Reflections on Anxiety
Anxiety is a broad topic, engaging all of us, and provoking reflection by thinkers like Kierkegaard and Heidegger who see in it fundamental aspects of our being human. We can place anxiety on a long scale, whose low end of arousal is uneasiness and whose high end is paralyzing terror. In between we find fear, social anxiety, agitation, dread, and panic.
Patients at Riggs experience all of this range, and when they come to therapy they expect us to do something to restore calm. Often the only and best thing we can do is to listen, understanding how difficult it is for the patient to get through the day. Perhaps medication will help. In the meantime, what we can do is share the anxiety, not imposing additional expectations on the patient, validating the experience by feeling its traces in us, showing patience, and sustaining hope that the anxiety will be mitigated over time. Our attentive presence and a proper reserve may be the best things.
Therapists also get anxious. We not only share the patient’s anxiety (in reduced intensity) but we also have our own anxiety: Am I doing enough? Will the patient survive? What do my colleagues make of this? What will the patient’s family think? Is the treatment going well? What will I say to colleagues on my team? Have I missed something? And of course personal concerns are also part of the therapist’s anxiety.
Families get anxious about numerous issues: Is this the right place for the patient? Will we be blamed for his or her difficulties? How long will this treatment take? Will we have enough money? What about other family members? How do we get involved with treatment but not over-involved? Can we trust the staff?
Patients get anxious about our anxiety as well as the family’s anxiety (they are usually very aware of both). In addition, they have their own history to contend with, full of questions about responsibility, guilt, shame, loss of competence, inability to function as they might have in the past, severe doubts about their future, anxiety about their own anger, and suicidality.
The questions that we deal with seem self-evident, expected, maybe even somewhat predictable. What is of note to Kierkegaard and Heidegger is that such questions, which are potentially endless, point to an underlying structure—or lack of it—of our human existence: the freedom of existence itself, and the unnameable beyond existence, the no-thing beyond every thing. Anxiety brings us to the dizzying edge of this gap in grappling with concrete questions. Settling the questions and concerns brings us a much-needed temporary calm. It does not “fix” the vulnerability we all share as fragile human beings.
Freud viewed anxiety as a signal. He distinguished realistic anxiety, which signals an external danger, and neurotic anxiety, which is about the repetition of a trauma, of which there are many for Freud, beginning with the experience of birth, dread of the loss of the mother or the loss of her love, and later the dread of self-condemnation for failing to live up to an ideal, and, last of all, the dread of death. These are “existential” issues having to do with loss, limit, and helplessness. We all share the same existential anxiety, if we are honest with ourselves. Often it is our patients who teach us this, and we become better therapists when we acknowledge this. As the psychoanalyst Harry Stack Sullivan put it, “We are all more simply human than otherwise.”