Måske kan angst også være en styrkeInformation | 25.01.2014 | | Sektion: Moderne Tider Side 24 | 1603 ord | Artikel-id: e43a4b13 |   

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Efter hele livet at have forsøgt sig med snart sagt en hvilken som helst terapiform, et hvilket som helst medikament og oceaner af sprut har forfatter og redaktør Scott Stossel givet op og indset, at hans angst er et livsvilkår. Det har han skrevet blændende erindringsbog om

af ANNEGRETHE RASMUSSEN

Lad os sige, at du er en del af publikum, og jeg er på talerstolen. Og jeg har forberedt mig. Fire timer tidligere har jeg taget et halvt milligram Xanax (hvis jeg venter for længe går min ' kamp-eller flugt-reaktion' så meget i overdrive, at medicin ikke er nok til at dæmpe angsten). For omkring en time siden har jeg taget yderligere et halvt milligram og måske 20 milligram Inderal.Jeg har brug for et helt milligram Xanax plus Inderal - en medicin mod forhøjet blodtryk eller en betablokker - for at dæmpe det sympatiske nervesystems reaktion og for at holde mine fysiologiske reaktioner på den følelse af angst jeg har over at stå foran et publikum, nede.Ellers overmander sveden, rysteture, kvalme, bøvsen, mavekramper og forsnævring i hals og bryst mig.« »Sandsynligvis har jeg skyllet pillerne ned med whisky eller, mere sandsynligt, vodka, hvis lugt er mere neutral. For selv to Xanax og en Inderal er ikke nok til at berolige mine tanker, der flyver forvirret rundt, og medicinen kan heller ikke fjerne den trykken, jeg har i bryst og hals, som ofte når et punkt, hvor jeg ikke kan tale. Jeg har brug for alkohol til at få reaktionerne ned i tempo, for at undertrykke de tilbageværende fysiske reaktioner, som lægemidlerne ikke kan dæmpe.Faktisk har jeg sandsynligvis drukket mit andet glas for mellem 15 og 30 minutter siden, under forudsætning af at jeg har kunnet slippe væk lige før introduktionen. Jeg har også altid nogle Xanax i en lomme og en miniflaske vodka eller to i den anden lomme.« »Jeg har været kendt for at tage en diskret slurk i sidste øjeblik, lige før jeg går på scenen, fordi selv da oplever jeg stadig den angst, der giver mig lyst til at drikke mere. På det tidspunkt er mine hæmninger bedøvede og min dømmekraft svækket af spiritus og benzodiazepiner.Men hvis jeg har formået at ramme the sweet spot - den perfekte kombination af timing og dosering, hvor den kognitive og psykomotorisk sløvende virkning af narkotika og alkohol har nedkæmpet min angst - ja så har jeg det godt oppe på scenen: nervøs men ikke elendig, lidt omtåget, men stadig i stand til at tale tydeligt.« »Ha jeg derimod taget for meget - for meget Xanax eller for meget spiritus - vil jeg lyde sløret og ikke så overbevisende. Og har jeg omvendt ikke selvmedicineret nok, så sveder jeg voldsomt, mens min stemme bæver svagt og min opmærksomhed vender sig indad, eller mere sandsynligt: Så er jeg forsvundet fra scenen, før jeg over hovedet nåede op på den. Helt bogstaveligt.«.

The Atlantic: Let’s say you’re sitting in an audience and I’m at the lectern. Here’s what I’ve likely done to prepare. Four hours or so ago, I took my first half milligram of Xanax. (I’ve learned that if I wait too long to take it, my fight-or-flight response kicks so far into overdrive that medication is not enough to yank it back.) Then, about an hour ago, I took my second half milligram of Xanax and perhaps 20 milligrams of Inderal. (I need the whole milligram of Xanax plus the Inderal, which is a blood-pressure medication, or beta-blocker, that dampens the response of the sympathetic nervous system, to keep my physiological responses to the anxious stimulus of standing in front of you—the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest—from overwhelming me.) I likely washed those pills down with a shot of scotch or, more likely, vodka, the odor of which is less detectable on my breath. Even two Xanax and an

Inderal are not enough to calm my racing thoughts and to keep my chest and throat from constricting to the point where I cannot speak; I need the alcohol to slow things down and to subdue the residual physiological eruptions that the drugs are inadequate to contain. In fact, I probably drank my second shot—yes, even though I might be speaking to you at, say, 9 in the morning—between 15 and 30 minutes ago, assuming the pre-talk proceedings allowed me a moment to sneak away for a quaff.

