The philosopher Søren Kierkegaard in his treaty On the Concept of Anxiety, wrote that if anyone claimed they never felt anxiety ‘I will gladly provide him with my explanation: that it is because he is very spiritless.’ Very spiritless!

For Kierkegaard, anxiety defines humanity, expresses our indomitable will for life and it is our compass towards freedom. To be sure, he knew what he was talking about. He wrote, ‘All existence makes me anxious … My distress is enormous, boundless.’

Still, his ideas, however inspiring, may be of no help to those in the thrall of paralyzing panic, phobias, obsessive thoughts, compulsive rituals or post-traumatic stress. We might keep them in mind, though, while we investigate this powerful affliction, hoping, perhaps, to draw inspiration from its least disabling manifestations.

What is anxiety?

The study and treatment of anxiety are at the centre of psychoanalytic theory and clinical practice. Psychoanalysis, like Kierkegaard, considers anxiety the affect at the core of our being. Psychoanalysis is, therefore, well placed to both help us make sense of it and manage its most disquieting aspects.

Anxiety is, today, among the most diagnosed mental health difficulties. It is so prominent to elicit for our times the label of ‘age of anxiety’ (W.H. Auden wrote a poem by that title). We all experience anxiety at some point in our lives more or less intensely. Its most severe forms can prevent us from working, studying, leaving our home or relating to others and require professional help.

In 1621, the Oxford scholar Robert Burton in his monumental treaty The Anatomy of Melancholy, described how anxiety makes one

‘affrighted still by some terrible object, and torn in pieces with suspicion, fear, sorrow, discontents, cares, shame, anguish, &c. As so many wild horses, that they cannot be quiet an hour, a minute of time, but even against their wills they are intent, and still thinking of it, they cannot forget it, it grinds their souls day and night, they are perpetually tormented (…), they can neither eat, drink or sleep’.

These words aptly describe the pervasiveness and intensity of anxiety. From the subtle dissatisfaction with life and the existential idleness below the surface of aimless hyperactivity, to the longing for something unknown or that somebody else can bestow on us – recognition of our efforts, requital of our love. From the worries that the schemer, the criminal, the envious may take away what we have, to the disabling feeling of being in public or in enclosed spaces, to the paralyzing effects of panic, to the phobic reactions to animals or objects. Maybe reading those words brings to mind the 'nameless dread' described by psychoanalyst Wilfred Bion.

In his book Inhibition, Symptom and Anxiety, Sigmund Freud explains how at the heart of all anxiety is the infant’s helplessness and its fear of being overwhelmed by her surrounding environment. As adults, we experience anxiety as having no target at all. We think of it, perhaps, as our own feelings attacking us from deep inside us. This is so because these feelings are linked to unconscious memories of when, so new to life, we experienced momentary hunger and loneliness. For Freud, the way in which the infant lives through those experiences, structures her character and her ability to manage anxiety as she grows up.

For instance, as an adult, she could be anxious about failing an exam or a job interview, or she might feel unable to establish a good romantic relationship. In these real and anxiety-provoking present situations, she experiences again the helplessness of the infant she was who needed food and could not produce it herself. The way in which as an infant she learnt to deal with helplessness, dependence, frustration and anger relates (a long journey made of many small steps) to the way in which, as an adult, she will respond to anxiety-provoking situations.

Psychoanalyst Melanie Klein, distinguished between two broad constellations of anxieties developing in the infant’s relationship with her carer, the persecutory and the depressive. They are more like poles of a spectrum along which we all move often in life, rather than a binary opposition. Persecutory anxieties haunt us to paralysis and imbue everything with danger. To protect ourselves we feel that our only option is to run, perhaps by not applying for that job we need, not going to that party, not answering that call.

In doing so, we might re-experience the desolation of the infant who felt abandoned, all alone and unable to fend for herself in a world so big and dangerous. She feels so lost. In her cot, alone and terrified, she hates her bad, bad, carer for abandoning her. But, then, her good carer comes back and provides the food she needs and the hug she craves and she loves her so much for this. In time, the bad carer and the good one (the “witch” and the “mummy” of old fairy tales) become one in baby’s mind and, in her cot, she can now hug her soft toy knowing she will not be alone for long.

In one of those calm moments, though, she realises that her hatred at the bad carer, really was aimed at the good carer as well, because they are the same person! Horrified by this realisation, baby feels guilty for the damage she has done in her thoughts (die witch, die, she might have wished) or perhaps when, still furious and angry, she bit the bad breast that had made her hungry. With the help of her carer, the baby will learn to recognise her contrition and find a way to repair the damage done and, in time, she will repair her way through her, now depressive, anxieties. As the baby grows, she carries in her mind her loving, and at time disappointing, carer. From inside her mind, that carer will care for her as she faces the difficulties of life and she will live as happily as it is realistically possible. But not all stories have a happy ending…

Psychoanalytic treatment of anxiety

In his book Psychoanalysis and Anxiety: From Knowing to Being, Chris Mawson evocatively writes that anxiety ‘lies at the foundation of our being in the world’ and that those foundations are shaped by ‘the original orientation of the mother toward that anxiety.’ If the nursing context is conducive to contain the baby’s initial anxieties, she learns that she can survive them. Later it will learn how they constitute a fundamental emotional response to the difficulties she faces both inside herself and from the outside. With time, she will develop the ability to contain her anxieties and by doing that she will develop her capacity to deal with increasingly more complex life experiences.

What, though, if those foundations are unable to endure the constitutive uncertainty of existence and life’s, sometimes traumatic, experiences? What if the infant internalises a carer who does not attend to her needs and abandons her when she most needs help?

Psychoanalysis can strengthen or rebuild the foundations of our life. On the one hand, understanding the structure of one’s character can have important repercussions on one’s ability to tolerate anxiety and draw inspiration from it. For this reason, psychoanalysts advise that to address the disabling effects of anxiety exploring its origin will yield better and more lasting results than manage its symptoms.

On the other hand, the very relationship with the psychoanalyst is the source of therapeutic change. As the patient’s patterns of relating are reproduced in the relationship with her analyst, they can be observed, contained, and changed. The process reactivates the experiences of the infant with her carers and continues the development of the self-caring part the patient’s self.

As we saw, for Freud and Klein, all anxieties relate to the initial, fundamental and universal separation anxiety. Our experiences of separation and loss in life are rehearsed in the analytic relationship, for instance at the end of the sessions, at the end of the week, before a seasonal holiday.

The psychoanalyst observes how the patient feels in those moments and helps her make sense of her feelings. Naming the patient anxieties can gradually shift the underlying structures of her personality and the carer in her can become stronger and more reliable. In turn, the trust in this internal support will affect her confidence, her daily relationships, and her behaviour when faced with the inevitable disappointments and losses. It is in this way that psychoanalysis can help us understand our anxieties so that we can use them to move along our journey in life. Because, it is anxiety, as Kierkegaard wrote, that leads us from one step to the next every time we lift our foot to move and we must lose our balance to progress anxious, though we may be, that we might fall. Sometimes we do fall, but when we do, we can take care of ourselves.

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