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[keyboard clacking]
[mouse clicking]
[computer chimes]
[computer chimes, vibrates]
[reporter 1] What do you do to deal with stress?
[reporter 2] We got a pill that's gonna take care of it in five minutes.
[reporter 3] What exactly does it do? How does it make you feel?
It takes the edge off for millions.
I keep my Xanax with me all the time. It's in my bag right now, actually.
I knew I always had that magic bullet. I have figured out a system that works.
[woman 1] The fastest thing to do when somebody says,
"I'm stressed out. I'm not sleeping well,"
it's "Take this pill. It'll help you sleep."
"This'll keep you calm. Goodbye."
[reporter 4] There has been a Xanax explosion.
[reporter 5] Prescriptions have skyrocketed in the last two decades.
[reporter 6] Roughly one in eight American adults use them.
[woman 1] That's a lot of prescriptions.
It's kind of always been around, to be honest.
You can always ask a friend,
"Do you have Xanax or do know somebody who has Xanax?"
Is it because we are more anxious as a nation?
Are we more aware?
Or is it because there are more drugs available?
[woman 2] Anxiety is an alarm saying something is wrong.
Something's very wrong right now.
To our brains and bodies, we're not ever taking a break.
We're basically working all the time.
A half a Xanax is kind of where I would like to live.
That's the mellow that I perceive
that everybody else is operating at. [laughs]
Wait. Hang on. It's Xanax o'clock.
A pill is a really simple solution
that we have created this whole infrastructure to promote.
But now doctors are warning they're more addictive and dangerous
than people think.
The first time I took it,
I said, "Oh, I understand why people get addicted to this."
[laughs]
I need to be careful with this one, definitely.
Knowing what I know now,
I would never have taken that first prescription.
[splutters] Never.
[man] You go to a doctor, and you expect to be helped,
what you don't realize is that if your problems didn't scare you,
wait till you see our solutions.
We're stuck in this old story,
fixing something that's broken
instead of building resilience against it in the first place.
[ominous music plays]
One of the things that's unique about modern life
is how much we spend our lives in our heads.
I mean, our lives really are now conducted largely,
you know, in this space between our ears.
We're not running away from tigers. In some ways, that'd be much simpler.
And 2,000 years ago, what was the main means of transportation?
-Fear. -Fear?
An animal would growl and give your leg a bite.
You'd run a mile in a minute.
-So fear transported-- -Fear kept you moving.
-I see. -Fear kept you going.
When we're anxious, what's happening in our body is very similar
to what's happening when we're fearful.
Most every brain of humans and primates and mammals,
and even reptiles, has a fear center, and it's called the amygdala.
In humans, there's two of them. They're symmetrical,
they're kind of in the middle, they're shaped a little like almonds.
The amygdala fires if there's anything to be nervous about or fearful about.
It's that fight-flight response.
So that's our sympathetic nervous system preparing us for action.
Our blood is pumping, our heart is racing, our muscles are activated.
Anxiety is actually a form of energy.
And energy, if appropriately channeled, is-- can be a really positive thing.
It actually energizes us to achieve, to accomplish.
We become smarter, more focused, more driven, more ambitious, more hopeful,
if we have that right amount of anxiety
that we can accept and engage with in our lives.
When I think about anxiety disorders,
I think that these are people who have a tendency
to have this adrenaline surge,
and it's paralyzing for them.
So either it's cognitively paralyzing, or physically paralyzing, or both.
When I'm having an anxiety attack,
the first thing I do is I feel hot and pressure.
I feel almost like the air is thick and sort of pushing down on me
like a really hot, really heavy blanket.
The heart is racing and thumping.
The breathing was getting faster
and felt like there was a tight band around my chest.
[Phoebe] It feels like I need to breathe more frequently
to get enough oxygen to just, like, survive.
And I just could not catch my breath.
Your pupils dilate. You start to sweat.
Blood runs away from your stomach to your limbs.
And, you know, for me, often it's, "Oh my God. My stomach hurts."
"What's gonna happen? Am I gonna get sick?"
My muscles are so seized up that I'm just clinching everything.
Rationally, you're like, "This is… This is ridiculous."
"There's nothing there." But we can't think with logic, um, at all.
[Scott] There's a whole host of changes that… that happen,
measurable down to the molecular level.
So that's the… the physical level.
Then there's a psychological level. What are you feeling? Dread.
-This apprehension. -Fear.
And then I would take a Xanax,
-and… three or four minutes later… -[clock ticks]
…it was like I was normal again.
And for me… [blows]
…you can almost feel it kick in with a click,
which is why it felt like such a magic elixir to me.
First of all, it gave me the physical relaxation
that I needed to be able to relax the muscles,
relax the hands, relax the breathing,
and took the intense pressure off,
while I was trying to regain my balance.
It was really nothing like I'd ever felt before.
[ominous music plays]
It gives you the ability to just let go.
Just let go of all the stresses of the day and all the worries of the day,
and all that weight that's on you is… is gone.
[man] I don't know if anyone here has ever tried Xanax,
but it's fantastic. [chuckles]
-Very muted claps for Xanax. -[crowd laughs]
You don't really get "Whoo's," it's more like, "Yeah."
[reporter] Benzodiazepines.
-[woman] Yes. -This is the class of drugs.
What are the names people recognize?
[woman] Valium. Xanax.
Klonopin. Ativan. One of the first ones is called Librium.
[man] Really, they pharmacologically share the same mechanism.
Benzodiazepines enhance a neurotransmitter in the brain called GABA.
You could think of it as being a depressant.
[mellow music plays]
That is, it reduces the communication from one brain cell to another.
So it calms the brain down. It's like, "Shh." You know? [laughs]
[heart beating]
[Dr. Dennis-Tiwary] It calms all of these fight-flight responses that we have.
It slows our breathing. It slows our heart rate.
So it's depressing all of those activations.
And as a result,
when we're biologically calmed, we feel emotionally more calmed.
I could think clearly. Um, my thoughts would flow smoothly.
It made me feel like a better version of myself,
and I think in some ways, I was.
By the time I was in second grade, I knew I was a nervous kid.
Um, I knew that I had a nervous stomach, um, and I didn't like it.
Very early in life, I developed an acute phobia
that my mom had, of throwing up,
um, which is a peculiar…
phobia, but not that uncommon, we now know.
From the time I was like six years old,
um, you know, I lived in mortal terror of that,
which led to phobia about germs and food, and food poisoning.
And sort of the amount of time that I spend surveying my environment
for that particular threat over… over my life is… is kind of insane.
As I got older, um, I would start to get panic attacks.
Hello and welcome aboard.
[Scott] Flying still provokes overwhelming physical anxiety.
[flight attendant] Take a moment to locate the exit nearest to you.
[Scott] If I have to do public speaking, overwhelming physical anxiety.
As I, you know, went through my career in journalism and writing and editing,
I was having to do more flying, more public speaking.
Over my thirties and into my forties,
I published two books for which I had to do public speaking,
and I, kind of, through that, learned how to kind of titrate my dosages.
And I still felt anxious
but it wasn't like Cindy Brady in that episode of The Brady Bunch.
When this red light goes on,
we're on the air and will be in everybody's living room.
[Scott] When the red light on the camera goes on,
and, you know, she freezes.
[laughter]
And then, in 2014, I published the book My Age of Anxiety…
which talks about my issues with anxiety, and I thought maybe it will help me
'cause that'd be the best breakthrough ending arc for the book.
A, I'd be cured, which would be the main thing,
B, maybe I would've had an even bigger bestseller
'cause it's, "Here's how you do it." Instead, it's like, "I'm still anxious."
