Your Mental Health and Your Work

Talking about Self-Awareness and Anxiety (with Hello Monday’s Jessi Hempel)


MORRA AARONS-MELE: I’m Morra Aarons-Mele, and this is The Anxious Achiever. Each episode, we look at stories from business leaders who have dealt with anxiety, depression, or other mental health challenges, how they fell down, how they pick themselves up, and how they hope workplaces can change in the future.

Why am I hosting this show? Well, frankly, it’s what I wish I’d had when facing difficult junctions in my career. I’m an extremely anxious overachiever. I have what we in my family call “transportation anxiety.” I’m always waiting for bad news, for the other shoe to drop. I fear that people in my life will die or leave me, almost all the time. I have a lot of social anxiety, which makes everyday life very humbling. I’m also an extreme introvert who adores public speaking, and I do many speaking events a year. What I found is there’s one common thread among my audiences: the most ambitious professionals are so anxious.

From 20 years as a progressive political consultant and a student of people at work, here’s what I know. No one can change the world if they’re unhappy at work. And so many people are unhappy, for many reasons, of course, but in particular because of anxiety, depression, and other mental health struggles. And the problem is set to get even worse because the Millennial and Gen Z cohorts have been dubbed the most anxious generations. And in today’s workplace, leaders pretend that they don’t have anxiety or mood disorders. It’s still taboo to talk about our mental health at work for most of us, despite the huge increase in amenities for physical wellness, like yoga rooms or treadmill desks or bouncy balls that you can sit on.

Although so much has been done rightly, to promote diversity and wellness at work, there’s a giant hole in the understanding of how temperament and emotions play, not just into our daily grind at the office but into our very trajectory of success. We’re in desperate need for better models of leadership, especially in a society that tells us anxiety and depression are weaknesses, that they’ll prevent us from succeeding. And I want to tell a different story. Anxiety is normal. There’s part of being a leader where being anxious can, in fact, enhance your leadership, your creativity, and your vision.

So, throughout the season, we’ll hear from great leaders who are compassionate, empathetic, and emotionally complicated. Look, we’re not here to sugarcoat things. We’ll look at the good, the bad, and everything in between. Along the way, I hope we’ll answer your questions about whether you can achieve your work dreams while struggling with a mental health issue, how to disclose them to your boss, how to find the help you need, and how to have constant conversations with yourself, your anxiety, your depression, and everything that comes along with it, as you journey on the road to success. Remember, anxiety is normal.

Rollo May wrote in the 1950s, “Anxiety is essential to the human condition.” The presence of anxiety indicates a vitality, like a fever. It testifies a struggle going on in the personality, which can be very constructive. It can lead to courage and tremendous growth. Part of me believes that, but of course, I’m not sure I’ve ever had an un-anxious day in my life. Well, enter Scott Stossel. Scott is the author of the book, “My Age of Anxiety: Fear, Hope Dread, and the Search for Peace of Mind.” He has been thinking and writing about anxiety for a long time. And one quote he’s written that I often think about is, “Anxiety is produced by the fear within ourselves.

So, to kick things off, I wanted to talk to Scott about what he’s learned about anxiety, how prevalent it is in the workplace, and some of the biggest challenges people with anxiety face in their careers. I started off by asking him where his anxiety comes from.

SCOTT STOSSEL: That’s a good question. And the bad days range … it depends on how bad, a bad day we’re talking about. But let’s say on a really bad day, the getting-out-of-the-bed part can be pretty challenging. You’re filled with dread, and simply launching yourself out of bed and into your day is a challenge. It just feels like the weight of the world, and the things that are weighing on me, are unbearable. And then sometimes you can fight through that, sometimes you can’t, and then sometimes a bad day can be a day that starts out okay. And the way that my own anxiety tends to work is, it can be bumping along just fine, and then something – and it can be a anxious trigger, having to do with a high stakes public speaking event or just something bad or seemingly bad happens at work, or sometimes nothing at all, or something in my body happened – just spikes my anxiety and sends my physiology into a fight-or-flight response. And if I can’t tamp it down, it goes into a full-blown panic attack, and that could just be debilitating, and I have to retreat.

