IRA FLATOW, HOST:
Up next, our monthly meeting of the SCIENCE FRIDAY book club. Flora Lichtman, our multimedia editor is going to stay here with us. And joining us now also is Annette Heist, our senior producer. Did you get your reading done? (Unintelligible) The book, the book, Annette, you chose, it was "Monkey Mind," right? "Memoir of Anxiety" by Daniel Smith. Tell us a little bit about why you chose that book. What sang to you when you chose it?
ANNETTE HEIST, BYLINE: Daniel Smith is saying to me over the radio. I heard him interviewed on a show called "Radio Times," and he was funny about a very painful topic, sort of like the David Sedaris of anxiety. I would sum it up like that. So I wanted to know more. And we were looking around for a book and it seemed perfect, so that was our pick.
FLATOW: Yeah. So we hope everybody - we announced it up(ph) at our website - got a chance to read the book. And joining us more - to talk more about the book and answer some questions about anxieties is my guest, Dr. Tracy Foose. She is assistant director of the adult psychiatry clinic at Langley Porter Psychiatric Hospital. She's also co-director of the Anxiety Disorders Clinic at the University of California, San Francisco. And she joins us from KQED in San Francisco. Thanks for joining us.
DR. TRACY FOOSE: Thank you. It's exciting to be here.
FLATOW: What did you think of the book? Could you relate to it?
FOOSE: Starting off with a personal question for the shrink. You know, all honesty, yes, I definitely could. And when Annette contacted me, that's probably the first thing that we talked about, is how relatable the book is. I think that's the magic of the book and why I'm excited about it and why I think patients of mine came in and recommended that I read it and were excited about it, is it does have that relatable, humorous approach to explaining anxiety in really very accurate terms.
FLATOW: Yeah. This is SCIENCE FRIDAY from NPR. I'm Ira Flatow. To give everybody a little thought, a little taste of what the book is about, here's a clip of the author himself, Smith, describing his anxiety on a show called "Radio Times."
(SOUNDBITE OF RADIO SHOW, "RADIO TIMES")
DANIEL SMITH: The term I think clinicians use is catastrophizing, so that anything that happens, even the most mundane thing - a thought might occur to me regarding that event, and it could be anything mundane like which salad dressing to put on my garden salad. Should it be balsamic vinaigrette? It should be blue cheese. Now, it seems like a very mundane choice, very pedestrian choice, but for me, my mind immediately starts making a logical progression from that moment to catastrophic events.
If I choose the wrong salad dressing, I'll have a bad lunch, and I won't be very nice to the person next to me. That person next to me will say something terrible about me, who will say something to my editor, who will cancel my book contract, which will lead to me to being impoverished and then homeless. I'll take up drugs. I'll end up having to sell my body for money on the streets, come down with a horrible disease and die disgraced and alone.
FLATOW: Daniel Smith sounds a little bit anxious. Did you get the impression? Could you relate, Flora, when you were reading the book? What did you think?
FLORA LICHTMAN, BYLINE: I don't think - I don't quite get to selling my body on the street or dying alone, for a salad dressing. But, yeah, I understand that predicament of feeling like your one choice has these sort of macro implications. And I think, you know, that clip is actually pretty representative. It's light, it's funny, and it also seems serious. So it's kind of an interesting mix of the two.
HEIST: Yeah. I thought so too. There a lot of - he describes a lot of situations in the book in his life when he just goes down, sort of spirals out of control and then - in a funny way.
FLATOW: I thought one of the interesting things is that he described anxiety as fear of fear.
FLATOW: You have a fear of the fear that comes with anxiety sometimes.
HEIST: Dr. Foose, is that how you would describe it?
FOOSE: I think that's probably one of the first things that hit me about the book, about what was so on target about it, describing what's unique about having an anxiety disorder as opposed to having anxiety which, of course, we can pretty much all relate to having. It's part of the human condition. There are things that make all of us anxious.
