Living with Anxiety: A British Girl's Story

Rachel Cooke has written about anxiety in Britain, pulling together accounts from people who live with an anxiety disorder day to day. Roughly a third of the population will face an anxiety disorder or panic attacks at some stage, and Cooke's approach of letting sufferers describe their own experience gives the subject a different texture than the usual statistics.

One of the people she writes about is Claire, who is 26 and, by most outside measures, doing well. She's funny, bright, holds two degrees, lives with her boyfriend in London, and works in sales at Penguin, a job she calls her dream. None of that stopped the panic attacks. Last January she needed a month off work because the attacks, which had followed her since her teens, were taking over. As she put it, panic attacks are the worst thing: you feel like you're going mad or about to die, you worry about everything, you lose any sense of control, you fixate on how you sound and look, and the voice in your head never quiets down. She described it as exhausting.

Claire wanted to recover. She started with a mix of antidepressants and benzodiazepines, which took the edge off a little, but she had no interest in being medicated for the rest of her life. That pushed her to look for a way to manage the anxiety on her own terms.

She found a charity called Anxiety UK and got in touch. Simply learning she wasn't the only one going through this helped. The charity also gave her practical direction: use exercise to burn off some of the adrenaline, and try Cognitive Behavioral Therapy. Claire could only afford ten sessions, but she says they changed everything. Part of it was being able to be honest about how she felt to someone who understood rather than someone who told her to snap out of it. The bigger part was learning tools to talk herself back into rational thinking. CBT takes commitment and time, she warned, but it works. She still has bad days; the difference now is that she has a plan for them.

The logic behind CBT is that thought, feeling, and behavior feed into one another. Shift the thoughts and the feelings and actions can shift too. Most of us fall into recurring thinking errors, and the therapy is about spotting those patterns and correcting them. Claire noticed hers formed a kind of formula. At work the voice would tell her she was a loser, that she was strange, that she was bad at her job and had only landed it through luck. Someone would be talking to her and, instead of hearing the words, she'd be stuck on a single thought: get out of here before you embarrass yourself.

Her therapist pointed her toward a phone app called Thought Diary Pro, which lets you log your thoughts directly on your phone. For Claire that removed a real obstacle. The app is always in her bag, and she doesn't have to pull out a pen and notebook in front of colleagues or friends. She also leans on distraction, especially at night, when she'll run through the names of every character in Sex and the City to break the loop of circular thinking. If her boyfriend is nearby during what she calls a wobbler, he'll suggest a game instead.

Where the anxiety comes from, she can't say. There's no family history of panic attacks, and she had a happy childhood growing up in Bolton. Her own definition of it echoes Freud: a threat with no object, sitting somewhere in the future, pointing toward ruin or humiliation. That sets it apart from fear, which answers to a specific, immediate danger.

Cooke is careful to say anxiety isn't some new 21st-century disease. The American journalist Daniel Smith, in his anxiety memoir Monkey Mind, which became a New York Times bestseller, points out that Freud wrote The Problem of Anxiety about ninety years ago, Kierkegaard wrote The Concept of Anxiety eighty years before him, and Spinoza preceded them both, writing in the 17th century about the human enslavement to what he called dread. Victorian novels are full of characters, women especially, showing what we'd now read as symptoms of an anxiety disorder, from fainting to hysteria. In their own time those signs of inner turmoil brought out the phrenologists to feel over their heads and the hydropathists to usher them into the new spas, where cold-water cures were a favored remedy for what was then treated as a kind of madness.

Psychiatry only recognized anxiety disorders as a serious, chronic illness late in the 20th century. A national survey from the Office of National Statistics found anxiety levels in Britain had fallen by almost 1%, which is cold comfort: 20.9% of people still rated their anxiety at 6 or higher out of 10, and psychiatrists generally agree that somewhere between 10% and 30% of the population is dealing with an anxiety disorder at any given moment.

The disorder is more widespread than people assume, and the numbers keep climbing. It can be inherited, tied to circumstance, or shaped by environment, but help exists. Organizations like Anxiety UK, alongside professional treatment, can ease the symptoms.