NYU Alumni 
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psychiatry

That Old Fear Factor

Are some hardwired, natural anxieties mislabeled as psychiatric disorders?

by Courtney E. Martin / GAL ’04

It is often cited that public speaking is the No. 1 fear of most adults. Not cancer, which kills 20,000 people a day worldwide. Not plane crashes, which—although statistically rare—make for an awfully grisly death. If one is a mediocre or even bad public speaker, it might result in embarrassment but not physical peril. So why do people experience such anxiety about something that, in reality, has such low comparative stakes?

Diagnosed anxiety disorders have increased by more than 1,200 percent since 1980, and an estimated one-in-five adults now takes at least one psychiatric drug.

University Professor Jerome C. Wakefield, who teaches in the Silver School of Social Work, has an explanation with implications far broader than the much-feared spotlight. In his recent book, All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties Into Mental Disorders (Oxford University Press), co-authored with sociologist Allan V. Horwitz of Rutgers University, he argues that public speaking and other common fears—such as heights, snakes, and darkness—“are living fossils within our own minds, vestiges of what we were more appropriately, biologically designed to feel in long-past eras.”

As the argument goes, human beings once feared pubic speaking because they risked alienating others within their small, deeply interdependent communities. Today, if you flub a client presentation, you might lose an account; in Mesopotamia, you could have lost respect, food, protection from predators, and, in time, your life.

Wakefield posits that many seemingly “excessive” anxieties may actually be perfectly normal. We’re a naturally vigilant species, he says, instilled with err-on-the-side-of-caution triggers that were necessary for the many dangers early human beings encountered. But inside our relatively safe modern existence, with its low tolerance for human foibles, our normal fears are mistakenly classified as psychiatric disorders and treated accordingly.

Not surprising to Wakefield, this notion failed to appear in the DSM-5—the fifth version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in May 2013, which provides a common language and standard criteria for those in the field. The DSM-5 contained revisions with potentially far-reaching consequences for anyone seeking psychiatric treatment, from those on the autism spectrum to those struggling with depression. However, like the DSM-IV, published in 1994, it made no reference to so-called natural anxieties, an omission that Wakefield and Horwitz believe can lead to overtreatment. Reuters recently reported that diagnosed anxiety disorders have increased by more than 1,200 percent since 1980, and studies claim that more than half the population suffers from such disorders.

In light of these numbers, it wouldn’t be outlandish for the authors themselves to fear making such a controversial argument. “What we’re saying could have rather dramatic implications for the current approach to anxiety disorders,” Wakefield admits. “We are prepared to be excoriated and rejected by some of our peers.” Most notably, Andrew Scull, head of the sociology department at the University of California, San Diego, critiqued Wakefield and Horwitz’s work in the Los Angeles Review of Books, writing: “The alleged features of normal human nature and the supposed hold our genes have over our behavior are as speculative as most neuro-maniacal accounts of modern man.”

But Wakefield and Horwitz, in rebuttal, can point to an exhaustive list of studies, the most obvious and convincing of which focuses on the fears of babies. For example, as soon as these ostensibly anxiety-free creatures start exploring the wild world of stairs, counters, and many other height hazards, they sense danger and do their best to avoid falling. Moreover, children commonly have intense fears of wild animals they have never seen except in pictures but were genuine sources of danger in ancient environments. To this point, Wakefield and Horwitz’s work has been favorably reviewed in The American Journal of Psychiatry and The Lancet, among others.

It’s important to note that Wakefield and Horwitz don’t argue that all anxiety is hardwired. They well understand the need for some people to turn to antianxiety medication; indeed, an estimated one-in-five adults now takes at least one psychiatric drug, such as antidepressants, antipsychotics, and antianxiety medications. But one might also try cognitive behavioral therapy or increasingly popular mindfulness practices to counter those fears, which, in Wakefield’s view, are natural, if sometimes (but not always) outdated. Studies show, for example, that those with more intense fear of heights from youth actually have fewer injurious falls during their lifetimes. By simply exploring the biological roots of our reactions, Wakefield says, “It opens up a larger space of possible responses and suggests why, in the face of our natural anxieties, courage has always been considered a central virtue of humankind.”