Scott Stossel has tried almost every treatment available for his anxiety, from drugs to yoga. Nothing has worked. Illustration by Miguel Gallardo

People don’t ordinarily self-medicate by writing a book, but “My Age of Anxiety” (Knopf) is an attempt at recovery by a man whom modern psychiatry has failed. The man is Scott Stossel, a successful journalist (he is currently the editor of The Atlantic), now in his forties, who has suffered all his life from an acute anxiety disorder. When he was a child, he had terrible separation anxiety; as he grew up, he acquired phobias about public speaking, flying, fainting, heights, closed spaces, germs, vomiting, and cheese. Many people have an aversion to those things (cheese excepted), and, given the option, go out of their way to avoid them. But, faced with the prospect of a plane trip or a speaking engagement or sometimes even a squash match or a meeting at the office, Stossel experiences full-blown panic: insomnia, sweating, vertigo, stomach pains, and loss of control of his bowels. The sight of an unfamiliar pimple can send him down a bottomless chute of dread. He nearly passed out at his own wedding.

Stossel has been in therapy since he was ten, and he has consumed a whole medicine cabinet of psychopharmaceuticals—Thorazine, Nardil, Prozac, Zoloft, Paxil, Wellbutrin, Valium, Librium, Xanax, Klonopin, and a dozen more—not to mention alcohol. A few drugs and drug cocktails have tempered his symptoms, but the respite never lasted long. His current therapist encouraged him to write this book, and he says he has taken the advice in the hope that “by tunneling into my anxiety . . . I can also tunnel out the other side.”

“My Age of Anxiety” is not a memoir. Stossel tells us things about his parents, his marriage, and his children, but only things that are relevant to what he calls, after a famous remark of Freud’s, “the ‘riddle’ of anxiety.” The same is true of what he tells us about himself. He appears simply as a sufferer. Most of his book is a scholarly exploration of the history of anxiety and a journalistic account of the present state of medical knowledge. It’s intelligent, interesting, and well written, but the subject of anxiety is a mess, and the book, intentionally or not, is an accurate representation of its subject.

It doesn’t solve the riddle, either, but that’s not Stossel’s fault. It’s because anxiety of the kind he is afflicted with is not a riddle. It’s an illness. There is therefore nothing, except in the medical sense, to solve. That’s not what Stossel wants to believe, though. He has an idea that more is at stake. He thinks that there is a metaphysics of anxiety. “To grapple with and understand anxiety,” he says, “is, in some sense, to grapple with and understand the human condition.”

Many people have made this claim, but it can mean different things. It can mean that human beings are creatures who care about the future, and so hoping for good outcomes and worrying about bad ones comes with membership in the species. This is, roughly, the existentialist view. Sartre thought that we feel anxiety when we appreciate the responsibility we bear whenever we act—when we realize that, ultimately, there is nothing out there, including the ethical systems we are born into, that backs up our choices, and nothing that guarantees that they will be the right ones. Dogs and cats, presumably, do not know this feeling. Anxiety is the price tag on human freedom.

The idea that anxiety is central to the human condition can also mean that our mental life is characterized by psychic conflict, and anxiety is the symptom of that conflict. This is, roughly, the psychoanalytic view. It’s what Freud meant when, in 1917 (not, as Stossel has it, 1933), he called anxiety “a riddle whose solution would be bound to throw a flood of light on our whole mental existence.” Anxiety is the common feature of all neuroses. Feeling anxious is what makes people seek psychiatric help. It’s a signal that unconscious drives are in conflict—that (as Freud believed in 1917) the ego is repressing a libidinal impulse. We’re not aware of the conflict itself—we’re not aware that we have a repressed desire—but we are aware of our anxiety. That’s what makes it the key to understanding what’s going on inside our heads.

Anxiety plays a big role in other accounts of the human condition, too. In theology, anxiety has been associated with the concepts of conscience, guilt, and original sin. Reinhold Niebuhr called anxiety “the inevitable spiritual state of man.” In evolutionary psychology, anxiety is usually explained as part of the “fight or flight” reflex that gets triggered in the presence of danger. The reflex is naturally selected for: organisms that lack it might fall off a cliff or get crushed by a mastodon, because their physiologies failed to warn them of a threat to their survival. And, in some schools of sociology and cultural theory, anxiety is interpreted as a reaction to the stress and uncertainty of modern life. It’s a natural response to unnatural conditions. It’s how we know that the world is headed in a bad direction.

This is the hand the student of anxiety is dealt. But he can pick only one card. The existentialist’s anxiety, the psychoanalyst’s anxiety, and the anxieties of theologians, sociologists, and evolutionary psychologists have almost nothing to do with one another. They are not even compatible with one another. If anxiety is a product of modern life, then it is not the result of unconscious drives. If it’s the result of unconscious drives, then it is not a sign of our existential awareness of the nature of freedom. It can’t be entirely conscious, unconscious, socially conditioned, and hard-wired at the same time. The most we can say is that a mood that almost everyone experiences has featured prominently in various theories of human life and the world we inhabit.

The term itself is a catchall. People describe themselves as excited, nervous, apprehensive, tense, stressed out, bugged, worried, panicky, vapor-locked, scared shitless, sick to their stomach, and feeling like they’re gonna die. Each of these moods is arguably a form of anxiety, but they are experienced as very different affective states. All sorts of events in life make us feel keyed up. The brain states may be similar, but the adrenaline rush we experience when we mount the stage to accept the Oscar for Best Actress does not seem to have much in common with a cheese phobia.

What makes the business even more confusing is that anxiety is hard to distinguish clinically from depression. We picture anxious people as hyper and overreactive, and depressed people as lethargic and indifferent. But depression, too, can be understood as a response to a perceived or imagined threat, and antidepressants like Prozac and Effexor also alleviate anxiety. Medically, anxiety and depression appear to be two related symptom clusters arising from (or causing) the same underlying neurological condition. So melancholy, grief, abulia_,_ Weltschmerz_,_ loss of libido, thoughts of suicide, and, presumably, a host of other symptoms associated with depression, like anger and irritability, all get lumped into the category of anxiety.

This gives Stossel a lot to sort out. He is an honest guide. He is committed to thinking through the philosophical, scientific, and human implications of a mood that appears to be universal (though people who live in underdeveloped countries seem to be less anxious) and that has attracted the attention of writers from Aristotle and Robert Burton (the seventeenth-century author of “The Anatomy of Melancholy”) to Søren Kierkegaard and William James. One of the best things about him is that he’s generally agnostic toward the theories and treatments he examines. He sees the possibilities in everything.