Now, they come out of nowhere. Oftentimes, the groundwork has been laid because I haven’t slept well, or because there are anxious stressors, or because I haven’t gotten exercise for a while, or because something is going on or some combination of all of those things.

MORRA AARONS-MELE: One of the things I really appreciated in your book was how honest you were. I too have often had a swig of vodka when I felt that panic coming on, but I’m wondering, say you really are about to walk onstage or walk into that big meeting, where drinking a bit of vodka is not an option. Do you have tricks that you’ve learned, when you’re in a bad state?

SCOTT STOSSEL: Yes, and they don’t always work. I also have – and I don’t anymore – use to sometimes take that swig of vodka in times when it was definitely counterproductive in the long term, before a high stakes meeting or a public speaking event. I can talk about those in a sec. What I try to do now, for one thing, I’ve gotten better at just saying no to things. I mean, there’s some things that, for whatever combination of circumstances, just end up feeling like they’re too likely to trigger a panic episode or an anxious meltdown. That would be bad for me and maybe bad for whoever is committing to have me appear. So, so I’m trying to get better about combating my reflexive tendency to say yes to everything that anyone asks me to do and say, “You know what, I’m not sure that’s good for me.”

So, there’s that. And actually, that has a virtuous cycle, and then I feel like I have more agency and feel less anxious, and I’m actually less likely to have those anxious episodes. I mean, beyond that, there’s sorts of things I try, all the things in the standard anxiety-combating playbook. I mean, I try to do things like meditation, deep breathing, and mindfulness practice, where you’re trying really hard to stay in the moment. I’ve done a lot of cognitive behavioral therapy, and I have tools and tricks from that, in terms of just trying to keep the thing, whatever it is, in its proper perspective and not catastrophizing it. They all work to a certain degree, and they all work sometimes, and then sometimes they just don’t.

So, I do all those things. I mean, I also take, as a baseline thing, an antidepressant medication. I don’t know how well it helps at this point, but I’ve been taking various ones for a long time, and they have, I think, lowered the frequency of panic attacks and generalized anxiety, the rumination … it cuts down on it. And like I say, I’ve been on them for so long, I don’t know if I were to stop taking it if I would it get much worse? The fear that it might is why I don’t, but I don’t know if it, in fact, would.

MORRA AARONS-MELE: What’s the current verdict in the medical, psychological, and biotech communities about whether anxiety disorders are mostly nurture or mostly nature, and at the end of the day, does it matter?

SCOTT STOSSEL: Yeah. That is a debate that has raged for millennia at this point. And does it matter? In some ways yes, in some ways, no. I mean, I think it does matter because it does determine what the most effective treatments are likely to be, and maybe diagnosis eventually, and maybe even prophylactic things to ward off anxiety disorders. That said, the answer is, it’s both. My own view, which is based on a lot of people who have more specialized knowledge than I do, is that your predisposition to anxiety is largely, or can be largely, coded into your genes. Basically, it’s something you inherit, and some people have a very high genetic and biological resistance to anxiety, and some people have a very high susceptibility to it. That said though, they do all these twin studies, which is what geneticists love to do, study twins, to figure out how much of a given trait is genetic or not.

If anxiety disorders were completely genetic, then two in an identical twin pair would always have anxiety. They don’t. I mean, they’re much more likely to both have it, but they don’t all. So, there is clearly, unquestionably I would say, a strong genetic component to your level of anxiety and whether you have an anxiety disorder, depression, or lots of other things too. There is also a strong environmental component, and that means that you’re not fated. Even if you have a large genetic load, as they say, of anxious genes, that doesn’t necessarily mean you’re completely doomed to permanent anxiety all the time. And it’s also not to say that if you’re resilient by nature, that you couldn’t be driven into having an anxiety disorder by severe stress, war, or trauma. Trauma drives many people into anxiety.

