It wasn’t very long ago that homesickness was considered a legitimate psychological disorder. The French called it maladie du pays, the Spanish el mal de corazón, the Germans Heimweh. The English called it “the Swiss disease,” because they thought the Swiss were sissies. Homesickness was a serious problem, particularly in the military; people died from it. In 1770, in his journal of Captain Cook’s first voyage, Joseph Banks reported that the sailors “were now pretty far gone with the longing for home which the Physicians have gone so far as to esteem a disease under the name of Nostalgia.” In a paper titled “History of a remarkable Case of Nostalgia affecting a native of Wales, and occurring in Britain,” the doctor Robert Hamilton wrote,
In the year 1781, while I lay in barracks at Tin mouth in the north of England, a recruit who had lately joined the regiment, . . . was returned in sick list, with a message from his captain, requesting I would take him into the hospital. He had only been a few months a soldier; was young, handsome, and well-made for the service; but a melancholy hung over his countenance, and wanness preyed on his cheeks. He complained of a universal weakness, but no fixed pain; a noise in his ears, and giddiness of his head. . . . As there were little obvious symptoms of fever, I did not well know what to make of the case. . . . Some weeks passed with little alteration . . . excepting that he was evidently become more meager. He scarcely took any nourishment. . . . He was put on a course of strengthening medicines; wine was allowed him. All proved ineffectual. He had now been in the hospital three months, and was quite emaciated, and like one in the last stage of consumption. . . . On making my morning visit, and inquiring, as usual, of his rest at the nurse, she happened to mention the strong notions he had got in his head, she said, of home, and of his friends. What he was able to speak was constantly on this topic. This I had never heard of before. . . . He had talked in the same style, it seems, less or more, ever since he came into the hospital. I went immediately up to him, and introduced the subject; and from the alacrity with which he resumed it I found it a theme which much affected him. He asked me, with earnestness, if I would let him go home. I pointed out to him how unfit he was, from his weakness, to undertake such a journey till once he was better; but promised him, assuredly, without farther hesitation, that as soon as he was able he should have six weeks to go home. He revived at the very thought of it. . . . His appetite soon mended; and I saw, in less than a week, evident signs of recovery.
The Russians weren’t so kind to their homesick as the English. When Russian soldiers were afflicted by widespread nostalgia on their way into Germany in 1733, the general in charge threatened that “the first to fall sick will be buried alive.” During the American Civil War, the Grand Army of the Republic recorded 5,547 cases of nostalgia, seventy-four of which proved fatal. This was almost two hundred years after the diagnosis was coined, by a Swiss doctor named Johannes Hofer. The first case Hofer reported was that of a fragile young man who’d traveled sixty miles from home. The young man had gone off to college.
• • •
About a month into my college career I began to call my mother in hysterics from a pay phone bolted to the brick façade of the student center. By that time, the possibility that one could die of homesickness seemed very real. Being away at college felt like a kind of living death—an exile. The exile was of course from childhood, and it was permanent. There would hereafter be visits home, vacations, holidays. But if all went according to plan, this was it. This was adulthood, Month 1.
“I don’t want to be here,” I wailed. “I hate it. It’s terrible. I can’t go anywhere. I can’t concentrate. I can’t think straight. There’s nowhere to go, there’s nowhere to be alone. I don’t know what to do.”
It was the old anxiety incantation: I I I I I I I. The phone I called home from, every day, sometimes two or three times a day, was tucked into a niche in the façade, but not so well tucked that it was out of hearing shot of the students parading sunnily past on their way to check their e-mail or buy french fries. But that didn’t matter anymore. By now the mental pressure had grown so intense that I was willing to risk exposure if it meant the chance of some relief. Specifically, I was after instruction. That’s the second part of the anxiety incantation: Tell me what to do! Tell me what to do! What should I do?
My mother is one of those women, either unlucky or unwise, who lives by the maxim, “A mother is only as happy as her least happy child.” But to her credit, she never revealed the slightest distress. For the first time in my life I became the beneficiary of the demeanor she reserves for her clients.
“Breathe,” she said. She said it over and over again. It was her tireless mantra. “Breathe, Daniel. You have to breathe. If you breathe, if you breathe the way I will tell you how to breathe, you’ll feel better. I promise you that.”
