Sweat: it is the great unspoken foe of the chronically anxious. It has no rival. Gnashed cuticles can be bandaged. Tears can be choked back. Intimations of catastrophe can be kept secret. But sweat—sweat is the mark of Cain.
Millennia ago, when Homo sapiens were evolving on the African plains, it was necessary to sweat when you sensed danger. Sweat cooled your body so you wouldn’t overheat as you fled a predator. Sweat made your body slippery so you would be harder to grab hold of. Nature was wise to give us sweat glands. Then, in the 1920s, Freon was synthesized and nature’s plan was forever altered. In the modern, climate-controlled office building, sweat has no practical use whatsoever. All it can do is expose a person’s jitters to those around him, causing him to grow more jittery, causing him to sweat more, causing him to grow more jittery, causing him to sweat more, and so on and so forth in a soul-degrading circle of humiliation and dread. Among the most important questions a contemporary anxiety sufferer has to ask himself, therefore, is, “What should I do about my arm-pits?”
The web site livingwithanxiety.com gives the following advice regarding excessive sweating, a condition known in medical terms as hyperhidrosis: “A good way to prevent this is to relax, so you can control triggering stress that causes this anxiety symptom.” This is somewhat less than helpful, like saying to a person in horrible pain because cancer is eating into his bones, “A good way to prevent this is not to allow your cells to proliferate, so you can control triggering tumors that cause this cancer symptom.” The fact of the matter is, so long as a person remains anxious the only thing he will be able to do about his sweat, short of removing or paralyzing his sweat glands (some dermatologists offer Botox injections for hyperhidrosis), is conceal it.
Dark clothing is advisable. So is a jacket of some sort, though in warm weather it will exacerbate the problem and cause the cluelessly observant to inquire why you are overdressed. The most effective method I’ve found so far is to use a material of some sort to soak up the perspiration as it comes. You have to choose your material wisely, however. Once during a temp job I wedged a wad of toilet paper into my underarms to stanch the flow. This worked well until I was called over to consult with my supervisor. As I was leaning over her desk to explain a report I had written the wad dislodged, rolled down my shirt sleeve, and landed beside her keyboard with a sickening splat.
Sometime later, in a state of desperation, I discovered sweat pads. I had been assigned to write an article about American expatriates in Dubai, where the average temperature during my stay was going to be about 170 degrees in the shade. This ruled out a sports coat and sent me on a frenzied hunt for a product that would get me through the trip unmortified. It wasn’t long before I learned of a company called Kleinert’s—“The World’s Authority on Sweat Protection.” The company’s signature product is the disposable sweat pad, which it describes as “highly absorbent, noiseless, thin, discreet, convenient, easily applied disposable unisex underarm shields which adhere (peel & stick) securely to all fabrics including silks providing outstanding protection from odors and wet-thru staining.” I ordered a case of twenty-four, enough to get both of my underarms through ten soggy days of reporting.
It fortified my confidence to read that the company has been manufacturing sweat pads since the Grant administration. Once I was in the desert, however, I was forced to conclude that in their nearly 140 years of business the good folks at Kleinert’s had yet to encounter a case as acute as mine. By lunchtime on most days, the sweat had fully inundated the pads and begun to transcend their boundaries, producing a corona of moisture beneath each arm that was even more conspicuous than an old-fashioned, solid sweat stain. There was also an adhesion problem. Kleinert’s is justly proud of its adhesive technology. The shields, which are shaped like morbidly obese butterflies, come outfitted with three parallel strips of tape that adhere wonderfully to your average male dress shirt—too wonderfully, was the problem. Perhaps the fault lay not with Kleinert’s but with the piercing intensity of the Dubai heat, but on more than one occasion the glue from the tape seeped into the fabric of my shirts, resulting in permanent strips of darkened material that look, ironically, like sweat stains.
The experience soured me for a while on sweat pads. I took to wearing a lot of black, and stayed home as much as possible. Then, one average Sunday afternoon, my wife returned from Costco carrying a box of 96-count jumbo packs of Always Ultra Thin™ feminine hygiene pads with Flexi-Wings and LeakGuard Core™ barriers. (“This is gonna last me through menopause!” she said), and I had one of those Archimedes-in-the-bathtub moments.
“Of course,” I thought. “Why hadn’t I thought of that before?” Naturally, the Kleinert’s pads had been inadequate. How many people buy disposable underarm shields? Not a lot. But there are more than three billion women on the planet. Feminine hygiene is a $13 billion a year business. Thirteen billion dollars buys you a lot of high-class R&D. It buys you absorbency so cutting edge it’s like the sweat is being sucked into a different dimension. It buys you adhesiveness that’s like some alien technology; you can peel the pad off your shirt and put it back on again a dozen times and it’ll stay just as sticky as before. It buys you maximum performance with minimum size, discomfort, or audible rustling.
