Chapter 11

METHODS OF DEALING WITH ANXIETY

Only that individual can go through life without anxiety who is conscious of belonging to the fellowship of man.

—Alfred Adler

ANXIETY HAS A PURPOSE. ORIGINALLY THE PURPOSE WAS to protect the existence of the caveman from wild beasts and savage neighbors. Nowadays the occasions for anxiety are very different—we are afraid of losing out in the competition, feeling unwanted, isolated, and ostracized. But the purpose of anxiety is still to protect us from dangers that threaten the same things: our existence or values that we identify with our existence. This normal anxiety of life cannot be avoided except at the price of apathy or the numbing of one’s sensibilities and imagination.

The omnipresence of anxiety arises from the fact that, when all is said and done, anxiety is our human awareness of the fact that each of us is a being confronted with nonbeing. Nonbeing is that which would destroy being, such as death, severe illness, interpersonal hostility, too sudden change which destroys our psychological rootedness. In any case, anxiety is the reaction when a person faces some kind of destruction of his existence or that which he identifies with it.

I am not here concerned with listing all the various methods of coping with such apprehension. I seek rather to clarify the basic principles people have found valuable in confronting anxiety.

Or what is wrong may be some expectation of one’s self that, at this stage in one’s development, cannot realistically be achieved. As is often the case when children are apprehensive, the anxiety can be resolved only by the maturation of their abilities. At such a time the anxiety can at least be experienced is a sense of adventure as new possibilities unfold before the young person. Or what is wrong may have to be accepted as part of the nature of life itself: for example, “that morbidity,” as some humorist has remarked, “with which we are all afflicted, death.” Or the anxiety may be cued off by an awareness of the limitations of human life—limitations of one’s intelligence or vitality or unavoidable loneliness, or some other aspect of human creatureliness. In these latter cases, anxiety may take the form of mild or great dread. The intensity of these situations can, of course, vary: dread may be simply an undercurrent of apprehension, or the imagining of another war with hydrogen bombs, or the fantasy of the approach of our own death.

Man is only a reed, the feeblest reed in nature, but he is a thinking reed. There is no need for the entire universe to arm itself in order to annihilate him: a vapor, a drop of water, suffices to kill him. But were the universe to crush him, man would yet be more noble than that which slays him, because he knows that he dies, and the advantage the universe has over him; of this the universe knows nothing.1

The confronting of these limitations can inspire us to create works of art, as it inspired primitive man to seize a coal from his spent fire and draw those fantastic bison and reindeer on the walls of his cave. Poetry, drama, science, and other expressions of human civilization are also the product, in part, of our recognition of our limitations. The yearning to give form to life arises out of our human anxiety about our own death. This it is which sharpens our need to create and enlivens our imagination.

Most people would be surprised to learn how much of their daily behavior is motivated by the need to lessen or allay their anxiety. Magazine advertisements and TV commercials—which present what the masses of people want to believe about themselves and life—uniformly show confident, smiling human beings who give the appearance of not having a care in the world or, more accurately, of having gotten over all their worries because they have purchased this or that product. To illustrate everyday anxiety-allaying behavior, we do not need to resort to such crass examples as our walking down the other side of the street to avoid meeting someone who reduces our self-esteem. In all sorts of subtle ways, the manner in which people talk, joke, argue with each other demonstrates their need to establish their security by proving they are in control of the situation, avoiding what would otherwise be anxiety-creating situations. The quiet despair under which Thoreau believed most people live is largely covered over by our culturally accepted ways of allaying anxiety.

IN EXTREME SITUATIONS

Some ways of meeting anxiety are vividly illustrated in a study of anxiety and stress made of a team of twelve Green Beret combat soldiers in Vietnam.² These soldiers were posted in an isolated camp near the Cambodian border. All the men had had past combat experience and all were trained in special skills such as demolition and radio operating. They all demonstrated an unusually high level of dedication to their job. The camp was located in territory controlled by the Viet Cong, for the purpose of obstructing the flow of arms down the Ho Chi Minh trail and training the local personnel.

The threat of attack by an overwhelmingly superior force was always present, but was considerably increased at the monsoon season early in May, 1966. On May 10 the camp was notified by radio that an attack was imminent between May 18 and May 22, and most probably on the night of May 19. Although this attack failed to materialize, there was mounting anxiety caused by the realistic stress until May 19, after which it tapered off.

