Fighting Life's "What Ifs"

One in four of us will suffer from an anxiety disorder in our lifetime. And the rest of us will worry, fuss, and fret far more than we need to. Now, in this excerpt from his book, Worry, the psychiatrist who helped put attention deficit disorder on the map offers his treatment program for brooders.

"Worry gives a small thing a big shadow."—Swedish Proverb.

Worry is like blood pressure: you need a certain level to live, but too much can kill you. At its worst, worry is insidious, invisible, a relentless scavenger, roaming the corners of your mind, feeding on anything it finds. It sets upon you unwanted and unbidden, feasting on the infinite array of negative possibilities in life, diminishing your enjoyment of friends, family, achievements, and physical being—all because you live in fear of what might go wrong. People who worry too much suffer. For all their hard work, for all their humor and willingness to laugh at themselves, for all their self-awareness, worriers just cannot achieve peace of mind.

Worry is amazingly common. At least one in four of us—about 65 million Americans—will meet the criteria for an anxiety disorder at some point in our lifetime. Even those individuals whose lives are going well may worry excessively on occasion.

And yet, worry is a very treatable condition. Most people today are not aware of all that we have learned about worry in the last 50 years. Just as rainstorms may strike in different ways—sudden thunderstorms, lingering drizzle, occasional showers—so does worry attack its victims variously. We've come to understand the many distinctly different types of worry, and the underlying triggers. Worry may accompany simple shyness, depression, generalized anxiety disorder, or even post-traumatic stress disorder. Each kind of worry responds to specific and powerful techniques, from cognitive therapy to medication to regular exercise.

What Is Worry?

Worry is a special form of fear. It is what humans do with simple fear once it reaches the part of their brain called the cerebral cortex. We make fear complex, adding anticipation, memory, imagination, and emotion.

Worry takes many forms, but it almost always stems from an overwhelming sense of vulnerability and powerlessness. Many of us locate the source of worry outside ourselves, believing it is triggered purely by life experiences: "What is going on in the world to make me feel this way?" Such thoughts only increase our feeling of vulnerability. And, as anyone who has worried knows all too well, even when the world is right, worry surfaces. Rational reassurances get no farther into the psyche of the worrier than words spoken in Martian. "Honey, everything will be fine. We are not about to go broke." "There really is no reason to obsess about your boss. He just told you that you were doing a great job!" "Truly, that mole on your back is not malignant melanoma!" The worrier may be momentarily calmed, but the fire soon flares again.

Why does the worrier go on worrying? His mind has, in effect, gone into a spasm, a grip that can't relax and accept good news. He is suffering a kind of "brain burn," because his system is continually pumping out a huge bolus of adrenaline under high pressure.

Today, we are finally beginning to understand the biology of worry, to pinpoint what is happening in the nerve cells of the worrier, rather than his soul. It turns out that some of us may be born worriers. Our autonomic nervous systems are cranked up higher, and our blood pressure, pulse, and respiratory rate may be higher. And we may be less sensitive than others to the brain's natural stress modulators, which are activated by the neurotransmitter GABA (gamma-amino butyric acid). People who have a good supply of GABA, or brains that are especially responsive to it, may be innately cool and calm. By contrast, a fascinating 1996 study actually linked a gene (called SLC6A4) to individuals who are highly susceptible to anxiety, pessimism, and negative thinking. Other pioneering research, by Jerome Kagan, Ph.D., has revealed that children who are high-strung and highly aroused early on often become tense, shy worrying adults. And brain scans have shown that people who ruminate have excess activity in a part of their brains called the cingulate cortex.

Our new knowledge has enabled us to stop blaming worriers for their woes, and begin helping them to get better. One of our newest and most powerful findings is that brains are adaptable and flexible. You cannot give yourself a new brain but you can be redirected, retrained, reassured, and reset. You can change.

Broken Bonds

Many people who worry too much do so out of broken trust or loss of faith. If these people share what they really feel in their hearts, their story will reveal the deep trauma underlying their worry.

