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A Point of View: Four types of anxiety, and how to cure them

Woman biting nails

Anxious by nature, Adam Gopnik has spent years looking for cures for his constant worrying.
I returned home to New York this week, after reporting trips to London and Paris, to find the city in a mild panic about…. Ebola. Now, Ebola is one of those things that really are worth having a panic about - a horrible and highly infectious fatal disease of mysterious vectors. On the list of things to worry about, this is real - unlike whether Chelsea's Diego Costa was fit enough to play Manchester United (another item on my worry list).
But how to worry - and how not to - that's the question. I am a professional worrier, anxious by vocation, one thumb always hovering above the panic button. I am so quick on the iPhone keyboard that, in London, riding the rising midnight tide of a toothache, it took me no more than 30 seconds to find an all-night dental clinic on Baker Street - not far, I noted (still a tourist at heart), from Sherlock Holmes's lodgings.
Undue anxiety is the New York affliction, as unearned melancholia is the Parisian one - and over the long years I have discovered various cures, or at least treatments, for galloping anxiety, which I shall now share. Four overlapping but largely distinct types of anxiety afflict modern people, each with its own pathology and palliative. They are catastrophic anxiety, free-floating anxiety, implanted anxiety, and existential anxiety. Let us take them one by one.

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Adam Gopnik
  • A Point of View is usually broadcast on Fridays on Radio 4 at 20:50 GMT and repeated Sundays, 08:50 GMT
  • Adam Gopnik writes for The New Yorker
Catastrophic anxiety is the fear of something really horrible happening, right out of the blue. The plane goes down, the virus was left lingering on your plane seat, the terrorist bomb goes off in your bus. By far the best treatment for this fear I've ever found came from a professional guide to cheating at cards.
There was a period in my life when I was spending time among great sleight-of-hand men, card magicians, in Las Vegas, and one of them slipped me a guide to card cheating that had been privately printed by a professional card cheat. (Card magic and card cheating are Siamese twins, and no great card magician has not flirted with fiddling his neighbours).
It was a sour piece of work, but it taught me something vital. Since a card cheat can only cheat effectively on his own deal, unless he has the cards marked (hard to do) the rest of the time he has to just play smart, and this means fully internalising, as instant reflexes, all the statistical probabilities of card playing. I recall the cheater's insistent formula about these odds, almost his precise words, with indecent clarity: If the odds on whatever it might be - say, drawing to an inside straight - are 10-to-one, you'll see it this week; if it's 100-to-one, you won't see it this week, but you will see it this year. If it's 1000-to-one you won't see it this year, but you will probably see it once. Anything more than that - 10,000-to-one, 100,000-to-one - you're never going to see at the card table. It's just never going to happen. Yeah, but it will happen, to someone you say! Someone draws an inside straight. Yeah, he said, but you won't.
Royal flushIt'll never happen (in all probability)
The great virtue was to think of the odds in terms of things you want to have happen rather than things you fear are going to happen. Turn the fears into desires, and you see how remote they really are. People draw five cards for a royal flush, somewhere. You'd be an idiot to think you ever will. Planes do go down. Yours won't. Those are 100,000-to-one odds, too - probabilities so remote that you can live your life in the conviction that it will never happen, and you won't be wrong. Even among catastrophic events the odds are often better than you think - the level of casualties among British soldiers in World War One were about 10%. The odds of surviving as a British infantry man were actually very good, considering. This doesn't make WW1 any less a catastrophe, but it reminds us that even catastrophes are rarely as catastrophic as we fear.
Now, free-floating anxiety is the worst kind of worry, because each worry can always be replaced with another - there will be no work tomorrow, the rent or mortgage can't be paid, the school fees, the work overdue… I have known it to get so bad, even with seemingly serene people, that it can only be treated with medicine, which works, fortunately.
Lion in NamibiaThe lion - an anxiety-driven beast
But it can also be sublimated, accepted, as inseparable from an aspect of human nature, and human ambition. You can learn to use it because it simply means, work to be done! Self-renewing worry is a legacy of our predatory nature. Herbivores graze nonchalantly across the pasture of the world. Lions and tigers, for all their glory, are anxiety-driven beasts - watch their eyes and you see not majesty but worry, floating free. Does the impala see me now? Has it seen me yet? Am I close enough? When to pounce? And will there be another impala to feed the cubs tomorrow? It does make for a driven life. But it is better to be a little bit driven than forever drugged. Zoo-fed lions, they say, become depressed.
