Medical Examiner

Worrying Enormously About Small Things

How I survive anxiety and you can, too.

Illustration by Rob Donnelly.

Illustration by Rob Donnelly

I sat in my tent in the Kenyan bush. It was nighttime. I was up late, in Kenyan time, at least. Back in the United States, it was afternoon. The afternoon that the tenure committee was meeting to vote on my future. As a university professor who had worked 13 years toward a goal of job security and respect from my peers, it all came down to this one conference room sit-down.

I listened to the lions roar. And I thought about walking outside the demarcated safari “safe area” into the night, into the bush, into the wild. Because, for me, the safe area was not safe. No place was safe. No place on Earth, I’d found, as I’d crossed hemispheres—west to east, north to south—trying to find one.

If the lions ate me, my family would get my life insurance. And then a tenure denial wouldn’t matter. Having a back-up plan made me breathe easier.

It was a very long night. No email arrived by 1 a.m. I took a sedative and tried to sleep. At 5 a.m., I checked again. There it was. The email.

I had been voted tenure.

So many colleagues across the country had tried to tell me that getting tenure would be anticlimactic. It wouldn’t matter, they said, because by the time the vote came around, I’d have a pretty good idea of whether I’d met the standards or not. I’d have a feel for the politics of my law school. I’d have heard through the grapevine which way the winds were blowing. The vote would not be a surprise.

But as I write today, a month after the board of trustees formally granted me tenure, six months after receiving that email after a very long Kenyan night, I can tell you that my colleagues and friends were wrong.

You see, for a person living with mental illness—in my case, a severe anxiety disorder—the kind of security and certainty that come with tenure are an exquisite relief. And that is because the six years it takes to get there are an exquisite kind of torture, of terror, of talking oneself into being semicalm through the night to make it to the next day, the next class, the next faculty meeting.

Those years are full of lions around every bend. And so the lions in Kenya were familiar, if not friends. And considering letting them eat me alive? It couldn’t be worse than the six-year job interview I’d just been through.

I started my academic career at a small, New England law school, where I was not on the tenure track but taught dozens of students for very little money. My children were small, my marriage was young, and my budget was tight. At night I obsessed over every student email and semester-end evaluation (was I really too demanding, as one student wrote? Did I really require too much reading, as another few complained?), but in front of a classroom, I was in my element. In fact, during the performance of teaching a writing class, I forgot that I was different, that I was hiding a monumental secret for which the students would certainly think less of me. In front of a classroom, I felt strong. I felt powerful. I felt normal.

Standing up there, talking about law, I forgot about the rest of my life. The life I had been living since I was 19.

As a college sophomore, I had everything going for me. I was attending a top college. I had spent two quarters studying in Italy and London. I had wonderful friends.

But one morning, I woke up to find that I didn’t want to wake up anymore. My heart beat at double its normal rate; I struggled to catch my breath; I felt dizzy and hot, then cold. I became scared to leave my apartment, then my bed. If I stayed under the covers, the lions could not get me.

It was that quick, the onset. And it was that bad. I went from carefree, happy, college-loving post-adolescent to suicidal inpatient in the course of about six weeks.

I would never fully recover.

For the next 25 years, doctors would try to figure out just what was wrong with me and just what would help. I was not schizophrenic, that they knew for sure. I was not bipolar, I did not have a personality disorder. I did not have OCD. But I had panic attacks, sometimes daily, sometimes 10 times a day, sometimes only once a week. When I wasn’t panicking, I panicked that I would start panicking. I panicked that someone would find out that I was panicking. I panicked that the rest of my life would be a constant state of panic.

I panicked that I would never have a career, or a family, or a regular home outside of a hospital.

Somehow, I did. Somehow, I graduated college (albeit with extensions on papers and other accommodations), I finished a master’s degree, and I got into the top law school in the country. When I missed class, I pretended that I had been up late studying and had overslept. When I lost too much weight, I praised the cabbage soup diet. When I requested a special room in which to take an exam, I explained that I needed to walk around, and I didn’t want to disturb others in a regular hall.

