studies and things like that. I've read some.

STOSSELBut I can say anecdotally that since my book came out a week ago, and since the Atlantic article came out a couple weeks before that, probably by far, the two most common -- I've gotten, you know, hundreds, if not thousands of recommendations. Some significant percentage say, dude, why don't you just smoke more pot. But the -- even more say -- are recommending different supplements of various kinds, and I haven't -- I probably should have looked more into this and tried more. I've done a little bit of it, so I can't say I've found one that worked for me, but I can say that I have had dozens, if not scores or hundreds of people writing in saying that whether it's fish oil or magnesium or vitamin B supplements, or vitamin D or, you know, all kinds of other things have worked for them and other kind of dietary adjustments.

GOLBECKYeah. You know, the more we hear from these guests, the more it seems it's a very personal way that people deal with it.

STOSSELI mean, there's no question that diet and sleep make -- have a huge impact on just, you know, whether you have anxiety disorder or not, or depression or not. You know, everyone can relate to if you had a poor night's sleep or aren't getting enough exercise, your state of mind is not as good as it can be. For people who have anxiety and depression, you know, getting regular exercise and getting enough sleep and having a healthy diet are in some cases crucial.

GOLBECKSo we'll take some more calls. We've got a lot more people with stories to share. But first I'd like to talk a little bit about the history of anxiety, which is something that you cover extensively in the book. We like to say that we live in the most stressful era yet, but there's not really any evidence today that that's necessarily true.

STOSSELYeah. There -- I'm of sort of two minds about this because I went into this thinking that we -- I was going to find that this is the most anxious era ever because everyone says that, and there is some truth to that. But what I was struck by, reading back through the history going back, you know, decades, centuries, even millennia, back to, you know, the ancient doctor Hippocrates in the fourth century BC is that every era sort of presumes to claim that it is the most anxious era ever, and it's really fascinating reading, you know, things from Victorian England or Georgian England, and these doctors talking about, you know, never have I seen such rates of anxiety, these anxious people.

STOSSELSo what that suggests to me is that is some fixed portion of the population who are, you know, going back to caveman times, who are disproportionately predisposed to anxiety, and it's part of the human condition that anyone subjected to enough stress will break down. But I do think that said that certain eras, including the one we're living in now are more productive of anxiety than others, and eras like now where the industrial revolution where you have rapid, rapid rates of change, where social roles are changing quickly, you know, arguably we've had an enormous expansion in the range, you know, in the west anyway of political freedom and range of choice and, you know, and everything from, you know, freedom to choose from 57 different breakfast cereals when walk into the grocery store to whether you want to -- what career to choose, what personal style do you want to have.

STOSSELDo you want to be a goth or heavy metal person or a square, do you want to be a stay-at-home home, you know, do you have kids or not. All of this is stuff that is -- on that balance it's great to have these freedoms. On the other hand, it's incredibly anxiety provoking because you have all these choices, and you're always worried am I making the wrong choice, versus say, in the middle ages where you probably had a lot more legitimately to be afraid of like your life was going to be probably rotten and you might die of pellagra or scurvy or be killed by bandits by the time you were eight.

STOSSELBut you didn't have the luxury of being -- of worrying about, you know, well, should I, you know, what brand of Cheerios should I buy, or am I sending my kid to the right school, or have I chosen the wrong line of work. You may have had more things to be afraid of, but there was less opportunity for neurotic anxiety. So I think now, you know, if people, you know, also the economy is uncertain. Uncertainty is very productive of anxiety, so people are not wrong to think that this cultural moment is particularly anxiety inducing.

GOLBECKAnd then how about anxiety as a biological problem? How far back did you find evidence of that?

STOSSELGoing back to the beginning of my research. I mean, there are sort of fascinating debates between, you know, in ancient Greece in the fourth century BC between, say, Hippocrates who was sort of, you know, the first, you know, the father of medicine, the first physician on the one hand, and Plato. And Hippocrates was saying, you know, anxiety and other mental illnesses are a purely medical condition. There is a problem of wiring or of the, you know, sort of -- he would talk about the different humors that you have in your body and that if they were out of whack you would be sick.

STOSSELPlato, on the other hand, would say no, no, it's a problem of philosophy. You're just not thinking right. We can reason you to psychological health, and that debate persists from back then all the way to the present day when, you know, for instance 10 years ago I was going to two different therapists. In the book I call them Dr. Harvard and Dr. Stanford. And Dr. Harvard was recommending, you know, you have a medical condition, it's like diabetes. If you had diabetes you wouldn't feel ashamed about treating it with medicine. That's the only way you can get a handle on it.

