Modern mainstream psychiatry really can’t be bothered with anxiety. For orthodox psychiatrists, anxiety is not an SMI (Serious Mental Illness) so it is generally treated as second rate and handed to psychologists. Very often, it is called ‘comorbid,’ meaning it occurs with something else, mostly depression but also alcoholism and other addictions, chronic pain and so on. The way psychiatrists use the word ‘comorbid,’ they mean ‘trivial, irrelevant, a sideshow which need not be taken seriously.’ In this book, I will argue that anxiety is not a sideshow, it is the biggest show in town and it has to be taken very, very seriously. Anxiety is much bigger, much more dangerous and much more difficult to understand and manage than, say, depression. But before I set out my case, it would help if you had some background so you can understand how I arrived at this almost sacrilegious position.

I studied medicine in Perth, Western Australia, which takes pride in its reputation as the most isolated capital in the world. But I was the only student in my year who came from a country high school, all the rest had been to school in the city. I was the first of my entire family to complete high school, the first to go to university, and I knew just one person in the city when I arrived there. As a scholarship boy, I was able to attend the most prestigious residential college but right from the beginning, it was clear to me, and to everybody else, that I didn’t fit in. What spoiled it was that not only did I not fit in, but I had no intention of fitting in. And this continued throughout my studies. I spent my summer holidays working on isolated farms far from the city, I took history, politics and religion and other Big Ideas very seriously and slowly, it dawned on me that I didn’t like anybody with power or money. I liked ordinary people, I was at one with them and that hasn’t changed.

Throughout the six years of my medical course, my plan had been to train to become a country general practitioner. I never intended nor expected to stay in the city longer than I had to but in my first posting of my first year, that all changed. I was sent to the neurosurgery unit and loved it, to the extent that two years later, I managed to get another three months on the unit. It was a busy life. In the good old days, we were rostered on duty in the hospital for as much as 103hrs a week. If you slept for a few hours here and there, you were lucky. On several posts, I was routinely rostered on continuous duty from 8.00am Friday to 6.00pm Monday. It was not unusual to work until sunrise on Saturday, or even longer. Yes, it was dangerous but there was no point complaining as many of our consultants had served in the Second World War and they scorned anybody who complained about being tired. Convinced that I had found my purpose, I applied to begin the training. A neurosurgeon must do the same training as a general surgeon, then a further two years in his specialty. I threw myself into the reading program, essentially basic medical school again, anatomy, biochemistry, physiology, pathology, with a big emphasis on neuroanatomy and neurophysiology.

At the end of my three years as a junior medical officer, just before I was due to start formal surgical training, I was given the choice of yet another term in the emergency department or going to the psychiatry ward.Psychiatry? It seemed that would be helpful for a neurosurgeon so that’s what I chose. My first day wasn’t much fun, it was difficult to reconcile all this talking with the idea of cutting heads open but within a few days, I realised that this was what I had always been interested in: Big Ideas. And psychiatry, of course, deals in the biggest ideas of all: mind, reality, the lot.

After three months, I left to go to another hospital to start as a surgical registrar,