Implanted anxiety is like the catastrophic kind but raises less from the fear of big disasters than from the ever-changing tides of long term public worry - from the headlines. Yesterday, it was the scary ISIS in Iraq, today the still-scarier Ebola in West Africa, always and the next thing coming to get us all. It is a natural consequence of living in a news culture - headlines are scary and the larger proportion of good news is not news at all. All over New York, in the early morning light, infections that would have killed in a minute are being cured. Women who a mere century ago would have died in childbirth are cuddling their ingeniously delivered babies, hearts are being cleansed. And one man is isolated for an Ebola infection. But he is all we see.
A man, dressed in a biohazard costume, stands on the corner of 546 West 147th Street in New York City
This asymmetry of inserted anxiety is built, blessedly, into an open society. Only totalitarian ones insist on reporting only the good news. But the daily dosage is still often unhealthy. The only remedy is to absent yourself from it, however briefly. Our family learned to do this, at first by accident, by going away for three weeks each summer to a house with no internet, no television, and no cell phone reception and variable electricity. We emerge and find out all the anxiety-causing events we have missed, and are puzzled by them. Hair-raising as they were, our hair was not raised, and by now most everyone else's scalp has flattened out too.
Of course, nothing fixes everything. Flee, say, to a small West African nation which has no internet etc - and you may find yourself in the midst of an Ebola epidemic. But one can say of the absent-treatment the most that can be said for any analgesic - it helps, usually. Of deliberately implanted anxiety, the kind that cynical politicians have used to control and regiment their people, not enough bad things can be said. After 9/11 in New York, a horrific but specific injury was deliberately levered into an apocalyptic panic. In the annals of courage and utter cowardice, none are more vivid than the contrasting pictures of Churchill on the rooftop of 10 Downing Street, coolly watching the Blitz, and Dick Cheney cowering in a bunker to make his fear contagious.
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Of existential anxiety - well, this is the inescapable kind. Our mortality is not a long shot. It is, so to speak, a dead cert. And even if we can hold that anxiety at the arm's length that we mostly manage, the existential agony for those we love is too great. One dead 20-year-old on the Western Front took many other lives - his parents, his finances, his friends - with him. Grief is absolute. The best that we can do is to take control of the other three kinds of anxiety, so that then there is a possibility that in the time we have left we will have the mental space to seek out pleasures rather than focus on unfixable problems.
I mentioned my London toothache and its Baker-Street-at-2am cure. As I sat in this strange single examination chair on the third floor - with, to be sure, the themes, and many scenes, from Sweeney Todd playing in my anxiety-prone head as I did - I thought of how lucky we actually are to be alive now. The fix was pricey - about the cost of a meal for two in a good London restaurant. But it was worth it. At 02:00 I had my tiny preoccupying tooth fixed, and felt exuberant, the weekend to look forward to.
Two dentists wearing masks
If humanism has a message it is not the fatuous one of progressivism that says everything will always get better, but the real one of the all-night dentist and his lonely, well-lit chair. Many pains can be relieved, for more and more people. And the good feeling afterwards is not an illusion but a weekend's worth of wonder. For millennia, the world has had a toothache - and thanks to use of critical reason applied to human pain, we do better. We have Novocain and electric drills and late-night dentists with well-washed hands.
The thrill of the ameliorative solution is built into our mythology of the modern, right there on Baker Street, by Arthur Conan Doyle. Sherlock Holmes is not a miracle worker. He is a problem-solver. The people in the Holmes stories don't become immortal or blessed when the Red-Headed League is exposed or the Hound of the Baskervilles shown to be no more than a big dog covered with luminescent paint. They just get to carry on living. Sometimes, Dr Watson even gets a wife out of it.
Sign for "Sherlock Holmes, consulting detective, 221b Baker StreetSherlock Holmes - a problem solver, not a miracle worker
The job of modern humanists is to do consciously what Conan Doyle did instinctively - to make that thrill of the ameliorative, the joy of small reliefs, of the case solved and mystery dissipated and the worry ended, for now - to make those things as good to live by as they are to experience. We cannot cure existential anxiety, but we can show that there is no necessity to have big ideas worth dying for in order to find small pleasures worth living for, and that the best use of intelligence is to solve real problems rather than seek imaginary consolations. Some days, or late nights, I think we do this a bit better than we once did. Other days I think that the endless cycle of anxiety, of needless panic and false promises, will win. It is, perhaps, my chief remaining worry.

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