Not as satisfying or useful, um, an ending.
Imagine having all your everyday activities crippled
by fears and anxiety.
Scott Stossel has fought anxiety his whole life.
Its author, Scott Stossel, is the editor of The Atlantic and a Harvard graduate.
He's also a married father of two.
I think in the short term, it had a paradoxical effect
in that it made my anxiety worse.
Like, my levels of, you know, benzodiazepine consumption went up.
How do you and 40 million other people treat this kind of anxiety?
[splutters] So I have tried lots of things,
but I'm medicated, and again,
this is something I never admitted 'cause I was ashamed.
But I take antidepressants, benzodiazepines, which are… [splutters]
-[Stephen] Like Xanax? -Xanax, an antianxiety medication--
-Did you bring enough for the whole class? -Um…
[splutters] I have some. Do you want me share?
One of the things I was trying to figure out in writing the book is,
"Is the source of that anxiety some hard-wiring that is genetic?"
"Is it some psychic wound from when I was a small child?"
A large proportion of your baseline temperament,
how you react to the world,
a lot of that you are born with.
And they've done all kinds of, you know, twin studies.
And they can show that has a profound effect.
[boy laughs]
As profound effect as that is, however, it is not complete
because if it were, paired sets of identical twins
would always have the same level of anxiety,
and that is not at all the case.
The experiences you have have a huge impact.
[chuckles]
[inhales, exhales]
[trainer] Mm-hmm.
Quick hip-hop drive. Drive. I want those feet to drive.
[exhales]
[inhales deeply]
[grunts]
[Phoebe] My first experiences with anxiety were definitely during my schooling years.
[exhales]
Because I was bullied for most of my schooling years.
There were three Black people in my entire elementary school.
So I was always the only Black person in the class,
and there was a lot of race-based bullying.
I had this fear of recess
because that was when the worst things would happen.
I grew up in South Florida, and I came from a humble background.
My parents, uh, didn't have a lot.
I joined the military right out of high school
because I knew I wanted to go to college.
I needed to find a way to pay for it myself.
I spent about fifteen months in Iraq.
I'm very fortunate to be able to say that my deployment was mostly uneventful.
On the other hand, though, I did experience sexual assault
while I was in the military, and that was the one thing that caused
a lot of the issues that I experienced after I left.
[trainer] Deep breath in. Feel that tension?
Mm-hmm.
[Phoebe] Seventy-five?
[Phoebe exhales]
[inhales sharply, grunts]
-[trainer] Close. Close. -[laughs] No.
After I came back,
I decided to move to New York City to go to college.
I wanted to study fashion.
I felt so distant from the students that I was studying with
because I was older than them
and had gone through things that they hadn't gone through.
I just couldn't relate at all.
And for me, sitting in that classroom
was the most important thing I was gonna do that day
because I gambled with my life for a chance to sit in that seat.
Also, my brain was sort of forcing me to start confronting
what had happened to me while I was deployed.
So all of that was coming up at the same time.
And that's when I was first prescribed medication,
and they were extremely helpful at that time
when I was basically at a crisis point,
and I was, like, hanging onto life by my fingernails.
[car honks]
[birds chirping]
[woman] I was thinking last night, before I went to bed,
"What will I need to calm down?"
I need, like, certainty.
It always attacks this, like, medium.
I need to know.
I need to know the future. I'm like, "Is it gonna be okay?" Like--
"No, no. No, doc." I need to speak to a doctor or a psychic.
[laughs] I need to know.
So, uh, two weeks into the pandemic, I lost my job.
I mean, I remember thinking, "What am I gonna do about rent?"
"What am I going to do about my bills? Like… Like, what's gonna happen?"
I made an arrangement to live with my boyfriend.
And then, I actually found out that he had been cheating on me,
so I had to move back home to my mom's.
So I had to stay home.
I wasn't working.
Um, I didn't have a car,
and my parents were working, and I was alone.
And so, I had to, like, hide this immense pain,
especially, um, because I didn't want to hurt my parents.
They were very hurt and very upset.
And that's what I was like, "This is anxiety."
I remember thinking, "I don't want night to come."
Like, every single night.
And then I had a friend who had Xanax, and I was like,
"I need to numb myself to be able to sleep."
[inhales] I asked my old therapist about it,
and I was surprised that she told me it was up to me.
I was like, "What the hell?"
I thought that it was going to be like… [inhales deeply]
like again, like that reassurance of a therapist who said,
"Oh, you're not… you're not there. You're not… You're not Xanax anxiety."
But then, she was like,
"Yeah, if you want to, we could explore that option."
So I was like, "Ugh, wow, ball really is in your court."
Kind of like a glass thing that you, like, break in case of emergency,
but you have to choose your emergency, like, so carefully.
Benzodiazepine prescriptions have essentially been rising
over the past two to three decades.
When you even just look at the numbers of people who struggle with anxiety.
It's a third of us in our lifetime. A third. One in three.
And that… that means that you are debilitated by anxiety
to a degree that you could be diagnosed with anxiety disorder.
So it's a pretty big stat.
So what I think is happening here is you're having a panic attack.
Oh no, those… those aren't real.
Those are a PR spin for celebrity publicists.
Trust me, I've known enough celebrities. [scoffs]
No, it's absolutely a real thing.
I think we're fed a myth that everybody else has it together.
"I'm the only one struggling. I'm the only one who has trouble."
Everybody else just manages it flawlessly.
What's wrong with me that I can't do that?
It's a cycle that keeps-- that spirals up at different times.
Part of that equation is expectations.
There's this expectation that you'll be able to create something.
Not only create it but then curate it on social media
and have a million followers.
Social media will make you anxious. There's really no way around it.
You're comparing your internal true experience
with their sort of external, curated, airbrushed experience.
You'll always come up short.
There are a lot of really brand new social problems.
You don't have boundaries between work and home.
[reporter] iPhones over eye contact has now become status quo.
If we're in our heads, on our phones,
on our laptops, we're not in our bodies.
You know, we're elsewhere.
Teens are not hanging out as much with friends.
We're separated from our bodies. We're separated from each other.
We're separated from nature.
We're all just looking into our phones, and we're by ourselves.
-Then suddenly the day's over. -That's a huge part of it.
Maybe psychotropics are a way to adapt to a world that we,
in some ways, are not built for.
-[woman] Oh my-- -[building explodes]
We're constantly being stimulated with these horrific events
that occur all over the world.
Are we witnessing the start of World War III?
I grew up in a time where the news was on only about three times a day.
-Nuclear weapons-- -This unit--
[Dr. Lindsey] Now you can get the news cycle going 24/7.
It's the sort of background hum
that you don't think about every day, but it's there.
[reporter 1] "Eco-anxiety."
[reporter 2] The epidemic of loneliness.
Election stress disorder.
Many Americans say they feel it, the anxiety and stress.
I'm gonna grab a Xanax from the bedroom.
Okay. Will you grab me six?
-I'm just gonna bring the whole bottle. -Okay.
We were already not in great shape before COVID-19 came.
Anxiety had already overtaken depression as sort of the diagnosis du jour.
The pandemic's obviously made it worse.
[reporter] It's one in a series of stunning meltdowns.
Child Care is one of the greatest sources of stress.
The only, uh, solution I had was to go into a closet,
kneel, get down on my knees, kneel,
start crying and praying. Like, "Please get me through this."
A group of mothers has found an unusual way to cope
with the stresses and strains.
-[reporter 1] Primal scream therapy. -[women scream]
[reporter 2] Scientists really cannot believe--
There's such a perfect storm of factors
that we would be more anxious today than ever before.
