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Tuesday, February 11. 2014
Editor's note: Dr. Azeff will be a regular contributor on medical topics
"Surviving Anxiety" was the cover story of The Atlantic magazine for January/February written by its editor, Scott Stossel.
One is a little flabbergasted when reading this man's story. While portraying himself as virtually crippled by anxiety in all of its forms, generalized anxiety, post traumatic stress, panic disorder and multiple phobias, he functions as the editor of a prestigious magazine which means likely conflicts with aggressive publishers and super-sensitive, if not querulous, writers. He is a writer himself and therefore a person expected to show up for promotional talks and for lectures. How does he do it? He begins his article, excerpted from his book, by describing his drug regimen for public speaking; xanax, inderal and scotch or vodka. As a clinician one is immediately tempted to take the bait and challenge the doses of his medication and balk at his use of ethanol which he acknowledges is risky at best, dangerous more honestly. From there we are led on a trip through his life and through the evolution of psychiatric treatments over the past thirty years, the good the bad and the ugly.
His first doctor who started treating him at age eleven and saw him twice a week for 25 years is roughly of my generation, I'll be 75 in a few months, Dr. L as he is called is probably in his early eighties. Analytically oriented therapy mixed with play therapy mixed with pharmacotherapy at the outset, progressing over decades to everything as it came along including EMDR and self-actualizing therapy whatever that means. One can appreciate the changes over the years as a picture of the evolution of a modality seeking a scientific framework. Just as edema was initially seen as a unitary "disease" called dropsy until science deconstructed the multiple causes of this symptom, so many of our psychiatric illnesses may be no less than psychological dropsy. I'll wager in the next ten years "schizophrenia" will be at least four different conditions of different etiology, and anxiety may follow suit as well.
But what I take away from this verbose, sometimes wry, sometimes antic, sometimes prolix piece is the transgressions of some of his caretakers. Well into Scott's treatment, Dr. L takes his father into treatment as well and uses Scott's sessions to get information about Stossel senior. The porous boundary is something we all grapple with but this is a destruction of the boundary that calls the treatment into question, perhaps from the start. After all, we may change course with a patient but usually with caution and discussion. I hope we are beyond the point of arguing that one cannot do both psychotherapy and psychopharmacology, but can one start with a classic dynamic model and wander into EMDR? Then there is the behavioral psychologist, Dr.M (both of these caretakers are "Boston" and Harvard trained and perhaps even faculty so we all must be clear that they definitely and unimpeachably know what they are doing) who determined his core problem was emetophobia, fear of vomiting, which she would treat with exposure therapy. Using the emetic ipecac which had cured other emetophobes, Stossel attempts the exposure with two doses of ipecac that produce retching and gagging but no vomiting in the course of four hours.
The next day he speaks to Dr. M who eventually relates that she was so shaken by his experience she cancelled all of her afternoon patients and spent the day at home nauseated and vomiting and taking to bed. Once again a transgression of questionable purpose. That treatment was fractured and collapsed fairly soon afterwards. We all have seen patients who are difficult to treat, who have disabling symptoms of anxiety or depression or psychosis, which are not easily medicated. How often do we ask ourselves about the possibility that the patient is consciously or unconsciously engaged in an attempt to make us feel as helpless and demoralized as he feels? Is it "blaming the patient" to weigh this possibility as a cause of intractable symptoms?
There is nothing glaringly obvious pointing to this in the story Stossel tells us and his brave walking through fire story is to be admired, but I'm just saying . . .
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We have all heard stories like this. Who knows what is entirely true?
Mr. Stossel sounds like what we used to call a "neurotic" but a very high-functioning person. Strange things can happen in transferences and in counter-transferences, and after reading Stossel's story one tends to feel "I could rescue this guy."
I agree about the impulse to rescue him, but the question is why hasn't someone succeeded after all these years?
Bearing in mind that his job is to do, say and write whatever it takes to sell magazines without running afoul of the law too often.
exactly. the demo for that mag must be liars, drama queens and woody allen impersonators.
with all due respect, Doc, Stossel is a drama queen. retriever's post (#4) totally hits the mark. he needs an ass kicking, not another pill or a shrink session.
