Many theorists distinguish between anxiety and fear. While fear is a response to a specific, objective and defined threat, anxiety is internal and objectless. It is a free-floating feeling of unease and apprehension that something bad is going to happen. It is accompanied with physical sensations such as choking and tightness, warning the person of a potential danger (Cohn, 1997; Spinelli, 2007).
However, this distinction does not clarify the concept of anxiety since it takes many forms and receives different emphases by a variety of approaches. A central term in the psychoanalytic theory is ‘neurotic anxiety’, while existentialists talk about ‘existential anxiety’. I will clarify the difference between the two and its implications for therapy. In doing so, I will consider Freud’s outlook on anxiety and its origin, as well that of various existential philosophers and psychotherapists.
a. Neurotic Anxiety According to Freud
Psychoanalysis emphasizes the influence of the unconscious mind on behavior. Freud believed that the human psych is composed of the id, the ego and the superego, which work together to create complex human behaviors. According to this topographical model, the id seeks to fulfill all wants, needs and impulses while the superego plays the critical and moralizing role. The ego is the aspect of personality which deals with reality, having to cope with the conflicting demands of the id and the superego (Hall, 1954).
Freud used the term ego strength to refer to the ego’s ability to function despite these dueling forces. A person with good ego strength is able to effectively manage these pressures. When the ego cannot deal with the demands of our desires, the constraints of reality and our own moral standards, we experience anxiety. ‘Neurotic anxiety’ is the unconscious worry that we will lose control of the id’s urges, resulting in punishment for inappropriate behavior. ‘Moral anxiety’ involves a fear of violating our own moral principles.
Whatever the anxiety, the ego seeks to reduce it. Operating at the unconscious level, it employs defense mechanisms to distort or deny reality. While all defense mechanisms can be adaptive and allow us to function normally, they can also be unhealthy. The defenses keep the threatening contents outside conscious awareness, restricting direct expression of drives. However, they provide indirect expression of these in displaced, sublimated, or symbolic form. Dreams, ‘Freudian slips’ and even symptoms, are a compromise between a forbidden impulse or thought, and the defense against it. When defense mechanisms are extremely overused or distort reality too much, this will result in symptoms such as OCD or phobias, an active expression of the conflict (Mitchell and black, 1995).
Existentialists consider anxiety ontologically and not a result of an individual ontic development. It is an inseparable, inevitable aspect of existence, and a potentially positive phenomenon. (Kirby, 2004; Cohn, 1997).
According to the existential approach, the individual’s anxiety-provoking basic conflict is not with repressed instinctual impulses, but with his confrontation with the ‘givens’ of existence that cannot be avoided. These pose the human with certain ‘ultimate concerns’ that are an inescapable part of the human being’s existence in the world (May and Yalom, 1995).
Several complementary models aim to reflect the structure of existence. One of the most known ones is Yalom’s (1981), which identifies four ultimate concerns: death, freedom, isolation, and meaninglessness. The individual’s confrontation with each of these provokes anxiety.
Freedom refers to the fact that the human being is the author of his own life, and responsible for his own choices and actions. This responsibility and ability to choose freely, evokes feelings of dread and angst, since the outcome of our choices are never certain and always imply the rejection of alternatives (Cohn, 1997). According to Sartre (1956), people are condemned, rather than blessed to be free.
Kierkegaard (cited in Cohn, 1997, p.71) describes anxiety as “the giddiness of freedom”. This dizziness is the price we pay for freedom, while making us aware of our possibilities under the limitations of the world we are thrown into. Anxiety is further intensified since we have no given meaning to guide us in our choices and to base our decisions on. “Like a person lost in the jungle, we are forced to cut our own path through life, with no directing signs or maps to point us in the right direction” (Cooper, 2003, p.22).
Spinelli (2007) accentuates the human need to create a reality with meaning, an ‘interpreted world’. If there is no preordained design in life, then we must construct our own meaning in life. We are torn between contradicting forces- between our deep wish for ground and structure on one hand, and our awareness of freedom on the other hand, as well as our need to find meaning in a meaningless universe (May and Yalom, 1995).