How these men defended themselves against their anxiety is highly instructive. First, there was their great confidence, their “self-reliance to the point of omnipotence.” Their faith in their own invulnerability bordered on a feeling of immortality. Second, they threw themselves into their work. “Their response to the environmental threat was to engage in a furor of activity which rapidly dissipated the developing tension.”3 In the third place, their faith and trust in their leaders was of course very important. It is clear also that religious faith played an important role as a defense against anxiety. To quote directly from the publication of the study:

One subject in the present group was a very religious individual who would drive many miles in a jeep over dangerous jungle roads so that a Vietnamese Catholic priest who spoke little or no English could hear his confession. By making this hazardous journey with sufficient frequency the man was able to maintain his strong belief in divine protection, and felt he had little to fear in combat.⁴

It is significant that the two officers of the group could not avail themselves of these defenses, nor could they handle the additional stresses as easily as did the enlisted men. They were in constant contact with the base forty miles away, and hence knew more about what might happen. Also they were generally younger men who were under the temptation to take risks in order to earn the right of leadership of their men. Most of all, they had the responsibility for the safety and the lives of the men under them. This responsibility, like that of a father with his children, extends the perimeter of possible threats.

To summarize, the defenses of the team against anxiety were self-esteem, work, belief in leaders, and religious faith.

DESTRUCTIVE WAYS

The negative methods of dealing with anxiety range all the way from simple behavior traits like excessive shyness through the gamut of neuroses and psychosomatic illnesses to the extreme of psychosis. And in very serious conflict situations—such as “voodoo death”—anxiety can be dealt with only by the surrendering of life itself. These negative methods consist of allaying or avoiding the anxiety without resolving the conflict which underlies it. Or, in other words, evading the danger situation rather than resolving it.

The line between “normal” and “neurotic” begins to appear when any activity becomes compulsive—that is, when the person feels pushed to perform the act because it habitually allays his anxiety rather than because of any intrinsic wish to perform the act. Alcoholism and compulsive sexual activity are examples of this. The motivation then is no longer the activity itself but the external effect of it. In the drama Peer Gynt, Ibsen illustrates both compulsive sexuality and compulsive drinking. Experiencing the battering of his self-esteem, Peer hides behind the bushes on the way to the wedding and soliloquizes:

A drink’d be best. Then the laughter doesn’t bite.5

Later Peer brags to three girls he meets:

PEER: (takes a sudden leap into their midst). I’m a three-headed troll, and a boy for three girls!

GIRLS: Three? Could you, lad?

PEER: Try me and see!⁶

The compulsive aspect of an act is shown in the fact that more or less severe anxiety appears when the person is prohibited from performing the act. In our society sexual activity is often used as a way of avoiding the anxiety of death. But then what happens when, like Hemingway, one arrives at the point of sexual impotence?

Frantic activity of all sorts may serve to relieve the tension mobilized in the organism by anxiety. Compulsive work is perhaps the most common way in America of allaying anxiety; it can be called in this country a “normal neurosis.” This is generally a combination of a sound reaction to anxiety—work is one of the handiest ways of relieving the tension caused by anxiety. But it can easily become compulsive. This latter is comparable to Harold Brown’s very rapid talking when anxious, and is only pseudo-productive.

Frantic activity, as everyone on some level knows, is generally neither productive of one’s best efforts nor authentically creative. Nor is it directed toward solving the problem which causes the tension. The significant question is whether the activity pursued permits the release of tension without resolving the underlying conflict. If so, the conflict still remains, and hence the activity must be engaged in repeatedly. We then may have the beginning of compulsion neurosis. This is oversimplified, to be sure; my purpose here is only to illustrate a crucial difference between the constructive and destructive methods of allaying anxiety.

We have seen that these behavior patterns were called into play when the person was confronted by an anxiety-creating situation. In Helen’s case, we noted that the more anxiety was present in certain responses in her Rorschach, the more she exhibited her particular defenses of forced laughter, denial, and intellectualization. Similarly, in the case of Agnes, the more she was made anxious by her male friend’s neglect, the more she exhibited her particular protective behavior—namely aggression and hostility. We saw, moreover, that when the anxiety abated, the defensive behavior likewise abated. The rationale behind these phenomena is obvious: when an anxiety-creating situation confronts the individual, the defenses against it are called into action. Thus there was a direct relation between the presence of anxiety and the presence of behavior patterns for avoiding the anxiety-creating situation.