Allison Barnes came to see me at a crisis point in her life. She had a good marriage and wonderful children, and had once loved her work as a physician, "But now I'm terrified," she confessed. "I worry every day about someone trying to sue me for malpractice."

Allison's worry was rooted in the reality of today's world. She had been sued five years earlier, by a patient named Jim whom she thought of as a friend. "We exchanged family pictures," she told me. "When his son Simon had leukemia, I gave blood and so did my whole family." Then Simon died, and a year later Jim came in for a headache workup. "I spent an hour with him, then sent him off for some tests. He said I dismissed him without giving him the time he needed, so he went to another doctor, who diagnosed a benign tumor." Jim filed a lawsuit against her for malpractice. Although Allison won the suit, she lost her peace of mind. "He took out his anger about the death of his son on me," she told me. "Now, everyone who walks in the door I see as a potential adversary. I can't stand it."

Allison's faith in the world had been shattered. She admitted she felt ashamed of her worry, and afraid to talk to her husband about it. And so the worry had spread like brushfire: "Now I can find worry in a cigarette butt on the sidewalk."

My job with Allison was to apply metaphorical cold towels to her forehead and to strengthen her with hot chicken soup for the soul. I also gave her techniques to retrain her brain, which I explain in detail later.

But the most important part of her treatment did not depend on me at all. Allison was living alone inside her worry. She needed to increase the amount of support in her life, to develop deeper connections to others, from her husband to friends, extended family, colleagues, and other physicians. Life is scary and insecure. But many people suffer excessively because they don't know how or where to get support. The sum of our meaningful connections, our connectedness, is the key to emotional health and the surest protection we have against the psychological ravages of worry. By promoting connectedness in your life, you will increase your feeling of power and greatly reduce your sense of vulnerability. There is strength in numbers.

Gnawing Old Bones

One of the original meanings of worry is "to gnaw." Like a dog with a bone, the worrier chews all day long, and sometimes it is a very old bone the worrier gnaws. The bone gets buried and dug up, buried and dug up, as the same old pain gets reworried ceaselessly. The only way to let go of that bone once and for all is to feel the original pain through and through.

Liz Brightman was preoccupied with a multitude of problems in her life, significant as well as trivial. But the real source of her worry was decades old. As I listened to Liz tell me her father had committed suicide in a mental hospital when she was 10, I thought to myself, "The sadness she has not felt has become the worry she continues to feel." Liz told me that after the funeral, her mother took the family to a carnival "to have some fun and forget." Her mother never talked about her father again. "Then she met my stepfather, and we went on. My father kept receding into the past, like a rowboat that had fallen off the big ship. I never even cried."

Many people's worries are really masked grief, still buried at home. People may even use worry as a psychological defense against feeling this long-buried pain. Often, the worrier knows what the pain is. Every day a little voice inside says that the answer to your worry lies in traveling north but still you spend your whole life deliberately going in every direction except north.

In Liz's case, going north meant talking about her father. She needed to remember and cry. For many people this is the act they fear the most. Crying feels humiliating, too out of control, too vulnerable, possibly overpowering. But Liz needed to let it out in front of another person and in front of herself, to discover that her world would not fall apart when she did it and that there was no shame in it.

How Liz and I worked on this together would make another book. It is not a simple matter, like saying, "Okay, Liz, cry." But once she had heaved up the big thing, it amazed her how the little things shrunk back down to size. She had gone north and she came back a whole person.

But What If?

Worry sometimes begins with a negative possibility, a mere "What if?" Then it burgeons up out of information that originally was neutral or innocuous. One of my patients, Becky, calls these endless "What ifs?" SBPOWs, which stands for "spontaneously branching polymers of worry." (She pronounces SBPOWs as "spouse" because she claims her husband is the source of most of them.)

"A little worry can branch spontaneously with a vengeance," she explains. "It's like a pattern of frost that shoots across a cold pane of glass. In seconds I am fighting with an enormous net of dangerous, intricate detail. You can't believe how quickly I go from dealing with one worry to having a jumbled mess of them."