The most obvious ultimate concern is death (Tillich, 2000). While we wish to continue to live, we are aware of the terrifying truth of inevitable death. “â€¦it is not only freedom and nothingness that brings with it anxiety, but also the fact that our existence runs up against unavoidable boundaries, such as death and chance. Indeed, it is only because of these boundaries that our choices are infused with angst” (cooper, 2003, p.23). This idea is well illustrated in the title of Heidegger’s work ‘Being and Time’- Dasein’s being is in time, it is finite (Steiner, 1987). Death’s inevitability makes life seem meaningless, reminds us of our existential isolation, and defines our choices as excluding one another due to the time limit (Yalom, 2008).
Whether it is presented in terms of life versus death, meaning versus meaningless or certainty versus uncertainty, this internal tension expresses itself as anxiety, which is unavoidable and non-pathological, but a basic given of the individual’s life. “Considered in this way, the dilemma of existential anxiety is not so much that it is, but rather how each of us ‘lives with’ it” (Spinelli, 2007, p.27).
How Do We Live with it?
Van-Deurzen (2002) suggests that in our attempt to escape existential anxiety, we either withdraw from living, or accept life like there is no choice, living automatically under the self illusion that freedom and responsibility do not exist. This self deception that Sartre (1956) calls ‘bad faith’ leaves no room for anxiety, but also no room for life itself. Heidegger describes the adoption of conventions as submitting to ‘the they’ and the absorption in the day-to-day distractions, as ‘fallenness’- Dasein falls into the ontic world, into inauthenticity. The fallenness is positive because feeling emptiness and alienation, one becomes aware of the loss of himself, and can aspire to return to his authentic being (Kirby, 2004; Steiner, 1987). “Anxiety throws Dasein back to that he is most anxious from- his authentic potentiality to being-in-the-world” (Heidegger cited in Spinelli, 2007, p.29).
Every attempt to escape or deny anxiety will only result in intensified anxiety, reminding us of our limitations. “Life[â€¦]will persecute those who attempt to play by their own rules until they too submit and bear their fate with courage rather than trying to escape” (Van-Deurzen, 2002, p.39). An encounter with death, for instance, is often a critical turning point in our attitude to life, an awakening experience. “Though the physicality of death destroys us, the idea of death can save us.” (Yalom, 2008, p.33).
Anxiety is indicative of one’s awareness level to his freedom. The more one recognizes and acts on his basic freedom, the more angst he will feel, which is a sign of authenticity (Cooper, 2003; Steiner, 1987). “When life is not taken for granted, existential anxiety is experienced” (Van-Deurzen, 2002, p.35). We need to embrace and explore anxiety as part of our life experience. We are all torn between the polarities of the existential questions. By facing the polarities and finding the balance, we find meaning.
Anxiety Comes in Different Disguises
The source of neurosis is held by Tillich to be the refusal to accept anxiety. Furthermore, Yalom and May (1995) emphasize failed death transcendence as the source of many pathologies. It is “the way of avoiding nonbeing by avoiding being” (Tillich, 2000 p.66). In our attempts to escape anxiety, we adopt restrictive patterns of thought and behavior, which are expressed through ‘structures’ of what can be identified as symptoms or disorders (Spinelli, 2007). The dread is disguised and concealed in various forms, which provide the illusion of safety, but also restrict growth (Van-Deurzen, 2002; Yalom, 2008).
Pathologizing certain categories of anxiety is clearly incompatible with the existential-phenomenological approach. It seems more fitting to acknowledge a continuum where on one end are courageous and authentic ways to respond to anxiety, and at the other, avoidant, despairing and inauthentic ways (Kirby, 2004).
Dave came to therapy feeling stuck and unsuccessful in all life areas. He married and quickly divorced and succeeded financially but lost everything. He even became religious and then secular again, after “religion turned from love to awe”. He followed the rules of Judaism “obsessively”, and also today, he fears he will be punished for various thoughts and acts. For over a year, he felt compelled to give charity in the first kiosk he saw that day, or else he would die.