But the fear of fear, that noticing, well, I'm anxious about something weird, I feel like this is weird or out of proportion, or friends of mine, loved ones of mine - well, in Daniel's case, that was not true - but people I'm looking at aren't anxious about this, and then the sort of, you know, you talk about catastrophizing, that leap to the worst-case scenario. That must mean I'm crazy or something's wrong with me or that it's - that it is something I need to worry about and therefore my sense of reality is faltering. And it's that kind of questioning your own fear and fearing your own fear, that snake biting its own tail of anxiety that really does define an anxiety disorder state.
FLATOW: OK. We're talking about "Monkey Mind: A Memoir of Anxiety" by Daniel Smith. We want you to join in. Our number: 1-800-989-8255 to talk about the book. Also with us is Dr. Tracy Foose, who's assistant director of Adult Psychiatry Clinic at Langley Porter Psychiatric Hospital. We're going to come back after the break and talk more about anxiety. Maybe you have some of your own you'd like to share, so stay with us. We'll be right back.
(SOUNDBITE OF MUSIC)
FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY. We're talking about our August Book Club pick - maybe you're reading it, we hope you are - "Monkey Mind," by Daniel Smith.
(SOUNDBITE OF MOVIE, "HANNAH AND HER SISTERS")
WOODY ALLEN: (as Mickey) If I have a brain tumor, I don't know what I'm going to do.
JULIE KAVNER: (as Gail) You don't have a brain tumor. He didn't say you had a brain tumor.
ALLEN: (as Mickey) No. Naturally, they're not going to tell you because - you know, sometimes the weaker ones will panic if you tell them.
KAVNER: (as Gail) But not you.
ALLEN: (as Mickey) Oh, God. Do you hear a buzzing? Is there a buzzing?
KAVNER: (as Gail) Mickey, come on, we've got a show to do.
ALLEN: (as Mickey) I can't keep my mind on the show.
KAVNER: (as Gail) But there's nothing wrong with you.
ALLEN: (as Mickey) If there's nothing wrong with me, then why does he want me to come back for tests?
KAVNER: (as Gail) He has to rule out certain things.
ALLEN: (as Mickey) Like what? What?
KAVNER: (as Gail) I don't know. Cancer.
ALLEN: (as Mickey) Don't say that. I don't want to hear that word. Don't mention that while I'm in the building.
KAVNER: (as Gail) But you don't have any symptoms.
ALLEN: (as Mickey) You - I got the classic symptoms of a brain tumor.
KAVNER: (as Gail) Two months ago, you thought you had a malignant melanoma.
ALLEN: (as Mickey) Naturally, I - you know, this sudden appearance of a black spot on my back.
KAVNER: (as Gail) It was on your shirt.
FLATOW: That actually is a clip from "Hannah and Her Sisters." Woody Allen and Julie Kavner, of course. And there is nobody who's more anxious in films than Woody Allen.
LICHTMAN: And used it for great art.
FLATOW: Yeah. And Tracy Foose, are there real people that anxious like that who are worried about everything and what's - and making up things, as our character in "Monkey Mind" is doing?
FOOSE: Most certainly. I mean, I think most of us - well, maybe I shouldn't speak for you all, but most of us have found ourselves in a state like that where we're checking in with a loved one, where we're saying, is this a crazy idea, and the reassurance just doesn't work. It doesn't stick. It kind of rolls off like water off a duck's back. And I think that, you know, Woody Allen sort of takes it to extreme and uses it for humor. And I get that sense from Daniel Smith as well, that this is very true for him, very personal for him, but he sees the humor in it. He's able to sort of entertain the rest of us, at the same time make us feel at peace perhaps with our own experiences, letting things spiral out of control as far as anxiety goes.
LICHTMAN: This other - sort of the thing that's interesting to me about reading this book is that the way that Daniel Smith describes anxiety, it sounds horrible. I mean, it just seems - his version seems really debilitating, but he doesn't get shut down by it. I mean the facts of his life prove that he's done very well. I mean, he hasn't just survived. He thrived. You know, he gets a full scholarship. He gets a great job. He lands a feature at 23 in The Atlantic Monthly. I mean - and he writes this book, you know.
