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Anxiety?
It comes over me all at once. First of all it is like something pressing on my eyes. My head gets so heavy, there’s a dreadful buzzing and I feel so giddy that I almost fall over. Then there’s something crushing my chest so that I can’t get my breath, this is anxiety.
My throat’s closed together as though I were going to choke. … I always think I’m going to die. I’m brave as a rule and go about everything by myself—into the cellar and all over the mountain. But on a day when that happens I don’t dare go anywhere. . . .
Freud’s description of Katherina (1966)
Anxiety is a universal emotion. In mild form it is experienced at one time or another by everyone; in more extreme form it leads to fears of impending death or catastrophe. The feeling of anxiety may occur without physical symptoms, or it may be accompanied by numerous overwhelming symptoms affecting many organ systems; it may cause no change in behavior, or it may lead to immobilization or chronic avoidance.
The unpleasantness—and universality—of the symptoms are evidenced by the fact that over 80 million prescriptions for antianxiety drugs are dispensed in the United States each year. Despite its importance, the nature of anxiety remains elusive.
Darwin conceptualized anxiety as an instinct; the learning theorist Hull saw anxiety as a drive. For Freud,
the problem of angst, which is usually translated from the German as anxiety, is a “nodal point … a riddle of which the solution must cast a flood of light upon our whole mental life” (Freud, 1943, p. 341).
For the existentialist Rollo May (1950), anxiety “is described on the philosophical level as the realization that one may cease to exist as a self. . . i.e., the threat of meaninglessness” (p. 193). On the other hand, for Eysenck (1979), anxiety is a conditioned fear response whose nature can be understood without reference to its subjective components.
There are many other aspects of anxiety that have been noted by the numerous clinicians and researchers who have attempted to understand and define it.
Although the nature and even the definition of anxiety remain elusive and controversial, the many different approaches to anxiety have generated a number of practical treatment ideas and approaches, which, when systematically applied, may bring relief to most patients.
The aim of the book is to help the clinician understand both the nature of anxiety and the numerous approaches to its treatment. In this chapter we will discuss the phenomenology and definitions of anxiety.