This kind of worrier broods incessantly. When the mind obsesses over negative outcomes at the mere hint of one, the worrier is suffering from a type of obsessive-compulsive disorder (OCD). About 5 million Americans are afflicted with OCD, and though we do not have a cure, we do have excellent treatments which can drastically reduce the severity of the symptoms.

In OCD, worry rules the mind like a sorcerer. The individual even resorts to superstitious rituals in the hope that the rituals will magically rid him of the dangers he senses and fears. I once treated a man who had to hop on one foot whenever he was waiting in line, because he felt he would be in extreme danger otherwise. The sufferer of OCD is obsessed with a variety of intrusive, unwanted thoughts. He also feels compelled to act out certain rituals in an attempt to stave off (imagined) dire consequences associated with his unwanted thoughts.

Treatment for OCD has been revolutionized by our recent discoveries about the brain. We now know that there is a physical basis to OCD. We have even found differences in brain scans of individuals with OCD. Only two decades ago the standard treatment for OCD was to try to ferret out the psychological conflict that must be causing such bizarre behavior. People would stay in psychotherapy for years, while still suffering from OCD. Today we know that a combination of medication and therapy works best in this kind of obsessive worrying.

Panic Attacks

Sometimes the brain's alarm system misreads danger signals, like a vast sprinkler misreading cigarette smoke as a fire, drenching everyone right in the middle of the grand ball. This alarm system, regulated by a group of nerves deep in your brain called the locus ceruleus, can simply go berserk. The name of this problem is panic disorder. And worry can be one of its cardinal symptoms. In panic disorder, a specific stimulus sets off a flood of terror.

Everyone who has felt panic knows how it hijacks the body: the rapid breathing and racing pulse, the burning waves of fear coursing through the body, the desperate feeling of needing to break free. Panic is the nervous system's turbo-charged means of escape. When panic strikes at the wrong time, however, it's like having an airplane take off in your living room.

Adrienne was standing in line at her bank one day when panic struck. "Suddenly, I became terrified. I felt as if I were being dragged to the edge of a cliff where someone was going to push me off. I broke out into a sweat, started to shake, then my legs gave out and I just collapsed to the floor."

"Do you have any idea what triggered this episode?" I asked her when she came to see me a few weeks later.

"I usually have no idea when an attack will hit," she replied. "It just happens. Sometimes I have three attacks in one week. It's crippling me."

Adrienne had begun to put off doing the most routine errands, saying she felt too nervous to go outside. She was developing agoraphobia, a condition that accompanies panic disorder up to 50 percent of the time. Agoraphobia is characterized by an intense fear of, and avoidance of, places or situations in which escape may be difficult or one imagines a panic attack may occur.

Panic disorder may show itself as social phobia, fear of public speaking, or of being the center of attention. It responds well to medication, as well as to desensitization techniques and cognitive therapy. By a variety of methods, those with the disorder are gradually and safely exposed to the source of their panic and worry: The intensity of the stimulus is slowly increased, and homework is often prescribed. This therapy alone has a success rate of 60 to 80 percent.

There is another kind of worry that is characterized by panic. But it is rarely focused on a single topic. It is called generalized anxiety disorder (GAD), and there is usually no apparent cause for the anxiety. It is free-floating. When GAD underlies worry, the thoughts can seem like mosquitoes. This means that they should be no big deal: just slap them away. But if you are surrounded by them, slapping them away constantly becomes, at best, tiring. Furthermore, they leave bites that itch and must be scratched. Like panic disorder, GAD can be treated successfully.

Taming Your Worries

The medications we have developed to treat toxic forms of worry mark a major breakthrough in healing human distress. While we must take care not to overuse medications, I am glad we have the option of using them when necessary. Listen to what my patient Jane wrote me, after she began taking Prozac: "My response to Prozac was dramatic. Within several weeks I stopped feeling depressed. I did not, however, expect that I would also stop worrying, but I did. I began to expect that problems would be resolved, and I resolved them." Psychotherapy, a program of exercise, and Prozac were the solutions to a lifetime problem for Jane.