From then on, whenever I have had to leave the house to meet someone it behooves me not to repulse, I have worn beneath my arms a product expertly designed by a multinational corporation to absorb eighty milliliters of menstrual blood at a wearing.
• • •
I wish I had known thirteen years ago what I know now about the versatility of the maxi pad, for it was my sweating that began to make life at The Atlantic truly intolerable. A painful pattern to my existence emerged. Every night I would go home to rejuvenate myself with drink and sleep, and every morning I would return to confront a series of forces that substantiated and anatomized the very anxiety I was desperate to escape: the galley pages color-coded like the old federal terror alert system; clippings, reference material, and transcripts testifying to the delusion that, with the correct titration of effort, solid ground could be found; the imposing editorial staff watching over my shoulder to make sure that even the assertions made in the poetry were sufficiently verified. By 10 a.m. my undershirt would be drenched. By 10:30 the sweat would breach the outer garment, planting a seed of moisture at the bulge beneath the arm where the two seams of fabric intersect. By 11 a.m. the seed would sprout, creeping up to the shoulder from both sides, down the trunk, and down the arm. Then it would become all about flood control. For the rest of the day I would make frequent trips to the men’s room to get myself dry.
The men’s room at The Atlantic didn’t have an electric dryer. All it had was a canister of thin paper towels stamped with dots and folded into thirds. I made these towels work for me as best I could. I would take a stack with me into the handicapped stall, remove my shirt, line my hand with a towel or two, and squeeze first one shirt underarm and then another in my fist, to sop up the worst of it. Then I’d start scrubbing. The trick was to scrub very fast. The faster I scrubbed the more friction and heat was produced. But I had to be careful not to scrub so fast that it would compromise the structural integrity of the paper towel, which had the habit of disintegrating when it took on too much water and which, in the process of disintegrating, deposited dozens of white pellets on the insides of my shirts. (They looked like miniature cotton fields.) All this cut down markedly on the life span of my dress shirts, but it did the trick—for a while. An hour or so later I would be back on my way to the bathroom, arms pinned to my sides like Frankenstein’s monster.
I tried not to consider what my coworkers thought was wrong with me. Dysentery? Urinary-tract infection? Bulimia? All I knew was that it was a deeply unproductive and disagreeable way to spend my days. On my trips to the men’s room I would pass the office of Peter Davison, the longtime poetry editor. Davison had been a protégé of Robert Frost’s, a friend of Robert Lowell’s, and a lover of Sylvia Plath’s. I would much rather have been sitting with Davison hearing stories about dead poets than ministering to my armpits. I’d much rather have been getting my eyelashes weed-whacked than ministering to my armpits. As in college, it was the lack of solitude that most rankled. Surrounded by people—and, of course, by my facts, my inextinguishable facts—I felt as if I were living in an emergency room, with all the light-headed unreality that setting causes.
Yet I also felt, for the first time, truly and sincerely pissed. It was enough already. Enough! I’d reached that point that comes in the life of most anxiety sufferers when, fed up by the constant waking torture, dejected and buckled but not yet crushed, they at last turn to their anxiety, to themselves, and say, “Listen here: Fuck you. Fuck you! I am sick and fucking tired of this bullshit. I refuse to let you win. I am not going to take it anymore. You are ruining my fucking life and you MUST FUCKING DIE!”
Unfortunately, this approach rarely solves the problem. Anxiety doesn’t bend to absolutism. You have to take a subtler, more reasoned approach. But that doesn’t mean anger is totally unhelpful. Being pissed off is a strong cocktail for the will. It stiffens the spine. It strengthens resolve. It makes a person less willing to run away from the anxiety and more willing to walk into it, which you’re going to have to do, ultimately, if you don’t want to end up a complete agoraphobic. Anger breeds defiance, and defiance is inspiriting. It’s good to refuse to give in to anxiety. You just have to know how much you can take.