The pledge was not unfamiliar. My mother is the Billy Graham of therapeutic breathing. Many years ago, she had little rectangular signs made with the word BREATHE printed on them in flowery epigraphical type, to display in her office. She owns dozens of sheets of neon-orange BREATHE stickers that she distributes to anyone in need. Growing up, one was posted on our refrigerator and another on the wall just beneath the kitchen telephone, at eye level. They were meant to remind my mother that whenever she felt unsteady, whenever the old anxiety feeling came back, she should sit down, close her eyes, and—
And what? What was this process by which the beast was to be neutralized? What alternate states of consciousness or bodily contortions did it require? I had never before asked, and when my mother had tried to tell me I hadn’t listened. I listened now, and I was incredulous, for the change in breathing my mother preached was, when you got down to it, minuscule.
“Go,” she said. “Find a quiet place to sit.”
“But there isn’t a place to sit.”
“Of course there is. I’ve been there. It’s a college campus. There are tons of places to sit.”
“No, there aren’t. The place is overrun. There are people everywhere. It’s an infestation!”
“The library,” she said. “Go to the library.”
“But there are loads of people in the library! That’s where they keep the computers.”
“Then try another floor. Go to the basement.”
I did as she said. In the periodicals room I found a wool-knit lounge chair with a heavy wooden frame and heaved it in front of a window overlooking a copse of trees at the base of a steep hill.
“The secret is to breathe much lower than you’re breathing,” my mother said. “When you’re anxious you breathe too high in the chest. You want to breathe lower, in your belly. You want to be able to feel your belly rise and fall. When you sit, put your hand on your belly and feel it rise and fall as you breathe. Breathe slowly. First breathe in through your nose. Count to four as you breathe. Then breathe out as you count to six. Close your eyes. Breathe. Keep your hand on your belly. In through your nose, four, out through your mouth, six. In through your nose, four, out through your mouth, six. In through your nose, four, out through your mouth, six . . .”
I did as she said. I laid my right hand on my stomach, closed my eyes, and breathed. I felt my belly rise and fall. In through the nose, four, out through the mouth, six. In through the nose, four, out through the mouth, six . . . At first, nothing happened. It was difficult even to sit still, let alone to focus on the numbers. I almost stood and bolted for the stairs. Then, gradually, I felt it working. Somewhere within me things shifted. My blood chemistry recalibrated. Ions flipped their charge. Molecules realigned. The organism settled. Behind my eyelids the dark was now a dampening dark rather than the dark of terrifying space. I felt, as I opened my eyes to the bending trees, as I imagined I was meant to feel. I felt lucid.
My mother is far from the only therapist to tout the powers of the breath. Anxious people breathe too quickly, and from the upper parts of the lungs, increasing the heart rate and throwing off pH balance and resulting in all sorts of unpleasant physiological changes. Learning to breathe slowly and more deeply is sound advice. “Once a client of mine can control his breathing patterns in a variety of situations, I believe he is 50 percent along on the road to success,” writes one anxiety specialist. “For some people, identifying and mastering breathing patterns will completely end their symptoms and resolve their problems.”
Unfortunately, this has not been the case for me. Breathing techniques have helped, but they haven’t been able to resolve the problem—probably because my anxiety is so cerebral. For true change, I require higher-order instruction. Whatever help breathing did bring, meanwhile, it didn’t bring for years, until I was ready to put in the time needed to change my habits. On that day in the library I was too desperate for a new mind, and too quick to despair. Sitting, all was well. I felt renewed. But when I stood up, I was aghast to find it all falling back into place: the fear, the tightness, the confusion, the icicle. And it was, for having been briefly better, even worse, like waking from a nightmare only to find that the waking was part of the nightmare.
Later that day, curled in my bunk bed, another image occurred to me—that of a series of strips from an old Peanuts compendium I owned in which Pig-Pen decides that it is at last time to go home and take a shower. There he is in the first frame, all fresh and combed and gleaming. Then he takes one step out of the house and wham! (he actually says, “Wham!”), he’s back in his accustomed state of filth and dishevelment. What else was going to happen? Being filthy and disheveled was who Pig-Pen was, and he knew it. “I’ve learned not to expect too much from a shower,” he tells Linus with admirable stoicism. “I have to be satisfied if it just settled the dust!”