We would agree—although I do not know whether Brown would have—that he was in a “healthier” state when his conflict did become conscious. I put “healthier” in quotation marks because this state was certainly more painful, less comfortable for Brown than when he had his symptoms. But now the situation could be resolved, whereas before he was encased in rigid symptoms. To generalize this implication: conscious anxiety is more painful but it is available also to use in the service of integration of the self. When Brown confronted his anxiety directly, he was relieved of his fear of cancer; but he could now no longer escape having to face the dilemma arising from his neurotic dependency on his mother. This point bears on the maxim taught to psychoanalysts and therapists, that a person with a phobia must sooner or later do precisely what he has the phobia of doing if he is ever to get over it. To put it anthropomorphically, the anxiety must be challenged in its lair. We would hope the patient could gradually overcome a good deal of the neurotic anxiety in his sessions with the therapist so that the outright confrontation is not such a shock when it does occur.

Inasmuch as the conflict in neurotic anxiety is subjective, the mechanism for obviating it always involves some form of repression, or dissociation, of some reality or attitude. In contrast to Bessie’s objective behavior in running out of the house and into the park, the person with neurotic anxiety endeavors to run away from some elements within herself or himself. This can be accomplished only by dissociating these elements, which sets up inner contradictions. While Helen attempts on one hand to deny outright the existence of her guilt feelings, at the same time she goes to considerable lengths to intellectualize these feelings. These two methods of obviating the guilt feelings are contradictory: if she really believed she had no guilt feeling, she would not need to intellectualize it. It is as though a general were to declare on one hand that there is no war going on, and on the other simultaneously call up his troops and rush them into battle. Specifically, the pattern involved in a person like Helen is outright denial in the endeavor to repress her feeling. On a deeper level she is aware of the deception involved in this repression, so another mechanism is called into play—namely, intellectualization. The dissociation which is necessary in the endeavor to reduce the subjective conflict involves the setting up of inner contradictions, which is one explanation of the fact that the behavior patterns which allay neurotic anxiety yield only a security which is continually in jeopardy. These behavior patterns are never lastingly successful in avoiding the conflict.

The distinguishing of anxiety which is used as a defense from genuine anxiety is particularly important in psychotherapy. For the defensive pseudo-anxiety constitutes an exception to the generally accepted principle that anxiety must be relieved before the defenses against it can be relinquished by the patient. When such anxiety is honored or taken at its face value in psychotherapy, the underlying conflict is not clarified, for the anxiety (like any other defense) serves to cover up the conflict. Wilhelm Reich’s discussion of the necessity in therapy for attacking the patient’s defenses despite the eruption of his anxiety is significant at this point.7

CONSTRUCTIVE WAYS

We have stated above that anxiety can be treated constructively by accepting it as a challenge and a stimulus to clarify and, as far as possible, resolve the underlying problem. Anxiety indicates the presence of a contradiction within a person’s value system. As long as there is conflict a positive solution is within the realm of possibility.

In this respect anxiety has been said to have the prognostic value of a fever: it is a sign of struggle going on within the personality and an indication that serious disintegration has not yet occurred. We saw in the case of Charlotte that when a person goes into psychosis, the anxiety may vanish. The presence of anxiety indicates that this has not yet happened.

In regard to the methods of resolving the problem causing the anxiety, two processes are held in common by the various schools of psychotherapy. These have a logical relation to our study of anxiety. One is an expansion of awareness: the person sees what value is threatened, and becomes aware of the conflicts between his goals and how these conflicts developed. The second is re-education: the person restructures his goals, makes a choice of values, and proceeds toward the attainment of these values responsibly and realistically. Obviously these processes are never achieved perfectly—nor would it be good if they were; they indicate, rather, the general aims of the therapeutic process.

But whereas the use of neurotic anxiety as a challenge for problem-solving has been agreed upon, in our day it has often been overlooked that normal anxiety also indicates possibility and may be used constructively. The tendency in our culture to regard fears and anxiety chiefly in a negative light, as results of unfortunate learning, is not only an oversimplification. It tends by implication to remove the possibility of the constructive acceptance and use of those day-to-day anxiety experiences which cannot be called specifically neurotic. Jerome Kagan echoes this view when he attacks the falsehood that “signs of anxiety are always bad and are indicators of psychopathology.”8 The judgment “Mental health is living without anxiety” has its valuable ideal meaning; but when it is oversimplified, as it often is in general usage, to mean that the goal in all life is a total absence of anxiety, the judgment becomes delusive and even dangerous.

