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HARVARD HEALTH Worry WartsWhen casual concerns turn toxicby John F. Lauerman Illustration by Chris Pyle |
People have their reasons for worrying. Forget precipitating circumstances, like a sick goldfish or a library card perilously close to expiration. People typically worry for a purpose and with a goal in mind. Worriers maintain that worrying staves off disaster. Fretting about a hoped-for promotion prepares one for grave disappointment. No one has yet proven that agonizing over an upcoming flight reduces the chances of a plane crash, but people use this form of prevention so frequently and with such success that the a priori results are hard to argue with.
We often hear that worrying solves nothing, and in these stress-conscious times, it seems a little unusual to tout the advantages of angst. But worrying, when defined as preoccupation with pressing, imminent problems, does serve in some ways to keep us safe. Prehistoric humans were probably in a near-constant state of fearful arousal, anticipating attack from the darkness around their night fires; their distress was an adaptive precaution.
Today, many executives credit worrying for their success. As Intel Corporation's Andrew Grove says in his 1996 book, Only the Paranoid Survive (Currency/Doubleday), analyzing a situation from even the most obtuse angles prepares employees for any in-house objections to their strategic proposals, and for the defenses and counterstrategies mounted by their competitors. Writes Grove, "I believe that the primary responsibility of a manager is to guard constantly against other people's attacks." "I like to work with worriers--people who have the strength of character never to be content with the cheap laugh or the easy thrill," says an appropriately agonized executive in Michael Gill and Sheila Paterson's Fired Up! From Corporate Kiss-Off to Entrepreneurial Kick-Off (Viking). "The biggest mistake I ever made was when I didn't worry enough," repents another.
I went on-line recently just to find out who else was worried and what about. Beyond purely personal concerns, there are plenty of perturbing situations to worry over: global warming, tooth loss, Y2K, computer security, privacy, the economy, ultraviolet rays, cholesterol, recycling plastics, care for the disabled, wealth, nuclear waste, colon cancer, sustainability, deflation, rabies, vacations, snowboarding...Keep in mind that these are just a few of the things people are uneasy about. Thousands of worries remain undiscovered and uncataloged (giving us one more thing to worry about).
But even though worry can be healthy on a daily basis for most of us, it becomes unsuitable when taken to excess. The Yerkes-Dodson Law, or so-called "performance-anxiety curve," illustrates this principle. In 1908, then instructor in comparative psychology Robert M. Yerkes, A.B. 1898, Ph.D. '02, and graduate student John D. Dodson noticed that a rat's ability to find food at the end of a maze was related to its stress level: underfed rats solved the maze more quickly. They also noted that rats that received a strong electric shock before running the maze found the food before rats that had received milder shocks, or no shocks at all. But, in both cases, there was a point at which too much stress became a hindrance--where anxiety no longer helped speed the rats through the maze. Instead, they froze in fear, or made unwise, hurried decisions.
This is what psychiatrist Edward Hallowell '72, an instructor at Harvard Medical School, calls "toxic worry." It's an advanced state of paralyzing anxiety that interferes with people's lives, and it's not that uncommon. In some people, worry becomes not a stimulus to action, but a shrill alarm that silences internal discussion and reason, not unlike chronic pain. It may even exacerbate physical problems, such as heart disease, skin disorders, infections, and many other conditions.
In his 1997 book Worry (Pantheon Books), Hallowell says that toxic worry may have an identifiable physiological basis. Many researchers believe that ancient structures located deep within the brain--the amygdala and the caudate nucleus--play an important role in worrying. A recent study has shown that a group of children who suddenly developed unexplained anxious feelings all had concurrent swelling in the caudate nucleus. During a crisis, floods of neurotransmitters from these brain structures may cause "brain burn," as Hallowell calls it--a scorched, brambly neural pathway where thoughts frequently stumble and become entangled.
Treating toxic worry has become much more sophisticated over the past few years with the introduction of numerous drugs that inhibit the action of neurotransmitters, such as serotonin, that are involved in brain burn. For instance, Hallowell believes that drugs like Prozac--in addition to their use as antidepressants--may prevent long-lasting worry from being seared into the brain. Psychotherapy and stress-reduction techniques like meditation and yoga can also be extremely helpful in reducing worry.
The most obvious and effective approach to reducing worry, Hallowell believes, is unfortunately often the most underused: action. Worry is at its most pernicious when it is a substitute for action. There's no way for us as passengers to make sure our next flight will reach its destination safely. But we can make sure that we get to the airport without having a heart attack by leaving home in plenty of time, driving safely, and bringing some work to do when the flight is late.
"'Stress management' has become a buzzword," says Hallowell. "It's important because emotional stress has consequences throughout the body. But my approach has to do with getting facts and making a plan, not lowering blood pressure. In my practice, I've seen people who are afraid to deal with money worries, but they have no will and no financial adviser. They'll talk until the cows come home about meditation, but the problem gets worse until they attend to it. To get relief from worry, you have to deal with the underlying cause to the extent you can."
Any life worth living is chock-full of worry and stress. Far more important is how we respond to it. In their ongoing study of New England centenarians, Thomas Perls, M.P.H. '93, M.D., and Margery Hutter Silver, Ed.D. '82, of the Harvard Division on Aging, have found that stressful lives are extremely common among the world's oldest people. One woman in their study fought in Israel's 1948 war for independence; another battled for the rights of workers and was tried by a state Committee on Un-American Activities. Despite these experiences, the centenarians calmly kept their sense of self and purpose. They shed stress more quickly and easily than other people, because they found ways of addressing it.
"If you just take medications without dealing with the circumstances for worry, you're not really addressing the problem," says Hallowell. "When Valium first came out, people would sedate themselves and temporarily deal with stress that way, and people use alcohol the same way. When used properly, Prozac and other SSRIs [selective serotonin reuptake inhibitors] can be a wonderful component of dealing with worry, but they are not the answer. Recognize the problem, explore it, and do your best to take care of it--that's the most efficient and satisfying way to deal with your worries."