[crowd talking indistinctly]
[static]
-[jaunty music plays] -[mooing]
[man] If you can get in a time machine and go back to the past,
I'd love to do it with you.
Americans drank. Oh, we drank.
[acoustic guitar plays]
Whether someone gets relief from the bottle of alcohol
or a bottle of medicine,
people are… are doing therapy, self-medicating themselves.
The human equipment for what we today call anxiety
has presumably been the same for tens of thousands of years.
We have called it melancholia,
the vapors, the English Malady,
neuroses, nervous temperament, nervous breakdown, neurasthenia.
And neurasthenia was kind of the disease of Gilded Age capitalism.
It was rampant.
People were being diagnosed with it left and right.
[Schuster] They saw neurasthenia as this new type of illness,
the product of modern life.
[Scott] People moving into cities, factories came online,
women moving into the workforce and sort of achieving independence.
[Schuster] The steam engine, the daily press,
and the flow of information.
[Scott] Crazy pace of news.
People would read in their newspaper in the morning
about a volcano that explodes on the other side of the world,
and then they would dwell on it all day
about how a volcano can destroy, um, an entire city.
Technology-induced anxiety
is not something unique to us. We're not the first to experience it.
[Schuster] A typical symptom would be an inability to turn off your thoughts.
Morbid thoughts, insomnia,
digestive issues,
different pains.
Back pain was very popular.
Sexual dysfunction, tooth decay.
Tooth decay.
A very lucrative market developed,
and that's through advertising, advertising, advertising.
"You feel this way,
well, you might have this illness, and here is the cure."
For many upstanding, middle-class families,
alcohol was considered sinful.
On the other hand, medicine was medicine.
And we still get that today.
You know, you'll talk to a friend, and the friend says things like,
"I don't take drugs." But they take medicine.
Uh, and… Yeah.
[man] I feel like I always knew I had anxiety,
but I didn't wanna identify myself as having anxiety.
It's like, "I don't want to go down that road that makes me weaker."
"I'm fine." Like,
"Yes, I have my like little quirks and things like that, but I'm not that."
I was watching, um, the show Girlfriends, and they have an amazing episode
about just how Black people and people of color sort of react
to therapy and mental health.
Y-You're going to therapy?
Joan, girl, Black people don't go to therapy, girl, they go to church.
[laughing] And I think for a lot of us, it was like they'd pray it away.
Pray away illness, pray away this, pray away that,
and you can't always pray away everything, as evidenced by much. [laughs]
When I was a kid, I was loud, a bit nervous,
I had to be the boss of everything, but I was just happy though.
I was just like, "Yeah, this is fun. This is who I am."
These are my tantrums. I need everything to be particular.
Um… [laughs]
But I think I was funny. I was always a pretty funny kid.
My parents put me in figure skating, and I was like, "I'll be an Olympian."
"This is the perfect sport for me. It's about precision, and I'm good at it,"
well up into adolescence.
And I gained some weight, which freaked me out, and then I was like,
"Oh God, am I gay too? Jesus, I really got dealt a hand here."
I was like, "Okay, well, this is everything that's wrong,
so I'll just become everything that's right."
So I became a very good student. Became very type A.
In college, I found a lot of relief in the party scene.
It was really sophomore year where I just couldn't keep it all
in balance anymore, and that's when--
In my head, I was like, "Yeah, it's because I can't focus."
"Everyone else is taking Adderall, so that's why I'll go see a doctor."
"I'll go take Adderall, and everything will be fine
because I'll be able to do it all." But very quickly after…
[chuckles] …anxiety reared its head because that was really the problem.
It was the anxiety and trying to keep the anxiety at bay,
and sort of destroying everything else in the process
because it took so much mental energy to keep it in check.
I like, went in and I was like, "I can't sleep anymore." I was like--
And that's really wrecking with things.
He's like, "Oh, okay, so do you feel anxious or anything like that?"
I was like, "I don't know if I'd call it anxiety,
but I definitely feel restless."
And he was like, "All right. Let's try Xanax."
I mean, had some of the best sleep of my life… taking Xanax.
No dreams, just hardcore, blackout sleep, um, which was great.
But I was never addressing my anxiety, and I never thought I had anxiety.
So it was, "Oh no, I have anxiety from my Adderall." [chuckles]
So it was never a root cause.
It was always the result of something else for a long time.
And then, as I met other people,
especially people I met from New York City,
or cities, or more affluent areas, they were all very much like,
"Yeah. We all see therapists. We all take pills."
Like, "Life sucks. We're not well, so that's how you manage it."
[Scott] The introduction of medical treatments
and pills that could treat these things very effectively
did change the… the notion of stigma.
If you have glaucoma in your eye and have trouble seeing,
you take, you know, a glaucoma medication that makes you able to see.
If you have diabetes and have insulin dysregulation,
you regulate your insulin.
That is not a moral failure that my pancreas doesn't work right.
It's not a moral failing that my eyes aren't working right.
So why is it a moral failing that, um, I am susceptible to panic?
There's a biological problem, and you fix it.
Benzodiazepines were invented in the 1950s, early '60s.
There was a great deal of excitement because they were to replace barbiturates.
There's a strong possibility that at this moment, in your medicine cabinet,
you have a drug that can hook you just as completely,
injure you just as terribly as heroin or morphine.
I'm speaking of barbiturates.
The number one cause of death by poisoning in the United States.
[man] You wake up a few hours later, and you forgot how much you've taken.
Better make it three.
Benzodiazepines are much safer than that.
So by the 1970s, benzodiazepines topped the charts
of the most frequently prescribed medications
in the United States and across the world.
There is something to the idea
that this is the way of medicating the masses.
It is the literal opium of the masses. It's the benzodiazepines of the masses.
Does anyone have a Valium?
[mellow music plays]
On an individual level, the unhappy housewife,
or the unhappy lawyer who might wanna be in a different career,
instead of figuring out that better life choice,
they are simply smoothing away those feelings of discomfort
with that… medication.
I can't believe the two of you are eating in the middle of a crisis like this.
-We're nervous. What do you want? -Then take a Valium like a normal person.
But lo and behold, as time went on,
we realized that you can actually take too much of these medications.
And there are a number of problematic side effects
that came with long-term benzodiazepine use.
Today a senate health subcommittee heard a series of terrible stories
told by people addicted to Valium.
[reporter 1] A doctor from California said withdrawing from it felt
as though someone poured kerosene under his skin and set it a fire.
[reporter 2] Valium is America's most widely prescribed drug.
The FDA is warning doctors not to prescribe for everyday stress.
[Gold] And then came Xanax.
[man] Upjohn scientists succeeded in creating a molecule
that helps control anxiety disorders.
Acting on nerve cells in the area of the brain,
which controls emotion and anxiety.
The drug is more selective in its action,
resulting in fewer side effects than older drugs.
[woman] Xanax. Prescriptions number in the millions.
I'm very much afraid that the same kind of over-prescribing,
the same kind of promiscuous… availability
is occurring with that drug.
And then, 9/11 was really when the floodgates were opened.
People's nerves were very jangly. People were on edge.
The anguish of the attack on America is taking its toll in many ways,
including mental health.
[reporter 1] How do we ever heal?
This disaster was also a mental health catastrophe
of massive proportions.
[reporter 2] Prescriptions for antianxiety medications
are up 23% in New York and 8% nationally.
And there was an uptake in advertising.
Ads saying, you know,
"Are you feeling more nervous? Our medicines can make you feel better."
They showed pictures of women
with worry bubbles of all the things they were worried about.
And women responded.
And the numbers of women who started taking antidepressants,
antianxiety meds, sleeping pills, after 9/11, went up and up and up.
