by Daniel Smith
And what was going on inside me? Remarkable invention! Creativity like I’d never known! A masochistic carnival! My brain was having a grand time whittling shivs with which to stick me, and it had no lack of material to fashion. Before then I had enjoyed school. All of the proximity—the daily crush of people, personalities, and outlooks—was a thrill. Now, to my horror, it became a grotesque pageant of lost opportunities, a parade ground for the display of hundreds of nubile, immaculate, fresh-faced girls to any one of whom I would now gladly have given my virginity, if they wanted it.
As distressing as the sight of girls, if not more so, was that upon my return my English class began to discuss Macbeth. It was the most excruciating assignment imaginable. The play seemed tailor-written to probe every one of my newly throbbing nerve endings. That Macbeth’s plot centered on serial homicide and not a premature ménage à trois was an inconvenience my anxiety had no trouble swatting away. My moist fingers pressing ghost prints into the cheap paperback, I looked down at the book and saw my reflection: a protagonist lousy with regret, desperate for calm, sleepless, self-torturing, self-isolating, self-warring, and so exquisitely tremulous that every slightest sound appalls him.
I read: “O, full of scorpions is my mind.”
I read: “I am cabin’d, cribb’d, confin’d, bound in / To saucy doubts and fears.”
I read: “Canst thou not minister to a mind diseas’d, / Pluck from the memory a rooted sorrow, / Raze out the written troubles of the brain, / And with some sweet oblivious antidote / Cleanse the stuff’d bosom of that perilous stuff / Which weighs upon the heart?”
And I read the doctor’s response to this question: “Therein the patient / Must minister to himself.” And the response horrified me, for it suggested what I immediately saw was an impossibility. Minister to myself? How? This thing I was feeling wasn’t something I could step outside of and examine. I couldn’t lay therapeutic hands on it. I couldn’t subject it to my will. I wasn’t even sure I had a will anymore. My new state of mind had come on with such force and suddenness, such elemental speed, that it was as if the cord of agency had been snipped with a pair of scissors. It, whatever it was, was in control now, not me. How then could I minister to anything at all? How could you be your own doctor when you are nothing but patient? Maybe it would be better, like Lady Macbeth, just to find a nice place offstage and do yourself in.
Then, too, there was the dagger that appears before Macbeth, the fatal vision, clean first and then sluiced with blood, that he sees but can’t touch. We read the famous soliloquy in class and I thought to myself, It’s real. The dagger is real. I felt this with great conviction because as we read my own dagger of the mind was forming, not before my eyes but inside my chest. That blossoming of frost in my sternum—cold, sharp, ice-dry. My icicle. My twenty-fifth rib.
It is commonplace to give superheroes extra-human senses. Spider Man feels a tingle when danger is imminent. The villain is throwing a boulder. The innocent has been launched from the skyscraper. Wavy lines appear above Spider Man’s head. Tingle. Dodge. Thrust. Catch. Act. But what if the superhuman sense signals nothing but itself? What if the hero’s only power is an inner alarm that rings to tell him he has an inner alarm?
That is anxiety. All that varies is the location and the quality of the alarm. Is it in the gut? Is it in the groin? Is it in the throat? The spine? The heart? The lungs? Is it a tightness? A looseness? An unraveling? A liquefication? Fluttering? Scratching? Scraping? Pulling? Is it hot or is it cold? Is it a presence or is it an absence? Is it a stone or is it a void? What do you call yours?
What do you call it? You call it what it feels like. Franz Kafka called his “the feeling of having in the middle of my body a ball of wool that quickly winds itself up, its innumerable threads pulling from the surface of my body to itself.” Mine felt like an icicle and today, nearly twenty years later—sitting here alone at my desk, door closed, cut off from the world and all its threats—it still feels like an icicle. It is working away now as I write, dragging itself around my chest. It is still there, it is still real, and I still fear it. I still hate it, yet now with a nagging affection, the way a child feels toward a parent who has abandoned the family. The way you feel toward something that is both part of you and not, maddeningly. The way you feel toward something that has taught you an unfortunate truth, the unfortunate truth: You are not at the wheel.
