Anxiety is an awful reality. You feel a horrible, paralyzing fear in the core of your chest or stomach, spreading to your arms and legs. The uneasiness gnaws away at you, or spreads into an overwhelming panic. It is paralyzing, and relief can’t come soon enough — only it doesn’t. There are anticipatory worries, debilitating fears, an inability to concentrate. There can be fear of heart attacks, strokes, etc. However, anxiety isn’t caused by something wrong with your biochemistry. The symptoms of anxiety come from neural circuitry, involving the amygdala — which regulates emotions like anxiety and fear — stimulating the limbic-hypothalamic–pituitary–adrenal axis, the sympathetic nervous system and hippocampus, which is implicated in emotional memory along with the amygdala. The key is that anxiety comes from emotional memories that are mapped as a result of one’s experience. The memories that generate anxiety are traumatic memories. It is traumatic experience that drive the limbic system’s response.
The myth that anxiety is a biological disease is false. The very idea that a pill can actually address the profound issues of the human psyche is an embarrassment on the face of it. The reason there is no evidence that human problems come from neurotransmitters and genetic defects is because it’s not true. We know that this ‘disease model’ has been promulgated by the APA and pharmaceutical companies. And sadly the sales job has been very effective. This wouldn’t be as dangerous as it is, if the biological treatments were harmless. They are anything but harmless. Not only that, but they interfere with the possibility for real treatment.
The specious biological treatment for anxiety are the Benzodiazepines. Benzodiazepines arrived on the scene with great fanfare — you know, “efficacious,” “non-addictive,” “no side effects,” “no habituation,” “no drug tolerance,” “no high” — starting with Librium and Valium. As always, the initial reports of problems were discredited and scorned. Information about a significant psychoactive drug effect — rage-reactions — was suppressed for a long time. When acknowledged, they were termed, “paradoxical” rage reactions. (as we will see, the rage is anything but paradoxical). Finally, suppressed evidence came out that was irrefutable that Librium and Valium are extremely addictive and habituating, never mind that they create significant highs. They fell into disfavor.
What ever happened to all the studies, all the papers, all the research that validated them?
But: fear not. Immediately new benzodiazepines popped right up to take their place — Xanax, Klonopin, Ativan, Versed, Serax, Restoril, et al. These, of course, are still touted as safe and efficacious. Worldwide sales in 2011 for benzodiazepines was $21 billion. This doesn’t even include the black market. It is admitted now that they are habituating and addictive, but the industry blocked the possibility of black box warnings.
The newest industry rules are that they shouldn’t be prescribed for more than 2-4 weeks. Withdrawal has to be carefully tapered and monitored which may last months to a year or more. Among the side effects are poor concentration, loss of memory, drowsiness, and unsteadiness. It may increase the risk for dementia and may produce memory loss. There are sleeping pills which are secretly benzodiazepines. There are legions of individuals who have been horribly addicted to these pills. This ‘cure’ for anxiety has ruined their lives.
I had a friend who was diagnosed with a stage 4 cancer. His primary care doctor thought he was anxious so he put him on Xanax. Fortunately, he miraculously lived for 5 years after diagnosis. Unfortunately, the whole first year was spent withdrawing from the Xanax; during which he was completely incapacitated. He needed to talk, to face it, sit with it, and deal with his cancer, not try to tranquilize it away.
To demonstrate the real story of anxiety, which is consonant with the brain and physical realities, I will use as an example my patient “Eddie,” from my book. His story illuminates the sadomasochistic mappings which reflect the trauma he was subjected to. Because of Eddie’s early abuse, in relation to his passive temperament, it was built-in that he would generate anxiety symptoms later in life, and he did. Everybody has their unique story. The particulars of traumatic abuse and deprivation are mapped into the “play” of consciousness of the individual. Abuse is mapped as a sadomasochistic war.
The central horror of Eddie’s mother was the absence of maternal love. From the beginning, she did not respond to his Authentic Being at all. He was an “it.” There was no genuine feeling from her and no feeling for him. Eddie’s very need for her love and care was an unwanted and an “unwantable” intrusion that drained her. Mother did not touch or hold Eddie with tenderness and warmth. Eddie adapted to his unrequited need for love with tears of rage, alternating with withdrawal into apathy. But his solutions to a cold and unresponsive world could not effectively protect him. His ongoing well-being remained in distress. All was limbically mapped.
When baby Eddie was hungry, he cried. His insistent crying was irritating to his mother. He was on a rigid four-hour schedule. A slap or a shake would quiet him down. Her slaps generated a sadistic discharge as well as sadistic contact with Mother. After a number of rounds, Eddie got intimidated and suppressed his stoked-up rage. He submitted and acted “good” on the surface. The retaliatory suppressed rage remained inside. All was mapped. Otherwise, he was left to his own devices. He was never held by a soft warm body, nor comforted with tenderness.