• • •
When my breathing lessons didn’t end my calls home—when they didn’t even reduce their frequency—my parents decided it was time to pay a visit. On a cool Saturday morning they picked me up at the same spot in front of my dorm where they’d dropped me off, just weeks earlier, and together we drove into Boston for the most uncomfortable tour of a city since Mussolini was dragged through Milan on a meat hook.
My father parked the car in an underground garage and we walked. We started on Newbury Street, with its shoe boutiques and pearl-bedecked women window shopping; proceeded past McCloskey’s orderly bronze ducklings in the Public Garden; past the sunbathers and loiterers on the Common; past the gleaming, gilded State House and brutalist City Hall; and finally made our way down the terraced slope of Government Center, where we sat to talk on a bench in the shade.
In hindsight, this was not the best place for my parents and me to stop. The shade in which we sat was cast not by trees or buildings but by the New England Holocaust Memorial, a monument which, I have always suspected, was engineered not to commemorate the greatest atrocity in human history but rather, in some perverse municipal joke or unconscionable psychological experiment, to evoke dread and fear in the minds of passersby. The memorial consists of a line of six glass towers, each of which is five stories tall and hollow. Into the interiors of the towers, which represent the six main Nazi death camps, the numbers of all six million victims of the Holocaust have been inscribed, and all day every day an ersatz smoke rises through steel grates at the towers’ bases, as if to declare that even now and here, decades later and thousands of miles away, the fires of the Final Solution continue to burn.
It isn’t just its design, however, gruesomely literal as that is, that makes the memorial so unsettling. It’s also its location. For some bizarre, unfathomable reason, the authorities in charge decided to construct the memorial on a concrete island alongside one of the city’s most congested downtown streets, just around the corner from the shopping mecca Faneuil Hall and directly opposite four—count them, four—Irish pubs. To be compelled in the middle of one’s day to contemplate the mass immolation of one’s European brethren is destabilizing. To be compelled to do so while a Paul Revere impersonator vomits in the bushes next to you is inhumane.
It is inhumane because it is liable to have appalling results. If you are already in an unsettled frame of mind, the sight and setting of the memorial could bring on a psychophysical onslaught of tremendous proportions—a sudden, almost revelatory flash of malignant-seeming power that overturns whatever mechanisms of biochemical equilibrium you possess, causing you to sweat, gasp, cower, tremble, and shrink, and that just as suddenly wipes out all of your cherished intellectual and interpretative functions, leaving you with nothing but a devolved, bargain-basement cognition capable only of the blunt detection of bodily danger, which it always, and almost always incorrectly, finds.
In short, you might have a panic attack.
• • •
People who are not pathologically anxious tend to think of panic as merely the purest form of anxiety. In the common view, a panic attack occurs when anxiety increases to the point at which it can no longer increase anymore: panic is the final marking on the anxiety thermometer. This view isn’t wrong, exactly, but it is incomplete. Anxiety and panic are related, and the relationship is one of degree. But they are also, at the same time, radically different experiences.
To explain what I mean, here is an example from my own life. It’s an unexceptional example, mundane and maybe boring. I’m truly sorry about this. I would defend myself by observing that anxiety and panic happen to be mundane phenomena, i.e., even when they are caused by extraordinary things like war and rape, they tend to occur when things are ordinary and predictable and relatively stable, against a backdrop of normal, everyday experience. This, of course, is one of the features of anxiety and panic that make them suck so bad.
The example I have is a work example: a writing example. It happened while I was working on the fourth paragraph of the preceding section, the one that starts, “It isn’t just its design, however, gruesomely literal as that is, that makes the memorial so unsettling.”