[Regina] Don't wanna stereotype, but I think a lot of women do get that
where we don't take care of ourselves and don't carve out time for ourselves,
and that really led into… my anxiety boiling over.
I'm of the generation where they told us that we could have it all.
They just didn't tell us how.
My mother was home with us.
And I think I did have the mental picture that I would be… mostly home,
just 'cause that's what I knew growing up.
But then,
I was 34 when my son came along, so I was already in the workplace,
and already had a mortgage, and had balanced out the life
to where I have to work, then trying to balance,
well, "Who's going to be able to take my son to this lesson,
or try to get off work in time to do it?"
Now I have to come home and cook dinner.
[laughs] And I felt like I was operating
on a high vibrating tension level at all times.
You think, "Okay, great. I'll finish work, and I'll just have a glass of wine,"
and overall, that's physically and mentally
a very unhealthy thing for me, personally.
I think for some people, it works great,
but that was actually ratcheting up my stress.
About two years ago,
everything really kind of ramped up at once.
My husband's mother has some dementia
and is in a nursing home out of state from us.
My son entered a new stage of adolescence.
So it was just re-navigating our relationship
and me learning to back up.
Work got incredibly stressful,
and then menopause can just throw everything out the window.
It's like, you're going along on an even keel,
and your life has been fine up until your '50s or whatever. [inhales]
And that throws your hormones and your life completely out of balance.
I think it's fair to say
that the female body and the male body are not exactly identical.
That there are very different hormones that work in one or in the other.
But probably more important than that,
women have a lot of role models of other women
who show them how to be anxious, let's say, in an acceptable way.
[Dr. Lindsey] We socialize girls to be more expressive of their emotions.
We support the little girl who is crying
and… and, um… and needs that extra attention.
Whereas with boys, we tell them to go out there and play,
to… to fight it out, to be tough and stop crying.
Now, let's blow our nose and dry our eyes.
[blows nose]
Wouldn't want Mike and his mother to see us this way.
[mellow music plays]
[Tasmin] I've been a therapist for about 16, 17 years.
I've worked in the schools. I've gone and done in-home therapy.
Finally, about five years ago, I started a private practice.
And in my practice, I just felt like not enough men were coming into therapy.
So in my process of really just trying to understand,
"Why? Why aren't men coming to therapy?"
I did some research on that, and cost, for one, like, you know,
they might be underinsured, uninsured, or not be able to afford it.
That's a huge reason why a lot of people I imagine might not go to therapy.
But specifically with Black men, also the issue of,
"Going into a system that is not built for me."
Which it is not. [chuckles]
It's not a system that is built for people of color.
I've been in session with a person of color,
and I'm like, "That's just not gonna work."
Like, "I can't say it that way."
The very best example is
one of my questions on my intake paperwork is,
"Have you ever experienced any traumas?"
This client has said no to that… that question, two, three times.
Then one day, as he was answering a question,
he was like, "Hmm, let me see… Was that before or after I got shot?"
And I'm like, "Whoa, whoa, whoa. Did you say, 'Got shot'?"
"You never told me you got shot."
And you know what he said? "You never asked."
And I'm like, "I can't put on my intake paperwork,
'Have you ever been shot,' because that's a unique experience."
And he said, "It's not that unique of an experience."
"I know a lot of people who've been shot."
That was the moment that told me that I needed to shift in the way in which
I am even asking questions or taking an assessment.
Perhaps, if you live in an environment
that your personal humanity,
your safety, security, well-being is constantly under threat,
you know, you have to show toughness.
So to then acknowledge
that you're having a mental health struggle or challenge…
No, that's… that's not the case.
I have a semester and a half at college. So, I understand Freud.
I understand therapy as a concept. But in my world, that does not go down.
Could I be happier? Yeah. Yeah. Who couldn't?
But I will tell you as a psychiatrist who treats men… [chuckles]
…uh, lots of men get anxious.
Um, I think that many men are getting more comfortable admitting
that they're anxious, talking about social anxiety,
or generalized anxiety,
or something like fear of contagion, for instance.
It's changing. I think there's a huge shift.
Everybody's talking about mental health. Now you have Charlamagne tha God.
Everything is mental. Everything starts with a thought.
So if you don't have this right, nothing else will be right.
You have Jay-Z.
Well, if you grow, you realize the… the ridiculousness
of the stigma attached to it. It's like,
"Why don't you just talk to someone about your problems," you know.
That is helping to normalize it for… for men.
That typical profile of a patient
who might be prescribed benzodiazepine is widening.
So, um, whereas it might have been, typically,
you know, 30 years ago, um, a middle-aged woman,
now we're seeing younger and younger age groups.
We're seeing very old people are not only being prescribed benzodiazepines,
but being kept on them for much longer periods of time.
The training about using these medications
is not always as robust as one would hope.
These are drugs that were really meant to be taken short-term,
no longer than, let's say, a month or so,
which is really stunning when you think about the fact
that many, many people who are initiated on a benzodiazepine
will be… will continue to take that for years or even decades.
[ominous music plays]
[Audrey] When I first had my… my very first panic attack,
I really thought I was going crazy.
I was like, "You need to lock me away 'cause I don't know what is going on."
So I was probably 14 or 15.
I had traveled a ton as a kid and enjoyed flying.
[inhales] But for some reason, this day we were about ready to take off,
and all of a sudden, I'm like-- Feel like I'm melting from the inside out.
I can't breathe. I thought I was dying. Uh, really.
And, after that, was a couple really smooth years.
When I was about to be a senior,
it was my summer going into my senior year in high school,
I worked at Panera at the time, and I was at the cash register,
and so I was interacting with people, and I started bawling
in front of this couple that had come in, and I was, I mean… mortified.
It was extremely embarrassing.
But I was like, "I don't know what was going on." Like--
"I've been here hundreds of times."
"Why am I…" Like, "What is wrong with me?"
It was getting to the point where I couldn't complete daily tasks
without, um, like, having a meltdown.
I couldn't go to the grocery store, I couldn't drive down the street,
like simple things that you normally do every single day.
You feel trapped and that's-- Who wants to feel like that?
I mean, you'd do anything to not feel like that.
[birds chirping]
Me and my dad have always been incredibly similar.
Just kind of an unspoken language that we have,
and he had experienced anxiety in his early adulthood.
Um, so he kind of recognized the signs right away.
He just wasn't qualified to deal with what I needed.
I honestly didn't know a whole lot about psychiatric medication at all
when I started therapy.
But she had mentioned a certain drug called Zoloft,
which I ended up taking and still take.
We didn't start talking about Xanax, um, until…
I had to fly again.
I had told my psychiatrist, I was like, "Look, there is no way in hell
that I am ever going to fly again." Like…
"I'll drive for three days in a row if I have to. I'm just not doing it."
And she was kinda like, "Have you ever thought about Xanax?"
[plane engine roaring]
I landed, and I, like, really wanted to go on top of a mountain
and just scream to the world that I did it.
I didn't cry. I didn't hyperventilate.
I didn't have a panic attack. I was completely fine.
It originally started off with using Xanax for certain situations,
and then I made the choice to take it daily
because it did work for me.
I need that release in order to go to sleep.
I was like, you know… [hesitates]
…at this point, I'm…
so far below my peers
and their, um, ability to just live.
Uh, and… and why would I do that when there is something that could help?
[Dr. Holland] Any medicine, any drug,
there's always a risk-benefit analysis, right?
So with the benzos,
the risk and the risk-benefit analysis is quite a few things.
The very common side effect
is just simply being fatigued, being sedated.
That is why they are commonly prescribed to help people fall asleep.
