The New Anxiety

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Although depression seems to have superseded anxiety as the defining emotional state of the modern age, mental health professionals are aware that we still live in a so-called Age of Anxiety. Modernity, however, has given rise to several new sources of anxiety that are less tangible and less controllable than the anxiety determinants of earlier times. Regrettably, attempts to understand anxiety in historical and cultural contexts are often overshadowed by explanations that emphasize the biological and physiological processes and the apparent universality of anxiety. But even though most human beings have the potential to experience anxiety, there exists extensive cross-cultural variation with regard to the general magnitude of anxiety, as well as the prevalence of anxiety disorders. Indeed, there have been some striking observations made on this subject in different cultures. In a study of 2,360 Yoruba Aboriginals of Australia, not a single case of overt anxiety was found.1 No indications whatsoever were found of such specific anxiety disorders as phobia or obsessive-compulsive disorder.

Some observers have persisted in the assumption that anxiety symptoms are present in all cultures, arguing further that an absence of symptoms means only that anxiety is expressed in alternative ways. We saw this same logic with regard to cultures that appeared to have few signs of clinical depression. It has been reported that Yoruba Aboriginals experience certain fears concerning witchcraft, evil spirits, the dark, and strangers. At times, these fears express themselves in ways that resemble "overt anxiety" (e.g., sweating, agitation, shaking), but it has also been observed that these fear responses are of short duration and subside once the object of fear is no longer present. Thus they do not resemble the persistent types of anxiety disorders with which we are familiar in the West.

Yoruba culture is unusual in its apparent total absence of anxiety disorders; in most cultures one can find evidence of pathological anxiety. It is probably possible for a culture to be organized in such a way that anxiety disorders are entirely precluded. Yoruba culture may be a case in point. In the vast majority of cultures, however, it seems that some members experience anxiety symptoms. One cross-cultural study examined the prevalence of various anxiety symptoms (nervousness, heart pounding, sleep troubles, upsetting dreams, and shortness of breath) in India, Nigeria, Chile, and Israel. The researchers found some evidence of all these symptoms in each of the four locations, but the prevalence of the different symptoms varied considerably from one culture to another.2 Nervousness, which we often equate with anxiety, was experienced by 48 percent of Indians, 36 percent of Chileans, 27 percent of Israelis, and 9 percent of Nigerians. Whereas the Nigerians had far fewer symptoms of nervousness, they reported considerably more disturbing dreams than people from the other countries in the survey.

This latter finding reflects the cultural significance attached to dreams in traditional Nigerian culture. Unwelcomed messages contained in dreams can generate stress and anxiety. In cultures that assign less authority to dreams, anxiety is not channeled in this direction to the same extent. In general, it is evident that anxiety can ground itself on a multitude of cultural structures. This is especially obvious when one considers culture-bound syndromes, such as koro.

The defining feature of koro is a high degree of anxiety associated with penis size. The sufferer is convinced that his penis is shrinking and disappearing into his abdomen. The idea involves the same sort of body image distortion that we see in anorexia nervosa, except that the koro victim perceives the penis as much smaller than it is in reality. The body image distortion of the anorexic causes the victim to perceive her/his body as larger than it is. Koro is a disorder that is found only in some south Asian countries (e.g., China, Taiwan, Malaysia) and can be traced to the cultural cognition "Be virile" that becomes a primary motivation of many men in these cultures.

It has been suggested that koro is the etiological counterpart of anorexia nervosa in Western culture.3 One could debate whether these should be classified as anxiety disorders, yet no one would question that both anorexia nervosa and koro involve a great deal of anxiety, in terms of the feared conditions of obesity and sexual inadequacy, respectively. So once again we see that culture determines to a large extent the form of anxiety expression.

From all we know about anxiety and culture, it would be oversimplistic to claim that modernization and/or Westernization is to be blamed entirely for the rash of anxiety problems that exist today. It may be that in the Age of Anxiety the West has a higher prevalence of anxiety disorders than many traditional non-Western cultures, but the complexity of this issue makes definitive conclusions rather difficult. An interesting study looked at the relationship between blood pressure and degree of Westernization in a number of Micronesian, Polynesian, and East African settings.4 The results showed that blood pressure is lower in non-Western tribal peoples and that it increases as contact rises with Westernized life-styles. This difference could not be explained fully by such factors as obesity, salt intake, and envious resentment. Instead, the researchers attributed the higher blood pressure in Western locations to acculturation, information overload, and competition.

Moderns have come to embrace high levels of stress as an expected and ongoing element of their inner experience. Conspicuous signs of being stressed are even worn by some as a badge of honor signifying their faithful adherence to the success dictates calling for physical and emotional overextension.

Rather than focus on anxiety disorders, it might be more revealing to think in terms of cultural factors that affect resting levels of anxiety, or what could also be termed general anxiety. One can then begin to think in terms of cultures that are anxiety-prone, as compared to ones that are less likely to instill anxiety in members. Some of the most thought-provoking work on this subject is that of Raoul Naroll, who analyzed all available cross-cultural anxiety research in an attempt to isolate the factors that predisposed cultures to the experience of anxiety.5 Working from the sizable body of data contained in the Human Relations Area Files, Naroll found that a culture was more likely to produce anxious members if it was competitive; individualistic; futuristic and anticipatory, with an emphasis on planning, saving, and working toward; restrictive of emotional freedom, with reliance on artificiality for success; repressive of sexuality; and lacking in overall integration (i.e., a weak "moral net"). Some of these characteristics are especially relevant to the Age of Anxiety phenomenon and need to be considered in more detail. We might begin by looking once again at competition, this time as it contributes to the experience of anxiety.

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