• • •
I have on my desk a summons from the Supreme Court of the State of New York, County of New York, stamped by the county clerk’s office October 1, 2003. The summons is stapled to a sixteen-page complaint suing me and the publishing house Houghton Mifflin for libel for $23 million. When I received the complaint I was living in a roach-infested former tenement building in Manhattan. The lawsuit was the culmination of an ordeal that had begun almost three years earlier with the publication of my first piece of writing—a long, in-depth article about electroshock therapy. The article, which was titled “Shock and Disbelief,” was a professional triumph for me. It appeared in The Atlantic when I was twenty-three and was selected to be included in Houghton Mifflin’s Best American Science and Nature Writing anthology. It was also a personal disaster. The article resulted, in order of occurrence, in the following: the longest, most debilitating bout with anxiety of my life thus far; my panic-stricken, half-crazed self-removal from the staff of The Atlantic; the termination of a two-year-long cohabiting relationship with a beautiful and intelligent woman; grief and despair of Old Testament proportions; and an extended period of psychic bottom-dwelling.
In retrospect, it should have been clear from the start that electroshock therapy was not the wisest subject with which to pop my journalistic cherry. In mental health circles, electroshock is as controversial as partial-birth abortion is in political circles. The controversy breaks down along fairly clear lines. Psychiatrists are generally in favor of electroshock. They have seen the treatment pull people out of profound, catatonic depressions, and back from the cusp of suicide. In Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness, the psychiatrist David Healy and the historian Edward Shorter call electroshock “powerful and beneficial . . . safe and effective.” They write: “ECT is, in a sense, the penicillin of psychiatry.”
Those who oppose the procedure have seen it ruin lives, often their own. They argue that electroshock can have calamitous effects on cognition, personality, and especially memory, and that it is no more legitimate a medical treatment than knocking someone over the head with a cinderblock. In Doctors of Deception: What They Don’t Want You to Know About Shock Treatment, Linda Andre, a writer and activist who underwent a course of electroshock in the early 1980s—and the plaintiff in the complaint against me * —writes:
The memory “loss” that happens with shock treatment is really memory erasure. A period of time is wiped out as if it never happened. Unlike memory loss associated with other conditions such as Alzheimer’s, which come on gradually and allow patients and families to anticipate and prepare for the loss to some extent, the amnesia associated with electroconvulsive therapy . . . is sudden, violent, and unexpected. Your life is essentially unlived.
Electroshock therapy is the sort of topic that makes the salivary glands of your typical magazine editor work double-time. In addition to the built-in conflict, it has a colorful history (the procedure was developed, in Italy in the 1930s, by applying electrodes to the anuses, mouths, and heads of stray dogs), a counterintuitive slant (what sounds brutal and primitive may in fact be therapeutic and empirically validated), madness, science, even a whiff of celebrity: Ernest Hemingway, Judy Garland, and Lou Reed all underwent shock therapy. (Reed had shock therapy when he was a teenager; his parents were trying to rid him of homosexual urges.) It is a topic rich with all kinds of complexities—medical, statistical, ethical, legal, narrative—and so one ideally covered by a journalist who knows what he’s doing.
I was not that journalist. I was not a journalist at all. I had never reported before, not even for my high school paper. I had never physically held, let alone read the articles in, a psychiatric journal. The only person I had ever interviewed was an electrician (coincidentally), and that was for a report I wrote in the third grade. At the time I proposed the article the only qualification I could claim was my work as a fact-checker. Checking had at least introduced me to the skills a good journalist needs: the ability to navigate the byways of databases and archives, to mine expertise for resonant generalizations, to sniff down elusive details and sources. But a journalist needs to know how to do so much more than that. He needs to be able to accumulate and digest innumerable discrete bits of information, many of them contradictory, and weave the most pertinent and telling bits into a text of a preordained length that honors both the letter and the spirit of the subject, satisfies the biases and pet curiosities of the editors on whose good dispositions the publication of the article depends, and holds the attention of thousands of anonymous readers with very little time or brain space to waste on something that isn’t super-interesting or -essential.
I had none of these skills. But I had watched the powers-that-be at The Atlantic hold the clammy hands of enough neophytes and incompetents—had watched with amazement as, time and again, they took an inferior piece of writing and alchemized it into something resembling literature—not to be paralyzed by the task ahead of me. “Not to be paralyzed” is indeed an understatement. I was soothed. If in the case of my mother I resented my anxious tendency to negate my will in favor of someone else’s, in the case of The Atlantic I invited it. It felt comforting to place myself in the hands of someone else’s competence, to feel that there was something authoritative and institutional backing me up, nudging me in the right direction, promising to save me. Giving over your will, I was learning, could be a balm as well as an acid.
William James knew this well and said it best. In The Varieties of Religious Experience, he describes the many ways that the “sick soul” can be redeemed: “[The] new birth may be away from religion into incredulity; or it may be from moral scrupulosity into freedom and license; or it may be produced by the irruption into the individual’s life of some stimulus or passion, such as love, ambition, cupidity, revenge, or patriotic devotion.”
