A friend is claimed to have given Bernstein the idea to write music based on The Age of Anxiety in a letter: When beginning to write the piece, Bernstein stated that Auden's poem was "one of the most shattering examples of pure virtuosity in the history of English poetry" and that a "composition of a symphony based on The Age of Anxiety acquired an almost compulsive quality.

Bernstein worked on the composition "in Taos, Philadelphia, Richmond, Mass., in Tel-Aviv, in planes, in hotel lobbies…"[2] Though called a symphony, "The Age of Anxiety" does not follow the traditional symphonic form: instead of a conventional four-movement, exclusively orchestral work, Bernstein scored it for solo piano and orchestra, and divided the piece into six subsections – mirroring Auden’s text – split equally into two parts that are performed without pause.

[citation needed] The work was dedicated to and commissioned by Serge Koussevitzky who was preparing to end his 25-year career conducting the Boston Symphony Orchestra.

[1] In accordance with Auden’s “Prologue,” the poem begins with four lonely individuals (three men and one woman) in a bar, each reflecting on his or her own disquietude while acknowledging the presence of the others.

It then proceeds to “The Seven Stages,” that tells the tale of the same “group [embarking] on a collective dream, one of even more heightened awareness, attempting to rediscover the deeper meaning of their own humanity.”[2] Emulating the characters conflicting ideals and desires, Bernstein weaves a frantic and confused musical tapestry that shows the characters trying desperately to find what they are searching for, but falling short, though becoming closer because of their experience.

The second half of the piece opens with “The Dirge”, a theme, first introduced by the solo piano, based on a 12-tone row that gives way to a contrasting middle section, reminiscent of Brahms’ romanticism.

The listener, as well as the reader, finds that “what is left, it turns out, is faith.”[2] The work was premiered on April 8, 1949, with Serge Koussevitzky conducting the Boston Symphony Orchestra and the composer at the piano.

[citation needed] The work was premiered at the New York City Center Theater in 1950 and showcased the artistry of Jerome Robbins, Todd Bolender, Francisco Moncion and Tanaquil Le Clercq.