If the usual pattern has held, as I stand up here talking to you now, I’ve got some Xanax in one pocket (in case I felt the need to pop another one before being introduced) and a minibar-size bottle or two of vodka in the other. I have been known to take a discreet last-second swig while walking onstage—because even as I’m still experiencing the anxiety that makes me want to drink more, my inhibition has been lowered, and my judgment impaired, by the liquor and benzodiazepines I’ve already consumed. If I’ve managed to hit the sweet spot—that perfect combination of timing and dosage whereby the cognitive and psychomotor sedating effect of the drugs and alcohol balances out the physiological hyperarousal of the anxiety—then I’m probably doing okay up here: nervous but not miserable; a little fuzzy but still able to speak clearly; the anxiogenic effects of the situation (me, speaking in front of people) counteracted by the anxiolytic effects of what I’ve consumed. But if I’ve overshot on the medication—too much Xanax or liquor—I may seem to be loopy or slurring or otherwise impaired. And if I didn’t self-medicate enough? Well, then, either I’m sweating profusely, with my voice quavering weakly and my attention folding in upon itself, or, more likely, I ran offstage before I got this far. I mean that literally: I’ve frozen, mortifyingly, onstage at public lectures and presentations before, and on several occasions I have been compelled to bolt from the stage.

Rædselsslagen lige fra babystadietSådan indleder Scott Stossel - chefredaktør på det respekterede ugemagasin The Atlantic - sin nye 416 sider lange bog My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind om den lammende, altoverskyggende angst, som han har kæmpet med hele sit liv.Og som har styret ham lige så længe.Angsten gjorde ham til en overnervøs baby, der altid frygtede at være alene. Som fik ham til at tilbringe alle sine aftener, da han var mellem fire og seks år i sikker forvisning om, at hans mor - som studerede jura på aftenskole - aldrig ville komme hjem, men ville dø i et biluheld eller forlade ham. Den fik ham til at tilbringe stort set hele sin tid i grundskolen hos skolesygeplejersken med først hovedpine og siden mavepine. Og den har ført til konstant medicinering, siden han var fem.

The Atlantic: Anxiety has afflicted me all my life. When I was a child and my mother was attending law school at night, I spent evenings at home with a babysitter, abjectly terrified that my parents had died in a car crash or had abandoned me (the clinical term for this is separation anxiety); by age 7 I had worn grooves in the carpet of my bedroom with my relentless pacing, trying to will my parents to come home. During first grade, I spent nearly every afternoon for months in the school nurse’s office, sick with psychosomatic headaches, begging to go home; by third grade, stomachaches had replaced the headaches, but my daily trudge to the infirmary remained the same.

Stossels angst og forbier, der inkluderer flere diagnoser, end pladsen her tillader at remse op, inkluderer blandt andet en stærk angst for lukkede rum, højder, at blive fanget langt fra hjemmet, bakterier, ost, flyvning, opkastning..

The Atlantic: I also suffer from a number of specific fears and phobias, in addition to my public-speaking phobia. To name a few: enclosed spaces (claustrophobia); heights (acrophobia); fainting (asthenophobia); being trapped far from home (a species of agoraphobia); germs (bacillophobia); cheese (turophobia); flying (aerophobia); vomiting (emetophobia); and, naturally, vomiting while flying (aeronausiphobia).