When we are dealing with the anxiety which inheres in such aspects of human contingency as death, the threat of isolation which accompanies the development of individuality, and so forth, the desideratum cannot be the complete absence of anxiety. An officer who had no anxiety for his men in time of battle would be irresponsible, and it would be dangerous to serve under him. Needless to say, living totally without anxiety in a historical period like the present would imply an unrealistic and insensitive view of our cultural situation and would betoken an irresponsible attitude toward our duties as citizens. Many demonstrations could be cited from the rise of fascism in Spain and Germany that the citizens who were unaware of the social danger were the ones who became putty in the hands of the rising dictatorships.⁹

To be sure, neurotic anxiety is the result of unfortunate learning because the individual was forced to deal with threatening situations at a period—typically in early childhood—when he was incapable of coping directly or constructively with such experiences. In this respect, neurotic anxiety is the result of the failure to cope with the previous anxiety situations in one’s experiences. But normal anxiety is not the result of unfortunate learning. It arises rather from a realistic appraisal of one’s situation of danger. To the extent that a person can succeed in constructively meeting the normal day-to-day anxiety experiences as they arise, he avoids the repression and retrenchment which make for later neurotic anxiety.

Our problem, therefore, is how normal anxiety-creating situations may be used constructively. Though this question has not generally been attacked in scientific writings, it was confronted directly by Kierkegaard a century ago. Kierkegaard called anxiety a better teacher than reality, for while reality situations may be temporarily evaded, anxiety is an inner function which cannot be escaped short of constriction of the personality. Kierkegaard writes that only he who has been educated in the “school of anxiety”—i.e., has confronted and worked through previous anxiety experiences—is able to meet present and future anxiety experiences without being overwhelmed. In this connection, there is evidence that soldiers who had experienced a fair degree of anxiety in their past lives and were in some cases relatively “high strung” were better able to face the anxiety experiences of combat than soldiers who had experienced relatively little anxiety before combat.10

In our times the question of the constructive use of anxiety has been addressed by Goldstein, among others. We recall Goldstein’s emphasis, as reviewed in Chapter 3 of the present study, that every human being encounters frequent anxiety shocks in the course of his normal development, and that his capacities can be actualized only through an affirmative response to these threats to his existence. Goldstein’s simple illustration is the healthy child’s learning to walk despite the fact that he falls and gets hurt many times in the process.

When we consider the constructive use of normal anxiety from the objective side, we note that it is characterized by the individual’s confronting the anxiety-creating situation directly, admitting apprehensions but moving ahead despite the anxiety. In other words, it consists of moving through anxiety-creating experiences rather than moving around them or retrenching before them. This, interestingly enough, is parallel to the ultimate lesson Peer Gynt learns. Ibsen describes the trolls as those who go around. Peer Gynt’s change of character is shown at the end of the drama when, hearing the trolls singing, “Go back! Go around!” he cries out, “Ah! No! This time straight through.”11 For example, if we may refer again to World War II, the most constructive attitude consisted of the soldier’s frankly admitting his fear or anxiety about going into battle, but being subjectively prepared to act despite his apprehension.

As a corollary we have pointed out that courage consists not of the absence of fear and anxiety but of the capacity to move ahead even though one is afraid. This constructive confronting of normal anxiety in daily life and in crises which require moral rather than physical courage (such as the crises in self-development, often attended with profound anxiety, which occur during psychotherapy), is accompanied by the feeling of adventure. At the other times, however, when the anxiety-creating experience is more severe, confronting it may entail no pleasurable affect whatever but may be accomplished only by the sheerest kind of dogged determination.

