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A Point of View: Four types of anxiety, and how to cure them

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Anxious by nature, Adam Gopnik has spent years looking for cures for his constant worrying.

I returned home to New York this week, after reporting trips to London and Paris, to find the city in a mild panic about Ebola. Now, Ebola is one of those things that really are worth having a panic about - a horrible and highly infectious fatal disease. On the list of things to worry about, this is real - unlike whether Chelsea's Diego Costa was fit enough to play Man-U, another item on my worry list.

But how to worry - and how not to, that's the question. I am a professional worrier, anxious by vocation - one thumb always hovering above the panic button, which is at least helpful when there's a real problem. I am so quick searching for comfort on the iPhone keyboard that, in London, riding the rising midnight tide of a toothache, it took me no more than 30 seconds to find an all-night dental clinic on Baker Street - not far I noted, still a tourist at heart, from Sherlock Holmes' lodgings.

Undue anxiety is the New York affliction, as unearned melancholia is the Parisian one, and over the long years I have discovered various cures, or at least treatments, for galloping anxiety, which I shall now share. Four overlapping but largely distinct types of anxiety afflict modern people, each with its own pathology and palliative. They are - catastrophic anxiety, free-floating anxiety, implanted anxiety, and existential anxiety. Let us take them one by one.

Catastrophic anxiety is the fear of something really horrible happening, right out of the blue. The plane goes down, the virus was left lingering on your plane seat, the terrorist bomb goes off in your bus. By far the best treatment for this kind of anxiety I've ever found came from a professional guide to cheating at cards.

There was a period in my life when I was spending time among great sleight-of-hand men - card magicians - in Las Vegas, and one of them slipped me a guide to card cheating that had been privately printed by a professional card cheat.

It was a sour piece of work, but it taught me something vital. Since a card cheat can only cheat effectively on his own deal, unless he has the cards marked, which is hard to do, the rest of the time he just has to play smart, and this means fully internalising, as instant reflexes, all the statistical probabilities of card playing. I recall the cheater's insistent formula about these odds, almost his precise words, with indecent clarity. If the odds on whatever it might be are 10 to one, you'll see it this week, if it's a 100 to one, you won't see it this week, but you will see it this year. If it's a 1,000 to one, you won't see it this year, but you will probably see it, once. Anything more than that - 10,000 to one, a 100,000 to one, you're never going to see at the card table. It's just never going to happen.

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Image caption It'll never happen (in all probability)

The great virtue was to think of the odds in terms of things you want to have happen rather than things you fear are going to happen. Turn the worries into wants, and you see how remote they really are. People draw five cards for a Royal Flush. You'd be an idiot to think you ever will. Planes go down. Yours won't. Those are 100,000 to one odds, too, probabilities so remote that you can live your life in the conviction that it will never happen, and you won't be wrong.

Now, free-floating anxiety is the worst kind of worry, because each worry can always be replaced with another - there will be no work tomorrow, the rent or mortgage can't be paid, the school fees, the work overdue, the... I have known it to get so bad, even with seemingly serene people, that it can only be treated with medicine, which works, fortunately.

But it can also be accepted, as inseparable from an aspect of human ambition - you can learn to use it. Self-renewing worry is a legacy of our predatory nature. Herbivores just walk across the lawn of life, munching. Lions and tigers, for all their glory, are anxiety driven beasts - watch their eyes and you see worry, floating free. "Does the impala see me now? Has it seen me yet? Am I close enough? When to pounce? And will there be another impala to feed the cubs tomorrow?" It does make for a driven life. But it is better to be a little bit driven than forever drugged.

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Image caption The lion - an anxiety-driven beast

Implanted anxiety is like the catastrophic kind but rises less from the fear of big personal disasters than from the ever-changing tides of long-term public worry - from the headlines. Yesterday, it was Isis in Iraq, today it's Ebola in West Africa, always the next thing coming to get us all. It is a natural consequence of living in a news culture - headlines are scary and the larger proportion of good news is not news. All over New York, in the early morning light, infections that would have killed in a minute are being cured; women who a mere century ago would have died in childbirth are cuddling their ingeniously delivered babies, and one man is isolated for an Ebola infection. But he is all we see.

This asymmetry of implanted anxiety is built, blessedly, into an open society. Only totalitarian ones insist on reporting only the good news. But the daily dose is still unhealthy. The only remedy is to absent yourself from it, however briefly. Our family learned to do this, at first by accident, by going away for three weeks each summer to a house with no Internet, no television, no cell phone reception and variable electricity. We emerge and find out all the anxiety causing events we have missed, and are puzzled by them. Hair raising as they were, our hair was not raised, and by now most everyone else's scalp has flattened out too.

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Of existential anxiety, well, this is the inescapable kind. Our mortality is not a long shot, it is, so to speak, a dead cert. And even if we can hold that anxiety at the arm's length that we mostly manage, the existential agony we feel for those we love is still too great. The best that we can do is to take control of the other three kinds of anxiety, so that then there is a possibility that in the time we have left we will have the mental space to seek out pleasures rather than focus on unfixable problems.

I mentioned my London toothache and its Baker Street at two am cure. As I sat in this strange single examination chair on the third floor - with, to be sure, the themes, and many scenes, from Sweeney Todd playing in my anxiety-prone head, I thought of how lucky we actually are to be alive now. The fix was pricey - about the cost of a meal for two in a good London restaurant. But it was worth it. At two am, I had my tiny preoccupying tooth fixed, and felt exuberant, the weekend to look forward to.


More from the Magazine

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How rumination can lead to depression (October 2013)

The age-old anxiety of exam time (May 2014)

Is stress good for you? (June 2011)


If humanism has a message it is not the fatuous one of progressivism that says everything will always get better. But the real one of the all-night dentist at his lonely, well-lit chair, many pains can be relieved, for more and more people. And the good feeling after is not an illusion but a weekend's worth of wonder. For millennia, the world has had a toothache - and thanks to use of critical reason applied to the problems of human pain, we do better. We have Novocain and electric drills and all night dentists with well-washed hands.

That thrill of the ameliorative is built into our mythology of the modern, right there on Baker Street, by Arthur Conan Doyle. Sherlock Holmes is not a miracle worker, he is a problem solver. The people in the Holmes stories don't become immortal or blessed when the Red-Headed League is exposed, or the Hound of the Baskervilles shown to be no more than a big dog covered with luminescent paint. They just get to carry on living. Sometimes, Dr Watson even gets a wife out of it.

The job of modern humanists is to do consciously what Conan Doyle did instinctively - to make the thrill of the ameliorative, the joy of small reliefs, of the case solved and mystery dissipated and the worry ended, for now. To make those things as sufficient to live by as they are good to experience. We cannot cure existential anxiety, but we can show that there is no necessity to have big ideas worth dying for in order to find small pleasures worth living for. Some days, or late nights, I think we do this a bit better than we once did. Other days I think that the endless cycle of anxiety, of needless panic and false promises, will win. It is, perhaps, my chief remaining worry.

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Image caption Sherlock Holmes - a problem solver, not a miracle worker

A Point of View is usually broadcast on Fridays on Radio 4 at 20:50 GMT and repeated Sundays, 08:50 GMT - or catch up on BBC iPlayer

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