Han beskriver, hvordan hans var gennemblødt af sved, da han skulle giftes, hans ben rystede, så han måtte læne sig op ad sin brud foran alteret for ikke at kollapse. Ved fødslen af hans første barn besvimede han. Hans lille pige har arvet hans skræk for at kaste op »uden at vi nogen sinde har talt om det derhjemme, og uden at hun kender diagnosen.«.

The Atlantic: My wedding was accompanied by sweating so torrential that it soaked through my clothes and by shakes so severe that I had to lean on my bride at the altar, so as not to collapse. At the birth of our first child, the nurses had to briefly stop ministering to my wife, who was in the throes of labor, to attend to me as I turned pale and keeled over.

Døden - eller det der er værreHan har også »forladt stævnemøder, eksaminer, jobsamtaler, lufthavne, tog og biler I sådanne tilfælde har jeg nogle gange været overbevist om, at døden eller noget endnu værre var nært forestående.«

The Atlantic: I’ve abandoned dates; walked out of exams; and had breakdowns during job interviews, plane flights, train trips, and car rides, and simply walking down the street.

»Og selv når jeg ikke er ramt af akut angst, er jeg præget af bekymring: over mit helbred og min families sundhed, over økonomi, arbejde, over at køre galt i bil eller få en vandskade i min kælder, over alderdom og dødens uundgåelige komme, over alting og ingenting.« En bekymring, der bliver til mavepine, hovedpine, vejrtrækningsproblemer, synkebesvær, svimmelhed, smerter i arme og ben, der føles som influenza.

The Atlantic: Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu.

Syv år gammel havde han slidt riller i sit tæppe i soveværelset ved at pace rundt derinde; i gymnasiet tabte han med vilje, når han spillede tennis, for at slippe for konkurrencesituationer, der ville fremprovokere angst.Den eneste date, han havde i gymnasiet, endte brat, da den unge dame lænede sig ind for at kysse ham, men hvor han uheldigvis blev overvældet af angst og trak sig væk af frygt for, at han ville kaste op på den udkårne. »Jeg var så forlegen, at jeg holdt op med at svare på hendes telefonopkald.«

The Atlantic: by age 7 I had worn grooves in the carpet of my bedroom with my relentless pacing, trying to will my parents to come home.…During high school, I would purposely lose tennis and squash matches to escape the agony of anxiety that competitive situations would provoke in me. On the one—the only—date I had in high school, when the young lady leaned in for a kiss during a romantic moment (we were outside, gazing at constellations through her telescope), I was overcome by anxiety and had to pull away for fear that I would vomit. My embarrassment was such that I stopped returning her phone calls.

Han har prøvet det meste inden for behandling. Individuel psykoterapi gennem 30 år, familieterapi, gruppeterapi, kognitiv adfærdsterapi, rationel følelsesladet adfærdsterapi, accept-og engagement-terapi, hypnose, meditation, rollespil, massage, bøn, akupunktur, yoga, stoisk filosofiog lydbånd han, havde bestilt fra »reklamer, jeg havde set sent om natten på tv«. Og tonsvis af medicin: Thorazin, Imipramine, Desipramin, Chlorpheniramin, Nardil, BuSpar, Prozac, Zoloft, Paxil, Wellbutri, Effexor,

Celexa, Lexapro, Cymbalta, Serax, Perikum, Zolpidem, Valium, Xanax, Rivotril - kombineret med storforbrug af øl, vin, gin, bourbon, vodka og whisky.Men som han skriver: »Og hvad virkede? Intet af det.«

The Atlantic: Here’s what I’ve tried: individual psychotherapy (three decades of it), family therapy, group therapy, cognitive-behavioral therapy, rational emotive behavior therapy, acceptance and commitment therapy, hypnosis, meditation, role-playing, interoceptive exposure therapy, in vivo exposure therapy, self-help workbooks, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

And medication. Lots of medication. Thorazine. Imipramine. Desipramine. Chlorpheniramine. Nardil. BuSpar. Prozac. Zoloft. Paxil. Wellbutrin. Effexor. Celexa. Lexapro. Cymbalta. Luvox. Trazodone. Levoxyl. Inderal. Tranxene. Serax. Centrax. St. John’s wort. Zolpidem. Valium. Librium. Ativan. Xanax. Klonopin.