FOOSE: It makes me feel like my anxiety is not good enough.
FOOSE: If I only was better at it, I'd have a book that I could be talking about right now on SCIENCE FRIDAY.
LICHTMAN: That's great. That's great.
FOOSE: Well, yeah, I think where you - when you find very high performance and very high standards, you certainly find anxious temperaments. I spent a lot of time talking to patients and talking to our residents. Langley Porter is the psychiatric hospital, an outpatient clinic at UCSF. So we're a teaching hospital, and one of the things that I do is teach medical students and residents about anxiety, and of course teach patients in the context of a clinical setting.
And it's that - that sense that, you know, this is something quite relatable to most of us. It's sort of anxious - or what we call in pop culture neurotic traits - have a lot of advantages to them. They can be used to drive us, not always comfortably, in fact, quite uncomfortably. And I think what Daniel describes so well is just how excruciating it becomes when it tips over into a kind of maladaptive or pathological state of anxiety, when it really - when it really gets ahead of him.
But how he uses many of the same techniques to drive himself to fairly close to flawless performance in many areas, that kind of perfectionism and the ability to postpone gratification and keep striving and striving and striving, I think is - in any case, I could talk a long time about how many of these traits that make us vulnerable to anxiety disorders often offer quite an advantage, even in our modern world, not just running away from bears in the ancient world.
FLATOW: Let's go to the phones. Julianne(ph) in Oakland. Hi. Welcome to SCIENCE FRIDAY.
JULIANNE: Hi. Thank you for having me.
FLATOW: Hi. Go ahead.
JULIANNE: I wanted to say a comment. I was just listening for the past couple minutes, and I wanted to say that sometimes anxiety, you say is a disorder, and it's hard to find out what the root of that was. And I actually had an unfortunate experience being on birth control pills for the last 10 years. And that resulted in - in the last I would say two years I had unexplainable anxiety towards flying, but I couldn't figure out what it was attributed to. And since February, actually, I went into a really super-dark depression. I was, like, questioning my life's purpose and, at times, like, suicidal. And I was like, my gosh, thank God I live near a hospital. Like, if I want to do anything to myself, I could do something about it. But I knew that wasn't me.
And so I actually went to an acupuncturist, and he asked me how long I was on the pill for. And I told him for about a decade. And he said your adrenal glands have been shot. You need to get off the pill. And it's been about four months, and I'm coming around. It's not 100 percent yet, and I understand that hormones need to balance themselves out again. But, yeah, pretty amazingly horrific cycle that I went through.
So I just wanted to put that out there for people to know that it doesn't have to be a disorder so much as something else may be going on, like environmental or something.
FLATOW: Thank you, Julianne. All right. Dr. Foose, any reaction?
FOOSE: Yeah. Well, you certainly wouldn't be the first woman to notice how birth control pills can drastically impact your mood. And, in fact, birth control pills are - that's a whole complicated topic to get into, but they involve hormones like progesterone and estrogen. And these hormones, most certainly, have mood impacts on women. We see that in a course of a menstrual cycle or during pregnancy when these hormones - or during menopause, for example, when these hormones fluctuate dramatically.
What's interesting is that some people have the experience where they feel very dysphoric, very unhappy or more anxious on birth control pills. And then other people are prescribed birth control pills to manage and flatten out a kind of roller coaster of emotions during their monthly cycle. So there's no simple equation, but it's a matter of listening to your body and paying attention, and like the caller pointed out, keeping in mind that these symptoms can be due to environmental impacts and things you're taking into your body.
LICHTMAN: So, what do people do? I mean, I think, you know, reading this book, it had me wondering, he - Daniel Smith says there's no cure for this.
FLATOW: You're right. He says, you know, I thought this would go away, and it doesn't. It comes back...
FOOSE: The moments of relief.
LICHTMAN: Yeah, right. So he'll go through phases were things will seem better, and it seems like maybe it was washed out of the system, and then it recurs. I mean - but what do you do then?
