Anxiety Inflation

Sixteen years ago I sat at a bus stop enjoying a delicious chunky chocolate chip cookie. I think I had enough teenage grace to admit that I had some pimples (but not too many!). A grey elderly woman came towards me with a slight look of concern, wrapped in a scarf and moving slowly against the wind. She was ready for some bus-stop pedagogy. ‘Now I’m not being rude you know but those cookies aren’t good for your skin. You really shouldn’t eat them.’

The Cookie Monster has wonderful skin so, frankly, I doubted the woman’s dermatology. In any event, she continued on a more sympathetic theme, ‘I spent my youth in London during the Blitz but I think today’s world is more difficult for teenagers.’ I’m an ‘entitled’ millennial, but this did take me by surprise, given the bombs and cream shortages and all that, but ‘Oh yes!’ she said ‘You have so much choice, it’s so complicated, and it all goes so fast. Take it from an old woman, make sure you enjoy yourself! Well…not too much. What with all the diseases and all that these days. Now I’m not being rude you know, but be careful where you dip your wick if you know what I mean?’

I did think she was being rude, to suggest that I should stop eating cookies. Eat them, I have.

What though, of her view that the modern world has been rendered more complex for the young? One view is that that young people have become more anxious. Perhaps in part as a reaction to the complexity of modern living. But can we say with any objectivity that young people are more anxious than previous generations?

Jean Twenge, a research psychologist at San Diego State University, has argued that the 20th century saw rising anxiety amongst young people in the USA. According to Twenge the average US college student in the 1990s was reporting greater levels of anxiety than 71% of students in the 1970s and 85% of students in the 1950s. For US children the change was so large that ‘normal’ 80’s kids reported higher levels of anxiety than child psychiatric patients in the 1950s.

Twenge’s data is based on long term survey data from standardized scales like the Taylor Manifest Anxiety scale and the Children’s Manifest Anxiety Scale. These scales ask people to identify with statements like “I am usually calm and not easily upset” and “I have very few headaches” as a way of indirectly measuring generalized anxiety. Her statistics showed a rising trend in scores on these scales in the US student population across the second half of the 20th century.

In 2015, a global survey by Booth, Sharma and Leader analysed anxiety scores published between 1970 and 2010. The data represented more than 205,000 participants from 57 nations. They concluded that anxiety has risen globally but not consistently across countries. In the USA and Canada anxiety appeared to have risen, albeit only among students, while anxiety appeared to have decreased in the UK and remained stable in Australia.

In my home country New Zealand, the anxiety statistics that I have seen relate to diagnosed anxiety rather than population wide anxiety. Nonetheless, the Ministry of Health statistics do show a continuously increasing prevalence of anxiety disorder in New Zealand. Anxiety among adults was diagnosed in 10.3% of the population in 2017, up from 4% in 2006. In children the prevalence had risen from 0.4% in 2007 to 3.0% in 2017.

Booth, Sharma and Leader suggested that the data they saw may be partially biased by changing attitudes towards mental health. On this note, the current discourse of an ‘anxiety epidemic’ echoes the rise of the ‘English Malady’ in the 18th century. The English Malady was popularised by George Cheyne, a society nerve doctor who in 1734 released a book called The English Maladythat gave prominence to the new concept of nervous disorder.

In the 18th century if we were to talk about anxiety we would be more likely to speak in terms of nervous disorder. A nervous disorder might capture a variety of ailments of which anxiety was a part. According to Cheyne, social conditions, especially prosperity, rapid social change, and self-indulgent lifestyles had led to an epidemic of nervous afflictions. Huge numbers of well-bred Englishmen suffered from the English Malady. He estimated that nervous disorders made “almost one third of the complaints of the people of condition in England”.

A number of Cheyne’s contemporaries seemed to agree that 18th century England was in the grip of a nervous order epidemic. Across the channel in Europe this view seemed to exist as well. For example, a competition was run in the Dutch city of Utrecht for the best essay on “The causes of the increasing nervous disease of our land.”

The English Malady coincided with a shift in medical approach in England. Up until that point English medicine had not advanced much beyond the Greek understanding of mental disorder, which centred around melancholy caused by an excess of black bile. But by the 18th Century English doctors had begun to focus on the nervous system as a source of health and illness, emphasising the importance of nerves, fibres and organs.

In retrospect, did the apparent growth in nervous affliction in England reflect the population becoming more unwell or was the concept of nervous disease becoming more prevalent in the language of the day. And what of anxiety in the 20th century?

Medically speaking, anxiety was not conceived of as a distinct illness until the end of the 19th century. Anxiety was bundled together with other symptoms in both the concepts of melancholy and nervous disorders. It was Freud that gave anxiety a distinct medical classification. Freud’s view was that “There is no question that the problem of anxiety is a nodal point as which the most various and important questions converge, a riddle whose solution would be bound to throw a flood of light on our whole mental existence.” Freud was immensely popular amongst the media and intellectuals and helped to establish anxiety as a distinct medical concept.

At the same time anxiety was increasing as a feature of the public consciousness. In 1947 W.H Auden wrote a poem titled The Age of Anxiety. A poem dealing with the quest to find substance and identity in a shifting and increasingly industrialised world for which he was awarded the Pulitzer Prize. That title caught on as popular phrase describing the era.

Since then, we have seen an explosion in the scope of anxiety as a medical disorder. The Diagnostic Statistical Manual, known as the DSM, is the bible of psychological diagnosis. In 1980 the DSM III dedicated 15 pages to anxiety disorders and 18 pages in the 1987 version. The DSM IV in 1994 dedicated 51 pages while the fifth edition of 2013 has 99 pages. Commensurate with this increase we see that the DSM-III in 1980 estimated that anxiety disorders afflicted 2–4% of the US population whereas now estimates sit at more like 20–25%.

The arrival of big pharma may have played a role in the growth of anxiety as a medical concept. Expand the scope of a disorder and you get a bigger market for your products. Anxiety is a big money spinner for pharmaceutical companies. When pharmaceutical companies began manufacturing and promoting their own drugs (a relatively new development, this used to be the job of chemists), anti-anxiety tranquilizers were at the forefront. In 2009, Xanax, an anti-anxiety drug, was the single most prescribed psychiatric medication in the USA.

Twenge’s statistics paint a picture of rising anxiety in young people in the USA over the course of the 20th century. But it’s pretty difficult to disentangle these statistics from the social and linguistic changes that might have occurred over the same period. In my view this means we should have a pretty high bar to cross before we reach any conclusions.

That said, I don’t mean however to discount individual and particular group experiences of anxiety. Broad statistics don’t speak to individual experience. While the data and historical perspective I’ve looked at comes from a white male perspective that certainly does not tell the story of marginalised groups. I hope though that this has given some food for thought, just in case a concerned older woman approaches you at the bus stop!

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