Also: beer, wine, gin, bourbon, vodka, and scotch.

Here’s what’s worked: nothing.

Hvilket ikke er helt sandt. Visse af lægemidlerne har hjulpet ham i kortere tid, nogle op til et halvt år ad gangen. Men intet har fundamentalt reduceret »den underliggende angst, der synes vævet ind i min krop og sjæl og til tider gør mit liv en elendighed«.

The Atlantic: Actually, that’s not entirely true. Some drugs have helped a little, for finite periods of time.…But none of these treatments has fundamentally reduced the underlying anxiety that seems hardwired into my body and woven into my soul and that at times makes my life a misery.

Intet melodramaDet, der gør Stossels bog til en fabelagtig fortælling, er, at angsten ikke har forhindret ham i i dag at blive chefredaktør på et af USA's mest respekterede medier. Han er velfungerende og formår at skjule sin tilstand meget af tiden. Og at arbejde. Hans liv er, som han også medgiver, »fuldkommen udramatisk. Der forekommmer hverken melodrama eller psykopater. Man kan ikke lave hverken film eller bøger om det.« Og han overlever.

The Atlantic: My life has, thankfully, lacked great tragedy or melodrama.…Robert Downey Jr. will not be starring in the movie of my life.…I am, as they say in the clinical literature, “high functioning” for someone with an anxiety disorder or other mental illness; I’m usually quite good at hiding it.

Han kaster heller ikke op. Som han noterer: »Det er i skrivende stund 35 år, to måneder, fire dage, 23 timer og 34 minutter siden, jeg kastede op sidst. Hvilket betyder, at mere end 83 procent af mine dage på jorden er gået, siden jeg sidst kastede op en tidlig aften, 7. marts, 1977, da jeg var syv år gammel.«

The Atlantic: I struggle with emetophobia, a pathological fear of vomiting, but it’s been a while since I last vomited. More than a while, actually: as I type this, it’s been, to be precise, 35 years, two months, four days, 23 hours, and 34 minutes. Meaning that more than 83 percent of my days on Earth have transpired in the time since I last threw up, during the early evening of March 7, 1977, when I was 7 years old.

Men det betyder ikke, at han er holdt op med at bekymre sig: »Jeg bruger vel omkring 60 procent af min vågne tid på at holde øje med de ting, jeg er bange for. Jeg undgår hospitaler og offentlige toiletter, jeg er besat af at vaske mine hænder og meget opmærksom på, hvor alt, hvad jeg spiser, kommer fra. Det er relativt almindeligt.« Han går imidlertid skridtet videre. Han hamstrer små poser beregnet til opkast, og han altid medicin mod maveonder på sig.

The Atlantic: What this means is that I have spent, by rough calculation, at least 60 percent of my waking life thinking about and worrying about something that I have spent zero percent of the past three-plus decades doing. This is irrational.

And yet, an astonishing portion of my life is built around trying to evade vomiting and preparing for the eventuality that I might throw up. Some of my behavior is standard germophobic stuff: avoiding hospitals and public restrooms, giving wide berth to sick people, obsessively washing my hands, paying careful attention to the provenance of everything I eat.

But other behavior is more extreme, given the statistical unlikelihood of my vomiting at any given moment. I stash motion-sickness bags, purloined from airplanes, all over my home and office and car in case I’m suddenly overtaken by the need to vomit. I carry Pepto-Bismol and Dramamine and other antiemetic medications with me at all times.

»Og som en generel overvågning af fjenden på forhånd, har jeg altid et detaljeret mentalt og opdateret kort med mig over globale forekomster af norovirus (den mest almindelige stamme af mavevirus) og andre former for gastroenteritis. Jeg bruger internettet til at spore udbrud i USA og rundt om i verden. Jeg kan til enhver tid fortælle dig, præcis hvilke plejehjem i New Zealand, krydstogtskibe i Middelhavet, eller grundskoler i Virginia, der kæmper med udbrud.«.

