Conclusion} How America Learned to stop Worrying About Worrying and Pop its Xanax Instead

March 24, 2012

Conclusion} How America Learned to stop Worrying About Worrying and Pop its Xanax Instead

In 1972, a psychiatrist named Gerald Klerman coined the phrase “pharmacological Calvinism” to describe Americans’ tortured love affair with psychopharmaceutical drugs. Klerman was writing at the height of the Valium era, when its huge popularity lived alongside the perception, fed and perpetuated by the nascent feminist movement, that the pills were creating a generation of robot wives—numb, unfulfilled suburbanites forced into domestic servitude by the men who ran things, including the pharmaceutical companies. “You wake up in the morning,” wrote Betty Friedan in The Feminine Mystique, “and you feel as if there’s no point in going on another day like this. So you take a tranquilizer because it makes you not care so much that it’s pointless.” As fashionable as it was to take the pills, it was also fashionable to blame them.

On the one hand, Americans love convenience and scientific progress and thus herald drugs like Miltown and Xanax as miracle cures (like the washing machine or canned spaghetti) for the travails of modern life. On the other, Americans value self-reliance and authentic experience and regard dependency on chemicals as weak. Especially in this era, when entire sectors of the population have devoted themselves to eating organic and giving birth without painkillers, when otherwise sane parents decline to vaccinate their children against fatal diseases, chemical purity is held up as a sacred shield against future environmental cataclysm and failures of personal health.

Benzos sit at the locus of all this ambivalence, the love and the loathing often bumping awkwardly together within the same person. The same people who rely on Xanax, joke openly about it, and share it with friends refuse to identify themselves on the record for fear of reprisal from colleagues and bosses (who, they tell me, are using it and joking about it as well). The same kinds of people who shop at the Park Slope Food Co-op, that high temple of food purity, also take the occasional Xanax to chill out. “Coming to the co-op and doing something that is easy and meeting people actually helps me relax (no Xanax needed!),” one member opined about her work shift on Yelp. The inconsistency dwells even in my own self: As I write this story, I keep wanting to insist upon my physical and mental health and the lightness of my benzo habit. I spin, I do yoga, I eat lean meats and vegetables. I take half a tablet of Ativan every three weeks. At most. Honest.

A friend of mine had dental surgery recently, a procedure she both hates and fears. So proud was she that she’d sworn off Klonopin that she decided to forgo the medication ahead of her dental appointment. “I thought, Don’t be a baby. That’s just weak. You should be able to handle things.” She had a panic attack in the chair and was “a total bitch,” she says, to the dentist. “Oh, wait a second,” she reminded herself as the drill whined and the tooth dust spattered, “there’s a medical reason for these things.”

Psychologists wish people wouldn’t take so many benzos and, especially, so much Xanax. “Surely it can’t be right that this level of pharmaceuticals makes sense,” says Hayes. Partly they say this out of professional obligation. Tone’s book refers to Xanax as “the crack [cocaine] of the benzodiazepines.” Its short half-life can mean disaster for people who use it daily: They crash as the drug is wearing off and immediately yearn for more. “The withdrawals are the worst (put me in the hospital),” reads a posting on a drug-rehab website. “Find something else to do like pot or beer.” Dr. Peter Breggin, who crusades against benzodiazepines, pointed out in an editorial in the Huffington Post after Whitney Houston died that even short-term use of Xanax can make people more anxious than they were before and that sporadic use can cause what he calls “medication spellbinding”: impaired judgment, loss of memory and self-control. “I have all these mixed feelings about psychopharmaceuticals,” says the friend who, like me, stole drugs from her deceased mother. “Messing with your brain chemistry isn’t something to be taken lightly.”

But the anti-benzo psychologists are also making a value judgment. They believe Americans would be better, and healthier, if they learned to manage their anxiety without pills. They believe people should feel their feelings. A pill can be a crutch, says Doug Mennin, an anxiety specialist at Hunter College who does private therapy for the functionally anxious. The more you use it, the less able you are to navigate life’s tough spots on your own. “I’m a New Yorker,” says Mennin. “I see dependency on pills all the time. What I say to clients is, ‘You’re selling yourself short a little bit.’ If you’re going through a stressful time, and you say, ‘I’m going to get some of these,’ then the next time you get to that kind of problem, you start seeking out that pill. If you didn’t have the pill, you’d probably be okay.” The mind is a muscle, Mennin adds. With practice, you can teach it to handle anxiety: “It’s the same kind of skill as learning a better backhand in tennis.”

