Americans can be so macho. And misinformed.

At times, I'm both.Years ago, when a family member confided that he had generalized anxiety disorder to such a degree that he needed a sabbatical from work, serious medication, and twice-a-week therapy, I said all the right things and supported him in every way possible. But one thought wouldn't leave my mind."You need to toughen up, buddy."I couldn't imagine why he couldn't rid his mind of the dark thoughts that would seemingly take control. He claimed, however, that when they came, he was defenseless. His heart would race so fast, the panic would be so great, that he feared having a heart attack.And the dark thoughts, no matter what he did, would not relent.Somewhat in the same way that "You need to toughen up, buddy" wouldn't let up in my mind.Then I got a tiny taste of his terror and realized taming dark thoughts had nothing to do with being tough and that "moron" is sometimes a perfectly suitable synonym for macho.In the summer of 2002 after nearly two months of unsuccessful traditional physical therapy, my doctor prescribed the Dynasplint, a spring-loaded tensioning device to provide a prolonged-duration stretch, to my seemingly frozen right elbow. In essence, the instrument incorporates the concept of the medieval torture tool called the rack to regain range of motion to injured joints.My need for the device, the doctor believed, resulted from the fracture of my olecrannon, the very tip of the elbow, going undiagnosed for five days and allowing the triceps muscle attached to it to roll up my upper arm like a window shade. That I was able to tolerate the contraction of the muscle and the moving of the chipped bone while teaching and continuing to work out, he said, demonstrated an unusually high threshold for pain.I told you I could be macho and a bit of a moron.But turning the screw on the Dynasplint to make my arm bend further than it would when my 180-pound PT pushed on it with all her might and keeping it locked on that setting for hours created a toothache-like torment that radiated from my elbow to my head and wouldn't let me think straight. Finally, it forced me to do something I had never done before: take the pain medication prescribed after surgery by a doctor.Unfortunately, when I gave in and popped the heavy-duty pills, it was just after a particularly painful rehab session and just before addressing parents assembled in the auditorium for Meet the Teachers Night at my school.Maybe I wasn't making sense because of the meds, but a father in the audience began heckling me. Maybe heckling is too strong a word, but he was asking question after question and making snide comments after my answers.Again, that toothache-like torment that radiated from my elbow to my head. My pulse quickened. I began to sweat and sweat and sweat.In torrents.Every pore in my body perspired prodigiously. As soon as I finished speaking, I hurried to the bathroom to splash cool water on my face.When I looked up at the mirror, I saw that the sweat had soaked through my shirt, not only at the armpits but also across my chest.From that year on, regardless of how much deep breathing meditation I did as I waited, no matter what positive mantra I kept chanting in my head, I would sweat unnaturally as soon as I started to speak at a Meet the Teachers Night. The problem continued for years until we changed the format of the program and began meeting with parents in classrooms.My story and my relative's make it painfully clear that anxiety in essence, supercharged stress with no identifiable root laced with enough fear to interfere with daily functioning can't be trumped by simply "toughening up." In fact, according to Paul Foxman, Ph.D. and operator of Paul Foxman's Center for Anxiety Disorders in Burlington, Vt., 40 million Americans, including 3 million children, have anxiety to such a degree that controlling it requires professional help.The problems that anxiety creates invariably escalate, however, for only one in four afflicted seek that out.That last stat is just more proof of American machismo and a product of Americans being misinformed.I know that I sad to say originally thought that my relative didn't need a doc, that the dark thoughts would stop if we simply took some time and had an in-depth, heart-to-heart talk.Not so.For those macho types, it may help to think of the yellow discharge that comes from your nose when you're feeling under the weather. Most times, it's just a sign of the end of a cold, and there's really no need to see a doctor.Other times, however, the yellow discharge comes from a sinus infection, something that's not going away without a round of antibiotics, which means for even the most macho a visit to the doctor's office.Anxiety is the same.