Eddie was bottle-fed. The doctor instructed his mother that bottle feeding was superior and more sanitary. And she could control for the correct dosage of milk. His feeding was administered with brusque hands, harsh hands, cold hands. Besides, holding and tenderness were not her strong suit. Mother found body contact disgusting and dirty. All was limbically mapped.
Because he was the recipient of his mother’s cruelty on an ongoing basis, Eddie was already filled with a suppressed retaliatory rage looking for an outlet. There was no responsive modulation of aggression through which Eddie and his mother would be brought back close, never mind that closeness was decidedly lacking in the first place. All was mapped.
The content of Eddie’s emotional memory was his play. The basic story was written. It consolidated and took form as a textured and nuanced sadomasochistic drama. Eddie was ‘bad.’ The persona of Mother was ‘mad.’ She dished out sadistic punishment. He deserved it. The punishment fit the crime. There was no relatedness on the basis of respect and tenderness. Relatedness was on the basis of rage attack. To retain relatedness, and discharge his built-up sadistic aggression, fighting was the substitute avenue of engagement. It was mapped as such by his limbic system. His life from now on, would be experienced through the cortical top-down prism of this persona play. This dark play of sadism, anger, badness, hatred, war, emptiness, and emotional isolation would continue to deepen and extend itself throughout his childhood.
As Eddie grew older, each new thing replayed and extended what came before. To his mother, his diapers were the source of dirtiness and disgust. He was dirty and disgusting, and he inflicted it on her. The cut of his jaw and the shape of his body were seen as ugly. She despised the sight of him. When he didn’t speak in full sentences by age one, he was stupid and embarrassing to her. She knew of other babies who were already verbal. He was the ongoing object of ridicule and shame. All was mapped as such.
Eddie told me the following story when he was four,
“Margie and Clara had gone off to school, and my brother and I were looking out the window, watching them walk to the bus. He grabbed me, and I pushed him back. And he said, ‘I’m gonna tell on you.’
“So I said, ‘Go ahead,’ and knocked him over. He cried and screamed, ‘Eddie hit me!’ My mother stormed in with that look in her eye. She was yelling and hitting me wherever she could. ‘I told you to leave him alone!’ Her hits felt distant and didn’t bother me. They kept coming. When she was done, she grabbed me by the arm and dragged me to the corner. ‘You stand here ’til I say so!’
“‘No, I won’t!’ I said, and pulled away.
“She grabbed me and threw me back up against the wall, ‘What did I tell you?’
“I said in an even tone, ‘You said, “You stand here ’til I say so.”’ I was thinking, What an idiot. You don’t even know the stupid question you just asked me?
“She got madder and hit me on my back. ‘Don’t you talk to me that way! You think you’re so smart.’ I pulled away again, and she slammed me back into the corner. This time, I stayed there. She continued, ‘You should be more like your brother. He’s such a good boy,’ and on and on. She went back to the window and continued to mumble under her breath. I stood there. And I stood there for what must have been a half hour. At this point, she was reading to him.
“She turned back to me and said, ‘What do you have to say for yourself?’ I didn’t answer. ‘I said, what do you have to say for yourself?’
“Uhmm… ‘He started it.’
“Okay, this is it. You apologize, or you’re going to reform school. What do you have to say?
“I said… He started it.
“’Okay, wise guy, I’m calling right now.’
“She went to the phone and dialed what I thought was the reform school. I didn’t know what “reform school” was, but I knew I didn’t want to be there. I assumed it was jail. I was sure I was going, and they were coming for me. So I panicked and started to cry. ‘Don’t send me to reform school. I’ll be good.’
“She waited for a while and then said, ‘Okay, I won’t send you—this time.’ And she picked up the phone again and told them not to come.”
Mother beat Eddie every day. He countered her beatings by refusing to cry during the beating by numbing himself, physically and emotionally. This, of course, infuriated her and resulted in escalated violence. Since there was nothing he could do to stop it, he joined it — “Bring it on! Gimme your best shot! I don’t care!”
One night, at age fifteen, Eddie and his friends got jumped by some college football players. They were walking home at midnight after a prank for which Eddie had tagged along. Some of his friends got seriously beaten up. Some ran. Eddie held his ground, despite his fear. Miraculously, he didn’t get punched. As a result of this event, Eddie was terrified to walk the streets at night for years, He felt a paralyzing apprehension in his chest. This anxiety was a secret shame, which he never mentioned to anyone. This state, in fact, was generated in resonance with the violent anger he carried from the beatings by Mommy Dearest.