MORRA AARONS-MELE: In your book, your therapist, Dr. W, says something that I love and seems to say that the root of almost all clinical anxiety is an existential fear of the ontological givens: death, failure, shame, loss, or fear of loss. And when I read that, I mean, for me, I believe my anxiety is based ultimately on a constant fear of the loss of people I love. For some people, it’s a sublimated fear of death, disguised as anxiety about more trivial things, and many people, of course, fear shame. And I’m curious, after all your work, insight, and writing on the topic, what do you think the basic root of your anxiety is, and also do you think it spurred your career choice as a journalist?

SCOTT STOSSEL: You would think my having spent years researching that book and years in therapy, I would have a better sense of what actually is the root of my anxiety. I mean, I guess I think it boils down to, as we were just saying, it’s not going to go. There’s a large genetic component to it. High anxiety runs through my family. I do think that in some ways the parenting I received, even though I grew up by global standards in a very comfortable middle-class American environment and was not subject to great deprivation, was a bad parenting combination. A super overprotective mom and an absent, alcoholic dad. There was a lot of stuff that contributed to that, which cultivates anxiety in lots of kids.

In terms of what is driving my anxiety, and I have thought about this a lot, and because it does, as I was saying earlier, come down to like this physiological thing. I’m like, “What is this?” Is there a thought component in it when I’m sweating and shaking and can’t think straight and feeling sick? Is that fear of death, or is it just my body? I have had that thought and then it gets down into my limbic system, sympathetic nervous system. I mean, I think for the most part, those severe … all anxious responses, and particularly those severe ones, are an evolutionarily adaptive response gone awry. It’s the fight-or-flight response. And when you’re confronted by a saber-toothed tiger or a war or something very dangerous, those things that are making me feel so awful in those moments, or anyone when they’re having a panic attack, actually can be useful in a true fight-or-flight thing where you need to have a spike of adrenaline to fight off something or run away from it.

There’s a lot of … even in terms of your hair standing on end, it may be derived from how animals in the state of nature look bigger when their hair stands, and it maybe scares off a predator. So, there is an atavistically, evolutionarily conserved thing here, but obviously it’s maladaptive. And that’s the difference between, in terms of the anxiety disorder and what Dr. W was saying, it being fear of death and fear of existential things. As physiologically rooted as it feels like my anxiety is at its worst, there are some underlying things. What sets us apart from animals is that, I mean, even for dogs and monkeys, they know sometimes when their owner has died, and they grieve. And elephants too, but for the most part, there’s no sense that they are afraid of death. They don’t have existential concerns.

And so overlaid on top of this hardwired fight-or-flight response that’s built into everything, from lizards up through higher primates, we have the capacity to impose these existential things that just deepen it all, and we’re aware of our own eventual demise, which is a pretty scary thing. And so, in the end, I don’t know, when I’m having a public speaking panic attack, or if one of my phobias is kicking up, is that fear of death or something to do with my upbringing? I don’t know. It’s in my wiring.

MORRA AARONS-MELE: It’s so weird, right? You’re about to go onstage and give a speech, and so all of a sudden, this existential threat that people you love will die, how does it match up? It just doesn’t really make sense, and yet it seems like there’s a lot of literature around these big stressors that we constantly stew on, creating these moments of panic at seemingly non-life-threatening moments.

SCOTT STOSSEL: Well, right. And the public speaking one is interesting. It often feels to me … I’ll be up there, and suddenly there’s no thought that I can perceive. It’s just all those eyes on me, and it’s like I’m Cindy Brady in that Brady Bunch episode, I literally can’t speak, and there’s no thought. I do think there is a lot of literature about fear of embarrassment or shame, or almost getting existentially crushed by disapproval or failure. Again, I’m not having those conscious thoughts in that moment, but I think a lot of people believe that they’re there.

MORRA AARONS-MELE: It’s very complex. Well, okay. So, what’s the upside of anxiety in a professional context? I’m curious.

