“Well, what do you think is going to happen? What’s the worst that can happen here?”

Daniel Smith is talking to Daniel Smith.

“I’ll give a shitty talk tomorrow.”

“Okay, so let’s say you give a shitty talk. What do you define as a shitty talk?”

“Well, if people are bored.”

When Smith asks the questions he is standing in for his psychiatrist. When he answers, he is just being Smith.

“How many people?”

“If more than half the people are bored.”

“Have you ever been able to quantify how many people are bored?”

“No.”

“Have you ever given a talk where you felt like you bored the majority of the audience?”

Smith furrows his brow and frowns slightly as if he’s surprised and displeased by the question.

“Yes, once.”

“And what happened?”

“What do you mean what happened?”

“Well what consequences did it have?”

“I felt bad.”

“Okay, you felt bad. Are there any other consequences? Did they write to you and say, ‘You shouldn’t have done that?’”

“No.”

This is cognitive behavioral therapy: a persistent, methodical approach that attacks anxiety at its logical joints. The aim is to change your thought behavior, to see that the intensity of your worry is at root unfounded.

Today, preparing for a talk on his new memoir at a college in New Rochelle, Smith seems more interested in theory than practice: “I’m going to spend every last minute agonizing over which one is the perfect idea and in the end preparing not enough.”

But he’s certainly under control. He speaks at a fast pace, but in the manner of an entertainer, a storyteller. There are no visible signs of perspiration. He sips on a small coffee. He rests his tremor-free hands on the wooden table. He makes sustained, seemingly unselfconscious eye contact.

It isn’t always this way. In his forthcoming memoir, Monkey Mind, Smith tells of seemingly endless, violently determined spirals of negative thought—something like rough-edged corkscrews contorted into pretzels. The outward effect, at times, was a bit like this:

“… I would do my best to weep—for cathartic purposes. These were pathetic attempts at weeping, the bleaty cries of someone who has weeped himself dry, like an ape laughing…”

And this:

“My back was knotted and hunched, my shoulders were up to my ears, my skin was pallid and clammy, my pupils were wide as deer’s, my cheeks were gaunt, and my fingertips were torn and scabbed from my gnawing at them day and night.”

And, this:

“I was… the tumor with lips and a tongue; the six-eyed, noseless, baguette-shaped head in the jar.” In other words, he says, “I was anxiety personified.”

Fortunately, I was having coffee with Smith in his whole-human form. Though he is currently experiencing a resurgence of anxiety, he now has more psychotherapeutic equipment to fight off the visions of doom (which lead to self-torture, which lead to paralysis and depression and snarling, forcible isolation, which lead then, in one way or another, back to doom). And Smith is not merely a passably functional person—in conversation he is witty and highly informed. As far as traditional success goes, he passes muster: his journalism and fiction has been printed in the New York Times, the Times Magazine, The Atlantic, n+1, New York, and Granta. His first book, Muses, Madmen, and Prophets—a historical investigation of the effects of auditory hallucination, particularly on great thinkers and leaders—was widely praised by reviewers. He has, in his possession, a two-page hand-written note from Dr. Oliver Sacks, who referenced Smith’s work in one of his own books.

Add to professional acclaim that Smith married the woman he loved—a person he almost pushed away for good during his struggle with anxiety, has a young daughter, a new book, generous friendships, teaching positions at two colleges, a podcast with n+1, and… well, the stakes of delivering a prepared speech to a group of college students seem to go down, don’t they.

“It’s eeeasy, easy like a Sunday moorning,” Smith sings along with Lionel Richie coming through the café’s speakers. “Now, this song makes me anxious.”

“Anxiety lives with you day and night, holding your hand and nudging you to act, urging you to get up, do more, fix something, make something… It wants you to win, to outlast the others, to impress, excite, excel, astonish… Then one morning, it has you by the throat and you find yourself weepy and overwrought, unable to respond to its call. Like a reliable friend, Xanax is there, offering an intermission, the gift of quietude, a break… I want tranquility once in a while. But I don’t want a tranquil life.”

The National Institute of Mental Health reports that anxiety disorders affect 18 percent of American adults—roughly 40 million people.

Soon after, New York Times Magazine’s Critic-at-Large Sam Anderson linked the use of “Stupid Games”—iPhone games and all varieties of addictive, interactive electronic entertainment—to our need to relieve anxiety, to shut down or escape. “The game… was an anesthetic, an escape pod, a snorkel, a Xanax, a dental hygienist with whom to exchange soothingly meaningless banter before going under the pneumatic drill of Life.”

