Understanding a Little More About Anxiety

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

Anxiety is probably the most common ailment of the modern age, ranking up there along with depression and addictions. But that doesn’t make it any easier to deal with. We may know a whole lot about it but for anyone experiencing regular anxiety attacks, the reality is frightening.
What makes it even more frightening is that, by its nature, it appears to arise without any particular trigger. It begins as a bad feeling inside that builds and builds until it has the person on the verge of an indescribable blind panic; with all the associated physical symptoms that entails. The other nasty thing about it is that it can happen anywhere, in a restaurant, at home alone, among friends, on a walk in the country.
The text books say that anxiety is a psychological and physiological state characterized by cognitive (Mind), somatic (Body), emotional, and behavioural components that combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.
The fact that it has no identifiable trigger is the very thing that distinguishes it from fear, which in contrast happens when a real, external threat appears. If something nasty and real appears in front of us we have the ability to run or fight – the fight or flight strategy. But with anxiety the threat is internal and is perceived to be uncontrollable or unavoidable. That is the kernel of the threat which these bad feelings represent – they threaten to overwhelm us in a way we can’t avoid.
In this regard nothing much has changed in our basic understanding since Sigmund Freud mapped out the territory of anxiety almost 120 years ago. In fact, he was the one responsible for separating out anxiety from a whole host of other ailments comprising ‘neurasthenia’ back in 1894 because he felt it was an enormous subject in its own right. Be that as it may, there is a normal side to anxiety too. It is a normal reaction to stress and can help us deal with difficult situations by making us concentrate and cope. But when anxiety becomes excessive, it is classified as an anxiety disorder.
There are a large number of anxiety disorders in the psychiatric profession’s manual, the DSM (Diagnostic and Statistical Manual) and they all have the main criterion of abnormal or inappropriate anxiety. So if you start sweating, your heart starts racing, you become breathless, your muscles tense and you experience intense fear all for no reason then you are experiencing inappropriate anxiety.
Provided there is no medically explainable reason, it is considered an anxiety disorder. And with the psychiatry profession’s love of new disorders, you have many to choose from. There is acute stress disorder; there is agoraphobia – phobic fear of open spaces (with or without panic disorder); there is generalized anxiety disorder; there is our old friend obsessive compulsive disorder; there is panic disorder (with or without agoraphobia); there are phobias generally (including social phobia) and finally there is post traumatic stress disorder.
So now you can begin to see why anxiety is one of the most prevalent and unpleasant conditions in contemporary society. It is the common element in so many varying ailments, either appearing on its own or in combination with a host of other factors such as stress disorders, phobias, compulsions and obsessions.
If we go back for a moment to the later Freud of 1926, he said there were two types – one a very primitive and primary anxiety that stems from our helplessness as infants and recreates the traumatic experience of overwhelming bodily sensations that threaten us with total disintegration and possible annihilation.
Remember, in psychoanalytic thinking, helplessness is the prototype of trauma. And when flooded by overwhelming quantities of instinctual tension as infants, that we have no way of dealing with, it heightens our helplessness and this is therefore traumatic. In turn, each time we are subjected to such a ‘flooding’ as adults it is also traumatic because we are confronted with the same uncontrollable flow of excitations.
But as we progress through infancy we begin to learn to defend against this primary anxiety by using Freud’s second type of anxiety - signal anxiety – which warns us about the potential emergence of the first or automatic anxiety i.e. our fear of annihilation. So, as infants, we cry or reach out or call out to our primary carer.
In short, the first warning we get is signal anxiety. It warns us through an increase in our bodily or mental tension. It is the mind’s way of adapting itself to take defensive action against something overwhelming that is about to happen from within. It is our human way of ensuring that we take whatever precautions are necessary so as we do not experience the more serious primary and overwhelming anxiety.
And so we come to a key concept around dealing with anxiety. The rise in mental or physical tension is, if we take Freud’s view, a signal that an anxiety attack is building. But who in our fast-paced world of short deadlines, work pressure, performance targets and so on is not subject to rising tensions? How do we recognize the signal when it comes?
Add into the mix, possible variables such as a lifestyle that includes an amount of alcohol or drugs, personality factors such as dependency or depressive or self-critical tendencies; and not forgetting the normal ups and downs of relationship and emotional issues. It all adds up to an impossible task to monitor or even recognize the stresses and strains that our psychophysical systems are under.
There are therapies that can offer solutions to anxiety attacks – usually they focus on teaching the person to listen out for these very signals. That is a skill that modern living, particular in Western culture, has blunted for many of us. And that is why spiritual solutions such as meditation or Yoga or old fashioned prayer offer comfort to so many.
Psychoanalytic psychotherapy offers its own solution – a talking experience in a professional relationship with a trained ‘other’ person in which ‘the pain of detachment’ as the anthropologists call it – the gap that exists between our natural and our civilized, technology-oriented selves – is made understandable and bearable.
Anxiety has a natural defense. It is called signal anxiety but its defensive purpose is redundant if we lose our ability to hear the signals.