SCOTT STOSSEL: There are a number, or at least I would like to think there are, and it really is the other side of the coin. And a lot of anxious traits, as bad as they can be … There can be a silver lining or an associated good trait. For one thing, the thing that anxious people have, scientists call it hypervigilance, which is, you’re worrying about everything, and so you’re always scanning the horizon literally, or metaphorically, for the things that are going to come up and kill me or make me feel pain. And in someone with anxiety disorder, that can be unproductive and debilitating, and most things are not going to kill you or cause you pain.

In a work environment though, it means you’re very attuned to what’s going on. And you’re maybe over-reading situations and maybe reading them too negatively, but you’re probably going to be more prepared for bad things that come around. You can think around corners. And I think, well, actually, Dr. W, who you quoted earlier, talked about how so many of his patients were lawyers, and they were really good lawyers because they were good about worrying about every worst case eventuality on behalf of their clients, which was great for their clients. Maybe not so good for them because it made the lawyers themselves anxious and miserable. People who are socially anxious in particular, have a version or a variant of the hypervigilance, where they’re monitoring everyone’s responses. Again, the downside of this is that it can become debilitating.

You’re always worrying about how you’re coming across. You have an overly negative sense of how people are perceiving you. You’re obsessing about what people are thinking about you, when they’re probably, in fact, not thinking about you. But you probably are more empathetic, you’re probably better able to project yourself into other people’s points of view than somebody who is low in anxiety and, therefore, maybe better able to relate to people. Again, as a manager, it can make you more effective because you’re better able to anticipate how something you’re saying or communicating, or your company is communicating, will come across to a given individual, and you’ll be better able to help them manage that.

And it flips. People who are super neurotic … Again, this isn’t true 100% across the board. But conscientiousness … I’ve read a lot by other people who’ve written anxious memoirs in that there’s a common trait about many people. Some people who are super anxious and come across as super anxious. A lot of high-achieving, anxious people, they feel super anxious, and they may even have meltdowns, but they work really, really hard to appear not anxious, which makes them seem competent and in control. And in fact, they are competent and in control because they are so conscientious, and the danger is, does it slide into excess people-pleasing? But again, this can all be adapted because you’ll tend to work hard and be motivated. Anxiety is a great motivator.

MORRA AARONS-MELE: I want to talk about the role of anxiety and ambition. There was a quote … you quoted Karen Horney, who was a Freudian, in your book. And she talked about … I’m going to read the quote actually, because it’s interesting. “A standard behavioral tick of the neurotic is to reduce himself to nothing in order to relieve the pressure to accomplish anything.” It’s almost as if she’s saying that embracing your neuroticism or your anxiety disorder is an excuse for not achieving your ambitions and facing a reality that you can’t measure up to. It’s funny because I don’t see it that way, but I’m curious if in your research or your experience, you have met people, or if you yourself have considered that “I can’t do X, Y, and Z because of my anxiety, so I’m not even going to try.”

SCOTT STOSSEL: That is a temptation sometimes, or a danger I guess I should say, to basically just say, “Well, I’m cursed with this anxiety disorder. It’s an excuse. I’m not going to try.” I think what Horney is getting at is something similar but slightly different and related. And this is something I’m definitely guilty of, which is the fear of negative consequences and the constant … and that if you have a built-in … well, it’s two things that she’s talking about. A lot of people with a neurotic temperament and people who suffer from depression, which relate, tend to feel low self-esteem, feel bad about themselves, and feel like they are unworthy. They have a self-worth problem.

And so what they tend to do – often maladaptively, but sometimes it spurs ambition – is, “If only I could achieve X, Y, and Z, if I could make vice president, or if I were the CEO, or if I made this much money, or if I make this person be my boyfriend or girlfriend, or if I achieve these externally validating measures of success, then I will feel better about myself,” to escape from this natural state of being. So, what that launches is then ambition. You’re going to try and get that girlfriend or boyfriend, or you’re going to try to make vice president, you’re going to try to hit your sales goals or exceed them, and you’re trying to have an exceptional performance. So, to everybody, it becomes outwardly apparent how amazing and lovable you are, and you will then conquer those internal feelings of low self-worth.