• • •
How cautious is the anxious mind! It gives no quarter to error, it makes no allowance for reasonable risk. Being anxious is like being Dick Cheney after 9/11, trumpeting the doctrine of One Percent, in which a one in one hundred chance that the enemy has secured a nuclear bomb is transfigured—poof!—into absolute certainty. All further analysis nullified. Slice the numerator from the fraction. From here on out the denominator shall be king. . . .
I had AIDS. I had no doubt. I’d been infected with HIV. The virus, with its horrid Sputnik protuberances, was even now stamping out replicas in my cells, unwinding my DNA to read and copy the code, fogging up my life force. It was a petty fear, really—commonplace. If you live near a volcano you’re going to fear lava. If you live in the rainforest you’re going to fear malaria. But here’s the thing: In your fears you’ll be rational. You won’t be crazy. As a matter of fact, you’ll be hyper-rational. You’ll be making excessive use of your sane faculties: the ability to reason and recognize threat, the capacity to apply logic. You will be nothing but intellect. This is the difference between psychosis and anxiety, perhaps the only difference. The psychotic fear nonexistent risks: alien abductions, microphones in the molars, demons in the trees, devils in the skies. The anxious fear actual risks: disease, dismemberment, assault, humiliation, loss, failure, success, madness, death. All the potholes on Future Road, all the risks distraction hides day to day from sturdier minds are, in the anxious mind, omnipresent and snarling. That is why therapists go to such lengths to urge their anxious patients away from intellectualization: The first step toward peace is disarmament.
I had AIDS. It was possible and so it was so. There had been a lot of mind-clouding substances going around in that living room. Who could say what had actually happened? How reliable was my memory of the event really? Maybe I popped in quickly without a sheath. Maybe there was a product defect, a pinhole, an internal rupture. Maybe transmission occurred during fellatio or cunnilingus. Maybe there was even a more notorious entry, now forgotten. All it would have taken was a momentary lapse and the opportunistic bugger would have darted right in and multiplied. Immediately afterward, I imagined, I might have been able to save myself. I could have rushed into the kitchen, snatched up a cleaver, lopped off the infected part. But now days had passed and it was too late. The virus would have made its way to my heart by now, and from there it would have been pumped everywhere, through every artery, every vein, every capillary.
The thought would not leave me. I was going to die. I was sixteen and I had $7,500 in bar mitzvah money in the bank and I was going to die. The unfairness of it was monstrous. It intensified my regret exponentially. Whereas before I had experienced the school’s foot traffic as a parade of lost sexual opportunities, I now began to experience it as a parade of lost opportunities, full stop. Everyone who passed by took on a distant, fading pallor, as if I were already drifting away. There goes Laura, whom I’ve had a crush on for years. Laura with her freckles and her sweet wildflower scent. Laura, whose love I’ll never even have the slim chance of earning now. . . . There goes Judy. Judy with her corn-silk hair and her paper-pale skin and her many gold bracelets. Judy, I’m lost to you now! . . . There goes Bradley, great friend of my early youth. Bright, talented, exuberant Bradley. Live two lives, Bradley, one for you and one for me! I won’t be with you long!
If this all sounds melodramatic, well that, too, isn’t a bad metaphor for anxiety—as a kind of drama queen of the mind. If you have ever been friends with a drama queen you know how taxing it can be. To have one in your head is enough to make you comatose.
This is essentially what happened. Another effect of my AIDS frenzy was a crushing fatigue. My teachers had known me as a voluble student, quick to participate and quick to argue. In response to questions, my arm always went up easily. Now I buried my nose in my desk and spoke only when spoken to. I shrunk from any and all involvement. In the early part of the day, when my anxiety still had an opponent in my sense of propriety, it was possible to hide this. But as the day progressed my exhaustion mounted. The guiding physical sensation shifted from the stab of my icicle to the weight of my eyelids.