You're disinhibited, you're a little loopy, a little sleepy,
maybe you make bad decisions.
Like, nobody really wants to share, like,
all the nitty-gritty stuff when you take medication.
For me, everything was just hilarious when I took it, um…
so that really would not be good
if I was going to an interview or something important like that,
and I'm just laughing the whole time.
For some people, that inhibitory effect actually is a dis-inhibition effect,
and they become more loose, and light, and goofy, and silly.
I just feel like I'm excited, and I feel relaxed, and I'm…
♪ Ready to party ♪
Benzodiazepines are basically alcohol in pill form.
You know, one of the problems with the benzos
is that they can really interfere with short-term memory,
with laying down new memories, with retrieving memories,
you know, everything gets a little fuzzy.
Don't really remember anything after taking it, um…
and yeah, that obviously can be really bad if you're, like, driving.
Some of the long-term risks of benzodiazepines are well-known.
The data about Alzheimer's disease and dementia, though, is relatively new
in just the last several years.
And it's a significant risk.
If you think about it, you're taking a depressant,
so with less use of your brain,
it could be that some of those brain cells began to, like die off,
decreasing overall brain activity.
There is also a much more ordinary side effect,
which we call tolerance.
And tolerance means needing more and more of the drug to get the same effect.
It was an essential part of my toolkit. I carried benzos with me all the time.
In fact, I had done that basically for 30 years.
It changed my overall level of anxiety
because I knew I always had that magic bullet.
I was like, "I have figured out a system that works."
"I can get through plane flights. I can get through public speaking things
with my Xanax and Klonopin."
Before that point, I would spend weeks, if not months dreading these things,
nightmares about them, cold sweats. That went away.
If I would go through a particularly anxious period
where… where I would intentionally take a lot more,
I would go up on a higher level and taper back down afterwards.
And I would feel it. Afterwards, I would get physical symptoms.
Um, sometimes I'd just feel like elevated anxiety,
and my GABA receptor is basically going, "Hey, where's that… where's that Xanax?"
The nightmares I started to have became different. What I would dream was,
"Oh my God, I have to do a post speaking, and I lost my Xanax."
Or, you know, I'm on an airplane, and I… I'm out of it.
I was clearly psychologically dependent from that point forward on,
on the benzos.
Not all benzodiazepines are created equal.
Xanax, for example, works more quickly than most other benzodiazepines
and wears off more quickly than most other benzodiazepines.
Agents that had that kind of immediate reinforcing quality,
but then wear off quickly so you get into that kind of dysphoric,
wanting, craving state, tend to be more addictive.
[calm music plays]
[Phoebe] I do have addiction in my family,
and so I have really resisted in having substances in my life at all.
I don't really drink at all, I've never smoked,
I've never been high because I was afraid
that maybe there was something about my family
that made it that people got addicted to things.
Yeah.
Great job.
But, you know, we talked about starting on a really low dosage.
We talked about, like, what sort of things to look for
and the fear that I had in the beginning,
of having to go up and up and up and up, didn't actually happen.
I was able to get a lot of relief with a pretty low dosage.
[chuckling] And I think having that very healthy fear of addiction
made it so that I really focused on, like,
"Medication is a tool for me to make space
for non-medication things to work in my life."
[Dr. Holland] If you're using them judiciously,
every once in a while for acute anxiety, it may not be too much of a problem.
If you take them every day, multiple times a day,
you know, abruptly discontinuing these medicines is very uncomfortable.
The consequences can be severe.
People can become psychotic. They can have seizures.
They can have severe anxiety, terrible insomnia.
I've even seen the distress of benzodiazepine withdrawal
result in suicidal thoughts and even suicide attempts.
Knowing what I know now,
I would never have taken that first prescription.
N-Never.
It was the biggest… …it was the biggest mistake of my life.
I moved to Colorado because I love the outdoors.
And I love… I love skiing.
I love rock climbing. I love mountaineering.
I love white-water rafting and kayaking.
In fact, I love so many high-risk, adrenaline-type sports,
that I kind of wonder,
"How did I ever get diagnosed with anxiety to begin with?"
Hi, sweetie. Let me see what you did.
-So, Dada… -Yeah?
…this is the Christmas tree.
[John] Yeah. Ooh, it's a tall one.
[girl] This is the snowman.
[John] I love it, sweetie.
I think I was maybe on one milligram of Xanax in college, or half a milligram.
And then over the years, it creeped up to one milligram,
to two milligrams, to finally three milligrams,
which is where I landed for,
you know, a good 12 years, 15 years.
And I never took any more than my exact daily dose.
So in about 2013,
I remember telling my psychiatrist that, "You know, life is going good right now."
Kelly was pregnant with our first child, and I couldn't wait to be a dad.
He reduced my Xanax from three milligrams to two-and-a-half milligrams.
And then, out of the blue,
I just started having some kind of mysterious physical symptoms.
Things like sounds and smells being overwhelming.
I would sort of have some heart palpitations.
The skin on my arms would feel like it was burning.
Random muscles would just twitch. I had this horrible, um, brain fog.
And the physical fatigue is one of the worst symptoms.
[tense music plays]
My wife and I started getting more and more concerned. I--
This is something serious going on.
I went to see rheumatologists
-and cardiologists and neurologists… -[heart beating]
…and all sorts of specialists.
Finally, uh, a doctor said,
"You know what, you've really been through the gamut."
He said, "I'm gonna write you a referral to the Mayo Clinic
because they're the best of the best."
Packed up the whole family and flew to Minnesota.
The Mayo neurologist said, "I think you have autoimmune encephalitis."
"It's an inflammation of the brain, and it's easily treatable."
"It is a little uncomfortable. You have to get IV infusions."
I did the eight weeks of infusions, and I didn't feel any better whatsoever.
I-- If anything, I felt worse.
And along this journey, I started asking the doctors
once in a while, I'd say, "Could it be anything to do with my medications?"
"Could my medications be causing any of this?"
And the answer was always, "Oh no. It's definitely not the medications."
"It's for sure not the medications."
By this time, my psychiatrist had crossed me over
from Xanax over to Valium.
I mean, call it just my intuition or--
"I don't know where else to go with this,
so please, I want to taper off of the medication."
[tense music continues]
[kids talking indistinctly]
February of 2018,
I woke up in the morning,
and something was very wrong.
I could hear the kids downstairs,
but the… the noise of the kids playing was… was piercing.
My skin was burning. My… My chest was burning.
I just couldn't take it anymore.
I stormed out of the house,
and I started driving really fast and really erratic.
A voice in my head just said, "I've got to escape. I've got to escape."
And I saw this hill off to the side,
with probably 300 feet high with a cliff on one side.
And I just said,
"I'm gonna climb up that hill, and I'm gonna jump."
[voice breaks] And as I was hiking up…
[sobs] …I had visions of my kids in my head.
And I… dropped on my knees,
and I said, "John, this is not who you are."
"This is not who you are."
And my wife heard me pull in and greeted me at the door.
And I looked at her, and I said, "It's got to be the Valium."
"It's got to be the Valium." [chuckles]
And my wife started Googling "Valium and suicide,"
"Valium withdrawal," "Xanax withdrawal."
[tense music continues]
[Gold] Unfortunately, it was patients themselves
and not the medical profession
that first recognized the problems associated with benzodiazepines,
including dependence, tolerance, and withdrawal.
That data really came from the 1970s and was characterized
by Dr. Heather Ashton, who was a psychiatrist
who ran a benzodiazepine taper clinic out of the UK.
There's been a lack of training in clinical pharmacology
and in the management of drug withdrawal.
Listening to patients has become a lost art,
and doctors have also been seduced by the idea
that drugs are the cure for mental illness.
