F. Scott Peck’s seminal book The Road Less Travelled famously opens with the following passage:
Life is difficult. This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly know that life is difficult—once we truly understand and accept it—then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters.
If Peck had stopped after “Life is difficult,” he would have provided immaculate proof forever that “less is more.” But for as hopeful as the rest of the passage is, there is a fallacy involved. While we can acknowledge a grey area, in general something cannot simultaneously be difficult and not difficult; some form of concrete action, not an abstract wishful thought, must occur to make the transition from “difficult” to “not difficult.” It is no different than saying “Once you truly know and understand and accept that you have a flat tire, then you no longer have a flat tire.” To reach the status of “no longer having a flat tire” you must travel to the moonscape of “having a flat tire,” pass thru the smoother country of “fixing the flat tire,” until you finally reach the paradise of “the tire is no longer flat.” If flat tires were the greatest threat to our collective and individual mental health, millions of therapists would swell the unemployment lines (also known as “the gig economy”).
To borrow Peck’s flawed logic and add a bit of my own, it seems clearer by the day the greatest threat to our collective and individual mental health is none other than our collective and individual mental health. If Peck were to say it he might come up with this: “Once we truly know that our mental health is the greatest threat to our mental health, then the fact our mental health is the greatest threat to our mental health no longer matters.”
Think again of the flat tire. If we are driving down the road and suddenly stop moving, any number of things could have happened. When we discover we have a flat tire, we can immediately begin to fix the problem. There is no such magic with mental health, and in fact the problem is even more difficult than people realise, because if there is anything more difficult than the treatment of depression and/or anxiety, it is determining whether you are actually depressed/anxious. In the case of the broken-down car, even if we don’t diagnose the problem right away there is a 99 percent chance someone will figure out what went wrong, and for the mere cost of that Hawaiian getaway you’ve been saving for they will fix the problem.
A flat tire is one thing, but when does one know it is time to seek help for mental health issues? How can you tell the difference between clinical anxiety and depression and the blues? I don’t know how to answer those questions about me and my own life, so answering them for another person is not an option. In general, though, it seems to me anyone alive and minimally invested in the world suffers from some level of general anxiety disorder, as opposed to merely being anxious about a given situation.
Something similar is at work with depression. It is often and accurately said there is a difference between being depressed and having depression. People who don’t understand mental health will often say something like “What does so-and-so have to be depressed about? They have everything.” That is a fairly common mistake, and I fall prey to it sometimes. Depression cuts across all levels of society and will come for the rich as it will for the poor and the huddled masses. But it is easy to see how someone on the outside could look at a wealthy person claiming to be depressed and wave away their “affluenza.” Affluenza is not something I understand easily, either, but it is not my place to question the validity or legitimacy of someone’s depression, and at the end of the day I come back to a position of humility and sympathy (if not empathy).
With anxiety, though, it is not as clear. In the United States more than any other western democracy, we live under a permanent state of anxiety, and the anxiety we face in the US is doubly damaging because we expend so much energy and resources denying it, trying to fight it, and, ultimately, treating it—and in the case of the last one, usually not very well. To parody Tolstoy’s famous axiom at the beginning of Anna Karenina, “Every successful treatment of depression/anxiety is the same: they are failures.”
When I was in Ireland the debilitating force of our way of life, the intense anxiety it fosters, struck me anew and strongly, as it has every time I have been to Europe. The first time I experienced this was in Verona, Italy. My hotel was outside the city center, and I wanted to walk there for dinner and to see Verona’s (not as grand as Rome’s) colosseum lit up at night. So I asked the hotel clerk if it was safe to walk there. Staring at me with a look I didn’t apprehend right away, but which I figured out later, she said, “Yes, it’s safe. You’re not in America.” A different American would have been offended, and perhaps rightfully so. I also thought the clerk was a little naïve; random crime can happen anywhere. And I think her view of America was informed and inflamed by the media. The reality of our perceived violence does not match the perception of it—but perception being reality, it doesn’t matter. Europeans think we are barbarians. Maybe we are, maybe we aren’t. But at the same time there is no denying the elemental truth of what the clerk said, and I now understand what was behind her expression: it was pity.
Walking the streets of Dublin, and more particularly after walking them, reflecting while on the train, I tried to think how I would feel in comparable situations in Seattle or New York or Los Angeles or any other big city in the U.S. If there was a device that could measure my anxiety the way, say, a Geiger Counter measures radioactivity, I suspect the reading would be statistically insignificant. But that wouldn’t mean it wasn’t there. What is the cumulative effect of the collective madness of our lifestyle? It is said that we have become numb to mass shootings, to far-off wars, to the cost of our healthcare, etc. It’s the cost of living in a free, powerful country, a market-based economy. The more mass shootings that occur, the better it is we can own our own guns to protect ourselves. If the security of our country is threatened, then we have no choice but to act. And say what you want about single-payer healthcare or the tens of millions of uninsured Americans, but it turns out we do have universal healthcare (and it’s the best in the world): anyone can go to the ER, anyone can make an appointment with a doctor. It is all part and parcel of living in a free society. What is most amazing about those kinds of statements is not necessarily their content but the ease with which they can be struck down, exposed as the false dogmas they are. But why bother? The majority of Americans are intractable in their belief in American exceptionalism, and have no interest in the truth. If you’re on fire but don’t admit it even as the flames melt the brain denying the heat, you will not do what it takes to put out the fire.
