The United States has become a country consumed by anxiety. Since 2010, the anxiety epidemic has grown to the point where 19% of Americans in 2019 — before COVID — reported an anxiety disorder every year. That’s 50 million people. Anxiety affects the teen population even more, with 31% of U.S. adolescents 13-18 meeting the criteria for a diagnosable anxiety disorder by age 18, according to the National Institute of Mental Health.
Anxiety disorders may serve as a gateway to more serious afflictions, including depression, drug addiction, and even suicide. In a new book, Harvard Medical School psychologist Dr. David H. Rosmarin argues that the anxiety epidemic is a manufactured crisis, caused by an unrealistic view of our control over life, abetted by a “medical model” that has taken a natural and necessary survival response and turned it into a disease.
Anxiety is not a disease
Anxiety is not a disease, although it can become disordered. It has no biological markers, no test that would detect a pathogen or chemical imbalance.
“The main cause of anxiety,” Rosmarin says, “is intolerance of uncertainty.”
Biologically, anxiety is produced by the activation of our “fight or flight” instinct. When we see a tiger in our path, the body automatically puts us on heightened alert, in which a part of the brain called the amygdala orders adrenalin into our system, demanding a survival response. Anxiety disorders arise when people conjure up fears about the future. They “catastrophize,” and this “false alarm” keeps them up at night worrying about everything from jobs, their relationships, the mistakes they made in the past, global warming, to worry that worrying is causing them to lose sleep and become depressed.
He recently discussed his new book, “Thriving with Anxiety: 9 Tools to Make Anxiety Work for You,” at a forum in White Plains hosted by the Child Care Council of Westchester and the Westchester County Department of Community Mental Health.
The root cause of anxiety
Rosmarin defines the root cause of anxiety as intolerance of uncertainty. Despite constant reminders that life is unpredictable — a pandemic being the latest reminder on a macro level — citizens of wealthy societies like the United States think they can control what happens to them, which causes worry and anxiety. Other societies do not share such illusions, which is why there is an inverse relationship between anxiety and wealth.
“Middle income countries like Mexico,” he says, “have half the anxiety levels of the US. And poor countries have half the levels of the middle income countries. … In low and middle income countries, there is no assumption you’ll have a good day. You expect security threats, poverty, lack of basic infrastructure, etc.”
Drugs not the answer to most anxiety
Rosmarin, an associate professor of clinical psychology at Harvard Medical School, is the founder of the Center for Anxiety, with one thousand patients and offices in three states. He is an internationally recognized authority on mental health disorders, and leads a movement of clinicians who have found success by counseling patients to see anxiety as an uncomfortable but essential part of personal growth. Anxiety, he says, does not improve in the long term with avoidance — whether using mindfulness techniques, or mind-numbing drugs.
In fact, he warns that treating anxiety as a disease with drugs threatens the health of every American.
“Last summer a federally funded panel of physicians across the United States recommended that all PCP’s [Primary Care Physicians] screen for anxiety,” Rosmarin said, “and that recommendation, if you implement it [means] any patient who reported anything but ‘Not at All’ for anxiety would trigger a potential diagnosis and treatment; and in a PCP’s office that means they’re going to walk away with a Xanax prescription.”
The three factors that affect anxiety and mental health
In his book, Rosmarin offers techniques on how to “thrive” with anxiety based upon understanding three factors critical to mental health.
The first is that the innumerable elements that can affect us as human beings make life unpredictable and inherently uncertain. Therefore, we should be more compassionate and forgiving of ourselves.
The second relates to our relationships with others. An ongoing study begun among students at Harvard in 1938 finds that of all the factors studied for longevity and happiness—diet, genes, exercise, financial success — the quality of our relationships with others is the number one predictor of happiness. Rosmarin finds that when you experience anxiety, having a friend or family member to whom you can openly share your pain not only makes you feel better, but deepens emotional connection.
Finally, Rosmarin says that spiritual people generally have improved mental health and less anxiety because they can more easily accept uncertainty. Spirituality, defined by Oxford Languages as “the quality of being concerned with the human spirit or soul as opposed to material or physical things,” brings with it a sense of humility that we are not the center of the universe, and not in control. Belief in something beyond ourself can bring emotional peace.
Westchester County is a national leader
Westchester County is a national leader when it comes to using spirituality and religious practice to treat anxiety disorders. Encouraged by Westchester County Mental Health Commissioner Michael Orth, churches, synagogues and mosques joined together to form the county’s Faith-Based Mental Health Initiative in 2020. One hundred members of the clergy received training called “Soul Shop” to help them assist parishioners struggling with mental health disorders, addiction, and suicidal thoughts. The County in 2022 released a Directory of Faith Affirming Community Mental Health Providers.
In a panel after Rosmarin’s presentation, the leaders of mental health services nonprofits, NAMI Westchester (National Alliance for Mental Health) and Westchester Jewish Community Services, echoed Rosmarin’s findings that anxiety needn’t be a burden if properly understood.
Dr. William (Drew) Mullane, Director of Innovation for Westchester Jewish Community Services, said:
“We see distress or discomfort as a problem and it isn’t always a problem. If you go to the gym and you don’t sweat, are you building muscle or cardiovascular fitness? You’re not. What I tell clients to do, it’s about embracing anxiety and making the most of anxiety because it’s adaptive. For those who have co-occuring addiction [with their anxiety], discomfort is a pathway to recovery.”
Alexander Roberts is a former New York City television news reporter and founder and CEO emeritus of the nonprofit Community Housing Innovations, based in White Plains, New York.