Mennin, Hayes, and other anxiety researchers are excited about a new kind of treatment that seems to work even on therapy-resistant worriers. It’s called “acceptance therapy” or “mindfulness therapy.” Instead of trying to show a worrier how his anxiety is irrational, ill-founded, overblown, or corrosive to his physical health, intimate relationships, and personal happiness (the protocol in conventional therapies), the therapist instead endeavors to teach him to regard his anxiety with the cool dispassion of a Buddhist monk. Thus the patient doesn’t get “entangled,” as the shrinks say, with his anxiety. He doesn’t try to flee from it. Nor does he try to evade or suppress it. He sees that it’s there but resists the urge to respond to its call: to pick up the phone, turn on the computer, check the e-mail, eat that bag of cheese puffs, pour another drink, take that pill.

“If you can train people to be more in the present moment, they may be less worried about what could happen in the future. The idea is to be accepting of what your experience may be, whether it’s anxiety or sadness or boredom,” says Susan Evans, a professor of psychology and clinical psychiatry at Weill Cornell Medical College. “It may feel this way now, but it won’t feel this way an hour from now, a day from now, a month from now.” Evans teaches “mindfulness-based stress reduction” to groups on the Upper East Side. The cost of the training is $600 for eight two-hour sessions.

It turns out that I am afflicted not just with pharmacological Calvinism but with mindfulness skepticism as well. For while I believe, in theory, that learning to coolly regard my anxiety as a purple, hairy monster I could stash in my tote bag, as Mennin suggests, might steady my pulse on sleepless nights, I am suspicious of any cure that requires more effort and expense on my part and more hours away from my work and my family. In this skepticism, I am like my anxious peers. “We go through rough patches, and we do things that make us feel better,” says Lisa Colpe, an epidemiologist at the NIMH, with the vocal equivalent of a shrug. A lot of people with anxiety would simply prefer to live with it; they know that when it becomes unbearable, the drugs will be there.

A cure isn’t what the PR executive with the occasional Klonopin habit wants. “My own personal experience is that there’s a healthy level of anxiety, and I don’t believe ‘healthy’ is the absence of anxiety,” she says. “I live in a world that puts unreasonable demands on me, and sometimes I need help. I wish I could do it without the pills, but I can’t.”

The real love affair, then, is not with the pills but with the anxiety itself. Anxiety is like the spouse you’re stuck with for better and worse, who makes you nuts but has permeated your cells and without whom you cannot imagine your own heart beating. Anxiety lives with you day and night, holding your hand and nudging you to act, urging you to get up, do more, fix something, make something. Never satisfied, always pressing, it wants you to win, to outlast the others, to impress, excite, excel, astonish. And, as in a marriage, you comply, mostly agreeably, for your anxiety traces the rhythm of your life. Then one morning, it has you by the throat and you find yourself weepy and overwrought, unable to respond to its call. Like a reliable friend, Xanax is there, offering an intermission, the gift of quietude, a break. Because the truth is, and I’ll speak for myself here, I want tranquillity once in a while. But I don’t want a tranquil life.

CHILL-PILL MATCHMAKING
FOUR ANXIOUS ARCHETYPES AND THE DRUGS THAT MIGHT SUIT THEM.*

AN ARCHITECT IS HEADING INTO A PRESENTATION SHE KNOWS WILL MAKE HER FREAK OUT.	A GRAY DIVORCÉ WHO LIKES THE OCCASIONAL SCOTCH IS KEPT AWAKE BY MONEY WORRIES.
→ SHE POPS A XANAX.	→ HE REACHES FOR THE ATIVAN.
Xanax takes effect very quickly but leaves the mind clear, which can make it an effective preemptive balm for predictable stresses. Since it can be highly addictive, the drug isn't recommended for people with substance-abuse problems.	Ativan is less addictive than Xanax but still has a relatively short half-life. It's good for older people with nocturnal anxiety—it helps them nod off, but won't have them too zonked to get up to use the bathroom. Ativan has a fall risk and is not a viable option for the frail.

A YOUNG WORKING MOTHER JUGGLING HER JOB, KIDS, AND ASSORTED DOMESTIC DUTIES FEELS CONSTANTLY STRESSED ABOUT HER TO-DO LIST.	A BICOASTAL ENTREPRENEUR DEEPLY AFRAID OF FLYING BOARDS A CROSS-COUNTRY FLIGHT; HE HAS NO PLANS TO DRIVE UPON ARRIVAL.
→ SHE RELIES ON KLONOPIN.	→ HE TAKES A VALIUM.
Klonopin is a longer-acting benzodiazepine with less withdrawal risk than other drugs in the category, providing relief without producing a high. "It is not a 'fun' drug," says Columbia clinical-psychiatry professor Philip Muskin.	Valium kicks in fast, but its effects can linger for a day or so. It is not recommended for substance abusers (our theoretical entrepreneur is a teetotaler) or people who need to operate heavy machinery.
*All examples here assume low dosages. Case histories of real people are of course far more detailed and nuanced than these hypotheticals; those vagaries, along with physicians' preferences, mean that actual prescriptions will definitely vary.