About Anxiety and Illness Pain Fear

About Anxiety (and Illness, Pain, Fear)

by Diane M. Gartland  Psy. D.

You know what "anxiety" is, right?  Anxiety is that feeling of tension or shakiness or quivering that you experience before you take a test in school or interview for that first job.  Right?  Well yes . . . and no. 

Over the past 120 or 130 years or so people have had a tendency to make concepts like "anxiety" and "depression" into ideas that are supposed to have the same meaning and denote the same experience for everyone.  But when people use the term "anxiety"  they are usually referring to an internal experience which is shared by no one else.  Most people do not have access to the psychiatric manuals that describe a group of signs and indicators of anxiety so their own idea is a combination of what they believe, have heard from others, and/or is a handy way of labeling what an internal "feeling" is.   The problem with our labels for internal experiences though, is that they don't always cover all the bases that those who have studied these concepts may feel best conveys the meaning of the words.  Sometimes too, it is hard or impossible to describe our feelings in words. Sometimes, in fact, we do not recognize any feelings at all, especially anxiety and/or depression, but may still suffer from it.  The current essay is designed to help others become more aware of what constitutes "anxiety" and its many faces.  

Anxiety has been considered the "model affect", the internal experience which is most commonplace and which can often drive or be driven by other experiences.  It is usually associated with feelings of fear, trepidation, hesitation, nervousness.  It may be limited to a few easily detectable causes or it may be all encompassing.  It may be a mild tinge or a feeling of outright terror.  It may not even be immediately associated with an emotion or feeling of any kind but be disorganizing, create distraction, problems concentrating, paying attention, thinking. Anxiety may also be reflected in the statement "I am overwhelmed" in which the individual becomes so saturated with the experience that they are not able to rationally handle their lives for that period of time and become partially paralyzed in terms of thinking and feeling. 

When someone is anxious or has problems with severe anxiety, they don't always know it.  Sometimes our friends may pick it up before we do from the extraneous body movements, tics and "nervous habits" we exhibit but often those outside of ourselves, don't recognize that we may be experiencing anxiety inside.  To a great extent they, themselves, have their own personal measures for what constitutes anxiety and it may be different than ours.  In addition, anxiety is associated with defenses that we maintain to protect our self worth and our self harmony or the experience of feeling a sense of wholeness or well being (feeling "integrated" or "together").  In order, to keep ourselves from having a feeling of "falling apart" or "falling to pieces" (as the great Pediatrician-analyst Winnicott called it), we construct defenses to protect ourselves.  So, when someone "gets defensive" it suggests they are getting anxious about something in their environment that they experience as threatening to themselves.  It doesn't necessarily mean something does threaten them but it feels that way.

When our anxieties function "spot on" we use them as signals that something is wrong in the environment and/or in ourselves and we make adjustments accordingly (test anxiety usually results in studying harder to lessen the fear, yes?)  But experiencing anxiety all the time as part of our make up, worrying all or most of the time, being unable to listen or pay attention or finding it enormously difficult to concentrate and focus, to do mental work at any length, to spend any time in relaxed thought and contemplation without experiencing an irresistible need to take action, being unable to communicate in easy flowing conversation with unbroken thoughts and ideas, may be a sign that the anxiety has interfered with life to an unacceptable degree.  

Anxiety may also be intimately related to illness.  Studies inquiring about the practices of family physicians often will cite figures of 70 to 90% of their practices as composed  of patients  with complaints that are directly or indirectly related to anxiety or nervousness. These experiences of anxiety may negatively affect basic life functions of sleep and appetite, blood pressure, temperature, blood chemistry, symptom reports and may constitute physical conditions which exact a heavy cost to the health of the individual.   For these problems, tranquilizers, anti-depressants and a host of other psychiatric medications are distributed to say nothing of the medication and other treatments that are dispensed for the condition that anxiety has brought on.  In addition, anxiety has been found to directly impact the perception of pain so that pain medication is also prescribed in, at times, unnecessary amounts and which can set up a cycle of discomfort followed by suppression of symptoms which becomes difficult to stop.

It is anxiety magnified as fear and terror that drives behaviors which can foment misunderstandings, conflicts, wars.  Anxiety may drive desperate actions and even contribute to anti-social behaviors and addictions, as the individual seeks a source external to themselves which they feel could provide the soothing of their fears and restoring a sense of self cohesion and well being.  Consider how anxieties turned into rage at being rejected or dismissed by a lover may give rise to domestic abuses, for example.  Consider how a disobedient child could stimulate anxieties over beliefs about one's parenting and which could result in overly punitive interventions or avoidance/abandonment.  Consider how an experience of peacefulness and calming may send one to the internet repeatedly or result in sexual compulsions as a response to unmitigated anxiety. 

Anxiety is a complicated phenomenon that is best understood from the inside out . . .in a personal therapy or analysis.  It is not an experience that we would wish would disappear completely but enable one to automatically engage in self care internally so one does not make themselves or anyone else sick.  While athletics, routine exercise and other actions have been shown to have a beneficial effect in quieting anxiety and its effects, they will most often do so temporarily and must be continued to maintain the effects.  An alteration in our internal experience is usually necessary to ensure more permanent changes in the personality that has been shaped around the experience of anxiety.  If you are able to engage in a psychotherapy and find some of these ideas helpful to you, please call me at 734-302-0309 or go to my contact page to email me and set up an appointment.  October 2014 - Contact author for permission to cite