As it happened, love was irrupting into my life at just this time, too. On a trip to New York to attend a party thrown by my brother Scott and his new wife, I met a girl, and the immediate and mutual attraction between us went a long way toward quieting my mind. It redirected my attention from myself to someone else, from my hatred of my nature to my affection for someone else’s, from despair and demoralization to excitement and anticipation. Of course, feeling soothed by love turned out to be as temporary and full of folly as feeling soothed by authority turned out to be. You can’t be converted out of anxiety any more than you can be shocked out of being gay. No one can do the work but yourself.
But both were nice while they lasted.
• • •
In a way it was like being an anti-checker, those long months of nights, weekends, vacations, and lunch hours I spent reporting and writing the article. During my salaried hours: stonewalling authors, uncited claims, unreturned calls, slogs through soporific government reports and hernia-inducing tomes on subjects in which I had no interest. During my catch-as-catch-can hours: information gathered steadily and by choice, no fear of error because there was no imminent deadline and because there were safety nets in place—and because error was no longer the point. Knowledge was. For once I wasn’t inspecting; I was building.
But there was a blind spot to my work: I was afraid of madness. I was terrified by the very thought of it. I was terrified of being contaminated by it. This isn’t unusual. Physical disease and mental illness are the two most common fears known to humankind. For the anxious, in whom the fears are naturally pronounced, it seems to be a matter of disposition which will be dominant. The best litmus test is a panic attack, during which some will be convinced they are dying and others that they are going insane. I thought I’d go insane. When I wasn’t in a panic, I simply felt a revulsion to anything that smacked of madness.
Over the years, therapists have tried to disavow me of my fear of insanity in much the way that another web site devoted to anxiety tries to disavow its readers of the fear. “No one with panic attacks and anxiety has ever gone ‘crazy,’ ” the site claims. “In fact, because you realize that you have panic attacks, this is just another indication that you are not going crazy. People that ‘go crazy’ lose contact with reality. Anxious people are too much in contact with reality. Thus, people with panic and anxiety problems NEVER ‘go crazy.’ It simply cannot happen.”
Counsel like this has never worked on me; you can’t reassure someone out of an atavistic fear. The only thing that has helped, perversely, is devoting a decade of my life to writing about mental illness—exposing myself to insanity until the urge to recoil is brought to bay. I have watched a man so tormented by compulsions that he actually applied to have two lesions surgically burned into his brain in a last-ditch effort for relief. I have sat in the back of a sweltering auditorium as dozens of people discussed the disembodied voices they walk around listening to. I have interviewed the schizophrenic, the schizoaffective, the depressive, and the manic-depressive, and I have pored over accounts of mental disintegration from Nebuchadnezzar to Zelda Fitzgerald.
I have done all this, in large part, because I suspect my fear of madness improperly influenced my electroshock article, and I have wanted to correct for the error. In reporting, I looked at both sides of the issue. I used The Atlantic’s clout to schedule interviews with everyone who seemed important in the debate about the politics and science of electroshock. I got in touch with Linda Andre, director of the Committee for Truth in Psychiatry, an organization made up of several hundred former electroshock patients, and interviewed her at an Italian restaurant on the Upper West Side. She brought her son, who quietly did his homework while Andre outlined the deceptions and venality of the psychiatric establishment. In a sun-drenched dining room in an exquisite Long Island house I interviewed Max Fink, a voluminous, aging psychiatrist who has studied and promoted electroshock for more than fifty years. I interviewed a representative of the Citizens Commission on Human Rights, a lobbying organization affiliated with the Church of Scientology that has been active in trying to get electroshock restricted in several states. I interviewed clinicians who presented electroshock as an invaluable treatment with an unfortunate history of abuse and a range of possible side effects. I interviewed Roland Kohloff, the principal timpanist for the New York Philharmonic, who credited electroshock with saving his life. And, on a cool fall day in 2000, I drove out to McLean Hospital, the legendary facility where Lowell, Plath, and Anne Sexton had all been treated, and I watched as doctors administered electroshock to a desperate-looking middle-aged man in tennis shoes and a purple shirt. They fastened a blood-pressure cuff around his ankle and injected him with a muscle relaxant. During the procedure, only his foot twitched.