STOSSELAnd then Dr. Stanford, who was more of a CBT practitioner, was saying, no, no, you know, the medication is actually -- it may be just masking some of the symptoms, but you're not treating the underlying anxiety. You need to, you know, deal with your underlying issues and change your thought processes. So this is a debate that's gone back and forth for a long time. My own view is that there is a very, very strong underlying biological component that is sort of programmed by the genes. But that said, genes are not 100 percent determinative.

STOSSELAnd so you can have identical twins, one of whom will have panic disorder, and one will not. So there's an element of luck, circumstances, you know, and learning how to kind of cultivate resilience and resistance against these things too.

GOLBECKSo we have a couple callers who want to share with us anxieties or issues that they're having around sleeping. So I'd like to take a couple calls and then have you comment, and we'll start with Millie in Washington DC. Millie, you're on the air. Go ahead.

MILLIEHi, yes. Thanks for taking my call. I have been diagnosed with, you know, anxiety, and I'm on medication, but I have -- a few times a month have this instance where I will fall asleep and it's sort of like the movie "Inception" where I become aware that I'm asleep, and I will try to wake myself up and scream and thrash around or, you know, think that I'm moving, like, try to roll over on the floor, anything to wake myself up, and nothing really works, you know, for, I don't know, a few minutes it feels like.

MILLIEAnd then I'll finally wake up, but then I become terrified to fall back asleep because I'm worried about being trapped again. And so I was just wondering if you came across that in your research, and I'll take my comments off the air.

GOLBECKThank you. And Scott, before you answer that, we also have a call from Cecelia in Washington on a similar topic. Cecelia, you're on the air now. Go ahead.

CECELIAYes, hi. Thanks for taking my call. I take Paxil and in regards to actually what you were talking before, the stress with children. I had four kids in five years, so it was a crazy time, so I ended up taking Paxil, and I'm still taking it. And I actually -- my question was why do I have nightmares at night, and I can't sleep well.

GOLBECKOkay. Thanks for your question. So both of these really, you know, revolving around anxieties and sleep and nightmares. You want to talk about what you found in that respect?

STOSSELSure. I'm not an expert on sleep disorders, and I should say as a general caveat I'm not a physician. But on the first caller, that sounds like sort of distinctive sleep disorder, and actually I don't know much about that, and don't know that I have that much to offer in the way of specific advice, but that sounds like a sort of harrowing condition. I have had experience with Paxil myself, and it is true that a lot of these SSRIs, of which Paxil is one, and which, as I say, I have taken, have strange effects or have effects on sleeping patterns and on dreaming.

STOSSELThey actually tend to suppress dreams in some people. So I can't say for sure that that's why you're going through that, but just generally on the matter of sleep and anxiety, I went to -- like, about five or six years ago, and academic conference of experts on anxiety where the whole focus of the conference was on sleep. And, you know, there's a profound -- I mean, sleep in itself is a fascinating area of research, but with regard to anxiety, there's tons of evidence that suggests that, you know, not getting enough sleep increases anxiety, and in people who are severely anxious, this can be a horribly -- and I experienced this when I was in high school where you get anxious, you can't sleep, not sleeping makes you more anxious, which makes you, you know, and you can sort of spiral into this position where you just protracted miserable anxiety -- or, sorry, protracted miserable insomnia at night, which leads to horrible anxiety during the day.

STOSSELThen you're more anxious and you can't fall asleep at night. And those are some of the hardest patients to treat, and what some of the experts at this conference were saying, you have to get them to be able to get a good night's sleep first, almost above, you know, before anything else or you're not going to be able to treat their anxiety.

GOLBECKSo turning back to something that we were talking about earlier, this nature versus nurture debate, what's psychological, what's biological, there's so much written about this. So could you kind of sum up for us what you found with that and what your thoughts are on it?

STOSSELSure. I mean, I -- in the book, I spend a whole chapter talking about in effect, you know, in what ways might my, for instance, mother's parenting style have led to my anxiety. She was extremely overprotective and, you know, in sort of really unusual ways. And it wouldn't -- it wouldn't be at all unreasonable to conclude, and there's a lot of evidence that suggests that, you know, separation anxiety of the sort that I had from the moment I was a young child all the way up into adulthood can be caused by sort of -- there's a whole school of thought called attachment theory that talks about the nature of the mother-child bond can lead to problems later in life.