A disclaimer. Writers like to believe their job is tougher on the nerves than other jobs. They like to pass around cool, pithy statements to this effect, like this one, from the screenwriter Gene Fowler: “Writing is easy: All you do is sit staring at a blank sheet of paper until drops of blood form on your forehead.” Or this suspiciously similar one, from the sportswriter Red Smith: “There’s nothing to writing. All you do is sit down at a typewriter and open a vein.” Or this one, from the poet Graycie Harmon: “Being an author is like being in charge of your own personal insane asylum.” I don’t subscribe to the exceptionalist school of writing, however. It’s true that writing has psychological pitfalls—oppressive deadlines, poor pay, baring one’s soul to an indifferent world—but so do all jobs. Even the imperative to make choice after choice without clear guidance—allegedly the most nerve-wracking part of the profession—isn’t exclusive to writing. What is probably true is that, for reasons having to do with solitude and a high allowance for self-obsession, writing attracts a greater percentage of anxious people than other professions. What is definitely true is that writers are better than most people at articulating their neuroses, and more dedicated to the task.
So: the paragraph. I’d begun writing it the day before. My goal was to finish it and then to write at least five hundred additional words before the day ended. I had four-and-a-half hours, nonnegotiable. During much of the period in which I have been writing this book my workdays have been restricted to the hours during which my daughter is at preschool—9 a.m. to 3 p.m.—with forty-five minutes lopped off either end for travel, chores, and sundry caffeinated-beverage-prep, e-communicative, and excretory acts. Consequently, I have been obliged to use time wisely, always aware of a very slim margin for professional error.
I got a good jump on the day. I was at my desk at 9:35 a.m., sipping Earl Grey out of an Aunt Sally’s Original Creole Pralines mug and staring at a legal pad on which were written the provisional lines, “But it isn’t just its design, gruesomely, horrifically literal as it is, that makes the Holocaust Memorial so damned unsettling. It is a matter, also, of its terrible location.” This was encouraging. They were awful lines, but it was easy to see why they were awful. By 9:50, after some preliminary dawdling, I’d managed to amputate the most offensive bits, editing the lines down to, “But it isn’t just its design, gruesomely literal as it is, that makes the memorial so damned unsettling. It is a matter, also, of its terrible location.” By 9:55 I’d changed “it” to “that” in the first sentence and cut “terrible” from the second sentence. At 9:57 I cut the starting conjunction and squeezed an “however” in there. At 9:59 I cut “damned.” At 10:02 I contracted “it is,” cut “a matter” and “of,” and took “also” out of commas. It was a nice run. After twenty-seven minutes, I was ready to move forward into actual writing.
The blank space in front of me didn’t feel like a Fowlerian void. I knew what came next. I had strong memories of the in-congruence between the memorial and its setting. I remembered the pubs and the smell of stale Guinness that wafted out when someone opened a door. I remembered Faneuil Hall being nearby because I could never forget the image of tourists eating clam chowder with sporks as they read the famous Niemöller poem off a plaque at the memorial’s base, the poem that starts, “First they came for the Communists, and I didn’t speak up because I wasn’t a Communist.” I had indeed once seen a Colonial impersonator puke beside the memorial, and for some reason I was pretty sure he was supposed to be Paul Revere. But what occurred to me as I stared at the page was that my memories weren’t detailed enough. This all happened fifteen years ago. How many pubs were there? Where exactly was Faneuil Hall vis-à-vis the memorial? Are there in fact bushes beside the monument into which Paul Revere could vomit?
To answer these questions, I turned to the Internet. What did memoirists do before Google Maps? I dragged the cute yellow homunculus onto Congress Street and clicked on those floating white carets that glide you digitally down the road. I clicked the “Satellite” button and surveyed Boston like God, or a Kennedy. I typed “bar” into the “Search nearby” field and counted all the red balloons that popped up. I was having a good time. And that was when, drifting comfortably in cyberspace, I began to sense my mind slipping off its moorings. It was a cognitive slipping. My thoughts began to drift from the screen and alight on other things, peripheral things: what I was going to make for dinner that night; what my daughter had meant when on the way to school that morning she’d said, “poopy is fun!” (how was poopy fun, exactly? making it? flushing it? playing with it? I should find out); whether I should commence defensive tactics against the hairs that had already taken over my shoulders and upper back and were now threatening to march south; whether it was going to rain; why, despite more than three decades of life, I still hadn’t been to Montana . . .