Both Miller and Anderson draw conclusions from personal anecdotal evidence. Miller applies them to an entire generation of type-A New Yorkers. In Anderson’s essay, we’re provided with around 2,000 words on the author’s personal experience because his reasons for playing are our reasons. In both cases, individual experiences of anxiety are held up as representative of a near universal condition.

This, according to Smith, can’t be done.

In the first post for the Opinionator series, Smith states that the phrase “age of anxiety”—which has been tossed around since a poem of that name was written by W.H. Auden in the ’40s—now serves as a “sticker on the bumper of the western world.” And this phrase, he says, is relatively meaningless. “Anxiety,” he writes, “is always and absolutely personal.”

The National Institute of Mental Health reports that anxiety disorders affect 18 percent of American adults—roughly 40 million people. By contrast, mood disorders, such as depression and bipolar disorder, affect only 9.5 percent. Xanax, or the generic Alprazolam, is the only psychiatric drug to be ranked in the top fifteen prescription drugs in the U.S. Smith himself, writing in Monkey Mind, calls anxiety “a universal and insoluble feature of modern life.”

But, he writes, the condition is “monumentally subjective.” On one level, this means that we all experience anxiety in our own way. Applying a more exact meaning of “subjective,” this means that we each see anxiety in our own way. And, in the case of anxiety, what we see, what we identify, and what we experience are inextricably linked. Anxiety doesn’t exist outside of our own perception; it doesn’t hinder us until we see that it does.

“I was hunched in an awkward squat behind a woman on all fours, a woman who was blond and overweight. Her buttocks were exposed and her knees were spread—”presenting,” they call it in most mammalian species… The vagina was businesslike and gruff… A real bureaucrat of a vagina. I inched closer on the tips of my toes, knees bent, hands out, fingers splayed… The air in the room smelled like a combination of a women’s locker room and an off-track betting parlor, all smoke and sweat and scented lotions.”

The encounter was debauched, seedy, and not at all as it should have been. It was a mistake he could never undo, and it became an obsession. For the first time, his mind seemed to take off on a wild, brutal course without him: “My brain was having a grand time whittling shivs with which to stick me, and it had no lack of material to fashion… It, whatever it was, was now in control, not me.”

The sexual experience was traumatic to be sure. Smith hadn’t really wanted it, he wasn’t ready for it. Afterward, he went home and wept on his mother, blubbering out the whole story as many young people still with a foot in childhood might after playing at adulthood a step too far. But how Smith understood the trauma and the crippling cycle of thought it led to may have been in part determined much earlier.

Smith says anxiety is “monumentally subjective,” and it might not be the best idea to strictly define the experience.

Smith grew up surrounded by mental pathology, both acknowledged and under cover. His mother, Marilyn, was a psychotherapist and long-time sufferer of acute, sometimes paralyzing anxiety. In Monkey Mind, he describes eavesdropping on her sessions with patients through a vent in his room. He quickly became well-versed in the language of confession and diagnosis. His mother would discuss sessions at the dinner table, leaving out names—a habit that infuriated her son. It seems harmless enough, but the words may have felt like a bit of leaked poison: stories of mental anguish now nesting in his mind. In general, Smith reacted to his mother’s work with low-grade aggression: in Monkey Mind he recalls defacing her business cards, of which “she was very proud,” changing them from “Marilyn Smith, MSW Psychotherapist” to “Marilyn Smith, MSW Psycho.”

Did his early exposure to mental illness as an intellectual and clinical concept have any effect on his own anxiety? “Was it good for me? I suspect that, in a lot of ways it was not. To fit human experiences into a clinical mold is something that unnerved me as a heady kid, and still unnerves me.”

His mother measured mental states often. She was always asking “What are you feeling right now?” “What are you thinking about?” “That drives you inward in a way,” Smith said. “You know, if she was concerned with my playing basketball—she wouldn’t have had much success there—but maybe that would have been better for someone with my tendencies.” She shared diagnoses liberally. “I’ll complain about something that she’s doing, and she’ll say ‘It’s not my fault, I’m very OCD.’” When Smith imitates his mother, he speaks just slightly higher in pitch, much faster, much louder, and with a Long Island accent. “Everything is pathologized.”