We now have many safe and effective medications to treat worry:

Benzodiazepines, such as Valium, are the most common group of medications used to treat anxiety and worry. They shut down the alarm system in the brain, but can be habit-forming, even addictive, and some interact dangerously with alcohol. They are used best as part of a short-term intervention.

Beta-blockers, such as Propranolol (Inderal) can be useful for worry associated with specific situations, such as stage fright, or fear of public speaking. Taking a low dose an hour or so before a performance or speech can curtail tremor, palpitations, and sweating. Beta-blockers have some side effects, and cannot be used in people who have asthma.

Buspirone (BuSpar) is a new antianxiety agent that does not seem sedating or addictive—but is also less potent than benzodiazepenes.

Antidepressants play an important role in the treatment of worry. By far the most famous antidepressants are the selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. For people who brood endlessly, an SSRI can break the cycle. This change is not mind-altering so much as it is mind-healing. Ruminations are like severe headaches. If they go away, you feel like a new person, although you are in fact no different at all. You are the healthy version of yourself. The SSRIs have also become the first choice in panic disorder, and can help OCD. An older antidepressant, Chlomipramine (Anafranil) is still the first choice for OCD, but its side effects are worse.

Wellbutrin is an unusual antidepressant that increases two neurotransmitters, dopamine and norepinephrine. It's a good choice for worry that is associated with depression.

MAO Inhibitors such as Nardil require dietary changes (users must avoid wine, cheese, and chocolate) but are very effective for worry tied to a fear of rejection, or to post-traumatic stress.

Facing Worry Head-On

Medications are only part of a treatment program for worry, and often they are not necessary at all. First, you must understand the pattern of your worrying. Is it based in anxiety, depression, unhealed trauma? Whatever your diagnosis, learn as much about it as you can.

Then develop a treatment plan. One of the most powerful methods to decrease worry is through gradual exposure. If heights make you nervous, you might start by imagining you are standing at a certain height, looking down. Then in your imagination, and in the presence of a therapist, start going up, a few floors at a time. After you feel comfortable being exposed to heights in your imagination, try it in reality, using the same graduated process.

Similarly, a therapist may deliberately recreate the physical sensations accompanying worry, to help you get more comfortable with them. I helped my patient Adrienne recreate the feelings of panic within herself—breathlessness, dizziness, rapid heartbeat. She'd exercise until her heart raced, then talk herself through the feeling, noting that nothing bad was happening. Then we tackled her dizziness: she sat in a chair and I spun her around a few times. In this way, she began to take apart her worried state until she got comfortable with each individual piece. When she experienced them all together, in the stew of worry, she was less afraid of their impact.

Retraining Your Brain

Most of the worriers I treat need to retrain their minds and learn new mental skills. It's like training your muscles to learn the pattern of a golf or tennis swing, so that the correct swing becomes automatic. You can train your brain to learn effective ways of dealing with situations that arise again and again, such as financial worries or fears of failure.

There is a window of opportunity that lasts about a minute, during which you can sever the tentacle of a toxic worry before it grips you totally. Your brain has not yet gone into spasm. That is the time to defuse worry.

Talk to yourself in a useful way. Most worriers talk to themselves in half-phrases of imagined doom, little punches and jabs of negativity. Try to erase those old, automatic patterns by deliberately distracting yourself. Whistle or sing. Snap your fingers. Insert a positive thought. One positive thought at a time can gradually shift the balance of your thinking from negative to positive.

Monitor your automatic thoughts whenever you get bad news or perceive danger of some sort. It's helpful to write them down. Often you can see immediately how wildly exaggerated they actually are. Then examine these thoughts for errors in logic. Create alternative hypotheses that are more logical.

You may find that these automatic thoughts and errors in logic grow out of the fundamental way you look at life and at yourself, your self-schema. Do you fear that the deck of life is irretrievably stacked against you? Are you afraid that nobody will ever find you attractive? Whatever your self-schema might be, you can change consciously. Over time, self-questioning begins to replace reflexive self-flagellation.