When we view this process subjectively—that is, when we ask what is going on within one individual which enables him to confront the danger directly whereas others in the same situation may flee—we discover some very significant data. To draw an illustration again from the studies of soldiers, it has been pointed out that often the subjective motivation which enabled soldiers to confront dangers was their conviction that the threat connected with backing out was greater than the threat faced in moving ahead into battle. Put positively, there were values to be achieved in confronting the danger greater than the values in flight. For many a soldier the common value was probably the expectation of his fellow soldiers—he must not let his battalion down. In simple terms this would be verbalized as the desire not to appear “yellow” to one’s buddies. In the more sophisticated soldiers it might be articulated as community responsibility. The sometimes platitudinous statement that one confronts and overcomes dangers by having a “cause” which more than counterbalances the threat is profoundly true. The one trouble with the platitude is that only in the more sophisticated soldiers, to continue our example, does the value for which they fight become verbalized in the deeper terms of a “cause” such as patriotism, freedom, or human welfare.

I hope that the above illustrative paragraph has prepared the ground for the following generalized statement: A person is subjectively prepared to confront unavoidable anxiety constructively when he is convinced (consciously or unconsciously) that the values to be gained in moving ahead are greater than those to be gained by escape. We have pointed out earlier that anxiety arises when the values the individual identifies with his existence are threatened. Let us picture anxiety as resulting from a conflict between the threat on one hand and the values the person identifies with his existence on the other. Then we can see that neurosis and emotional morbidity mean that the struggle is won by the former (the threat), whereas the constructive approach to anxiety means that the struggle is won by the latter (the individual’s values).

On other levels social prestige is certainly a very important value on the basis of which the individual confronts dangers. Another is the satisfaction to be achieved by the expansion and wider use of one’s own powers (as Sullivan, Goldstein, and others have emphasized)—which presumably is operative in the child’s learning to walk and many other phases of development through crises. More highly differentiated forms of value occur, for example, in artists and scientists who, in creating new art forms or radically new hypotheses, experience many shocks to their existence. But to the healthy artist and scientist, the discovery of new truth and the adventure of moving into unexplored fields are sufficiently rewarding that they move ahead despite the threat of isolation and anxiety. In the long run, the confronting of normal anxiety depends on what one regards as of value in himself and his existence.

The system of value on the basis of which we confront normal anxiety can be called, as Fromm does call it, our “frame of orientation and devotion.”12 From the theological viewpoint, Paul Tillich expressed this valuing in his term “ultimate concern.” Broadly speaking, the values reflect the person’s religious attitude toward life, with the term “religious” defined as the basic presuppositions of what is and is not of worth. Such an assumption of value is illustrated in Freud’s passionate devotion to science in general and to the discovery of psychological truth in particular. Though, as is well known, Freud attacked the orthodox religious formulations severely, there is no doubt that his own passionate affirmation of value—his “religion of science”—enabled him with remarkable courage to persevere in his lonely, individual investigations for the first ten years, and then to continue in his explorations for several decades despite vilification and attack.¹³

Our point is likewise illustrated by Kierkegaard’s devotion to “infinite possibility”—i.e., devotion to his conviction that unless a person pursues with inner integrity and individually sustained courage the intellectual and moral insights which arise as part of his new experience of every day, he is forfeiting his possibilities for expansion and meaning in his existence as a human being. Thus Kierkegaard, in ways not dissimilar to Freud, was able to produce astonishingly creative works despite social misunderstanding, conflict, and very great isolation and anxiety.

We now arrive at a more complete understanding of Spinoza’s statement, referred to above, that negative affects like fear and anxiety can be overcome in the long run only by more powerful, constructive affects. The ultimate constructive affect consists, he believed, of the individual’s “intellectual love of God.” In the context of the present discussion, Spinoza’s term “God” may be taken as a symbol expressing that which the individual conceives to be worthy of ultimate concern.

As already pointed out, the values on the basis of which people meet anxiety-creating experiences may vary from simple preservation of physical life to classical hedonistic, stoic, and humanistic values, to the “frames of orientation and devotion” given in the classical religions. It is not my purpose either to imply that all these assumptions of value are of equal efficacy or to make a judgment among them. My interest here is only in indicating that the experiences of normal anxiety are confronted constructively because there is more at stake, more to be achieved in moving ahead than in retrenching. In this discussion I wish to remain on the psychological level by holding to the point that these values will vary greatly from person to person and from culture to culture. The only implicit psychological criterion is, which of these formulations of value will serve a given individual most constructively as a basis for confronting anxiety? Which, in other words, will release the individual’s capacities and permit greater expansion in the development of his own powers as well as enhancement of his relations with other human beings?