And she wrote this whole treaty called The Ashton Manual,
which you can find online, which is really a great, great document.
[John] All of a sudden, we came across The Ashton Manual.
There was every symptom I had reported to every doctor,
one right after another.
My wife and I kind of looked at each other like,
"How in the world?"
We went to 32 different doctors, and none of them
connected the dots that I was reducing my benzodiazepine,
and I was in benzo withdrawal.
Some patients have no problems, and some patients are sensitive
to even the most small dose adjustment, dose reduction.
This is particularly true in older people.
You know, as we age, our brains are less plastic.
So, you know, once people get above 50
and they've been on benzodiazepines for decades…
very, very hard to get off.
Too few people are aware of the potential dangers.
Too few doctors are aware of… of those dangers.
And probably somewhat surprisingly to me at this point.
These are useful tools. I'm very happy to have them.
You know, I'm grateful to the people who invented them.
The problem is that we're using them way too often,
and we're using them way too long.
When you look at all the different risk factors
for addiction,
one of the most important is simple access to the drug.
And we live in this age of incredible overprescribing and oversupply,
which means you're more likely to try it and more likely to get addicted to it.
[somber music plays]
I've been a psychiatrist since the mid '90s,
and back then, if somebody came to me
and they had symptoms of anxiety or depression,
I had to sort of explain, you know, "Oh, you have depression."
Or "These are--" "You know, this is a panic attack,"
and I had to spend some time in the first visit or the second visit
where I would sort of destigmatize the fact that they had to take medicines.
Ever since 1997, when the FDA decided
that drug companies could advertise directly to people.
[woman 1] You can't just snap out of clinical depression.
No one can, because it's a real illness.
[man] You may feel anxious. Can't even sleep.
[woman 2] We know what social anxiety can feel like.
The chemical imbalance could be to blame.
[woman 1] You can get your life back. Life can feel like life again.
I don't have to do any kind of educating or destigmatizing or hand-holding
because I have people coming to me saying, you know,
"Should I take Wellbutrin or Effexor,"
you know, or like, um, "My Pilates instructor is on Paxil,
but my dental hygienist said that Zoloft is better, and what's the difference?"
There was really no maintenance about it. There's really no checking in on.
"How are you feeling?"
"What's going on up here?"
"What's your emotional state?" Like, it was just very transactional.
Medicine has become industrialized to the point
where doctors kind of function like workers on an assembly line.
And after him, all of my psychiatrists, I guess, were very transactional.
And I found people who were transactional, because I was like,
"I don't wanna get into what I'm feeling. I don't wanna talk about that."
There's enormous pressure on doctors to see patients quickly,
to get them in and out, to prescribe pills,
because that's what third-party payers will reimburse.
One doctor was like, "Could you tell me about your childhood in Texas?"
And I was like, "I don't wanna." Like, "Let's just get to the script part."
[Dr. Lembke] We're now asking patients were they satisfied with their service.
Doctors very eager to be rated highly
because their professional advancement is tied to how they do on those surveys.
So, naturally, with all of those kinds of invisible incentives,
you know, doctors will write for what patients want.
The other issue is that in the short term, these agents really work.
I went to a therapist when I was thirteen in New Hampshire.
[tsks] Uh…
Who, the day I--
First day, I went there, he said… And this is in '84 or something,
and he said, "I'm going to write you a prescription."
"Every time you feel sad, you take one of these."
It was Xanax.
I do want to be careful. I don't wanna demonize all benzodiazepines, all drugs.
What I do know is that they're overprescribed, like opioids.
And they're both painkillers.
One is of emotional pain, and the other of physical pain.
There's this huge Xanax crisis in so many communities.
[Dr. Lembke] We're in the midst of a prescription drug epidemic.
So a lot of times people think that was just about opioids,
but it wasn't just about opioids.
[interviewer] Rapper Lil Xan, that's short for Xanax,
is one of the more than 50 artists
we found who reference Xanax in their music.
I was probably taking… [exhales]
…12 two milligrams to 14 two milligrams a day.
Wow.
It was… It was really bad.
["Praying To The Sky" by Lil Peep plays]
That double-edged sword of…
of acknowledging pain, or anxiety,
or whatever it is, and not glamorizing it.
It's a very sharp double-edged sword. It's just so easy to…
to not walk… walk that line.
And we don't give young people many tools for doing that.
[interviewer] It wasn't long before Bobby mimicked his idols
and swallowed his first pill in tenth grade.
I got hooked the first pill I took.
One phone call, one text away from getting it. Yeah.
Any type of pill, basically.
[reporter] Social media, now an essential tool
to buy these pills online.
Essentially, this is now… This can now be your dealer.
By tapping a few things in, you can get Xanax easily.
Those pills are all over the place.
I found this account which is the 104 dealers
that are using Snapchat,
that you can contact if you just type in their name.
So it's basically a drug dealers directory.
Now we've got a lot of people in illicit laboratories,
illegal laboratories,
who are making these super potent versions of benzodiazepines.
[reporter] New information about a deadly drug.
It's a small, white pill designed to look like the antianxiety drug, Xanax.
But it is mixed with an extremely strong opioid
called fentanyl.
[man] People can go online, and they can buy a pill press.
They can buy the pill dye.
[woman] This is going to be the fentanyl with any other cutting agent,
and then as I spin the wheel…
and then up comes the tablet.
You can have two pills that you bought from your drug dealer,
and one has a little bit more fentanyl than the other.
And that one will be the one that ends your life.
The pills that are coming up from Mexico are professionally, uh, done.
You can't tell the difference.
The color's perfect, the markings are… are fine,
and the texture of the… of the pill…
They just look exactly like the real thing. Scary.
Celebrity TV therapist, Laura Berman, has revealed that her teenage son died
of a deadly drug overdose on Sunday.
You said you think it was fentanyl laced with something.
Was he in any kind of pain that he'd be taking these drugs to begin with?
-Do you think he knew what he was taking? -No. He--
No.
In the last ten years, what we have often seen
is that most overdoses are not just one substance.
It's usually a combination of different medications.
A benzodiazepine is not very dangerous when taken in high amounts alone,
but when you combine it with opioids,
that's essentially anesthesia and is very dangerous.
[Dr. Dennis-Tiwary] Because then you have a double-depressant effect.
So you can actually have a cardiac emergency.
You can die. You can stop breathing.
[reporter] He was only twenty-one.
A popular YouTube star and emerging rapper,
Lil Peep, died last night.
[Dr. Dennis-Tiwary] There's just so many deaths in the news,
um, that have to do with painkillers or benzodiazepines.
They're struggling so much with that perfect storm
of pain and anxiety, and needing to dull it and get through somehow.
[Lil Xan] I looked in the mirror and I'm like--
it was just that moment, you know, like,
"If I keep doing this, I'm gonna die soon."
So I just quit, cold turkey,
and I actually ended up having a few seizures,
and I landed in the hospital.
[reporter] After numerous attempts, Xan told us he got clean.
So I wanted to make a movement, Xanarchy,
about just nothing but anti-Xan use,
and that's really what I'm trying to promote.
I think that we need to start holding each other and ourselves accountable
for our glorification of the drug culture, one hundred percent.
♪ Don't give me the Xannie now, or ever… ♪
I did not like growing up with people I really loved
and then them turning into people they weren't.
It's just weird to watch, and I don't wanna have people die anymore.
I don't want people to die, due.
Kids are the canaries in the coal mine now.
They are definitely the signs that things are not okay… in our world.
My clinic has become about 50% a "de-prescribing" clinic,
meaning I'm having more and more patients coming in
or being referred for help getting off of opioids
or benzodiazepines or both.
