W.H. Auden's (1947) poem 'The Age of Anxiety' was part of a discourse of anxiety that exploded into everyday life in post war Europe and America. The legacy of the Second World War, the birth of the atomic age and the beginning of the cold war all brought anxiety to the forefront of philosophical, scientific and psychological study. Since Rollo May's (1950) groundbreaking work 'The Meaning of Anxiety' was published, many thousands of books, scientific studies and magazine articles have focused on this most 'universal' (Spinelli, 2007, p27) and 'basic' (van Deurzen, 2002, p61) feature of human existence.
Reviewing just some of this literature reveals a quagmire of confusing definitions, contradictory explanations and bewildering etiologies (Lewis , 1967; Hallam, 1985). And the waters have continued to muddy through the end of the 20th and beginning of the 21st century.
Some writers, like Zeig (1987) have used the terms fear and anxiety synonymously. Others, such as Tillich (1951) 'distinguish anxiety from fear by emphasizing it to be the fear of fear, without having the concrete object that fear does,' (in May, 1977, p76).
Of those that differentiate, some see anxiety as resulting from fear (Freud, 1974) others, including May (1977), reverse this and see fear resulting from anxiety.
Anxiety for many is seen in pathological terms (e.g. Freud ,1936; Beck, 1985; Barlow, 2002) or as a symptom to get rid of (e.g. American Psychiatric Association, 2000). For others it is described as an inevitable and therefore normal consequence of human existence (Yalom, 1980; van Deurzen, 2002; Spinelli, 2007) and something we can l earn from 'whoever has learnt to be anxious in the right way, has learnt the ultimate,' (Kierkegaard, 1844, p155).
Evolutionary psychologists see anxiety as an evolutionary response to day to day dangers (Lewis & Haviland-Jones, 2000) and others, like van Deurzen and Kenward (2005) as something beyond these daily trials--' ... anxiety or angst is an apprehension of something beyond everyday concerns,' (p6).
Theories on the psychic origins of anxiety have proliferated at a similar pace. Rank (1952) proposed a basis in separation, Sullivan (1948) and Mower (1939) in frustration of a central value, Kardiner (1945) in the introduction of taboos early in life, Freud (1936) in helplessness in the face of a threat, Stekel (1923) in psychic conflict, Ellis (2001) in irrational thoughts and Spielberger (2005), in possession of a particular personality trait. Existential philosophers, writers and practitioners have described its origins in existential givens such as death (Yalom, 1980), freedom (Kierkegaard, 1944), isolation (Heidegger, 1962), non-being (Tillich, 1980), nothingness (Sartre, 1958) and consciousness (Niebuhr, 1941). Perhaps Macquarrie (1973) hits the nail on the head when he says 'anxiety has a subtle and elusive character that thought can scarcely grasp,' (p173).
Many have tried to divide anxiety into different types (e.g. Tillich, 1951; Jaspers, in Schilpp, 1957; May, 1977; Baumeister, 1991). This paper centers on two of these--Existential Anxiety and Neurotic Anxiety--but also considers Normal Anxiety, without which the picture would be incomplete.
The meaning of the two core terms in many ways mirrors the two different focuses brought upon the subject by doctors/psychotherapists who follow the medical model (and focus almost exclusively on Neurotic Anxiety) and existential philosophers and practitioners who use a phenomenological approach (focusing on Existential Anxiety, while acknowledging its vital relationship with Neurotic Anxiety). This paper looks at definitions of Neurotic and Existential Anxiety from this second, existential point of view, and leaves the discussion of Neurotic Anxiety from the point of view of other schools of psychology/ psychotherapy to the relevant proponents of those schools.
Figure 1 summarises the key features of Existential and Neurotic Anxiety, together with illustrative quotes from a wide range of authors, philosophers and practitioners. It is important to note that not all 'anxiety experts' would agree with every identified feature of Existential or Neurotic Anxiety. Therefore, the two categories cannot be taken, as a whole, as representative of any one view, nor can they be seen as de facto definitions of the two terms (though they do inform the definitions outlined below).