To be fair to my anxiety (it is after all a relationship of a sort), it wasn’t the only thing coaxing me toward unconsciousness. My mother was, too. Shortly after my return to school she began to mete out medication to calm my mind. Specifically, she sent me packing each morning with a small orange cylinder rattling with Xanax—then as now the most popular compound in the benzodiazepine class of psychopharmaceuticals and, with all due respect to friends and family, the contemporary anxiety sufferer’s most reliable and cherished companion.
How grateful I was for those chalky little tablets! I adored everything about them. I loved to stare at each engraved name and dosage. I loved to trace my finger along the tiny canal scored down each midline. Washing a pill down with a mouthful of tepid water from the school’s hallway fountain was like pulling a wool sweater over my brain. It cozied up reality, gauzed up the edge. Just five or ten minutes of waiting and I swear I could feel the chemical taking the reins from my frontal lobes, saying, “Whooooooa boy! Easy does it. There there.” And then everything was better.
Is it necessary to defend my mother against those who would impugn the wisdom of packing sedatives in a child’s knapsack? I hope not. It must have been terribly confusing for my mother to watch her youngest child change, seemingly overnight, into a patient. Downstairs in the converted den my mother sat all day with sufferers she treated but as a matter of policy could not love. Upstairs she sat all evening with a sufferer she loved but as a matter of policy could not treat. It was a dilemma of impulses—the clinical and the maternal—she would be caught in many times in the coming years, as she fielded panic-stricken phone call after panic-stricken phone call from her afflicted son, mentally flailing out there in the world. She didn’t always navigate the dilemma wisely. For instance, it probably wasn’t the best idea for her to have encouraged me, a little while after I became anxious, to make use of a relaxation tape she’d recorded for her clients. When you’re three years old, it is lovely to close your eyes and bask in the sound of your mother’s voice rocking you into complacency. When you’re sixteen and struggling to process a formative sexual experience, it’s downright creepy.
The tablets of Xanax were a safer bet. Aside from the illegality of prescription-sharing, they posed no ethical problem. They were like soothing mommy surrogates I could carry around with me wherever I went. The only trouble was the fatigue. As my body metabolized the drug the agitation holding me conscious fell away, and I began to drool and fall asleep in class. This aroused suspicion. It also aroused an awareness that the pills were merely a stopgap measure. If this condition of mine appeared to be what it was, not a passing episode but a mental sticking point, then I would need to learn to rely on my own strength of mind to get by. I would need, as my mother had before me—as probably generations of her bloodline had before her, dozens of wiry neurotics roaming worriedly through the shtetls of Eastern Europe—to become skilled in defense. I would need a therapist who hadn’t breastfed me.
• • •
My mother found a therapist for me by asking around among her colleagues, and quickly settled on a kindly middle-aged social worker named Sandra.
Sandra. Immediately I didn’t like this name. I had seen enough old movies to know full well that a psychotherapist was most effective when he—almost always he—was referred to by his surname and the word “Doctor,” and when his surname was as Teutonic as possible. My strong preference was to be treated by someone named, say, Dr. Niedlehöffer, or Dr. Schlict, or, better yet, Dr. Niedlehöffer-Schlict. (An umlaut would have been very reassuring.) But somehow I doubted that there were any Niedlehöffer-Schlicts living and working in our part of the world. Fried-mans, yes. Silverblatts. Goldsteins. Truckloads of Goldsteins. But no Niedlehöffer-Schlicts.
I would have settled for a Goldstein. The trouble with the name Sandra was that it sounded predatory. “Sandra” cried out to be said in a purring, smoke-cured voice. It was the name of someone who sidles up to men in hotel bars.
Not that Sandra acted in a way that justified these associations. Yet this, too, turned out to pose a psychic difficulty for me, for Esther hadn’t acted in a predatory manner toward me either, at first—and Sandra, as luck would have it, bore a striking resemblance to Esther. They had the same thick frame, the same scrunched face and small brow, the same pale complexion. My demon, my confessor: It was as if Esther had returned to help me sift through the confusion she had wrought, only now she wore long floral skirts and accepted Blue Cross Blue Shield.