It's confusing for the patients too,
because patients who are dependent upon the medications,
who take them long-term, they can't imagine a life without it.
And it may not even be they're without anxiety
or that they're doing well,
but they just can't function without the medicines.
The idea of it is terribly frightening to them.
And that's really the withdrawal symptoms.
That's the nature of tolerance and withdrawal.
[inhales, exhales]
[faucet running]
[exhales]
[deep breath]
It's a good thing I took chemistry in college.
This isn't anything that any doctor is gonna teach you how to do.
That's called a liquid micro taper.
And what it allows you to do is to…
reduce your dose by a tiny, tiny fraction…
every day.
If you go too fast,
you can go into a state of complete terror.
These chemicals are so powerful,
even tapering slowly like this takes… years.
[ice tinkling]
[train horn blaring]
[Audrey] So from center line to top of rail?
-[man] Five foot one. -[Audrey] Five-one.
[man] Tell me when you're ready for number one.
[Audrey] Go for it.
[man] All right, over here we're looking at… two foot six.
Two-six.
So I work with the state of Michigan,
and the program that I work in is to become a civil engineer.
I've had it for three years now, this job, and it's, um,
you know, it's a big-girl job. I got it right when I turned 18.
And it was nice to have people rely on me for, uh, certain things.
Stressful, no doubt,
but it was the right amount of stress to push me to get it done.
Wasn't so much that I was overwhelmed.
Most of the people who are very anti-Xanax,
get that idea from the recreational use of it.
For people like me, when you kind of see people using it
in the wrong way, it's like,
"If you only knew what it could do to someone who really needs it."
I take one milligram daily,
and that was my starting dose,
and it's been my dose this whole entire time.
It can be addictive. Um, it's not in my case,
but psychologically, yes.
I mean, it's always gonna be, "If I don't have that, what do I do?"
I mean, it is easy to… to become…
totally, 100% dependent on a drug,
and I don't--
Even if it's a helpful drug, that's, um, a scary thought.
"What if you run out of it?" Or "What if someone takes it?"
Or "What if you forget it?" Then what do you do?
And that thought terrifies me.
Medication is-- it can be really important for people,
and I do not want to underplay the importance that it can serve
to help people manage really overwhelming anxiety.
What it does is it brings us back to a baseline,
it brings us back to being more ourselves,
but the minute you go off them, unless you've gotten other treatments,
the anxiety goes up again.
[Matt] When my mom got sick, we found out it was advanced colon cancer.
Ran to the airport.
We basically lived in Boston, myself, my Dad, and my sister.
Every single time I went away, I was like, "Is this it?"
And those thoughts kept going and going and going,
which was really where I had my first panic attack.
It was because I had to come down for work.
And I was supposed to give a presentation, and I just had a full breakdown
and found myself in our company's bathroom,
hyperventilating, thinking I was having a heart attack.
I was like, "This is-- Oh my God."
Um, like the kind that you just can't pull yourself out of.
[suspenseful music plays]
Before my mom passed away, she wrote this letter.
She wrote a letter to all, my brother, my sister, and I and my dad.
Um, and in my letter, she said, "I'm sorry for putting you in a box,
and I'm sorry for making you feel like you had to be something
that you were never going to be." And…
reading it, I was just-- I broke down.
I was just like, "Yeah."
And that's what made me feel so tense and so anxious for so long too,
because you're expected to be a certain way. For me, it was like,
"Okay, you're not expected to be as flamboyant as you want to be."
"You're a person of color. Why do you talk that way?"
"You're expected to talk like this. I expected this."
My mom passed in, like, August, and then that's really where…
everything bubbled up to the top.
There's just this feeling of,
"I have myself, and I need to figure this out."
Um…
And that's when I was like, "I need therapy." [laughs]
If you know there are things that make you anxious,
and they're not going away,
it becomes really important to just remember the very basics.
I mean, first of all, breathe.
[exhales sharply]
Getting appropriate hours of sleep.
I really encourage people to sleep a ton.
There's exercise.
[Phoebe] And getting outside as much as possible.
[Dr. Holland] Getting exercise and getting sunshine.
Doing things like yoga or meditation.
[Phoebe] Meditation has been really helpful for me.
[Dr. Dennis-Tiwary] We know that actually creating a biological state of relaxation,
it actually disrupts an anxious experience.
So you cannot be relaxed, um, and anxious at the same time.
There are other medications
that are not habit-forming in the same way.
The Selective Serotonin Reuptake Inhibitors,
they don't cure anxiety in the moment,
but they lower the overall anxiety quotient
to make people less likely to have panic attacks.
You know, I'm a psychiatrist in New York City,
and of course, I write prescriptions for antidepressants,
and for antianxiety meds.
But I also like to talk to my patients about cannabis-based medicines
because it can be very helpful for anxiety.
You're not disinhibited. You're not cloudy.
You still very much have your wits about you,
but you can sort of handle stress a little bit better.
We know a lot about the treatment of these disorders,
and the most successful treatments with the best evidence base
tend to be the cognitive behavioral therapies.
So the techniques tend to focus on these systematic habits of thinking,
of behaving, the choices we make.
And they also create a new mindset, I think,
about how we think about our distress.
[Phoebe] Having that additional layer, that sort of little voice
that therapy grows for you that says, "Hey, it's okay."
"You're feeling your feelings right now. And it's okay to feel feelings."
"Feelings are not facts. Thoughts are not facts."
"All you have to do is keep going through today,
and then tomorrow will happen,
and eventually, there'll be enough tomorrows
that you won't be feeling this anymore."
And it's just enough to keep going.
Because, ultimately, when you're experiencing
those really difficult times, you just have to keep going.
[mellow music plays]
[Dr. Dennis-Tiwary] It's become so apparent during the pandemic,
but social connection is one of the most powerful ways
to disrupt anxiety.
Loneliness is one of the biggest, um, detriments,
not only to mental health, but to physical health.
[Phoebe] I experienced a divorce this year,
and between the revelations that ended my marriage
and being faced with starting my life all over again,
I ended up again in a depression-anxiety cycle.
I hadn't told my mom.
I hadn't told my best friends about what had happened in my marriage.
I was just trying to focus on meditation and journaling,
and "I'll go to therapy,
and do all the things I can do to try to deal with this,"
when really the thing I needed to do was lean on the women in my life
who loved me enough to help me through it.
[both laugh, talk indistinctly]
[Dr. Dennis-Tiwary] In whatever way we can find connection that's authentic--
[laughs] I mean, forget everything else I said,
that's probably the best thing we can do.
But the truth is, normal responses to abnormal environments,
uh, that… that you don't have to say is a disease.
In some ways,
instead of fixing our world and the real problems in it,
we're using psychotropics
to have people just sort of accept
the broken world that we're offering them.
The Great Resignation.
That's what experts are calling the growing trend of workers quitting
or just changing careers.
[woman reporter] Americans are retiring in greater numbers too.
The push to shorten the work week from five days to four,
gaining momentum around the globe.
Clearly, this pandemic has transformed
the way that Americans are wanting to work and the work that they're willing to do.
We are building a movement to address mental health in America.
We want to build a society where no person has to feel isolated
and shamed because of their struggles.
We want to build a world where anyone who needs help can get it.
We don't want to be just reactive to mental illness.
We want to be proactive about mental well-being.
New generations of athletes,
including Simone Biles and Naomi Osaka, are speaking out about mental health.
[Simone] We go through our own things, and it's hard.
You don't even realize how many people you're helping,
even though you're sitting in this really tough moment.