Become creative in finding ways of quenching worry. Allison Barnes would blow into the palms of her hands sometimes before going into a meeting and say she had just "blown off" her worries. She bought an ugly-looking toad figurine, which she kept in her purse ready to deposit on a shelf whenever she needed a reminder that her worries could be put aside. You have to be willing to play along and suspend your disbelief for this method to work, but if you are willing it can work very well.

Worry paralyzes the sufferer and prevents him from taking action. My brain-training program teaches you to make concrete plans, eliminating unnecessary worry before it occurs. I call this program EPR: evaluate, plan, remediate. Evaluate a possible problem rationally, set up a plan to take care of it, then act on the plan. Turn worry into action. I recommend that worriers make a list of three—and only three—changes they want to make in their life. They might be as simple as making a dentist appointment or consolidating their credit cards. Persist until all three tasks are done. Then make a new list of three, and only three, changes you want to make in your life. After six months to a year, you will have dramatically changed your life for the better. And you will worry less, because you will be safer. Structure reduces risk.

Working Out Worry

As simple as it sounds, exercise is the best natural antianxiety agent we have. Exercise reduces tension, drains off excess aggression and frustration, enhances well-being, improves sleep, curbs the tendency to overeat, aids in concentration, and reduces distractibility. It is healing to the body, and therefore to the mind. Getting exercise at least every other day should be part of your plan to reduce anxiety and control worry. But you can also exercise on the spot to reduce acute worry. If you are having a bad day at the office, try walking up and down a flight of stairs five times. Your mind will be less troubled when you come back to your desk. The change in physiology induced by exercise calms the mind.

Don't Wring Your Hands: Clasp Them

Prayer or meditation can change the state of your brain as well. Talk to God when you feel worried. If you are not religious, learn how to meditate. Brain scans and EEG monitors show beneficial changes in the brain during meditation and prayer. These changes correlate with most of our measures of improved health, including longevity and reduced incidence of illness. And extended worry subsides with regular prayer or meditation.

Worry Wisely

I was playing squash one Sunday morning with Jeff Sutton, a neuroscientist and good friend, when I told him I was writing about people who worry too much. He instantly responded, "But worry is good! You have to worry to survive!" He then went on to talk about worry in the most animated, unworried tones, as he whipped the ball against the wall with a sharp smack. "Fear is wired in. Deeper than any other feeling." Smack! "Worry is good! If you don't want to worry, be a plant!" Smack! "Worry gives successful people an edge."

Jeff, of course, is right. There is such a thing as wise worry. It is our reaction to worry that counts. For winners, worry is a reason to take positive action. They use fear as a fuel.

Imagine the bow of a violin as life experience and the strings of the violin as our biological makeup. The bow of life's experience draws across the violin strings of biology to produce the music of life. What kind of music we make depends on both the bow and violin. And now, with advances in medicine, psychotherapy, and other techniques, the music wafting from that violin is truly in your own hands.

Excerpted from Worry by Edward M. Hallowell. Copyright 1997 by Edward M. Hallowell. Reprinted by permission of Pantheon Books.

30 Days In Worry Detox

In which our not-so-fearless news editor describes her efforts to become more carefree.

AUGUST 1. Reading Ned Hallowell's book on worry today, I found myself thinking of a picture taken years ago on a family trip to the mountains. My sister Sally, at five years old a year younger than me, stands at what looks to me even now as a perilous few inches from a precipice. She is beaming, dizzy with the danger or the altitude. And me? I'm off to the side, brow furrowed, arm reaching past the edge of the picture to hold my mother's hand.

At age six, I was already an inveterate worrier, and so l approached with some skepticism my latest assignment for PT: enrolling in Hallowell's "comprehensive program for controlling worry." Could a book change behavior so entrenched in temperament and habit? I agreed to try, and to keep a journal of my efforts.

