What is anxiety? And how can good therapy hope to address it?
In a previous post I wrote about how I saw depression as a defense against the emotional truth of one’s life. I see anxiety in much the same way.
People often enter my practice in a state of chronic contraction and vigilance, as if every moment is the moment before a doctor administers a shot. This moment of contraction, of physical girding against, is a moment of resistance to the unpleasant experience imagined to be just around the corner. It’s an automatic bodily “NO” to the inevitable; it’s the opposite of acceptance. And in fact this is how I understand anxiety – as a contraction in the face of inevitable pain; as the opposite of accepting the quite physical experience of one’s own emotional truth. In that sense, it is a defense.
Of course at times anxiety (like depression) is a function of an underlying medical condition, or a nervous system out of balance due to acute stress, poor sleep, drug abuse, etc. Our focus here is the chronic, long-standing anxiety that appears to be a personality type. So often, beneath such anxiety is a well of emotions that are being resisted, much as we resist the pain of the shot. When we are chronically anxious, often there’s something – or some constellation of things – that we are committed to not letting ourselves feel.
With people who are stuck in perpetual states of hyper-arousal, I see the work as getting to, and eventually allowing, the emotional truths beneath the resistance. The arena for this work is often the body itself – the physical experience of anxiety and what lies beneath it.
To understand why this is the case, why to work with anxiety we must work with emotions as they exist in the physical body, we must first understand what an emotion is.
In the late 19th Century, William James proposed that an emotion — that mysterious phenomenon we typically consider a mental experience — is in fact a physical event experienced subjectively. That is:
[W]e feel sorry because we cry, angry because we strike, afraid because we tremble, and not that we cry, strike, or tremble, because we are sorry, angry, or fearful, as the case may be. Without the bodily states following on the perception, the latter would be purely cognitive in form, pale, colorless, destitute of emotional warmth. We might then see the bear, and judge it best to run, receive the insult and deem it right to strike, but we could not actually feel afraid or angry.
Or, as he also famously put it: “A purely disembodied human emotion is a nonentity.” Which is to say, if you remove the physical experience of the phenomenon we call an emotion, nothing else remains.
Of course, many of these physical phenomena we call emotions are extremely painful and even terrifying to experience. Many of us have been made to feel emotions so painful at such an early age that we had little choice but to build unconscious defenses against the experience of them; perhaps there would have been no other way to continue to move through the day-to-day tasks that living demands. These defenses can and do take many different forms: denial, depression, hyper-aggression, hyper-achievement. Our focus here is the defense of anxiety itself: the physical girding against other physical experiences (emotions) that we are unwilling or unable to bear.
When I work with people struggling with anxiety (and it is a mighty struggle; life lived in such contraction and control-seeking is a joyless affair removed from the flow of life), I’ll at some point ask them to go inward and tell me what they notice happening physically within their bodies. Many people who experience intense, chronic anxiety are not even aware that they are so anxious; that is, they are defended against the defense, and they can’t tell me much of anything about what is happening on the somatic level. They are disembodied from the physical experience of perpetual clenching and tightening in the core, shoulders, neck, and head that typifies the anxiety syndrome, and instead report either a pervasive emptiness, or not being able to notice much of anything at all.
Working out of chronic anxiety demands working with the physical experience of chronic contraction and arriving at the emotional experiences that we are contracting against. This demands tremendous safety, and that safety is not easily won.
In therapy, I believe that two essential ingredients contribute to the creation of the psychic safety required to feel what lies beneath the anxiety defense: the first lies within the therapy relationship itself; the second, as we begin to touch upon the emotions that lie beneath the anxiety defense, within the narratives we tell about why we are experiencing these emotions.
Of course, in good therapy, the relationship is paramount. If we suffer from chronic anxiety we likely experienced quite early in life an environment that taught us we were not safe to feel and express unpleasant emotions; the defense of contraction from these emotions was an adaptation to a world that we understood to operate in a particularly lonely way. To work through this in therapy, the therapeutic relationship must become its own world, a world that operates very differently than the one that taught us that painful emotions are unbearable and/or inexpressible. This goal informs the position of the therapist: he or she must remain clear, allowing, compassionate, while not over joining or slipping into packaged cliché. The necessity is to be the adult in the room who can be believed, who can hold charged emotional content, who neither feeds off it nor shuts it down, but allows it to emerge as completely appropriate and, by definition, transitory phenomena at the heart of the human experience.
And as the emotions beneath the anxiety defense begin to emerge, we must be able to make sense of them. Without a coherent understanding of why we are experiencing these emotions, we are unlikely to allow ourselves to continue to experience them, or we are likely to continue to experience them but with a sense of great shame, as though the hugely unpleasant and quite physical experience of anger or grief or terror is somehow a reflection of a deficiency of character. The coherent narrative that helps us understand the utter legitimacy of our emotions is an absolute requirement if we are to meet with compassion that which we have long defended against. And here again, of course, the therapist’s role is crucial. The adult in the room must not only allow the difficult emotions of early life to emerge; he or she must also help identify the life struggles that have made these emotions so appropriate.
A chronic anxiety condition is not a life sentence. In many ways, it is a learned (if unconscious) position to take vis-à-vis the painful complexities of life. It is far from easy or quick work, and yet that which has been learned can be unlearned; or perhaps more accurately, we can learn new, healthier, more effective ways of relating to the often painful emotional truths that we have we contracted against, and is so doing find ourselves perhaps more easily in the flow of life.