Anxiety is one of the most common mental health issues encountered in clinical practice today and probably one of the most misunderstood, often neglected and minimized mental health issue. Just browse any psychotherapy website, and I bet you’ll find anxiety mentioned in every single one of them. But what is anxiety to psychoanalysis? How do we understand it from a psychoanalytic point of view and what can we do to overcome it?
Everyone experiences anxiety to a certain degree. In fact, it is well proven in the field of psychology that moderate levels of anxiety are actually beneficial and foster learning, problem-solving and productivity. However, when the anxiety becomes too high, relative to our resources and abilities to cope with stressors and changes in the environment, it becomes overwhelming and can cause one of three responses – fight, flight or freeze (I know of a very interesting Anxiety Curve Model that explains this and can be applied to various issues in adult as well as child and adolescent psychotherapy but I will save it for a future post).
Manifestations of anxiety
Anxiety manifests in various forms, some of which are classified in the Diagnostic and Statistically Manual of Mental Disorders (DSM) and some aren’t. Think about what you do when you are “nervous” or “worried,” which is really another way to say that you are anxious. Some people play with their fingers, bite their nails or crack their knuckles, others clean or keep themselves busy; some drink or use substances, while others try to meditate or journal.
We all have established methods to defend against or cope with feeling anxious but sometimes, they are not enough and when that happens, the anxiety manifests itself in what in psychoanalysis we call symptoms. Here are several examples:
Probably the most noticeable and forthright manifestation of anxiety is when you have a panic attack – your heart starts pounding, you cannot breathe, your body starts sweating, your hands are shaking, thoughts start running through your head, you feel like you are having a heart attack or you are about to die and you are absolutely terrified.
Inattention and difficulty focusing
Another manifestation of anxiety is difficulty focusing and staying on task at work, school or home. You may find yourself having a hard time starting a project, finishing a project or being easily distracted, unmotivated and unable to get yourself organized.
Difficulties with sleep
Struggling with falling asleep and staying asleep is another common manifestation of anxiety. You may find yourself lying in bed, thinking and worrying about various aspects of your life, responsibilities you have, deadlines, money issues, romantic issues, family issues, anything that may be a cause for concern at the moment.
Somatic symptoms and complaints
Sometimes, anxiety manifests in the body in the form of stomach troubles, uneasiness, gastrointestinal complaints, headaches, fatigue, etc. In children and adolescents, in addition to somatic and physical complaints, the anxiety may manifests itself in behavioral acting out at home, difficulties at school or problems with social interactions, to name a few.
Other diagnosable anxiety disorders
For some people, the anxiety can become as severe as trichotillomania (a compulsive urge to pull out your hair, eyelashes or eyebrows), panic disorder, phobia (fear of certain objects, animals, people or situations, usually very common and normal with young children) or obsessive-compulsive disorder, all of which are your psyche and body’s attempt to cope, unfortunately, unsuccessfully.
Psychoanalytic understanding of anxiety
The question of anxiety is central in psychoanalysis. In his Introductory Lectures on Psychoanalysis, Freud distinguished between two kinds of anxiety: “realistic anxiety“, i.e. fear of actual danger, and what he called “neurotic anxiety,” which stems from internal psychic conflicts. He also said that anxiety can be a stand-in for almost any feeling that transforms itself or discharges into the form of anxiety.
Depending on which school of psychoanalytic thought you ask, you will get different points of view on the matter. However, one thing in common is that as with any other symptom in psychoanalysis, the symptom of anxiety is understood as having an unconscious meaning, specific and unique to the individual, who presents with it.
In psychoanalytic psychotherapy, you can speak about your anxiety and how it manifests itself. From a psychoanalytic point of view, it is only in the context of who you are in relation to your analyst/therapist and where you come from, that you can begin to understand its meaning and overcome your anxiety.
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