What has all this to do with anxiety? Here, in the modern United States, everything. We can claim numbness all we want, but the almost universal reaction to mass shootings is one of shock, sadness, and anger. Ask a parent—or, better, a student—about what they fear the most, and when the answer is “school shootings,” you will know anxiety. Talk to someone who has to choose between food and medicine and you will know anxiety. Look in the mirror and ask yourself: what would happen if I lost my job? That expression you see glancing back at you? That is anxiety. And then ask yourself how free we really are because of some of the freedoms we cherish so much.
Why the selfish focus on the modern U.S.? It is not that we have more to worry about today than we did in, say, 1959; the particulars are different, but there was plenty to be worried about then too. It would be the easiest thing to engage in pointless discussions about what is more anxiety-inducing, Subject X or Subject Z.
What is undeniable is that in 1959 we could more effectively pretend the world wasn’t messy, and while it was possible to receive information to disprove this, it was information we had to actively pursue. Today we are not so lucky. There is nowhere to run from the continual stimulus assault of the modern world, and for that reason (among others), at least in the United States, it feels like the world is getting worse, that we are more likely to be the victim of a violent crime, that because of the Internet our children will be preyed upon much more often. Etc. The truth is that there is clear evidence the world is better now than it was in 1959, violent crime has been dropping since the 1970s (though in the last few years it has gone up again), and random crimes against children remain vanishingly small. There is simply no evidence the world is as bad as it appears, and yet we persist in believing.
There is a bewildering contradiction at work here. It is not pure cognitive dissonance, but it is an offshoot of it. Failing to detect and believe the truth as it swallows us is one of the most nefarious and beguiling problems we face, a problem made much worse because humans, when faced with direct proof that one of their long-held beliefs is in fact false, change not their minds but cling to the old beliefs with even more conviction. Unfortunately we have leaders all the world over pumping out easy-to-prove-false lies, and yet the followers of those leaders not only fail to see the lies but also worship said leaders all the more. When a lie is repeated enough it not only ceases to be a lie but it also emerges from falsehood to truth.
For as interesting as all this is, however, it feels ancillary to the main discussion: that of anxiety and depression, and how to diagnose and treat them. Sometimes it seems that what we all suffer from more than anything is the disease known as the human condition. When I hear of the increase in teen depression and anxiety over the last 12 years or so, I wonder how many of them suffer from the timeless problem of being 15. (In the case of teenagers, however, the reasons for those increases seem obvious enough: school shootings, social media, the pressures of getting into college and succeeding, and the failure of parents, via helicoptering, free-range parenting, etc.)
No matter what I may think of the cause of the twin terrors of anxiety and depression, everyone who claims to be depressed or is suspected to have general anxiety disorder needs to be taken seriously. Yes, of course, there are going to be false positives, and there will be people medicated simply because it’s easy, not because it will be more effective than counseling or a combination of the two. Teenagers whose only real problem is that they are teenagers will be overmanaged and overmedicated, too. Inevitably mistakes will be made, but it is crucial those mistakes stay in the realm of “over”: overcautious, overmedication, overdiagnosed.
Though the differences are obvious, there are similarities between mental health and a concept like poverty, and the various methods we employ to alleviate it. An idealist on one side of the argument might claim that social welfare programs won’t cure poverty and in fact might have the opposite effect: a cradle-to-grave state-sponsored support system will enable its recipients to “be lazy” and stay on the dole the rest of their lives. An idealist on the other side will agree that it will take more than social welfare programs; it will take a complete overhaul of inherently unfair economic and social systems that are broken and have been for many years. It’s the classic treating the symptoms versus treating the illness dilemma.
We are clearly in the former stage, adopting what I like to call the Volvo approach. Most commercials are guilty of some unrealistic panorama of treatments for non-existent problems, but there is something uniquely irritating about Volvo’s vision. Basically the ads show a bunch of frazzled parents going from point A to point Z and all points in between. The solution to those parents’ overscheduled lives lies not in reducing the number of commitments but in getting a larger (and safer) car. It is not often a commercial is so blatant in its intentions, but there is no grey area here, no obvious attempt at satire (as in the beer commercials that promise promiscuity but don’t really mean it). The message is presented with no trace of irony: be busy, get a Volvo, be happy. But it’s not just Volvo or ad agencies. A common recommended “cure” for anxiety and depression is to get busy and to stay busy. It seems clear this approach is even worse than a band-aid—that busyness will only add stress and anxiety while maybe keeping it offshore for an hour at best. But we hear it still, and we hear it often.
If the problem feels impossible, it is perhaps because it is. Some hybrid of medication and counseling is the best solution we have for now, but for anyone who has ever been on anti-depressants/anti-anxiety meds, we know they, in particular, are a mixed bag at best. Counseling can also be effective, but it too has its limitations. It is expensive even with insurance, and it can be counter-productive if you don’t find a compatible counselor as soon as possible.
So we are left with the symptom vs. illness conundrum. At this rate it is painfully obvious any changes to our way of life will be slow in coming if they come at all. We are likely to be stuck in the Volvo solution for the unforeseeable future. Maybe we should all “suck it up” more or, as Peck would suggest, we simply admit life is difficult and move on. Well, guess what? We are sucking it up, we know life is difficult, we are on meds; we spend billions of dollars on Volvos and talking doctors and Prozac. The surprise in the year 2019 is to meet someone not taking some sort of medication, not seeing some sort of talking doctor, if not several of them. Like every generation we face a raft of problems, but a society caught in the grips of an epidemic of anxiety and depression cannot hope to solve small problems, much less large and complex ones like climate change, gender equity, and so forth.
But we can’t do anything to fix the mental health problem until we acknowledge that standing in the way of fixing the problem is the problem itself. The current treatment is not working; it is barely treating the symptoms. And yet we persist, like poor Sisyphus and his rock, and you know what they say about doing the same thing over and over and over and expecting different results.