“As a kid I sensed that it was a dangerous habit of mind, that in naming things you could often go very wrong. And that you’re automatically taking a very… what’s the opposite of capacious? Uncapacious? A very narrow view of things to always adhere to a clinical interpretation.”

“Yeah. I think I have it worse than a lot of people.” He spoke quickly and without hesitation.

Is there a qualitative difference between the experience of the acute sufferer and that of the generally under-slept, over-worked New Yorker who has trouble quieting their mind? “No. It’s a spectrum,” Smith said. “It becomes more pronounced as you habituate to it. As you glom onto it. Maybe for whatever genetic reasons, for reasons of nature and nurture. I’m far on the spectrum.”

What does it feel like? Smith writes in Monkey Mind, “Is it a presence or an absence? Is it a stone or is it a void? What do you call yours?… You call it what it feels like… Mine felt like an icicle and today, years later—sitting here alone at my desk, door closed, cut off from the world and all its threats—it still feels like an icicle.”

Smith survived his first phase of extreme anxiety in high school. He went to largely ineffective weekly therapy—he would mostly stonewall his counselor—and, on the side, he was dosing himself: “I was stoned all the time.” When his mother found his stash of pot, she had a conniption: “You shouldn’t do it because once I was at a party and I got stoned and there was a baby there, and it looked like a Devil and someone must have SPIKED it and marijuana triggers PANIC attacks!” Smith remembers her saying the words, “Trigger Panic Attack! Trigger Panic Attack. TriggerPanicAttack,” over and over. Exactly a week later, he was stoned, listening to Phish, long hair hangin’ loose, and he felt his heart beat quicken and his lungs contract. “I had a panic attack because my fucking mother planted it in my head that I was going to. She ruined one of the great joys of my life.”

“When I die my epitaph will read: HERE LIES DANIEL SMITH. HE LIVED IN FEAR OF AN EXPONENTIAL EXPLOSION OF ERRATA.”

When he went off to Brandeis University outside of Boston, it roared back, worse than before. Again he went to therapy—the other option was returning home, defeated—and again it was mostly ineffective. Eventually he discovered a type of calm and security within the vault-like walls of the library. He found that James, Faulkner, O’Connor, Cheever, DeLillo, Gaddis, and Pynchon caused the icicle in his chest. Hemingway, Bellow, Updike, Doctorow, and Styron melted it away. Philip Roth was a particularly sweet discovery—he provided Smith a type of liberation: in his writing, self-awareness was power. It insisted Smith need not stifle his mind but let it seek, and with force. Though Smith says he now sees a type of immaturity in Roth, the opening structure of Monkey Mind mirrors that of Portnoy’s Complaint. Both begin with therapy, then flash back to sexual deviance, then wind forward to the certainty of doom resulting from that deviance. For Portnoy, the doom was cancer; for Smith, HIV, then full-blown AIDS, then death, homeless and alone. “Disaster, you see,” says Portnoy, “is never far from my mind.”

After college, Smith began working as a fact-checker for The Atlantic—a dream opportunity and a special challenge for the anxious mind. Smith was aware that his smallest mistakes could sneak into the pages of the magazine and live on, deceiving readers, misleading researchers, misguiding authors, leading “into an exponential explosion of errata.” This was pure horror. His mind’s “default setting,” as he writes in the memoir, “is the perpetual, paralytic awareness that even the most mundane decision can be the fulcrum on which fate turns and personal Armageddon is permitted to dawn. When I die my epitaph will read: HERE LIES DANIEL SMITH. HE LIVED IN FEAR OF AN EXPONENTIAL EXPLOSION OF ERRATA.”

Smith spent a significant portion of his time at The Atlantic mopping sweat from his underarms in the men’s room and wondering how well he was passing for sane. Many of his fears weren’t irrational, or even necessarily unusual for a young, creative intellectual. Fact-checking, he writes, “makes you ask yourself some unsettling questions about Truth. It makes you wonder if maybe you’ve hitched your wagon to the wrong epistemological horse.” Where these thoughts became acute anxiety was in their unstoppable outward drive: soon spinning fast, untethered, lassoing uncertainty in empty space. “It makes you wonder if you have the first inkling what’s good for you,” he writes. According to the anxious mind, you certainly don’t.

“That’s bat-shit crazy,” Smith tossed back. “What are you talking about?” Then they peed in the ocean and went home.