Tonight presented me with my first opportunity to follow Hallowell's advice. My sister—she of the mountain's edge—was coming for dinner, and she was late. Never mind that there is no recorded instance of her being on time for anything: worry, as Hallowell reminds us, easily leaps the bounds of what's reasonable and rational. He calls worry "a disease of the imagination," and tonight my imagination was flush with fever, envisioning all the misfortunes that might have befallen Sally between her door and mine. Feeling the acid seep of a "toxic worry," I put myself in Hallowell's hands: clearly, what I needed was a dose of what he calls "constructive thinking." "Sally is always late," I reminded myself, and part of me listened attentively—and most of me kept on worrying. My body wasn't fooled for a minute: my hands were still clammy, my stomach still jumpy, my heart still throbbing with worry and with the conviction that some of us were born to be anxious.

And others not: just then Sally strolled through the door. "Hi," she said, as unconcerned as ever. "What's for dinner?"

AUGUST 14. Although my first attempt at following Hallowell's instructions was a failure (later I worried I wasn't trying hard enough), I looked forward to applying them to another iffy situation: flying to Chicago and back to report on the annual convention of the American Psychological Association. It's not that I dislike flying: it's the takeoffs and landings that worry me.

Strapped into a seat near the emergency exit, I watched with rapt attention as the stewardess lifted and bent her arms in rote pantomime, and studied intently the laminated card that explained how to leap off the wing of the plane or slide down an inflatable chute, should the occasion arise. Unlikely as these events seemed (my imagination favored more apocalyptic scenarios), mentally preparing for them did make me feel better—what Hallowell calls "getting the facts."

My other weapon against worry was my traveling companion, Marian Jones, otherwise known as the book editor of this magazine. Having learned from Hallowell that one has to ask for comfort outright, I called upon Marian to assure me at various times that the pilot was not asleep, that a bomb was not on board, and that the plane was simply banking to the left, not going down for the final time. Connectedness, says Hallowell, is everything, and when the landing gear connected with the runway I was the happiest passenger aboard.

AUGUST 18. Conference covered, I was on my way back to New York, this time without Marian, who had stayed to catch the last day of the meeting. Never worry alone, says Hallowell, but (as I thought while heading down the runway) we're always alone when we worry. When worry has my ear, it's hard to hear anyone else, and their reassurances only deepen my grim conviction that something is about to go wrong. That's the arrogance, the presumption of worry: that you can anticipate future disasters and, by an act of mental exertion, avert them. It's what Hallowell calls "the secret pleasure of worry," and it may be one I'm not ready to surrender. After all, worry has its uses: it pays my bills on time, keeps batteries in my smoke detector, gets my stories in by deadline (mostly). At that moment, I was sure it was keeping the plane in the air. Safe at the airport, I congratulated myself on a smooth landing.

AUGUST 24. Number 34 of Hallowell's "Fifty Tips on the Management of Worry" is "Take a vacation," and in this case I was happy to oblige. My unconscious packed my worries for the trip, however, as I discovered this morning upon awakening. I'd had a dream about work—something about a double issue of PT that was already late—and its undertow of anxiety had a stronger pull than the ocean I'd come to relax by. There's no vacation from worry, I thought, since it has set up long-term residence in my body: setting in my muscles, working on my neurons. Well, perhaps what begins in the body must be addressed there. Remembering Hallowell's praise for the mood-altering effect of exercise I pulled my running shoes from the depths of my duffel.

Forty-five minutes later, I was sweaty, sun-burnt, and exultant. My worry was laying low for now, and putting on my swimsuit, I headed for the beach—heedless of deadlines or the ocean's head-high waves. I didn't even wear a beach tag.

AUGUST 30. Tomorrow is Labor Day, and as vacation ends and fall begins I already feel weary. Worry is work, and I wonder if I'll ever be done with it. These days, dangers seem to be created as fast as they can be eradicated: a new virus for every vaccination, a carcinogen for every cure. Is it worry that's toxic, or the world we live in? And home is no haven from anxiety. I was raised on worry, fed a steady diet of possible disasters. My mother worries too much, as did her mother; worry's been passed on to me like an old debt, a cracked heirloom nobody wants, and some misplaced loyalty won't let me give it away. A patient of Hallowell's told him "I think me worrying is an much a part of me as my skin." I think so too; if I should shed that skin, what reckless or undefended person would emerge?