I graduated from law school with honors (I never knew how). I got married (I never understood why, given my belief that I was totally unlovable). I became a law professor (pretending every day to be confident, when I knew inside that I must really be a poser, a fraud).

Essentially, since I was 19, I have felt that the sixth sense is not ESP, but some sort of feeling that all is right with the world, or, a la Anne Frank, that people are essentially good. I don’t have this sixth sense, and without it, I feel as disabled as I would if I were blind or deaf. Just as you can’t explain to a blind person what “red” is, you can’t explain to me what “peace” is. I feel like I am missing something essential that others use to function. The phrase “don’t sweat the small stuff” is ludicrous, impossible for me, because my very existence is catastrophizing: worrying enormously about small things. If an administrator tells me that he met with one of my students today, I immediately become worried that I have done something wrong vis- à-vis the student. If someone disagrees with me in a faculty meeting (even collegially), I worry that something terrible will happen—perhaps the colleague will tell others how stupid I am, and the dean will call me in, and they will decide that I’m not cut out for the job (of course, with tenure, this is now unlikely, but until very recently I was convinced it would happen). If I teach a class of 40 students and 39 say on their evaluations that I’m a great teacher but one says (as one did this semester) that I am one of the “mean girls like in high school,” I truly believe that the one critic can get me in trouble. And when a senior colleague reads a draft of a paper I’ve been working on and tells me she hates my quotes, draws frowny faces in the margins, and questions my terminology? It’s cause for a long, long weekend of calls to the crisis hotline and emergency medication.

For 13 long years (six on the tenure track), I panicked, using close friends as yardsticks for what was real, what was imagined, what was possible, what was exceedingly unlikely. I panicked that I would get fired, then I would not be able to support my family (my husband is a stay-at-home dad), then we would be homeless, and then my kids would die of malnutrition. It sounds crazy because it is. That’s an anxiety disorder. A person like me, one who is mentally ill, truly believes it all, and obsesses about it for days, crying and losing sleep, breathing into a paper bag.

But I am lucky, as nonsensical as that word might seem in describing someone who lives life afraid. You see, now that I have tenure, I am one of the very, very few people living with mental illness who does not have to worry about what might happen at work tomorrow, which irate student or grumpy colleague or persnickety dean might decide that I am just not right for this job. I have a job for life. I can pay my mortgage. I can feed my children. I have health insurance. And I will never want for those things. I will never again have to lay careful plans to ensure that my family gets a payout from my life insurance.

Of course, that is not to say that I do not panic, even now, in the weeks after earning tenure. I fear confrontation, far, far more than others do, I think. I still have irrational thoughts (not surprisingly, about whether people are whispering that I do not deserve tenure), and I go to bed early every night, in part because I am exhausted from a day filled with worry, in part because I need to escape from the world, in part because I know I might wake up in the night, still thinking about the student who perceives me as a mean girl, still seeing those margin frowny faces in my mind. But I no longer need the yardstick, at least to measure the likelihood that I will lose all that is truly essential in life. I am safe. The lions cannot get me, or my family, or my job.

And so the summer of 2013 is the beginning of a new era for me. Instead of the hunted, I can become the camp guard, the one who patrols to keep the lions away from the tents where safari guests sleep. Though I know I will panic about how others will perceive my efforts, I seek to eliminate, or at least lessen, the terror on the tenure track. We in academia have come to accept people of color, gay people, and people with physical disabilities. We have acknowledged their difficulties, our (even subconscious) prejudices, and we have changed our views of their capabilities.

And people with mental illness? We in academia cannot see them. We do not know what lions stalk them. All we can do is try to create a safe place, a place where they can use us, their senior colleagues, as yardsticks for what is real in the world on the tenure track. We cannot eliminate the terror. But we can support the people who live through it. From a place of safety, I will speak out in their honor.