Stossel is probably worthless to anyone outside of his world, but these people:
His first doctor who started treating him at age eleven and saw him twice a week for 25 years
... and the rest of his enablers whether medicos or the other adults in his life should be horsewhipped.
Agree with MissyW, nothing brave about this loser. First, this guy is an active alcoholic and drug addict and needs to get clean and sober. Second, "anxiety" is one of those cover diagnoses used by people who want to be able to tell people something when they mutter "WTF is the matter with you, "without actually revealing the personality disorder or other equally stigmatizing diagnosis.
This fellow is clearly highly functional at certain activities: writing, getting people's attention. But I cringed reading his article. What kind of guy demands attention by developing symptoms when his own wife is in the agonies of childbirth? Answer: someone neurotically needing to be the center of attention at ALL times.
All of us love attention some of the time. But this guy's anxiety, that he claims is about the fear of judgment or disapproval or not measuring up or whatever, actually seems to function primarily to ensure that he is ALWAYS the center of attention. That he can never just be a good house guest, fit in, get along, but rather must clog the septic system if necessary to make his mark. Yuck!
What I'm struck by is the difference between him, and people I've known who have had real reasons for anxiety: i.e. people who have been traumatized as children, or soldiers suffering from PTSD, or young women being stalked by drunken louts on a college campus, or nerdy guys being bullied by jocks, or ethnic minorities facing persecution. This guy appears NEVER to have faced discrimination, or bullying or to have suffered anything worse than perhaps waiting for a mom to come home. Unless he is being very coy about his real issues, I don't have much patience and would want him to meet some people who have had REAL reasons to be anxious who manage nevertheless to live productive, altruistic lives in the community without inflicting their personal miseries and demons on others.
My own nanny for instance: who was thrown down the stairs and brutally beaten and abused repeatedly as a child by her drunken brute of a French Canadian farmer dad. She had every reason to have been anxious and abuse substances. But instead, she took the pledge so as never to be like her father, and dedicated her life to helping raise other people's children (her childhood abuse had left her unable to have her own children). Numerous families of children grew up adoring Annette, whose tender loving care was often more consistent and devoted than that of the rich and absent minded mothers who hired her so that they could lunch and pursue their own more frivolous interests. Interests like writing and editing....
How's the Subaru?
Do you mean the nanny you employ yourself, or one who helped raise you?
I miss your blog.
Hi, Jerry. Miss chatting via comments w you, too. Offspring didn't like me blogging, so shut it down. Nanny was one my mom hired when I was an infant she could write full time. Actually a Godsend to us kids as she adored us and raised us to love God, cheer for the Red Sox and feel loved. Any of my virtues I owe to her. My obnoxiousness (for example, being so judgmental about a lost soul like Stossel, which now regret, and am ashamed of) is a family trait and will be something friends have to wack me upside my head about til I improve.
Ooh, I think I'm going to like you, CT.
I had a similar reaction to retriever, wondering whether this guy would qualify for some Cluster B diagnosis once his substance issues were under control.
Anxiety disorders can be a cover, but they are no joke when they are real. They can unravel your personality in much the same way that chronic pain can. So I think I was willing to give him a lot of benefit of doubt. He squandered it. I'm saving my sympathy for someone who has done all the right things to treat anxiety.
I will note in passing: I thought EMDR was voodoo for years, and I still think its practioners misunderstand the mechanism. But pulling the emotional force out of traumatic memories by bringing them up and creating another form of the memory, which gradually and with repetition replaces the old painful one, does square pretty well with recent memory research.
In the end I need to sit with a patient to feel and understand his (we need a new pronoun that incorporates his and her in three letters) complaint/problem/illness. Without that we are all dueling with shadows.
Can anyone provide an update on doc Mercury? I haven't seen his byline here in some time.
I've been a subscriber to the Atlantic for many years - but it has gone downhill, and after reading the editor's article, I know why.
Everyone suffers from anxiety at some point, but usually the worse it is and the more publicly displayed, the more self-absorbed the affected person. And as more attention is doled out, it gets worse. Stossel is a perfect example of this and he unfortunately has a platform.