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Excellent New York Times article about anxiety.

Posted Nov 11 2009 3:26pm

"Understanding the Anxious Mind" appeared in October in the NYT Magazine. It's a good read, a long, intelligent look at anxiety -- at the physiological responses related to anxiety, at neurological processes related to anxiety, but mostly at the ways nature and nurture combine to cause these disorders.

On the nature side of the equation, the article spends a lot of time looking at experiments by Harvard psychologist Jerome Kagan and others, which study temperament and its role in anxiety among adults:
Jerome Kagan’s “Aha!” moment came with Baby 19. It was 1989, and Kagan...had just begun a major longitudinal study of temperament and its effects. Temperament is a complex, multilayered thing, and for the sake of clarity, Kagan was tracking it along a single dimension: whether babies were easily upset when exposed to new things.... He suspected...that the most edgy infants were more likely to grow up to be inhibited, shy and anxious. Eager to take a peek at the early results, he grabbed the videotapes of the first babies in the study, looking for the irritable behavior he would later call high-reactive.

No high-reactors among the first 18. They gazed calmly at things that were unfamiliar. But the 19th baby was different. She was distressed by novelty — new sounds, new voices, new toys, new smells — and showed it by flailing her legs, arching her back and crying. Here was what Kagan was looking for but was not sure he would find: a baby who essentially fell apart when exposed to anything new.

Baby 19 grew up true to her temperament. This past summer, Kagan showed me a video of her from 2004, when she was 15....

On the monitor, Baby 19 is a plain-looking teenager, hiding behind her long, dark hair. The interview, the same one given to all 15-year-olds in the longitudinal study, begins with questions about school. She has very few extracurricular activities, she says in a small voice, but she does like writing and playing the violin. She fidgets almost constantly as she speaks, twirling her hair, touching her ear, jiggling her knee. “This is the overflow of her high-reactive nature,” Kagan told me, standing near the monitor so he could fast-forward to the good parts.

Here was a good part: The interviewer asks Baby 19 what she worries about.

“I don’t know,” Baby 19 says after a long pause, twirling her hair faster, touching her face, her knee. She smiles a little, shrugs. Another pause. And then the list of troubles spills out: “When I don’t quite know what to do and it’s really frustrating and I feel really uncomfortable, especially if other people around me know what they’re doing. I’m always thinking, Should I go here? Should I go there? Am I in someone’s way? ... I worry about things like getting projects done... I think, Will I get it done? How am I going to do it? ... If I’m going to be in a big crowd, it makes me nervous about what I’m going to do and say and what other people are going to do and say.” Baby 19 is wringing her hands now. “How I’m going to deal with the world when I’m grown. Or if I’m going to sort of do anything that really means anything.”

Her voice trails off. She wants to make a difference, she says, and worries about whether she will. “I can’t stop thinking about that.”

Watching this video again makes Kagan fairly vibrate with the thrill of rediscovery: here on camera is the young girl who, as an infant, first embodied for him what it meant to be wired to worry.

The article notes that while high-reactive babies are more likely to grow up to be anxious, their temperament doesn't necessarily condemn them to anxiety:
...having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. “The brain state does not make it a disorder,” Kagan told me. “The brain state exists, and the statement ‘I’m anxious,’ exists, and the correlation is imperfect.” Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut.

Here's where nurture comes into the picture:
Attempts to see what kind of parenting works best with an anxiety-prone temperament leave almost as many questions asked as answered. Which is better for a fearful, high-strung child — a parent who coddles the child and says everything will be all right, or a parent who sets firm, strict limits and has no tolerance for skittishness? You could picture it as going either way, really. On the one hand, it might be good to shield children from the things that worry them. On the other hand, it might be better to urge them, maybe even force them, to confront the things they dread.

Scientists...have looked at this question in a systematic way, and they have come up with two somewhat different findings. Both studies involved a series of home visits and hours of videotapes of mother-baby interactions. But one study...found that what seemed to be best for high-reactive babies were mothers who set firm limits and did not rush too quickly to comfort them when they cried. And the other...found something slightly different: that the best fit for high-strung babies were sensitive mothers, who met their fearful children on their own terms and interacted with them in a way that was accepting and supportive without being intrusive. Sometimes, of course, there’s a fine line between firm and hardhearted, and a fine line between supportive and intrusive....

The best outcome, however it happens, is to rear a child who learns to wrestle his demons on his own. Some children figure out themselves what works best. “Inner struggles pulled at me for years until I was able to just let go and calm myself,” wrote one of Kagan’s high-reactive study subjects in an essay, revealing a wisdom far beyond his 13 years. “For example, when I first heard about the anthrax in Washington, I began to have an upset stomach. I realized it was simply because of my anxiety that I was feeling sick. As soon as I realized that, the stomachache went away. Because I now understand my predisposition toward anxiety, I can talk myself out of simple fears.” There are many adults, anxious or not, who can’t control their own interior monologues as well as this boy can.

For the children who need help grappling with their fears, some psychologists try to intervene early, with programs that give worried children tools for quieting the scary thoughts in their heads. Kids are often taught the same skills that anxious adults are, a variation on cognitive behavior therapy, designed to stop the endless recursive loop of rumination, replacing it with a smart, rational interior voice. In a way, it’s teaching anxious people to do what non-anxious people do naturally.

The article closes with a look at a fascinating question: Why did anxiety evolve in the first place?
In the modern world, the anxious temperament does offer certain benefits: caution, introspection, the capacity to work alone. These can be adaptive qualities. Kagan has observed that the high-reactives in his sample tend to avoid the traditional hazards of adolescence. Because they are more restrained than their wilder peers, he says, high-reactive kids are less likely to experiment with drugs, to get pregnant or to drive recklessly. They grow up to be the Felix Ungers of the world, he says, clearing a safe, neat path for the Oscar Madisons.

People with a high-reactive temperament — as long as it doesn’t show itself as a clinical disorder — are generally conscientious and almost obsessively well-prepared. Worriers are likely to be the most thorough workers and the most attentive friends. Someone who worries about being late will plan to get to places early. Someone anxious about giving a public lecture will work harder to prepare for it. Test-taking anxiety can lead to better studying; fear of traveling can lead to careful mapping of transit routes.

Kagan told me that in the 40 years he worked at Harvard, he hired at least 200 research assistants, “and I always looked for high-reactives. They’re compulsive, they don’t make errors, they’re careful when they’re coding data.” He said he would bet that when the United States sends people up in space, the steely, brave astronauts were low-reactive as infants, and the mission-control people down on the ground, doing the detail work that keeps the craft aloft, were high-reactive.

An anxious temperament might serve a more exalted function too. “Our culture has this illusion that anxiety is toxic,” Kagan said. But without inner-directed people who prefer solitude, where would we get the writers and artists and scientists and computer programmers who make society hum? Kagan likes to point out that T. S. Eliot suffered from anxiety, and that biographies indicate that he was a typical high-reactive baby. “That line ‘I will show you fear in a handful of dust’ — he couldn’t have written that without feeling the tension and dysphoria he did,” Kagan said.

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