That is, she did when she showed up. My hang-ups weren’t the only things getting in the way of a recovery. There was also the problem that my healer had some pretty serious time-management issues. When my mother was running late for a session she would call down for me or one of my brothers to unlock the door to the waiting room, so that her client could sit and read National Geographic while my mother changed her clothes or put on her face. When Sandra ran late she ran late off-site.
Her office was in her home, a stately wood-paneled house on a street lined with plane trees. At the appointed hour my father would drop me off at the curb and drive off to find a way to kill fifty minutes. I would walk along the side of the house to the office entrance and half the time the door would be locked. Five or ten minutes later Sandra would drive up and rush out of the car apologizing. Once she failed to show completely. I sat on her front steps and waited. When my father pulled back up to the curb I was still sitting there—forgotten. This did not do wonders for the therapeutic process.
The question I still ask myself is whether anything would have done wonders for the therapeutic process. In sixteen years of anxiety I have had six therapists—as many shrinks as Henry VIII had wives—and five out of six have been almost completely ineffectual, like taking aspirin for leprosy. Without exception I have come to them in extremis and without exception I’ve left more or less the same—sometimes months later, sometimes years, in one unfortunate instance the same day.
I think I finally know why this is. It’s because they were wrong. They were not, save one young man, incompetent. They were well-trained, well-credentialed, and well-meaning. They all had experience treating anxiety, and they were all familiar with multiple schools of thought on the subject. How they conceptualized their knowledge differed some from therapist to therapist; each had a slightly different take. Yet in practice each took essentially the same approach: They encouraged me to talk things out, pure and simple. They didn’t get very much involved. They refused to be didactic, even when I pleaded with them. What they were up to was always slippery and vague. All seemed simply to be adherents to the old therapeutic cant: Let the neuroses unveil themselves. Release the steam through the valve. Let it out.
There is some wisdom in this, but it’s a casual wisdom and unsuited to the job. Merely talking is calming. A receptive ear helps. But it doesn’t change things.
A case in point: These days I am not in therapy (lousy insurance, not enough time), so whenever I am feeling anxious I pick up the phone and call my friend Kate, with whom I appear to share whatever genetic material that codes for hysteria. I would call my wife whenever I am feeling anxious, but if I did I wouldn’t be married for long. So I call Kate. I called her just yesterday. I said, “Kate! Thank god you picked up the phone. I’m a wreck! I need to talk!”
“Oh, no!” Kate replied. “Me, too!”
“No!” I said. “What’s going on with you?”
Kate said, “It’s my h
ealth insurance forms. I can’t do them! And no one will help me! I’m all alone here!” Kate and I also appear to share the genetic material that codes for an allergy to practical behaviors, such as opening one’s mail or returning library books, but unlike me Kate doesn’t have a spouse to pick up the slack, so she’s devised an idiosyncratic ritual to get her through the shame of incompetence. Here is how she has described the process to me:
First I walk around my apartment crying, with tears streaming down my face, and then, because it feels really weird to just walk back and forth crying, and also because I just can’t bear standing up anymore, I get down onto the floor by bending my knees and then leaning forward, so that my face is on the ground and my arms beside me. After a while, this feels even more pathetic and ridiculous—in fact, I sometimes wonder if I get onto the floor to prove to myself how ridiculous I am being—and I get up, stop crying, and wash my face. And it’s all over health insurance forms.
“So that’s my problem,” Kate said. “What’s going on with you?”
“I’ve forgotten how to write!” I said. “Yesterday I said something dumb to a guy at the post office, something just totally not nice and dumb, and I’ve been obsessing over it ever since. And today I don’t know how to write. I literally can’t write a sentence! It’s like I’ve had a stroke. Do you think I’ve had a stroke?”
“I don’t think you’ve had a stroke.”
“But how do you know? How can you be sure I haven’t had a stroke?”
“What are the symptoms of a stroke?”