FLATOW: Is it just coping, I mean, you just learn how to cope? You try behavior modification?
FOOSE: I think "Singin' in the Rain," the DVD. We recommend it when you're down.
HEIST: I've got to try that. I'm going to try that later.
FLATOW: I like the movie.
FOOSE: People are often tempted to say just coping. And I would actually say that I think Daniel's book does a really nice job of taking the just out of coping. He really describes how herculean a task coping is. And that is - I mean, if you have anxiety, this is what you do. It does not go away inasmuch as this is hardwired. Now, there may be people who would disagree with me. I'm a clinician. I'm not a researcher. But from putting together the research that I've read and to the extent that I understand it and get exposed to it in our department, you know, what we're discovering more and more is that anxious temperament, it can be connected with another - a number of genes.
And we see that in Daniel's story, you know, of his family. We see a very strong genetic basis for anxiety. Now, it's interesting. He says, we weren't raised by Buddhist monks. So he talks a lot about the attribution to, you know, the environment in which you're raised. I would actually say the cards were stacked against him from the get-go.
He came from anxious parents. He had an anxious brother. This stuff runs in the family. And I encourage people to embrace that. You know, this is who I am, and so this is part of the fabric that makes up me. And that's why I like to emphasize the - some of the attributes that come - that tend to come along with anxiety that are good that are good. And I can go into those, but that would take more time. But I do think that he's really an example of this kind of active coping, the constantly challenging that part of his brain that runs off and sends him into the apocalypse or that he's brought the apocalypse upon society at large and challenges it very aggressively, and it takes a lot of work.
FLATOW: Yeah. He makes that point in the book. And his mother, who is an essential character in the book...
FOOSE: Absolutely. Yep, same thing.
FLATOW: ...talks about facing up to your fear. And...
HEIST: Yeah, he does that. I'm thinking that was the part where he carries himself literally into the therapist's office at college, and he just forces himself. He actually has to think about putting one leg in front of the other.
HEIST: And it's just - it's so painful, the way he describes it. I mean, you're pulling for him, but it just - then he gets this really terrible therapist. Spoiler alert. But...
HEIST: ...he describes it so well.
LICHTMAN: One thing that...
FOOSE: Oh, the anxious therapist. So helpful.
LICHTMAN: One thing that Smith talks about in the book that I - it was an idea I hadn't considered before, is this thought that maybe anxious people acknowledge reality more, and that's why they're anxious. I think it comes from a Kierkegaard idea that he -you know, he sort of takes a philosophical approach in some parts of the book. I don't know. What did everyone think about that one?
HEIST: I think I'd like to believe that, you know, as an anxious person.
HEIST: I just know more about the way the world looks now. I don't know. I didn't - I don't totally buy that, myself.
FLATOW: I kind of think that they're secretly more anxious people than they're willing to admit.
FLATOW: You know. Don't let the - the theory of our society a lot is don't let them see you sweat. Right?
HEIST: Mm-hmm. I think that's why I liked it. I liked reading this. He's so honest. And, I mean, he talks about - literally about his sweat and how he's going in to talk to his supervisor at work in a wad of toilet paper he has in his arm falls off (unintelligible) sweat, lands on her desk with a - I have that page open - a sickening splat. It just is so painful, and I - it's amazing that he could describe these things that happened to him with so much honesty.
LICHTMAN: That is the charm of the book. He'd really - he does not shy away from these stories that are just totally cringe-worthy.
FLATOW: Yeah. This is SCIENCE FRIDAY from NPR, talking about anxiety. It's our August Book Club pick, "Monkey Mind" by Daniel Smith. He is very frank...
FLATOW: ...about - sometimes a little too much - TMI on some of the stuff. Yeah.
HEIST: Yeah. No, I mean, he really goes into detail with the sweat stuff, particularly I'll never forget that Daniel Smith put maxi pads in his shirt.
HEIST: Or how he lost his virginity, which is (unintelligible)...