A couple of years later, Smith began acting strangely. He was shifty and withdrawn—really, he was stoned all the time. His parents, worried, took him out for a cheeseburger and a talk. They laid out plainly what his brother had let slip: his father had heard voices for most of his life. They would give him directions, mostly mundane, like, “Move the coffee cup to the right.” It was similar to an audible obsessive compulsive disorder.

Smith’s father, Leonard, told no one about his voices until he suffered a nervous breakdown when Smith was very young. “I think it was because of the silence,” he said. “He had been carrying it around for twenty-thirty years. He went to college, law school, got married, had three kids, and he couldn’t tell anyone.” When it finally came out, Marilyn asked why he hadn’t told her. “I thought you wouldn’t marry me,” he said. She agreed she probably wouldn’t have.

When Smith was in high school, the family helped put together a memoir of his grandfather’s life, based on “a catch-as-catch-can” journal of stories and jokes. They found a page titled “Voices.” Smith’s father’s father had heard them, too. “He thought they were no big deal,” said Smith. “They were like this intuition that he heard. They helped him on tests as a kid. He used them to play gin rummy… He wasn’t oppressed by them. My father heard the voice and thought, ‘If I tell anyone people are going to think I’m a psychotic.’”

Inspired in part by this striking difference, Smith went on to write his first book, Muses, Madmen and Prophets: Hearing Voices and the Borders of Sanity, a historical look at auditory hallucination. In it he argues that abnormal sensory experience can be a positive force on artists and intellectuals. The broad implication is that society might miss out on great achievements by relegating voices, or other atypical sensory experience, to the realm of insanity.

In a 2007 New York Times article partially adapted from Muses, Smith investigated the accepted knowledge on voices. Psychologists don’t believe that all voices are the mark of psychosis, but most say that listening to them is a mistake. A handful of psychologists disagree, as does a large U.K.-based treatment organization called the Hearing Voices Network.

If Smith illustrates a type of addiction (a monkey in the mind does indeed resemble one on the back), it’s an addiction to awareness, control, and effort.

The HVN, which holds group therapy led by professional counselors who are also sufferers, sees voices as a “meaningful, interpretable experience.” Most importantly, its members, and supporting practitioners and researchers, seek to “put voice hearing in the realm of normal human experience” in the public view. An HVN support group member said to Smith, “Negative thoughts are universal. Everyone has them. Everyone. What matters is how you cope with them: that’s what counts.”

In a profile of Aaron Beck, the psychologist who developed and pioneered CBT, Smith describes the differences between traditional psychoanalysis and cognitive therapy:

“Whereas psychoanalysis uncovers deeply buried impulses, Beck is interested in those thoughts that lie barely concealed beneath conscious awareness. Whereas psychoanalysis uncovers the historical motives behind troubling emotions, Beck scrutinizes the present-tense logic of his patient’s emotions. And whereas psychoanalysis is ultimately pessimistic, seeing disappointment as the price for existence, Beck’s approach is upbeat, conveying a sense that, with hard work and determined rationality, one could learn not only to tolerate but to stamp out neurotic tendencies.”

CBT is a can-do practice. Its name tells the theorized order of influence behind the practice: first come the thoughts, and then the behavior. There is evidence in the field now that CBT might actually work in the reverse: changes in behavior may bring about changes in thought patterns. But either of these hierarchies places the onus on the patient, who must work to change by implementing a specific practice of awareness and discipline. The traditional model of psychoanalysis, on the other hand, relies on the slow, somewhat agentless discovery of the roots of feelings and behavior. While Freudian analysis does not necessarily set out to change a patient, the driving force of cognitive behavioral therapy is the idea that people can change. And, in fact, they will only change if they begin to: the patient must take a leap. CBT is an active practice, dependent on rigor, method, and discipline.

Smith is wired to embrace a challenge. Cognitive therapy and Zen meditation are the only things that have worked to quell his anxiety. (Monkey Mind is in fact a term from Zen Buddhism meaning: “A state of being in which the thoughts are unsettled, nervous, capricious, uncontrollable.”) Smith also takes the anti-depressant/anti-anxiety drug Lexapro—which he says helps only to “sand off the peaks”—preventing him from going to the most extreme heights of anxiety. Now, though, he says it doesn’t do much of anything at all for him. Recently, with the new book coming out, tight finances, and various personal stresses, he decided he needed a cognitive “booster.” With the financial support of a friend, Smith began a new bout of therapy with an expert practicing “radical acceptance”—a type of CBT in which the patient’s task is not to parse his own logic but to see his anxiety and send it away. It’s about letting go on purpose, which may be one of the strangest things you can ask of an anxious mind.