Mental health has everything to do
with everything that we live and breathe
and… and realize in our lives, you know,
whether, you know, we're in circumstances that are favorable for us
or unfavorable, right?
Like, mental health is everything.
Oh my God. I can't. Stay still, heart. He says,
"Thanks for providing a safe space for people like me." I can't.
[Tasmin laughs]
He's so sweet. [laughs]
It started with an Instagram post that said, "Free Therapy For Black Men."
I thought it'd be hard to get Black men to come to therapy
because that's what all the media and everything would have you believe,
and that was not the case.
Um, actually, we started kind of backwards
because when we put out Free Therapy For Black Men,
initially, within that first two days,
we had 50 men who are like, "I want the free therapy."
And we were like, "Wait a minute. We didn't think this all the way through."
We give them eight free individual sessions.
Right now, 75% of them continue on with the therapy,
after it's no longer free.
And it's like, we're giving them that drink of water,
and that drink of water should be teaching them,
"Damn, I didn't even realize I was so thirsty." Right?
And so now, even when we go take the water away,
it's like, "Oh. But you know what?" Yeah, that might be the next shirt.
[all laugh]
One thing I've been talking to my patients about for a while
is this idea of flow.
That you can lose yourself in doing something,
and it can be anything. But whatever it is you're doing,
you've totally put yourself in the doing, and you lose yourself in the doing,
and there's something else bigger than you.
[tense music plays]
[Regina] Twelve years ago, we had gone to this horse ranch,
and they had a mission of rescue horses.
I think they're up to 60 rescue horses,
where most of them have been in bad situations of one type or another.
Then we found out they were looking for volunteers.
I thought, "Okay, in the middle of a pandemic,
when the gyms are shut down, and we can't go out to eat,
and we can't do anything. We can't socialize."
"Maybe this outdoor volunteer work could be a good thing to do."
The volunteers come out and clean up the paddocks,
and groom the horses, and take them for walks.
Being able to be outside, doing physical work for a good cause,
getting to bond with animals again,
just everything about it completely has gelled
to get out of my house, get out of myself,
and go do some hard work and get some fresh air.
Having a bad day and hugging a horse
is really a wonderful thing.
[Matt] I need more of a stimulus outside of myself to focus in on,
so I took up flower arranging.
There's just something so peaceful about that process for me,
from going and sorting through the flowers,
and looking at the flowers and the colors, and it's all very tactile.
And realize I need those tactile things
to sort of cope and to calm myself.
[mellow music plays]
So much of my anxiety is rooted in
feeling like you're not gonna accomplish something
or… that what you're doing is wrong.
The things that bring me peace are these things where I'm like,
"I'm making for myself."
So there's no one that's gonna look at it and judge it or critique it.
Expectations.
There's so much weight to them,
and when you can sort of let 'em go a little bit,
there's a freeing feeling to it.
That doesn't look good. Yeah, it's all trial and error. [chuckles]
[Dr. Dennis-Tiwary] Anxiety is holistic,
and what it tells you is that your mind and body are one.
That is really the insight that anxiety gives us,
that our body and our mind are in service of each other,
and they're reciprocal.
The problem with you taking a Xanax every time you get anxious
is that you're not building up the mental calluses
that you need to tolerate more anxiety.
Because if you're squelching that experience of anxiety,
you miss the opportunity to learn how to cope with it on your own.
So there's an opportunity cost of benzodiazepines.
I'd say I probably take them as needed. Um…
Probably a couple times a month.
I really think it's more at this point, "I know I have it if I need it."
If the diet and the exercise and the volunteering,
and if my resources fail,
or if life ramps up to an out-of-control level,
then I've got another tool.
[Matt] For me, with Xanax, it never really addressed
the lingering anxiety that's just sort of always there.
And the first time I tried Klonopin, it was a different feeling.
Say it's a smoother type of anxiety relief,
versus Xanax, which is really like a hit to the face. It happens fast.
That's the reason people don't party on Klonopin.
Klonopin is not a party drug. [chuckles]
I still take, um, Lexapro, which is an SSRI antidepressant,
um, kind of a… a moderate dosage of that.
And then I have cut way, way back on benzos,
um, to the point where I try not to take them.
If you're not confronting your anxiety head-on, if you're doing it
mediated through a Xanax that you took, you're not really confronting it.
The only way out is through. Really.
What's gonna get you on the other side of the anxiety
is to actually go through it and experience it and understand it
and make some sort of peace with it.
On the other hand,
there is something awfully stigmatizing and shaming for someone to say,
"Pull yourself up by your bootstraps, just do it," if you can't.
You wouldn't tell someone with diabetes, "Make your pancreas work better. Come on!"
[Audrey] You know… Xanax is obviously
one of those drugs that
kind of raise people's eyebrows a bit.
And there is a part of me, um, you know, that really resents the fact
that I need… something other than myself to help.
And it's-- [sighs]
I think the stubborn part of me really doesn't want to be on it, um,
for an incredibly long time.
I'd love to be able to figure out how to do it without… without Xanax,
but for now, um…
it has done its job, and I'm very thankful for it. [laughs]
What is insidious about benzodiazepines is how well they work.
Our society may not be very forgiving of people who have anxiety or depression,
but we've all got that inside of us.
And when people get exposed to that benzodiazepine for the first time,
boy, ever does it make it go away.
And then it sets them up to think,
"I don't have to feel that way all the time, so I shouldn't,
and now I want more benzodiazepines."
I believe that benzodiazepines erode,
the resilience that we must rely upon at some point in our lives
to manage distress, anxiety, difficult situations,
and just the painful aspects of being a human being.
Resilience is kind of the key to everything
in terms of not just anxiety,
but mental health generally, surviving in the world,
tolerating the existential reality of the way things are.
Whether you're talking about living through Covid, or our own mortality,
or the fact that I have an anxiety disorder.
Acceptance is key. And the closer you can come to that,
the closer you will be to mental health and contentment.
Looking back on it, I don't know that I had any anxiety
that was really any different than what the average person goes through.
Just the transition from high school to college,
I just felt a little, um, lost.
One of the first things I did was go into student health.
I just vividly remember, you know, having, a prescription in hand
and thinking, "I'm an adult now."
"This is what student health has recommended that I take,"
and that's what I did.
Yeah, life is hard,
and somehow we've sort of forgotten that,
and if we're not happy, then something's wrong,
and we need to change it or take a pill.
Our job is not to take away all of our patients' pain and suffering,
but to make that suffering tolerable
so that they can still find a life worth living.
There's a phenomenon in withdrawal called windows.
This is when your symptoms melt away.
And I was at the playground with my son,
just out of nowhere,
the ringing in my ears went quiet,
the pressure in my head just vanished.
And I just had this incredible sense of calm come over me.
It was like something I'd never experienced
my entire adult life.
[laughing] And I've been on a benzodiazepine my entire adult life.
So if that's what life is like after benzos,
I… I can't wait.
I… I can't wait. [chuckles]
-[trainer] Let's go. -[inhales, exhales]
-Yes! Easy. Yes. -[grunts loudly]
-Yes! -[trainer] Good job.
-[laughs] -[trainer talks indistinctly]
-Yes! -[trainer] It was awesome.
[Phoebe] I worked really hard to change a lot of aspects of my life
so that I wasn't experiencing anxiety as intensely.
Learning how to cope with the world is a journey.
It's not something where you take a pill, and then it's fine.
It's something that you learn to do over time,
and the messy work is what allows me to show up here looking all cute,
like I have everything, uh, handled.
[laughs] Um, there will be times when I have to go back
and do more messy work, and I'm okay with that.
And… yeah.
[upbeat instrumental music plays]
[upbeat instrumental music continues]
[music fades]