Since Kierkegaard (1944) almost all existential philosophers and practitioners have examined Existential Anxiety and have contributed significantly to its understanding. However their observations and conclusions have differed widely. To Kierkegaard (1944) it was an 'adventure that every human being must go through' (p138) and 'the recognition of our freedom' (p64). Heidegger (1962) linked it to our awareness of the inevitability of death and the 'impossibility of our possibilities'. Sartre (1958) described it as a necessary experience that allows us to 'become free in relation to our nothingness' (in van Deurzen and Kenward, 2005, p7). Lidell (1956) saw it as the 'shadow of our intellect' (p82)--the necessary counterpart of us being truly alive, and Jaspers (1971) described it as 'the metaphysical fear of choice,' (in van Deurzen & Kenward, 2005, p7). van Deurzen and Kenward (2005) describe it as the 'instigator of reflection on the situation one is in' (p7)and van Deurzen (2008) as the 'key to our authenticity'. Finally, Tillich (1965) saw it as a pointer in the direction of the 'ultimate concern' (p92).
Existential Anxiety is clearly a complex phenomenon, difficult to define concisely. For the purposes of this paper I have defined it as:
Neurotic Anxiety has received somewhat less attention from existential philosophers and practitioners. However, it has been variously described as 'mere worrying, and is a smokescreen, a distraction, a psychological evasion, so that the worrier can shift his or her attention away from their angst,' (Tillich, 1980), as the 'feeling one gets when one decides to conform, accept the conditions of worth of others, and give up possible personal growth, all in the name of safety and security,' (May, 1977). It's what occurs when we displace Existential Anxiety--'the nothing which is the object of dread becomes, as it were, more and more of a something,' (Kierkegaard, 1944)--or the price we pay when we avoid it--'(it) is avoided at the price of apathy or numbing of one's sensibilities and imagination,' (May, 1977, p76). To Yalom (1980) it is Existential Anxiety 'transformed into something less toxic for the individual' (p93) and to May (1977) it is a cover up for the more essential deep anxiety (p127). It is what people experience when they try to 'eliminate the awareness of (this) fundamental choice,' (van Deurzen, 2002, p41) or when they cannot manage their Existential Anxiety (van Deurzen, 1998) or when they attempt to run against 'unmovable boundaries such as death and chance.' (Cooper, 2003, p23). Bugental (1981) describes it as the result of 'defensive behaviours' (in Cooper, 2003, p66) that cause more problems than they alleviate and Kirkand-Handley(2002) as 'the dread which accompanies our attempts to distort reality by seeking to evade the challenges of our human situation,' (p167).
Once again, such diversity of views makes a definition difficult. In this paper I define it as:
Despite Heidegger's (1962) view that the distinction between Neurotic and Normal Anxiety was unnecessary, I have sided with May (1977) and Tillich (1980) who see them as separate entities.
Normal Anxiety--what Freud (1936) called 'objective' anxiety--is a response to everyday life events, such as starting a new job, being threatened by a s tranger, or getting lost on the way to an important meeting. It is proportionate to its cause, and can be used constructively to identify and confront the dilemma from which it arose. As we will see below, however, It can also become Neurotic Anxiety, if the individual is unable to confront the experience constructively.
The Cognitive Behavioural Therapist might be content to use learning theories to change the focus of a client's Neurotic Anxiety (May, 1977). However, there are a n umber of negative implications in responding to anxiety as purely neurotic, including the focus on symptoms, and the implication that these are part of a pathological problem that needs to be cured, without recognition of the purpose these strategies play in avoiding wider, ever-present anxieties. This is likely to result in a focus on the individual's internal world, without a look at the universal issues that face us all. While the client might learn to 'manage' his or her anxiety, they are unlikely to appreciate the power it has to invigorate, inspire and teach. For the Existential Therapist, the focus is on helping the client to listen to what the Neurotic Anxiety is trying to tell them (Kirkland-Handley, 2002).
Practically speaking, it is very difficult in most cases to distinguish the normal from the neurotic elements in anxiety--most people present with the two types interwoven (May 1977) so that, as Tillich points out, we are mostly 'unable to draw the boundary sharply' (p181).
If we insist on treating the two 'types' of anxiety as distinct entities, we do nothing to demonstrate the integral relationship between the two, nor do we illustrate to our clients, or to our fellow practitioners, a way in which the concepts can be integrated and responded to within the psychotherapeutic setting. Anxiety as a totality (existential, neurotic, and normal) is a vital source of information 'pointing its subject towards a more authentic way of living,' (Kirkland-Handley, 2002). We can't deprive the client of something that may benefit them greatly for the sake of a neat typology. For these reasons, the rest of this paper considers anxiety as an integrated concept, and looks of the implications of this stance for the client, whether they present initially with Neurotic or Existential Anxiety.