“You have tracks in your brain, like wagon tracks, formed by your habitual thoughts,” Smith says. “You have deep patterns in the pathways of your mind. And you have to work”—as he speaks he holds his two hands as if the sides of a small, imaginary wagon and repeats its slightly curving forward motion—“by discipline, by repetition, by mindfulness. To remake those tracks.”

These days, with a resurgence of his anxiety, it’s hard for Smith to calm himself down with music (when he does listen, he’s ecumenical: Rye Cooter, Ladysmith Black Mambazo, early ’70s Neil Young, Nick Cave, classical). Lately he’ll listen to edifying podcasts instead: “Highfalutin stuff. I was just listening to one on the Reformation. It’s like… there’s this infinite bar of knowledge, things you could know,” he stretches his hands wide apart across the table to illustrate the bar, “and I just filled in this little tiny bit. Now I know something about the Reformation.”

Exercise does not help Smith relax. He once boxed every day for two hours and it didn’t make a difference. I told him that my thoughts became very quiet when I run. “No. Yeah. Not me,” he said. “I tell myself I have to have a good run. Everything’s an opportunity to beat the shit out of myself.” He’s able to mentally check out with television shows like “New Girl”—“This character Schmitt is like this new male type never before seen on television!”—and Angry Birds on his iPhone (Anderson was on to something). Humor helps as well, but rather than just a way of letting loose, it seems like another way of carefully ordering information.

In a sense, Smith breathes restraint, effort, rigor. When he’s anxious about work, he says, “It’s not about ambition. It used to be about ambition. But not now. If I’m not writing sentences, I’m not practicing my scales.” We discussed if he feels he’s accomplished a fair amount in his relatively short career. He has trouble imagining looking back on any work as tidily successful:

“What person with honorable ambitions feels that they’ve arrived? There’s always something you want to be learning. You learn something and then you learn the next thing”—as he says this his hands cut narrow slices from the imaginary bar of knowledge he laid out a bit earlier—“and you learn the next thing, and eventually you die.”

In her piece on Xanax in New York, Lisa Miller concludes that our society is not “in love” with anti-anxiety drugs but with anxiety itself. In Miller’s view, anxiety, and the drugs that quell it, helps high achievers become what now seems to qualify as a type of super-person: someone who both gets the job done and sleeps at night. But Smith’s drive and discipline are by no means synonymous with anxiety. His bouts with severe anxiety don’t help him to do anything. In fact, they forced him to resign from the only regular job he’s ever held (at The Atlantic); they nearly destroyed his relationship with his now wife; they frequently threaten his ability to write at all; and they make choosing a salad dressing an experience of hellish panic. His severe anxiety can strike at the happiest, calmest of times. If Smith illustrates a type of addiction (a monkey in the mind does indeed resemble one on the back), it’s an addiction to awareness, control, and effort. His is a mind addicted to thinking as work—a habit closely related to the obsessive thoughts of anxiety, but not equivalent to the overwhelming fear he has experienced in waves throughout his life.

Smith has no settled future place at which to arrive and rest. The milestone accomplishments Lisa Miller is concerned with mean little to his existential fear. In an email he wrote following our in-person conversation:

“If I had money, and space, and glory, would I still be anxious? I believe I would be, yes. I’m certain I would. Anxiety is omnivorous. Or at least my anxiety is. It feeds on what’s available. Also, to be philosophically reductive, I’d still have to die. I’d still have to contend with my mortality, with limited time, with the problem of right action, with human relationships. With the potential for illness, and loss, and failure. Hell, maybe I’d be more anxious. (Mo money mo problems, as the great logician Biggie Smalls reminded us.) Yes, the more I think about it, the more convinced I am that money etc. wouldn’t change the essential difficulties. My mind is my mind, and will always remain so, National Book Award or not, brownstone on Prospect Park West or not (which I don’t even want).”

Smith’s allotted calm is in getting the wagon tracks right, in practicing his scales. It’s in doing the work. When doom is certain, or might very well be certain—a paralytic concept of its own—the means become more important than the ends. Smith writes at the end of his Opinionator column, “If you start to believe that anxiety is a foregone conclusion—if you start to believe the hype about the times we live in—then you risk surrendering the battle before it’s begun.” For now, suspending the conclusion might be the best he can do. And that’s a lot.