So that can be a spur to great success. Of course, it starts to feel like not such an adaptive spur because you get to that higher level and then, I think what tends to happen is, you still feel worthless and need to do even more. And it’s a hedonic treadmill, where you’re running faster and faster and faster to chase after something that needs to come a little bit more from within. So even though it can motivate legitimate achievement, it’s not always a route to contentment. The other thing for me, and I do find myself reflexively falling into it, is the stakes start to become so high in a given situation, and so I’ll build in the expectation of failure from the beginning.

I mean, it’s not even a conscious thing, but it’s like, “Well, I’m doomed to fail anyway, because I have anxiety disorder, and I’m a neurotic failure anyway. So, I can’t expect anything of myself, and no one can expect anything from me. If I can just get through this, it’ll be all right, let alone, if I succeed.” And it’s anticipating the worst-case scenario so that when it comes, you feel like, okay, well I was expecting it anyway. The flip side of that of course, is that it’s like you’re living through the worst-case scenario twice because you’re fearing it and then experiencing it. And there’s a lot of research that suggests your attitude … A positive attitude can help produce a more positive outcome.

MORRA AARONS-MELE: And it’s interesting. I mean, I do that too, but I also find that the older I get and the more I follow my intrinsic motivation, so not what will make other people happy or what looks shiny, but the things that I really want to pursue in life, I’m still anxious about them. So then, I just work so hard on them and attempt such a level of perfection, that I usually don’t screw up anymore, but the process of getting there feels really exhausting. I don’t know if you experience that too.

SCOTT STOSSEL: Yes, it can feel exhausting. What do you do? I mean, what kind of things particularly exhaust you when you’re going through that?

MORRA AARONS-MELE: I think just the over preparation and the ruminating, the coming up with 37 different worst case scenarios when I get laughed off the stage. It is, it’s exhausting. So, I want to talk about leadership a little bit because I think there’s a lot of agreement that anxiety can make people really conscientious, great workers, very attuned. Have you, in your time, interviewed or read about or thought about any of our great leaders who are extremely anxious and perhaps qualities that their anxiety lent them that helped them become great leaders?

SCOTT STOSSEL: Yeah. I mean, I talk in my book a little bit about, I mean, Gandhi had acute public speaking phobia, maybe Thomas Jefferson, Abraham Lincoln. I don’t know if it was so much anxiety. They called it “melancholy” then or depression. But in all those cases, all those traits I was talking about before, which are the ability to read situations, to feel empathy and therefore know what motivates people, and to be understanding and able to anticipate sometimes those worst-case scenarios. So, yeah, I do think that there are plenty of examples of people who overcame anxiety and managed to harness it. I mean, there were these fascinating stories. These were studies, not from famous people, but of primates. Where they were measuring, they basically bred these genetically anxious monkeys and then anxiety-resistant monkeys and then put them into different social situations.

And the general feeling going in was that the anxious monkeys end up becoming the bottom of the monkey hierarchy because they’re anxious. They have low serotonin, and they’re always getting beaten up. And that is true in some cases, if they have anxious temperaments genetically and anxious upbringings, unproductive parenting. If you take monkeys who have anxious temperaments at birth and put them in a healthy, adapted environment, those monkeys often become the alpha males in the troop or alpha females. It was like that combination of anxiety, hardwiring, and the learning of adaptive skills through the environment that made them really, really good leaders and better than the thug ape who beat everyone up and better the ones who were so anxious that they were unable to get out of a corner.

But yeah, I found myself, just in reading some of these accounts of not just leaders but also thinkers, like Darwin, who seem like they suffered acutely from anxiety but then managed to accomplish really great world-changing things. It didn’t make me think that I could be Darwin, but because they were going through it and were able to persevere through it, it just somehow made me feel better that maybe I could persevere through whatever I was going through.

MORRA AARONS-MELE: I have to tell you, I told someone your Darwin example the other day, because I thought if Darwin, suffering like he did, could travel halfway around the world in a leaky boat, you can surely step on this commuter jet to LaGuardia and do your thing. I thought it was very, very helpful to think of poor Darwin in the Beagle, suffering but doing it anyway.

