The Anatomy of Anxiety by Ellen Vora review – the physical basis of mental health

A psychiatrist explains how distressing states are often rooted in bodily dysfunction – and what it means when they aren’t

The world is in the midst of an anxiety epidemic, and it’s no wonder, according to Dr Ellen Vora. Modern life is fraught with stressors, ranging from our phones to an “always on” work culture and underexposure to sunlight. But, she argues, our understanding of this crisis is in need of an overhaul.

In her warm and highly readable new book, The Anatomy of Anxiety, Vora makes a compelling case that anxious people should tackle the condition not just in their minds but in their bodies. That begins with sorting unease into two categories: “false anxiety” and “true anxiety”. Both cause real suffering, but each one calls for a very different approach.

False anxiety, as Vora describes it, is largely rooted in our physical health. We might feel anxious because we’re chronically sleep deprived, or over-caffeinated, or eating too much junk food. All this can provoke a stress response in our bodies, which send a message to our brains: something’s off. “At these times, our minds are all too happy to swoop in with an explanation,” Vora writes, and we decide that it’s relationship issues, a recent email from work, or fears about the news that have us on edge.

This should come as a relief, because it means there are fairly simple steps we can take to rectify the situation. Vora, who describes herself as a holistic psychiatrist, focuses on changes we can make to our daily habits.

Many of her suggestions feel achievable: minimise blue light exposure late in the day; eat more vegetables; limit social media use. Others seem more daunting, including quitting sugar altogether. But Vora writes with compassion and is rarely prescriptive, noting that acting on even a few of her suggestions will be beneficial and urging readers not to be overcautious about diet: “The multifaceted pleasures of food are, in themselves, powerful medicine for anxiety.”

Once we’ve eliminated these sources of false anxiety, we can turn to what Vora calls true anxiety. This is any unsettled feeling that remains, “which we can think of as an emotional compass telling us something is not OK”. Perhaps it’s a signal that we’re following the wrong path in our career or relationships, or distress at the state of the world and a sense we should take action. Instead of trying to erase this sensation, we should embrace it: “Our uneasy feelings are no longer the enemy or something to vanquish – they become our tools and allies instead.”

The key, Vora says, is to figure out how to 'tune in' to this true anxiety and hear its message

It’s a redeeming way to look at the condition, as not merely a burden but ultimately a blessing. As Vora shifts to focus on true anxiety, the book becomes unexpectedly moving; as someone with lifelong anxiety, I found the idea validating and hopeful. The key, she says, is to figure out how to “tune in” to this true anxiety and hear its message. That depends on learning to sit quietly and listen to ourselves. Vora offers a simple and nonjudgmental guide to meditation, and suggests calming ourselves by getting in touch with nature and with others, since, “at the end of the day, our wellbeing rests on our connections with other people above everything else”.

Vora has a medical degree from Columbia University and extensive experience in alternatives to western medicine. The result is an open-minded and well-rounded approach to the psyche. But there are a few moments – as in her discussion of psychoactive substances or eating disorders – where Vora’s judgments can appear a little too reflexively anti-orthodox, and she seems sometimes to give greater weight to individual patients’ stories than to the scientific consensus. That said, she is careful to advise readers that their own experiences are unique.

“The tone of life these days is anxiety,” Vora writes. “Anxiety is the verb, the vibe, the texture, the pH of our age”. Anxious people are the proverbial canaries in the coalmine, Vora argues, sensitive to “the toxic influences of our modern world” before others identify them. Those living with the condition, then, can take pride in it; they are empathic, intuitive, creative. Anxiety “means you may have a bigger antenna than the average person, so you pick up more of the background noise,” she says. “This can be a liability, because the world can be pretty loud these days, but it’s also a gift.”

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