Anxiety a mental health disorder or part of human condition?
THIS is the age of anxiety, the era of the benzodiazepine Xanax - "all jumpy and edgy and short of breath," as New York magazine puts it.
Climate change, terrorism, recession - there's something for everyone to worry about, and a medication or a book to go with it.
But is anxiety a medical condition or just the new - even not so new - normal?
"Anxiety is a necessary emotion; we need it to perform well," says Dr Natasha Bijlani, a consultant psychiatrist at the Priory in Roehampton, south-west London, "and life is no more dangerous than it ever was.
"But people's expectations are different - we're more achievement-oriented and we want a quick fix."
A fix such as Xanax (alprazolam)? Yes, though you can't get it on the NHS in the UK.
Hugely popular in the US (48.7 million prescriptions were written for it there last year), it's known as the crack cocaine of benzos.
It's similar to Valium but faster-acting and with a much shorter half-life - Valium stays in the system for 20 to 100 hours, Xanax for only six to 12.
This is an advantage in some ways - less of a hangover - but accounts for its more addictive qualities. You want more and you want it now.
Anti-anxiety meds are nothing new.
Miltown (meprobamate), the first blockbuster tranquilliser, became the toast of Hollywood in the 1950s. Lucille Ball, Tennessee Williams, Aldous Huxley, Norman Mailer and Salvador Dali's wife, Gala, were all fervent fans.
Then came the benzos: Librium, followed by the wildly successful Valium, both developed by Leo Sternbach at Roche's plant in Nutley, New Jersey, and approved by the Food and Drug Administration in 1963.
Perfect for Cold War angst, more potent than Miltown, Librium and then Valium (developed because of Librium's bitter aftertaste) were also less toxic and sedating and set the way for the "codification of anxiety into medical pathology", as Andrea Tone puts it in The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers (Basic Books).
Paul Gilbert, professor of clinical psychology at the University of Derby and author of The Compassionate Mind, says that "our cognitive abilities are plumbed into an ancient anxiety system", and that in anxiety disorder, the threat/self-protection system - useful if to avoid being eaten by a lion - seems to be inflamed and easily activated, and that the amygdala, that part of the brain's limbic system that plays a vital role in the regulations of emotions, has become oversensitive.
And - no surprise there - it's in the amygdala that the benzos concentrate their soothing, often addictive, magic.
We worry, states The New York Times, which has a whole section of its Opinionator blog devoted to exploring the navigation of the worried mind.
"Nearly one in five Americans suffers from anxiety. For many, it is not a disorder, but a part of the human condition."
Should this human condition be medicated? "Much better to learn how to tolerate distress," says consultant psychiatrist Dr David Veale, who recommends compassion-focused therapy (CFT), a type of cognitive behavioural therapy particularly effective with anxiety, "though it's much harder than benzos."
In CFT, only just gaining a foothold in the UK with Professor Paul Gilbert and Dr Chris Irons in the vanguard, you learn to build up a "soothing system" that calms and comforts.
But sometimes, meds can tide you over a bad patch - not everyone gets addicted, after all.
Joe, a teacher, whose anxiety achieved an "apocalyptic, political edge" around the time of the American election, when he couldn't sleep for worrying about whether Barack Obama would get in, calls his form of anxiety the "learnt doom and gloom" - all the long, pessimistic articles he was reading sent him over the edge.
He felt "immobilised by angst" but Ativan (lorazepam), a benzo that's often prescribed for panic disorder, helped him to cope, short-term, with the daily stress of work, family and money problems and put the latest Atlantic piece in some sort of perspective.
Dee, a gerontologist, became so consumed with worry about her teenage son "lying dead in a gutter when out late" that she started taking a low dose of Prozac to help her to calm down.
She stopped a few years later when her son was older but found herself still so racked by amorphous regret and anxiety that she has started taking it again.
"I can't get off the track in my brain that goes over and over some bad thing - something I feel certain I should have done or something I fear could happen."
She describes her anxiety as being like "veins in my brain, iron ore or something. When I'm gripped by it I try to imagine a laser penetrating my brain and zapping the awful thought."
A search for anxiety self-help books on Amazon yields more than 5,500 titles. Constable & Robinson publishes 57 anxiety-related books, including The Compassionate Mind Approach to Overcoming Anxiety by Dennis Tirch, the US guru of CFT.
Anxiety is even a memoir genre: in The Little Book of Anxiety: Confessions from a Worried Life (Robson Press), Kerri Sackville (who is not a fan of meds as they "knock me out so I can't function") kicks off with her groundless fear of abandonment by her mother, progresses to teenage acne, skin-picking and fear of public toilets, on to obsessive fears about her husband having a fatal accident, paranoia about her friends hating her, and then motherhood, when she turns strangely calm (she knows child-related worries would take over completely so she blocks off all such thoughts) until her daughter gets an infected chickenpox spot and almost dies, at which her anxiety levels hike up a notch again.
"I believe I was a born a worrier," says Sackville, who lives in Sydney.
"I have an anxious father, too, so I think it is a combination of genetics and upbringing. When you are around an anxious person you are more likely to feel anxious." Joe agrees.
"I think I inherited my mother's brain chemistry. Now I understand her awful anxiety that my dad and I had to dodge and cater to. She was always a very early riser, and I feel I know what she was doing from 4am on - worrying, thinking in circles, consumed with shame."
Meds may come and meds may go - Xanax now far outsells Valium and Roche will close its Nutley plant next year as part of a streamlining operation - but panic disorder, anxiety, worrying: they'll go on for ever.