SCOTT STOSSEL: Yep. Although, those commuter jets are pretty scary. I agree with you.

MORRA AARONS-MELE: Well, that’s true. Well, looking at yourself, I mean, you haven’t let the excuse of your anxiety prevent you from achieving so much in your career. And I’m curious, I know you’ve had many road bumps along the way, what would you tell yourself, your younger self, about what your road to success would feel like and what to worry about and what to worry less about?

SCOTT STOSSEL: One thing I think I would tell young me is something that I try to tell my kids. My son is 12, and I can see in him many of the same traits that I had. It’s to go easier on yourself. I mean, it’s so easy, and I still do it but to just beat yourself up when you have a setback? And this is true, again, of people suffering from depression too and also anxiety, that no matter how well I’m doing in life, I will have a panic attack or some anxious meltdown, and I feel like God, there I go, I’m back, reduced to my lowest common denominator. And you have to realize that it doesn’t … you’re not stuck in that state.

And so young me felt like, “Oh my God, this is also overwhelming. It’s never going to get any better. I’m never going to be able to escape anxiety.” I mean, one key thing I think that I’m still learning, but I wish I could have learned when I was nine or 12, is that it’s true. I can’t ever escape anxiety, and I’m never going to escape anxiety. And I shouldn’t try. I just need to learn to embrace it and accept it. And that at 12, and even now at 50, that’s a pretty terrifying thought, but now I’m starting to realize to actually accept it. It’s real, and it’s okay, and it will get better. This too shall pass.

So I would tell young me that, and just that as bad as it sometimes seemed and as bad as I felt about myself, for how bad things seemed, some of those traits actually were going to prove worthwhile and useful to me, and I would be able to achieve things. I do wonder if I’d actually known some of the things that I would achieve later on when I was a teenager, would that have made a difference? It probably would have. I mean, I would have been freaked out if my future self was coming back in time to tell me these things. But aside from that, it would have been useful.

MORRA AARONS-MELE: Could have helped. It’s funny though, because one of the things I also found so helpful in learning about you and your work is that you have come to this place of radical acceptance, right? My anxiety is part of me. I feel the same way, but it seems un-American to say that. We have this approach that this too shall pass, and if you just get enough therapy and take enough meds, it will go away. What do you say to people who think, “Oh, it should go away. This is not who you are.”

SCOTT STOSSEL: I mean, I think for some people, it can go away, and I wouldn’t discourage anyone from trying it. I think it has to do with how severely anxious you are, and some people, they go through a short course of therapy, and they really are cured. I think for many more people, and certainly for me, it is so deeply ingrained in my temperament. It is in my hardwiring. And so, that part of me, it’s not going to go away, and it’s like beating my head against the wall to think that I can get rid of it. So, learning that I can manage it and learning to accept it, it’s just a much more adaptive thing, and I work on this with my therapist now.

The irony is, and there are a lot of cruel ironies having to do with anxiety, but a nice irony is that the more I can actually accept my anxiety or can accept life is full of things that make you anxious …You are going to feel anxious, the more you accept that, the less anxious you will actually be. So, there’s a perverse Zen of the more you accept it, the less you have to deal with it. Easier said than done, I can say from experience, I do believe it to be true.

MORRA AARONS-MELE: Scott Stossel, I want to thank you very much for your time and your continued work on this topic and so much else.

SCOTT STOSSEL: Thanks so much for having me. I enjoyed talking to you.

MORRA AARONS-MELE: That’s it for this week’s show. If you like what you’ve heard, be sure to subscribe and submit a review in Apple podcasts or wherever you get your shows. And if you have an idea for the show or you want to tell us your story, drop me a note at anxiousachiever@gmail.com, or you can tweet me @morraam, that’s M-O-R-R-A-A-M. Special thanks to the team at Harvard Business Review, my producer Mary Dooe, the team at Podcast Garage, and all of our guests who are telling us their stories from the heart. From the HBR Presents Network, I’m Morra Aarons-Mele, and this is The Anxious Achiever.



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