My father had what his mother called ‘nerves.’ He couldn’t sit still for more than twenty minutes. He slept badly, woke early, filled every available hour with activity. He was enormously productive. He was also, I understand now, running from something that had no name in the world he grew up in. The name, if you were going to give it one, was anxiety. But that word didn’t exist for him as a description of a condition. It existed as a character flaw — the thing you overcame by getting on with it.
The vocabulary that didn’t exist
The diagnostic language for anxiety disorders didn’t enter common usage until the DSM-III in 1980, and it took another decade or two to filter into the cultural conversation in any meaningful way. Before that, what we now recognize as generalized anxiety disorder, panic disorder, or chronic stress simply had no framework. The experience was real — the racing thoughts, the physical tension, the inability to rest without guilt — but the framework for understanding it as a medical or psychological condition rather than a personal failing didn’t exist.
The generation raised in the 1960s processed their anxiety through the available categories. You were high-strung. You were a worrier. You were nervous. You were difficult. Each of these categories placed the problem in the domain of personality rather than health, which meant the solution was effort rather than treatment.
Research from the National Institute of Mental Health estimates that anxiety disorders are among the most prevalent mental health conditions in older adults, and that they are significantly underdiagnosed in people over 65 — in part because that cohort was raised to present symptoms as personality traits rather than medical concerns.
What high-strung actually meant
High-strung was a revealing word. It implied something tightly wound, taut, capable of great performance but easily snapped. It acknowledged the cost — the tension — while framing it as a feature rather than a problem. The high-strung person was often also the reliable one, the one who got things done, the one whose anxiety expressed itself as hypervigilance about tasks and responsibilities.
My aunt Helen was described her entire life as high-strung. She was also the most competent person I knew — the one who handled every family crisis, remembered every detail, never let anything fall through the cracks. The anxiety was the engine of her competence, and it was also the thing that gave her, at 71, a stress-related autoimmune condition that her rheumatologist said was about twenty years in the making.
The body’s accounting system
The phrase ‘the body keeps the score’ has become familiar since Bessel van der Kolk’s research on trauma made it a cultural touchstone. But the principle applies beyond trauma, to the ordinary chronic stress of a life managed rather than examined. The body maintains an accounting of everything the mind has processed by pushing it aside. Cortisol levels, inflammatory markers, cardiovascular load — these don’t care whether you’ve named what’s happening to you. They respond to the physiological reality regardless.
A longitudinal study published in Psychosomatic Medicine found that adults who reported high levels of chronic worry in midlife showed significantly elevated inflammatory markers in later life, independent of other health behaviors. The worry itself — not the circumstances causing it — was a measurable physiological event with a measurable physiological cost.
How the bill arrives
It arrives differently for different people, but it arrives. For some it’s the autoimmune condition that shows up in the sixties after decades of high cortisol. For others it’s the insomnia that was always there but becomes unmanageable when the structure of work is removed. For others it’s the panic attack that seems to come from nowhere at 58, which is actually the first time in forty years the person has slowed down enough to feel what they’ve been running from.
What’s striking in each case is the patient that the body has been. It waited. It managed alongside the person managing everything else. And then it presented the account.
The generation learning the language now
Something interesting is happening among people in their sixties and seventies who are, sometimes for the first time, encountering the clinical vocabulary for what they’ve experienced their whole lives. The recognition tends to be profound and slightly absurd at once — the experience of learning at 68 that the thing you’ve been managing since childhood has a name, a mechanism, and treatments that work.
It doesn’t undo the decades. But it does something important: it removes the shame. The high-strung person discovers they were never difficult. They were just anxious, in a world that hadn’t learned yet to say so.
Final thoughts
The generation that managed its anxiety through work and will and the refusal to name it produced remarkable things.
They also paid a price their bodies are now presenting. And they are, many of them, finally learning to read the bill.
