Scott Stossel: 'I think many anxious people can benefit from mindfulness'

Here, Scott Stossell talks to us about his struggles with generalized anxiety disorder, ideas of happiness, and why mindfulness could hold the key.

Through all your phobias and anxieties, you've managed to hold down a job for 30 years, write and promote a bestselling book and successfully bring up children, all the while appearing 'with it'. You seem to have developed a lot of resilience. How has that happened?

I don't really know exactly. I often don't feel terribly resilient - quite the opposite, in fact. But then I usually manage to muddle through. I suspect that part of any resilience I possess is pharmaceutically enhanced - that is, medication may afford me the perseverance that I might not otherwise have. Also, having a supportive spouse and family helps sustain me through difficult times.

My current therapist argues that I'm more resilient than I give myself credit for (which is not uncommon among people with anxiety - the feeling of fragility and non-resilience being in effect a part of and a contributor to the disorder), and I hope he's right (though I worry he's wrong). But I suppose that even if I feel inside as though I'm only faking resilience, I've been faking it for long enough that that fake resilience has effectively become a kind of real resilience.

In My Age of Anxiety, you list a cocktail of medications and therapies that you've tried over the years, and how it feels as though you are still 'fumbling around for the keys' of inner, non-medicated balance. Could you ever see yourself using mindfulness as a sole coping mechanism in the future?

Based more on my research than on personal experience, I think mindfulness has tremendous potential to reduce anxiety and other mental health disorders. I find some of the research studies quite compelling: novice meditators reporting reduced anxiety and a greater sense of well-being after just a few weeks of meditating, with that greater sense of well-being correlating with changes in the physical structure of the brain. And I've encountered lots of people who say that meditation has been transformative for them.

There's something quite appealing about what mindfulness represents: the idea that we can learn how to reduce anxiety and feel better by literally exerting mind over matter. Also, the prospect that with mindfulness, we might be able to achieve the benefits of medication, but without the costs and side-effects and dependency issues, this is enormously appealing. But of course learning to practice Mindfulness is hard - and probably harder for anxious, stressed, easily distracted people like myself.

I've tried various forms of meditation, and I do find it helps. But I've not become practiced enough at it for it to have a really transformative effect. I would love to have mindfulness be my sole coping mechanism at some point in the future - I think many anxious people can benefit from mindfulness.

When we talk of mental health issues, we often cite the negative and traumatic events that have contributed to those issues. However, happiness, or the notion of happiness at least, can also insight anxiety and fear amongst us - let's take your wedding day (in his book, Scott describes having a panic attack whilst waiting for his wife-to-be to arrive at the alter) as an example. What are your thoughts around happiness?

I've seen studies whose conclusions suggest that thinking too much about how to make yourself happy is a sure route to unhappiness. And nowadays social media make it all too easy to compare other people's relative level of (apparent) happiness with one's own - and engaging in such comparisons is a time-honoured path to misery. So I do think that the obsession with 'happiness' - as opposed to, say, seeking to live a good or virtuous or productive life - may be counterproductive.

That said, I do find much of the happiness research to be quite interesting - and who doesn't want, all things being equal, to be as happy as possible? After all, the right to 'life, liberty, and the pursuit of happiness' is enshrined in the United States Declaration of Independence. But focusing too much on happiness as an end itself may have a paradoxically negative effect.

Looking back, did you ever worry that your mental health problems might get in the way of your future goals?

Sometimes, yes. In some ways, they have gotten in the way - I've turned down interesting opportunities, because of my anxieties about travel, or about public speaking. But overall I've been blessed in being able to carve a rewarding career while managing, or working around, my anxieties and phobias.

In your book, you talk about being half Jewish and how that may have contributed to your anxious predisposition. Cultural heritage and mental health is an interesting area to consider - how do you think cultural identity might impact upon our mental health?

I am familiar with various studies that suggest being a minority in a majority culture is inherently stressful and can contribute to anxiety and depression and other disorders. I recall one study which found that Nigerians in Nigeria have notably lower rates of schizophrenia than Americans do, but when Nigerians emigrate to America, they end up being diagnosed with schizophrenia at notably higher rates than, not just Nigerians in Nigeria, but Americans in America. This could be because of different standards of diagnosing the disease in the two countries, or there could be something schizophrenia-inducing about American culture - or it could be that the stress of immigration and minority-status increases the risk of mental illness.

Certainly, confusion about personal identity - whether racial, sexual, cultural, or whatever - can be stress inducing, especially if you feel you have to conceal some part of your true self, or if you feel you are living your public life in way that's not aligned with your personal sense of identity.

Cultural values and genetics and personal circumstances interact in such complex ways, it's hard to disentangle what their respective effects on mental health are precisely. But I'd venture that, as a general rule, the more you can accept all aspects of yourself and your cultural heritage, the better off you'll be. Acceptance therapy, or acceptance and commitment therapy (ACT), is its own well-established mode of treatment now.

You also talk about the role of genetics and how they might contribute to mental health issues such as generalised anxiety disorder and other phobias. What do you think the future holds for research into mental health and genetics?

The research on the genetics of anxiety and other disorders has been piling up rapidly for years. I don't think mental health issues will ever - or can ever - be fully reduced to heredity, but researchers are learning a lot about the genetic underpinnings of various brain functions and neurotransmitter systems.

I suspect that in the years to come this research could yield new treatments - pharmacological and otherwise - and could also produce better precision in targeting which treatments will work best for which patients, based on their genotypes. There's always the danger of saying that a mental health disorder is exactly equivalent to a certain constellation of genes, when in fact most disorders arise from an interplay of genes and environment. But, on balance, this area of research is rich and promising.

The internet can provide a great source of comfort for people living with mental health issues like anxiety but it can sometimes also fuel those very fears. You're the editor of a successful online magazine so obviously the internet has some benefits! But how has it served you in relation to your phobias?

Yes, I do think the internet, while bringing many new conveniences and entertainments, fuels anxiety and possibly feelings of depression and loneliness as well. For one thing, the internet has been profoundly 'disruptive', as they say, to many industries, including journalism, the one I work in. This disruption, even though it can yield benefits and efficiencies, is stress inducing because of the insecurity and the rate at which things change around us.

Beyond that, social media makes it possible for you to compare your own life to the (outwardly presented) lives of your friends and peers in ways that might not always be conducive to good mental health. Plus, the internet's ecology is one of constant distraction and interruption and short-attention-span 'theatre' - in other words, the opposite of what mindfulness teaches, which as we know is probably the optimal state of being for warding off anxiety.

Knowing what you know now, what advice would you give to a young person who has just experienced their first panic attack?

First, don't feel ashamed. (Easier said than done, of course.) Know that many, many people have endured what you've just gone through - and many of them have gone on to success, fame, and fortune. You are not alone! Be kind to yourself - don't beat yourself up over what's happened.

"Second, understand that an anxiety attack is simply a evolutionarily adaptive biological mechanism (the fight-or-flight response) that has misfired at an inopportune time. As scary as it might have felt in the moment, it's not dangerous.

"Third, if the problem recurs, or if you continue to feel badly about it, don't feel shy or ashamed about seeking professional assistance, either by going to a physician or to psychotherapy. Anxiety is treatable - so there's no reason to suffer when plenty of different kinds of help are available."