All this was typical, of course. Everyone gets distracted. What wasn’t typical was what followed, which was the emergence and blossoming of anxiety. It started with a simple effort to regain focus. At first I was able to swat away most of the distracting thoughts, like gnats. But like gnats, the thoughts always returned, and in force, so that before long swatting them away changed from an effort to get back to my primary occupation to the primary occupation itself. I changed, sitting there at my computer, from a writer to a thought-swatter.
That was Phase One: the thought swarm. Phase Two was a perplexity about what to do next, a desire to find a way back to a state of undistracted productivity. This phase didn’t last long. It never does, because the thing about thought swarms is that not only do they make rational, directed thinking hard to come by, they make the effort at rational thinking so frustrating that all you want to do is escape. And so I soon entered Phase Three. This was the self-hatred phase, in which my energy went toward demeaning myself for being the sort of writer who allows himself to become distracted and confused after only an hour of work, which is to say the bad kind, the kind doomed to failure. At this point I made the mistake of looking at the clock. It was half-past noon, which meant that my workday was halfway done, which meant that my workday was halfway wasted, wasted by my ineptitude and lack of psychic strength, an analysis that conjured an image of my editor, a really lovely woman who likes me and wants to see me succeed, deleting my name from her electronic Rolodex, shaking her head as she does because she can’t believe she was foolish enough to sign up a writer whose potential was so obviously fated to be destroyed by his weaknesses—the very weaknesses that were supposed to be the subject of the book she had signed up, which made it all that much sadder. And that—at around 12:40—is when I began to hyperventilate, sweat, and look nervously around me, and make little birdlike chirping noises, and run my fingers through my prematurely graying hair like those put-upon middle-aged men in commercials for tax-prep services. That’s when I began to tremble, and cry a little. That’s when the desire mounted to go running out of my office, out into the street, and down the block, in order to burn off the overwhelming sense that I had doomed myself because of a couple of hours of tough writing. That’s when, instead of running down the block, I called Kate and, getting her voicemail, laid my head on my desk, closed my eyes, and begged whoever might be listening for a half-hour of blissful unconsciousness. Just a half-hour, to reset my nervous system.
This was an unpleasant experience, and pretty much ruined the rest of the day. But it wasn’t a panic attack. It was what I would call an anxiety attack—an 8.3, I would calculate, on my personal anxiety scale. The scale runs from zero to ten, zero being catatonic and ten being the guy in Edvard Munch’s The Scream, where, psychologically speaking, you’re on a bridge surrounded by faceless strangers who are unable or unwilling to help you and the sky is blood-orange red and swirling and hectic and everything is so bleak and awful that you’d rather die than spend another second where you are.
A panic attack is worse than that. A panic attack is off the charts. A panic attack means you’ve ascended through every stage on the scale and then broken right off it, fallen right off the edge of the earth into some kind of neurotic satori, where anxiety isn’t even a factor anymore because anxiety is related to thinking, and with panic there is no thinking. Panic is pure reflex. It is a reversion to a state of being in which you are a kind of puppet to forces above and outside you, forces whose only purpose, once they have caused you to panic, is to get you to stop panicking. When you are in the midst of a panic attack you are no longer human. You are no longer a reasoning being. You are an animal under attack, indistinguishable from the animals whose panic Charles Darwin, who himself suffered from crippling panic attacks, described in The Expression of the Emotions in Man and Animals:
With all or almost all animals, even with birds, terror causes the body to tremble. The skin becomes pale, sweat breaks out, and the hair bristles. The secretions of the alimentary canal and of the kidneys are increased, and they are involuntarily voided, owing to the relaxation of the sphincter muscles, as is known to be the case with man, and as I have seen with cattle, dogs, cats, and monkeys. The breathing is hurried. The heart beats quickly, wildly, and violently; but whether it pumps the blood more efficiently through the body may be doubted, for the surface seems bloodless and the strength of the muscles soon fails. In a frightened horse I have felt through the saddle the beating of the heart so plainly that I could have counted the beats. The mental faculties are much disturbed. Utter prostration soon follows, and even fainting. A terrified canary-bird has been seen not only to tremble and to turn white about the base of the bill, but to faint; and I once caught a robin in a room, which fainted so completely, that for a time I thought it dead.