The Atlantic: Like a general monitoring the enemy’s advance, I keep a detailed mental map of recorded incidences of norovirus (the most common strain of stomach virus) and other forms of gastroenteritis, using the Internet to track outbreaks in the United States and around the world. Such is the nature of my obsession that I can tell you at any given moment exactly which nursing homes in New Zealand, cruise ships in the Mediterranean, and elementary schools in Virginia are contending with outbreaks.

Angst er en folkesygdom Ikke desto mindre er budskabetIkke desto mindre er budskabet om, at man kan både overleve og leve et godt liv med angst vigtigt. For som Stossel skriver, så er angst og de dermed tilknyttede lidelser den mest udbredte officielt klassificerede psykiske sygdom i USA i dag. Angst er mere almindeligt end depression og andre affektive sindslidelser.Ifølge National Institute of Mental Health og det amerikanske sundhedsministerium vil omkring 40 millioner voksne amerikanere - eller en ud af seks - på et tidspunkt af deres liv lide af en eller anden form for angst. Og en ud af fire kan forvente på et tidspunkt at blive ramt af invaliderende angst.I 2012 blev der skrevet 50 millioner recepter på bare en bestemt angstdæmpende medicin alprazolam, det generiske navn for Xanax.

The Atlantic: Anxiety and its associated disorders represent the most common form of officially classified mental illness in the United States today, more common even than depression and other mood disorders. According to the National Institute of Mental Health, some 40 million American adults, about one in six, are suffering from some kind of anxiety disorder at any given time; based on the most recent data from the Department of Health and Human Services, their treatment accounts for more than a quarter of all spending on mental-health care. Recent epidemiological data suggest that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetime. And it is debilitating: studies have compared the psychic and physical impairment tied to living with an anxiety disorder with the impairment tied to living with diabetes—both conditions are

usually manageable, sometimes fatal, and always a pain to deal with. In 2012, Americans filled nearly 50 million prescriptions for just one antianxiety drug: alprazolam, the generic name for Xanax.

Konklusionen på bogen er interessant. Som Stossel skriver: »Angst han være uudholdeligt. Men måske er det også en gave. Måske er angsten en essentiel del af, hvem jeg er. ' Jeg hader at du er angst' siger min hustru til mig, ' og jeg hader, at du bliver så ulykkelig af angsten. Men hvad nu, hvis det, jeg elsker ved dig, er forbundet med din angst? Hvad nu hvis du bliver rask og det viser sig, at du ender som et totalt fjols.' Måske har hun ret. Min angst er forblevet et blødende sår, som af og til holder mig tilbage og fylder mig med skam - men måske er det også, samtidig, en styrke, en ressource, der måske kan være forbundet med en vis velsignelse."

The Atlantic: I’ve come to understand that my own nervous disposition is perhaps an essential part of my being—and not just in ways that are bad. “I hate your anxiety,” my wife once said, “and I hate that it makes you unhappy. But what if there are things that I love about you that are connected to your anxiety?

“What if,” she asked, getting to the heart of the matter, “you’re cured of your anxiety and you become a total jerk?”

I suspect I might.…My anxiety can be intolerable. But it is also, maybe, a gift—or at least the other side of a coin I ought to think twice about before trading in. As often as anxiety has held me back—prevented me from traveling, or from seizing opportunities or taking certain risks—it has also unquestionably spurred me forward.

anra@information. dk.»Jeg bruger vel omkring 60 procent af min vågne tid på at holde øje med de ting, jeg er bange for. Jeg undgår hospitaler og offentlige toiletter, jeg er besat af at vaske mine hænder og meget opmærksom på oprindelsen af alt, hvad jeg spiser« — SCOTT STOSSEL.

Fakta: Scott StosselMy Age of Anxiety Fear, Hope, Dread and the Search for Peace of Mind.416 sider. 17,68 dollar.Knopf.

The Atlantic: http://www.theatlantic.com/magazine/archive/2014/01/surviving_anxiety/355741/