Freud might see this compulsive behavior as an expression of ‘moral anxiety’. There is an intra-psychic struggle between Dave’s id’s drives (that made him sleep around and get involved in delinquency), and his super-ego, according to which he should not be doing and thinking such things, making him feel guilt. In his maladaptive efforts to settle the conflict, he tries to undo his acts and please the super-ego by giving charity that will save him from punishment. Treatment will aim to free the repressed conflict and allow it to enter consciousness and become integrated. Another aim might be strengthening his ego, allowing the development of healthier defense mechanisms in order to rid of anxiety (Hall, 1954).
An existential approach will conceive this ‘neurotic’ behavior as an expression of trying to escape death awareness. Dave’s fear is not from dueling inner forces, but from ‘non-being’. In his attempts to avoid the dreadful recognition that he too will die, he adopted a rigid and restricting behavior that gives him a sense of security from this threat. A behavior that says “if I will donate, I will not die; it even says so on the box  â€¦”
In therapy, Dave should be encouraged to face anxiety and awaken from this illusion. We are all going to die, and acknowledging that enables living. An existential approach does not try to eliminate anxiety, it sees it as an important source of information that motivates and guides us to a full authentic life. According to Van-Deurzen (2002), in the first phase the therapist shows the client the various ways in which he escapes anxiety and chooses not to live. After that, the aim is to help him face anxiety and understand its’ meaning. The final stage includes exploration of creative ways to rise above the challenges presented by existence, and finding the courage to live with anxiety constructively.
Dave and I are at the first stage, investigating ways in which he avoids living. He neglects many aspects of life and escapes thoughts and coping by concentrating on career and money, which give him the illusion of security. He found temporary refuge from anxiety in further frames, such as marrying despite a terrible relationship and becoming religious. Religion gave him meaning and a set of rules to live by, freeing him from the burden of freedom. He followed the ‘Halacha  ‘ strictly, with no room to maneuver.
Dave also described always feeling distant from his family. When I asked for a specific memory of feeling that way, we started to touch upon the second stage- the meaning of anxiety. At the age of 7 he witnessed his father get electrocuted and fall off a ladder. This evoked thoughts of life without him, and since then, he kept distant. Dave was exposed to death and the loneliness that accompanies it at a young age, with no one to talk to and process his feelings with.
My role as a therapist is to help Dave cope with the complexity of reality and accept the risks and anxieties involved in active living. Dave will hopefully find the courage to give up some sense of security and control for more freedom, and find further compromises between extremes. Hopefully, from the expansion of perspective and learning to deal resolutely with life and death, he will abandon his limiting symptom that resembles the security of prison.
According to a Freudian perspective, ‘neurotic anxiety’ is disproportionate to the situation and should be eliminated. It involves repression and distortion of reality that allows temporary security, but eventually tends to paralyze the individual. The source of anxiety is unconscious intra-psychic conflicts and drives, and Freud sees it as “a sign of pathology, a psychological mechanism explicable in terms of cause and effect” (Kirby, 2004, p.76). It is an abnormal state of mind and a result of a weak ego.
Existentialists understand anxiety ontologically, as an unavoidable part of our being-in-the-world. It does not require repression, but rather should be embraced since it teaches us to open up to possibilities and find our own inner-voice. The human-being is not perceived mostly as driven, but as suffering and fearful, anxious in the face of awareness. The anxiety takes place not in one’s inner-psychic world, but in his encounter with the external world. Hence, the therapeutic aim is not working on defense mechanisms and inner forces, but expanding the client’s perspective and relatedness to the world.
It may seem tempting for both therapist and client to concentrate on eliminating the symptom and supposedly getting rid of anxiety. However, Existentialists see this so called ‘neurotic anxiety’ or ‘pathological’ symptoms as trying to avoid existential anxiety. Since anxiety is a valuable source of information, we should encourage the client to learn what it can teach him, and not eagerly attempt to get rid of it with medication for example. Out of recognizing and accepting the anxiety, the disturbing symptoms will hopefully stop. Tillich (2000) recognized that we should understand anxiety ontologically before we can help our clients deal with it on an ontic level. The aim is living as much as possible without ‘neurotic anxiety’, but with the ability to tolerate existential anxiety.
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