All through our walk across Boston my anxiety hovered at around a 5.5 on my anxiety scale. The comfort of my parents’ presence might have tamped it below the halfway mark (no small accomplishment) had I not been mortified that they’d had to come all this way, or if their coming wasn’t going to be followed in less than thirty-six hours by their leaving, either with me, which would be unspeakably shameful, or without me, which would be unspeakably awful. The point at which the mental needle started to migrate upward was, first, when the Holocaust Memorial came into view, shouting Genocide! Genocide!, and then again when my parents and I found a bench and my father started to talk. We were seated in front of a bronze statue of a man from a different era, wearing that era’s uncomfortable clothes. Beyond that were the towers and the fake smoke and the tourists strolling through it all, and, farther still, the strenuously charming trattorias of the North End, where we’d decided to go for lunch. I thought I caught my father looking pleadingly in their direction before he draped his arm over my shoulder and said, “So. Pal. How are you doing?”
I cleared my throat.
“We’ve been pretty worried about you,” he said. “All those calls. We know it’s been tough.”
It’s remarkable just how quickly mental weather can go extreme. We were only twenty words and one participant into the conversation and already I could feel the hysteria rising up in me like coffee in a percolator. I felt I couldn’t allow it to spill over. Not in front of my father, whom I wanted to see in me at least the semblance of masculine fortitude, and not in front of my mother—not again. Not now that I had packed up and said my good-byes. Not now that I had reached the age of legal maturity and therefore, I felt (being far stupider than I realized), of mental self-sufficiency. There seemed to be large matters of propriety and self-respect at stake, and so I lowered my head and focused my eyes on the small patch of scuffed brick at my feet; just a glance at the memorial or my parents’ worried faces, or even at the faces of normal human pedestrians, and I knew I’d be a goner. And I clenched—a Herculean, full-body-and-mind clenching. Never in my life have I concentrated so intently on making sure that every muscle, organ, membrane, and thought are held in static check. The only common analogy I can think of is the state of being at once exceedingly nauseated and dead-set on not vomiting. I found a quivering equilibrium.
Then my mother took over.
“I know how you’re feeling,” she said. “I’ve been where you are. I see it in my patients every day. You’re confused and you’re scared.” I braced myself. The bricks at my feet seemed to soften. “I can see the anxiety in your eyes. You’re staring at everything like it’s going to jump out and grab you around the neck. I know what it feels like to be vigilant like that. It’s horrible. It’s awful. You feel like you’re going crazy.” I heard a spate of giggles in the distance, from just around the spot where the crowd emerges from faux-Buchenwald into the open air. Things began to loosen further. “You feel like something terrible is going to happen at any moment. It’s awful. Awful.” Something, curiosity or fear, compelled me to glance up and I saw a group of teenage girls walking away from the monument licking lollipops. Lollipops! I quickly put my head back down. “But nothing bad is going to happen to you, Daniel. I promise you. Nothing bad is going to happen. You’re not dying. You’re not going crazy. It just feels like you’re going crazy. But that’s all this is. You have to see that. That’s all it is: a feeling. It isn’t real. It’s just a feeling.”
There was a slim part of me, an intellectual sliver located somewhere in my prefrontal cortex, that wanted to argue with my mother regarding the distinction between feelings and reality. Was there one? Really? It didn’t seem like it. But that part was quickly subsumed by the rising anxiety, which now reached the point at which tears were unavoidable. My mother saw them begin to fall.
“Oh, Daniel,” she said, stroking my back between my shoulder blades. “You’re not crazy. Honey, you’re going to be okay. You’re just anxious. You have severe anxiety . . . like me. It’s a mental disorder, that’s all. You just need some help to get you through it. Therapy. Some medication. You have a condition, a treatable condition.”
And with that—my first ever diagnosis—my anxiety at last breached the borders. Like me. On a concrete island two hundred miles from home I’d unwittingly attended my own coronation, and I saw at once that there was little hope of abdication. Darwin was right about panic: the hairs bristle, the breathing is hurried, the muscles fail, the mental faculties are much disturbed. Utter prostration soon followed.