The nature of anxiety

For many people, anxiety is an ever-present, and distinctly unwelcome, companion. Sometimes it can erupt into a full blown panic attack, but often it’s just there in background: a barely perceptible but continual sense of unease, a sense of anticipation that something unnamed but terrible is about to happen.

And this is problem with anxiety: it appears to have no obvious cause. If it had, then, technically speaking, it would be fear, not anxiety. Furthermore, as much as we may not like to be afraid of particular things or people, at least the fear can be named and, much of time, steps can be taken to alleviate or even remove the source of the fear. With anxiety, however, things are very different .

In one sense, anxiety really is unnameable. In fact it not only unnameable, but, as a consequence, is also outside of meaning. Or perhaps we should say, the cause of anxiety is unnameable and therefore beyond meaning. The problem here is that a lot of the psychological treatments of anxiety, such as cognitive behavioural therapy (CBT), are based on trying to give meaning to anxiety. In other words, to try and name the cause of a person’s anxiety and then to explore how they might come to view the thing they are anxious about in a different, more positive light. Effectively, then, such approaches are treating anxiety as if it were fear.

Of course, there is some logic to this strategy. If the power of talking treatments or psychological therapies is to encourage individuals to talk about things that are bothering them, then first they must have something to talk about. So on this basis it makes perfect sense to transform something which cannot be named, i.e. the cause of one’s anxiety, into something that can be named, and therefore ‘managed’ or even eradicated.

Unfortunately, this approach doesn’t really work, even though on the surface it can appear to – at least for a short time. The reason it doesn’t really work is precisely because the cause of anxiety is beyond meaning, is outside of language and representation. So trying to name something which is beyond representation is a fruitless exercise. Not only that, but in fact it is somewhat deceitful. It gives both client and therapist the (comforting) illusion that they are actually talking about something meaningful, and thus something that can be reinterpreted.

All is not lost however. Even if it is not possible to talk about why one is anxious (as opposed to being afraid) it is still perfectly possible to talk around one’s anxiety. In other words, to talk about things that might be associated with anxiety. For example, anxiety often gives rise to fantasies. In fact, fantasies can be seen as attempts to give structure and meaning to anxiety. So a psychotherapist may well encourage a client to talk about the fantasies that surround their feelings of anxiety. This is very different from asking a client what they are afraid of, which is to misrecognise the nature of anxiety.

To give a simple example. A senior executive in a high powered City corporation may experience intense and overwhelming anxiety attacks every time she has to give a presentation to the Board. In talking about this in therapy she describes a fantasy whereby she is standing totally naked in front of group of sexually aroused middle aged men, who are all leering at her and making all kinds of lewd remarks and suggestions.

At this point it might be tempting to interpret this fantasy in terms of it being, in some ways, an accurate description of what it is for a woman to ‘present’ herself in front of a group of powerful individuals – be they male or female. The fact they are middle aged sexually aroused men, and she is naked, simply drives the point home.

However, this is to miss the point entirely. What matters here is that the woman is able to construct a fantasy in place of her anxiety – its actual content is of less importance. The other important point here is that once the fantasy has been constructed it can then be ‘played with’, developed, associated with other fantasies, thoughts, memories, and so on. In other words the anxiety becomes ‘translated’ into something that can be represented, talked about.

And this is where psychoanalysis or psychoanalytic psychotherapy, which actually takes such fantasies seriously, can be helpful.  Instead of simply ‘dismissing’ such fantasises, and the anxiety that is related to them, as being of no importance or something to be eradicated, such an approach will spend time exploring how such fantasies ‘work’ for the individual, how they help individuals construct a sense of their experiences and ‘manage’ their anxiety.