Given the entrenchment of the opposing sides—the activists disdainful of the integrity of the psychiatrists, the psychiatrists resentful of the severe rhetoric of the activists—the article I wrote over the next few months was bound to elicit criticism. The article gave ample space to electroshock’s detractors, delineating their backgrounds and presenting their complaints at great length—but it failed to treat those complaints with seriousness or compassion. It lent credence to the view that electroshock can sometimes cause profound memory loss—but it made no real effort to explore the medical science behind that side effect, to describe its emotional costs, or (most egregious from the point of view of electroshock’s critics) to investigate the claim that in many cases patients are still administered electroshock without informed consent. The article couldn’t do any of those things—I couldn’t do any of those things—because to do them would have meant inserting myself into the experiences of people whose lives were defined, rightly or wrongly, by madness. It would have meant having to empathize with some truly horrifying feelings of anger, betrayal, and trauma, and I simply couldn’t do that. My anxiety wouldn’t even let me get close to that fire, for fear of falling in. And so I came down, ultimately, on the side of order—of a refined medical treatment meted out cautiously, meticulously, undramatically, and usually successfully, with the comforting sanction of esteemed professional organizations. I came down in favor of electroshock.
When the article was published it was lauded by almost every one of the mental health professionals who chose to comment. Almost. Fink wrote me an e-mail that seemed to suggest that by giving voice to electroshock’s detractors my article would dissuade seriously ill patients from seeking out or assenting to the treatment and would thereby result in the deaths by suicide of thousands. I had blood on my young hands. The other side of the line was more crowded with dissent. On The Atlantic’s online comments page, I was pilloried for incompetence. In the lawsuit Andre eventually filed, she counted that the comments were 70–2 against the article, and offered some choice denunciations:
‘This article feels like marketing; it saddens me to see Atlantic’s reporting so biased.’ (Comment #4) ‘Journalistic standards that would apply to high school newspapers are thrown out the window when it comes to electroshock.’ (Comment #10) ‘DANIEL SMITH IS NO JOURNALIST.’ (Comment #12) ‘In Journalism 101, we were taught the basics, and I’m afraid that Mr. Smith has ignored what he should have learned in college . . . Daniel, you should have CHECKED your piece.’ (Comment #15)
One commenter went through the article line by line, pointing out all the inaccuracies in a document that ran for many single-spaced pages. He fact-checked my article! I got several calls from Andre, demanding answers. The editors heard from Andre, demanding answers. The journalist Liz Spikol, later a prominent blogger on mental health issues, responded with a column titled “Shocked and Appalled.” The last line of her piece was, “I’m thinking maybe it’s time for Daniel Smith, the author of ‘Shock and Disbelief,’ to have his head examined.”
My sentiments exactly. By then I was well on my way to a mindset that made my response to losing my virginity seem like a pleasant afternoon nap. I still had to work. I still had to sift through other people’s articles for errors. I still had to monitor my underarms for moisture. And now I had to contend as well with the mounting indictments of my own potential errors and the consequences I was being told they would have—not on me, which was self-evident, but on other people, and on the world.
Consequences. It is not a favored concept for the anxious. During those times when I am berating myself for all that I’ve done wrong, all the mistakes I believe I’ve made, I call Scott and he reminds me that the only choices that have permanent consequences are creating life and ending it. I hadn’t killed anyone or knocked anyone up. I hadn’t even acted maliciously. I had worked hard and tried my best and hoped to do well, to do good. But the thought I could not shake was that there was no way to know what effect those 500,000 or so copies of the magazine circulating out there in the world were going to have, whether they would coax some unlucky person in distress to have electroshock and thereby have his memory erased, or whether they would coax someone in distress not to have electroshock and thereby to sink further into distress and self-destruction. The deed was done, and the result could be anything.
And for what? Toward what end? A byline? For that I’d opened myself up to scorn, demands for a retraction, legal threats? I wasn’t Christopher Hitchens. I took no pleasure in controversy. I was a junior editor twenty months out of college. All I’d wanted was to write and be published. A little light literary glory, that was all. Instead I’d called up a storm. A great tidal swell of panic overtook me and refused to recede. No permanence save life or death? Tell that to my brain, big brother. It didn’t hear the news. It was too busy counting bodies. Every day at work the postmortem continued, every day I was reassured by my superiors that all was well—this was journalism, this was how it sometimes went—and every day I became less able to hear a positive or logical word anyone said. The sensation was like when your ears fill with fluid and you can’t get them to drain: a cocoon of the self. I stumbled viscously through. I began to dream of being mad and institutionalized, face up on a gurney, electrodes at my slick temples. Nooses. Pill bottles. Pistols. Bridges. Knives. The absence of choice. The absence of consequence. If this was life, what was the point?
* See pages 227–30 of Andre’s book for a seriously unflattering portrayal of yours truly.