The Integrated Anxiety Model (IAM) in Figure 2 opposite demonstrates the relationship between the three types of anxiety defined above. Key assumptions underlying this model are:
* The anxiety to which a person is subject consists of Existential Anxiety and Normal Anxiety;
* Existential Anxiety is universal and unavoidable;
* The individual's response to anxiety is influenced by a range of factors including their sensitivity to anxiety, life events to which the individual is subject, values they hold as fundamental, awareness of and ability to cope with life's paradoxes and the adaptive capabilities they possess;
* These factors can all operate in a positive and a negative direction and combine to influence whether or not anxiety is successfully negotiated or needs to be 'managed' through resistances and defenses;
* Successful negotiation results in the individual learning from the anxiety, growing as an individual, becoming aware of the choices they face and freedom they have to make them;
* Unsuccessful negotiation leads to the creation of resistances and defenses designed to help the individual avoid the original anxiety. These disguise, rather imperfectly, the Existential Anxiety and Normal Anxiety which transforms into symptoms of Neurotic Anxiety.
* Left unaddressed, or addressed merely through the implementation of techniques to manage it, Neurotic Anxiety leads to stagnation, rigidity and restriction in the individual's life. Examined and understood, it can enrich and enlarge their life.
The psychotherapist informed by the Integrated Anxiety Model is able to respond to anxiety as both Existential and Neurotic. The implications of this are outlined below:
* While beginning therapy, as Yalom (1980) suggests, 'at the level of the patient's concerns,' (p112), the therapist will be able to support the client in an exploration of the deeper Existential Anxiety these presenting issues may be obscuring;
* The 'various ways in which the client evades her anxiety and attempts to opt out of life' (van Deurzen, 2002, p40) will be identified as such and the costs and benefits of facing such anxiety explored;
* The therapist will convey the message that anxiety is 'neither avoidable, nor is it an aspect of pathology, but rather a basic 'given' of human existence' (Spinelli, 2007, p27) encouraging the client to view it as an opportunity for learning rather than as a troublesome symptom;
* The therapeutic relationship will encourage the identification of what Spinelli (2007) terms 'a more adequate and courageous way to acknowledge and live with the inescapable given of Existential Anxiety,' (p79), rather than working towards the impossible aim of eradication of anxiety;
* Helping the client to clarify the internal conflicts which can exacerbate anxiety will enable them to 'come to terms with inner freedom, through facing inner existential anxiety,' (van Deurzen, 2002, p35);
* The client will gain awareness of the paradoxical nature of human existence (van Deurzen, 1998) and the ways in which such paradoxes can be tolerated and will be able to explore their personal stance to them--learning, as Winnicott (1971) says, the importance of 'a paradox to be accepted and tolerated and respected, and for it not to be resolved,' (pxvi).
* Focusing on increasing what May (1977) calls 'insight handling capabilities' will offer the client new ways of learning from Existential and Normal Anxiety and make it easier for them to avoid Neurotic Anxiety;
* Examining their individual response to Existential and Normal Anxiety will help the individual to discover ways in which they can use their special talents (van Deurzen, 2002), or their sensitivity to anxiety (Taylor, 1995) to negotiate anxiety successfully;
* Regarding Neurotic Anxiety as having a basis in Existential Anxiety and existential givens will encourage the individual to work to identify the source of meaning in their life and to clarify their personal values. van Deurzen (2002) confirms that 'what ultimately matters in existential work is to determine what it is that really matters to the clients, and not what ought to matter to them.' (p106);
* Finally, the Integrated Anxiety Model will allow the client to choose the depth at which they wish to explore their experience of anxiety. The existential perspective might, as van Deurzen (2005) suggests 'for some clients offer a welcome opportunity to embrace their life situation' (p187) but for others might be alien and inappropriate. Ultimately the therapist will be led by the client.
Regarding anxiety as either Neurotic or Existential serves only the theorists/practitioners who seek to support their particular modalities through a focus on one or the other. An integrated model, such as presented in this paper, offers the client insight into the relationship between Neurotic and Existential Anxiety. In particular, the use of the IAM to inform therapeutic practice achieves the therapeutic aims highlighted by van Deurzen (2002). It:
* 'Pinpoints the various ways in which the client evades her anxiety and attempts to opt out of life';
* Encourages her to 'face the anxiety once it is uncovered';
* Assists her in 'understanding the significance of her anxiety';
* And finally 'explores constructive and creative ways of rising to the challenge pointed at by the anxiety,' (p40).
Our purpose is not to collude with the client in evading life by avoiding its unpalatable realities, but rather to help them to embrace anxiety, learn from it and thrive with it despite them. As Kirkland-Handley (2002) states
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