But if so weak a thing as will can keep worry in check, then I'm determined to do it. Not to change my essential orientation toward the world: Hallowell doesn't promise that, and I still think such change is impossible. He writes, instead, of controlling worry, managing it, "using it wisely." What I want, and what his book might yet help me get, is one part of worry without the other: the clear-eyed gaze at the world, without the defensive stance; the acute sensitivity to the unfamiliar, without the predictable drill of alarm. Knowing full well I might fall, I want to get to the edge and look out.

Weaving A Web Of Life: A Talk With Edward Hallowell, M.D.

Psychology Today: You're known as the man who helped bring attention deficit disorder to national attention. Why have you turned now to the subject of worry?

Edward Hallowell: Because I'm such a worrier. I attribute my worrying to my chaotic childhood. I tell people I'm from the WASP triad of alcoholism, mental illness, and politeness. I had an alcoholic mother and a psychotic father, and as much as I love my parents dearly, they provided me with no stability. It seems a minor miracle that I've done as well as I have. And I really attribute it to the power of connectedness. I've seen that, time and again, personal happiness depends on the richness and depth of our connections. The connected person is much stronger and able to deal with adversity than the disconnected person.

There's been a lot of research recently looking at anxiety and social connectedness. But how does one go about getting connected?

Number one is the family you're born into; it's our biological connectedness. Many people these days have very little contact with grandparents, cousins, aunts, uncles. They tend to feel less secure.

How do you stay connected if you've got a chaotic family, as in your case?

You can replace [the family connection] with a strong set of friends, which also can be a security network. People today have a host of acquaintances, but don't have someone they can pour their heart and soul out to. A friend in the old-fashioned sense can be very sustaining. A related kind of connectedness is to institutions and organizations, and this is really threatened these days. The world of Dilbert is the world of the disconnected employee, the employee who feels cynical, exploited, about to be downsized at any moment.

You also talk about connection to information and ideas. But can't the world of ideas isolate you from people?

It can, but done properly it has just the opposite effect: It throws you into the world of other minds. It's important to develop a comfortable relationship with information and ideas.

Historical connectedness is also important. If you have no awareness of the past, you're cutting yourself off from something significant. I named my daughter after my great-great-great great-grandmother, who fought to free slaves and supported women's rights. That name will deepen her sense of where she came from—a strong woman from another century.

And finally, there is connectedness to what is beyond knowledge—God, your sense of the transcendent. Those six spheres of connectedness—to family, friends, the past, information, institutions, and the transcendent—give you a psychological armor that can sustain you through life.

Even if you put all the connectedness into place, isn't there a vulnerability you're going to carry with you from a difficult childhood?

Absolutely. I will never be able to have the bedrock security that someone who had a different kind of childhood would have. But I can come very close. Yes I'll always be a little bit haunted by what was missing in my childhood. But no matter where you're coming from, you can get to a better place with these simple techniques. One of the real bits of good news from the neurosciences is that as much as you can burn the brain, you can heal it, too.

You "come out" as a practicing Christian in your book, which is a risk for someone of such renown in the psychiatric community.

It's a risk that I take knowing that some people will dismiss me, but I think it's worth it. When I wrote "Driven to Distraction," some people said, "You can't say you have attention deficit disorder. You'll be dismissed as some kind of a nut." I said, "How can I tell people not to be ashamed of it if I can't even say I have it myself?" I feel the same way about writing about God. How can I say to people. "You ought to develop a spiritual life," if I don't dare acknowledge my own? I think doctors, and certainly psychiatrists, have not known what to do with spirituality. As a result they've just ignored it, which to me is a huge mistake. It's a very powerful part of the mind, and at least as powerful a part of one's life as sexuality. In my case, a relationship with God is another source of connection. And ultimately, it makes sense of my life in ways that nothing else can. But that's just me.