STOSSELSo sort of explore that, and there's some evidence that, you know, that's nurture in effect. But then I look at my extended family going back four generations and, you know, my great-grandfather was dean of Harvard College and developed, you know, I tracked down his medical case files from when he was there in the 1940s, '50s, and '60s, and was sort of disconcerted as I may have mentioned earlier about how many similarities there were between myself and him, and now my own kids who are six and ten at this point, are starting to develop evidence of some of the same anxieties that I had.

STOSSELAnd we've tried to get them into therapy early because, you know, having read all that I've read, I know that early intervention can be very, very effective. But all of this suggests to me that there is a strong genetic component to anxiety which, you know, basically there's a psychologist who studied for 60 years the sort of inheritability of temperament, this guy Jerome Kagan at Harvard. And he basically suggested that people lie on a spectrum from what he called an inhibited temperament on one side to uninhibited on the other.

STOSSELAnd people with inhibited temperaments tend to be more prone to developing anxiety disorders and depression as adults. He also though says that -- and this is where there's sort of redemptive value and anxiety, he prefers to hire only people as lab workers who have inhibited temperaments because they tended to be more conscientious, sometimes more creative. They were afraid of screwing up. So bottom line, it's impossible to entangle the way that nature and nurture and just luck and circumstances all interact.

STOSSELBut I believe there is a strong genetic biological component to, you know, the human experience of anxiety, but overlaid on top of that are not just, you know, your own personal life experiences, but the culture that you live in, and a whole bunch of other things too, including just, you know, luck.

GOLBECKAnd medicine now is starting to look at genetics to really get down to the DNA level and identify genes, and you had some genetic testing done kind of hoping that would illuminate some things for you.

STOSSELYeah. No. So actually, I had myself tested. So there's -- every year now there's thousands of studies trying to isolate and do studies on what they call candidate genes for, you know, producing different aspects of anxiety, and I talk a lot about them in the book. But I had myself tested for two in particular, and one was kind of the serotonin transporter gene that basically -- which version of the gene you have determines how effectively serotonin, the neurotransmitter, gets ferried across your synapses. And another one called the (word?) gene which has something to do with processing of dopamine.

STOSSELAnd I didn't, you know, I sort of thought, and I talk about this in the book, about whether if I were to find that I had the anxious of both these genes would I feel like, oh, my God, I'm doomed to, you know, being anxious, because I'm -- it's woven into my genes, or would I feel relieved like, oh, you know, this -- see, I'm not just malingering, it's written in. Or, on the flip side, if it turned out that I didn't have the anxious versions of these genes, like, here I've been, you know, conferred a non-anxious genetic inheritance and I'm somehow managed to squander it by just becoming anxious on my own.

STOSSELSo it's -- this -- I think a lot of the research here is going to yield, you know, more and more insight into how the mind works and also help us figure out how to -- which drugs work most effectively with which people because you can literally figure out now, you know, if you have this genotype, this drug is more likely to work for you than Drug B or, you know, vice versa.

GOLBECKSo we have a lot of callers, and about one minute left.

STOSSELSure.

GOLBECKBut to sum up a lot of the questions that are there that you can maybe give us a quick answer to, are people wondering kind of how you deal with this, how do you decide who you're going to tell, you know, how do you seek out getting help when the idea of help can make you anxious? So can you give a, you know, sort of one minute set of recommendations for people who recognize they're having anxiety problems and want to start getting help but don't know how to.

STOSSELSure. I mean, as I mentioned earlier, there's the ADA, which is the Anxiety and Depression Association of America and they have a website and there's tons of just interesting resources there, and it's totally confidential. You can -- but I would, you know, if you're in severe distress, you should call your, you know, if you have a family physician, they're very good at, you know, steering you to the right person, and, you know, if you're in severe distress, you know, your doctor can get you the help you need quickly.

STOSSELSo don't, you know, you're not alone, and there are lots of different modes of therapy that can work for you. So if you think you might need help, don't feel shy about seeking it, and, you know, don't be afraid about the stigma and, you know, all this is usually kept confidential anyway if you're dealing with your doctor.

GOLBECKGreat. Scott Stossel is author of "My Age of Anxiety: Fear, Hope, Dread, and Search for Peace of Mind." Thanks for joining us.

STOSSELThank you for having me.

GOLBECKI'm Jen Golbeck from the Human Computer Interaction Lab sitting in for Kojo. Thanks for listening.