LICHTMAN: The opening...
HEIST: ...that he opens with. He is amazingly honest. I don't - yeah. I don't know. Do you need that much information to sell a book?
FLATOW: Well, but, you know, it's almost as if also - he has a great sense of humor, so he knows when he's reached that envelop and then injects a little bit of humor into it to pull you back in, because you don't want to know all that other stuff too much.
LICHTMAN: Yeah. I was - I did find myself thinking he probably could've gone further if he had wanted to. Yeah, it's a delicate line.
FLATOW: But, you know what, also I was thinking about there are a lot of books out, now, about anxiety. You know, we here at SCIENCE FRIDAY, we get all kinds of - hundreds of books a week, and so many of them coming out of anxiety.
HEIST: A lot of self-help books.
FLATOW: A lot of self-help books. Dr. Foose, is this now coming, you know, people are facing a little bit more or is it just something that publishers have picked up on?
FOOSE: Well, I'm - like I said to Annette, I'm sort of a hammer that's going to see everything as a nail. So I'm excited. I do think there is some greater attention being paid to anxiety disorders and people sort of owning up to having anxiety disorders who are in very powerful and prestigious positions. I don't think that necessarily reflects that there's any more anxiety around now, but I think that our culture is somewhat more tolerant of the kind of vulnerability or authenticity that Daniel gives us in this book.
And when I was reading it, I kept thinking of just sort of what's going on, you know, in HBO and watching "Girls," which again is this kind of honest, sometimes excruciating exploration of one's inner world and all of its awkwardness. And I think that that is being more generally embraced. And as a psychiatrist, I enjoy that, since I'm always trying to encourage patients to consider the possibility that they can tolerate being vulnerable and authentic to the extent that it feels safe with other people. That's how we get close to one another. We, you know, we sort of let it all hang out around the people who love us, and some people are more able to do that than others. Some people, we wish they would it keep it in a little bit more.
FOOSE: But, you know, I think he models this kind of, listen, I'm going to let it all hang out for the benefit of all of you anxious folks out there, so you can feel a little better and also so you can get to know me. I mean, in some ways, this is just him being honest about who he is and taking the leap.
LICHTMAN: Yeah. I mean, and also getting a book out of it too.
FOOSE: That too. That's - yeah, that's a nice...
FLATOW: Did he break any - did his mother break any ethical grounds in treating him in the book - as his mother? I was wondering.
FOOSE: Oh, that's a sticky place to go.
FOOSE: You know, I think that as a mother, I will say you stop at nothing to protect and help your brood. But I do think that, you know, it's always tough to treat your kids because you just can't step back far enough to see the full picture of what might be going on, including your own role in it. And - but I think she did a great job of mothering him in myriad ways. She was what, you know, we'd call in psychoanalytic literature, the good enough mother, which is basically the end all and be all of what you want to be as a mom.
So - but I do think, you know, the prescribing of benzodiazepines, I remember when reading it, I had this reaction, oh, you know, that's a tough thing for generalized anxiety, to have benzodiazepines be the first go-to, and it's because they have been shown to impair fear extinction. And if we get a chance, I can talk a little bit more about fear conditioning and fear extinction and how they're parts of these disorders. But...
FLATOW: Well, we'll save that...
FOOSE: ...benzyls aren't usually the first go-to that you want to hit.
FLATOW: Well, so much to talk about anxiety. We'll have to just do a show on anxiety because this is making me anxious. Thank you very much for taking time to be with us. Dr. Tracy Foose is co-director of the Anxiety Disorders Clinic at the University of California in San Francisco. And thank you, Annette Heist and Flora Licthman.
LICHTMAN: Thank you.
HEIST: Thank you.
FLATOW: And our book club. We'll have another pick for September, right?
HEIST: Coming up. We haven't chosen it yet but...
LICHTMAN: Stay tuned.
HEIST: ...maybe a classic again.
FLATOW: A classic. Can't wait.
(LAUGHTER) Transcript provided by NPR, Copyright National Public Radio.