Anxious: Using the Brain to Understand and Treat Fear and Anxiety by Joseph E. LeDoux
My rating: 5 of 5 stars

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This book examines the neuroscience of anxiety, though psychology also makes a prominent appearance in the discussion – particularly toward the end of the book. It’s written by one of the top researchers in the field emotional neuroscience, though LeDoux discusses the work of other labs, comparing and contrasting their work with that of his own, and thus giving an idea of the fault lines in the field. (By that I mean more the questions that remain in dispute, not who hates whom.)

The book addresses a number of key questions such as: How does brain activity result in the emotional experience? How do conscious emotional feelings relate to and interact with non-conscious responses to threatening stimuli? Is the human emotional experience a hand over from animal ancestors or a uniquely human condition? How effective are drug-based versus psycho-therapeutic approaches to anxiety disorders? What has been learned about extinguishing anxious responses to threatening stimuli? Needless to say, this book doesn’t answer all the questions, as many of the questions – particularly those regarding consciousness – remain to be definitively answered. It does offer a great overview of the state of understanding in the present day.

I won’t present a chapter by chapter outline, but rather a look at the book’s general flow. LeDoux starts by laying groundwork, and in this case that means clarifying the relationship between fear and anxiety. While the former often captures the imagination because of its dramatic and traumatic causes, the latter is more of a concern as its grinding long-term effects can cripple the immune system and have other adverse effects. The early chapters also discuss what has been learned about how emotions are formed in the brain and how views about this have changed over time.

Chapter five is where LeDoux explores the relationship between animal emotionality and human emotional life. This is an important subject as it relates to the question of whether research with animals can teach us anything relevant to the human experience. As it has become progressively more difficult to conduct any research that causes human subjects any emotional distress, this question may be instrumental to making progress in the field.

Chapters six through eight are interconnected by the question of consciousness. Chapter six discusses the nature of consciousness, which remains one of the most slippery and least understood concepts in the natural world. Chapter seven delves into memory and consciousness – an important topic as anxious responses can be viewed as learned responses and this begs the question of unlearning. Memory will later be revisited with respect to the question of whether it’s possible to erase painful or anxiety-inducing memories (ala, “Eternal Sunshine of the Spotless Mind”) – based on work that came out of LeDoux’s lab – and, if so, whether it’s a good idea. The final consciousness chapter gets into consciousness of emotion, specifically (as opposed to all the other thoughts and feelings of which one can be consciously aware.)

The last three chapters are also interconnected by movement from the question of how is anxiety felt / experienced to the question of what one can do about it. The first of these chapters discusses an epidemic of anxiety (entitled “40 million anxious minds,” and that refers to the US alone) and what has been learned about drug-based treatments. As it happens, drug-based treatments haven’t proven reliably effective, leaving plenty of room for other approaches, e.g. psychotherapy. This fact is the basis for the last two chapters that discuss different approaches to extinguishing the connection between a stimulus and the anxious response. The first of theses chapters (ch.10) is more general and the last chapter dives deep into the research that has been done in recent years. Chapter 11 also offers a nice discussion of how breath exercises and meditation can be instrumental in reducing the adverse effects of anxiety.

As would be expected of a scholarly work, the book is heavily annotated, has an extensive bibliography, and uses a great number of graphics in an attempt to lend clarity.

I would put this work in the same category as the works of Robert Sapolsky. That is to say, it resides in a space between the level of detail usually seen in works of popular science and that which is seen in textbooks for specialists. That is to say, LeDoux does get into some detail and this isn’t a light read for anyone without a heavy-duty background in biological sciences. That said, if you have a basic scientific literacy (and / or don’t care too much about the fine detail), it’s by no means impossibly dense. When it’s not diving into the various brain regions and neuronal pathways, it’s quite readable.

I’d recommend this book for anyone who is interested in a detailed look at how anxiety arises and how it can be quelled.

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