Eddie told me that he routinely felt anxiety—at dusk, in social situations, if he ventured into unfamiliar places alone, even if he drank a glass of wine. Under ordinary circumstances, he never told anyone about his anxiety. He just lived with it. He said that he was so used to it that he didn’t consider it noteworthy. In actuality, he was secretive about it because he was too ashamed to expose this “weakness” to anyone.
Eddie was a quiet, studious, even-tempered senior in college. One afternoon he had an argument with his professor. Although the professor was in error, Eddie submitted to his authority. For the rest of the evening he was subject to a nameless anxiety that he felt gnawing away in his chest. He had a hard time falling asleep that night.
What transpired during Eddie’s argument with the professor was loaded with his underlying war. There was a disparity between his conscious awareness and his invisible play. His internal drama was not seen, felt, or known. Yet it was happening. During and after the argument with the professor, Eddie was aware only of a content disagreement. He thought his professor was stupid and unreasonable. This is what he ruminated about. However, this intellectual disagreement was the vehicle for activating the battle between his inner personae. The sadomasochistic aggression of his hidden cortical play was activated by the argument in a powerful way. Yet Eddie had no awareness of being filled with impotent rage. If he had been asked, he would have denied any anger at all. Eddie was unaware that his activated phantom drama was intensely percolating throughout the discussion and into the evening.
The ‘tell’ was the anxiety that gnawed away in his chest. The play was present and operating as invisible top-down processing during his fight with the professor. In his theater, the ongoing fighting between Eddie’s internal personae occupied a tremendous amount of his brain activity. His personae were fighting, just as if they were in an actual battle in physical reality. This fierce and consuming battle was a steady state of murderous rage between them. Eddie’s anxiety didn’t come out of the blue at all. It was generated by the masked, intense, war of his internal play. If there had been no impotent rage in his “Eddie” persona, there would have been no anxiety. Eddie dreamed that night that he killed a monster who was stalking him. His anxiety disappeared.
After a bad acid trip Eddie broke down into an anxiety state of unrelenting terror, which resulted in the beginning of therapy with me.
A turning point in the Eddie’s therapy happened when he was denying his anger at a girlfriend who had broken up with him and who had called him out of the blue to go to a lecture with her, after which she was gone again. The old rejection pain had come back in full force. I said to Eddie, “It wasn’t really about the lecture; it was about Cathy. ‘Friends,’ in this context, is always bogus. You knew that, and so did she.”
“No, it’s not her fault. She was up front with me. I agreed to go on her terms, as ‘friends.’”
“I don’t even think she should have asked you. You were hoping she’d come back. The pain that followed was 100 percent predictable.”
“No, it was me. I messed it up. You’re just taking my side because you’re my therapist.”
“That’s not true. Obviously, you played a major role, but she is still responsible for hurting you. And besides, even though I don’t know how exactly, I think it was manipulative on her part.”
“You’re just blaming her because you don’t like her… Now you’re real angry at me!”
As he spoke, the little finger of his left hand visibly twitched. At this point I felt a tension in my chest and my arms, my resonance with his denied and suppressed anger. I said, as I usually did when he was mistakenly certain that I was the one who is angry, “No, I’m not angry.”
Then he looked at me funny and said,
“Maybe you’re not… I’m the one who’s angry! I’m really angry! I feel a rage!” The twitching stopped.
This may seem like a small event, but it was major. His normal persona designations had been that I was the angry attacker, while he was the deserving recipient of attacks. Remember, his masochistic orientation was really maso-sadism, an inverted expression of his own anger, by which he was the designated object of attack from others. He had located his anger as mine, rather than his. He had been uncomfortable sitting with these unacceptable feelings as his own. At this juncture, Eddie re-internalized his own projected anger. He literally retracted his projection off of me and located it inside himself, where it belonged. Eddie dared to own that the anger was his not mine for the first time.
It is very common that when a patient is approaching owning his unacceptable rage I’ll hear “I was talking to my primary care doctor, she said you shouldn’t be suffering from anxiety, I’ll give you Xanax.” Then there is a discussion, wherein I address how destructive Xanax is. My patient argues “How do you know? Maybe it is biochemical. You’re the only one who doesn’t think so. And maybe you’re wrong.” But eventually the pills are set aside and the therapy proceeds.
Anxiety is not biochemical. All feeling is expressed through the body. The limbic system is operating though one’s emotional memory caused by a damaged play of consciousness. When that play is mourned through a relationship of trust and caring the emotional memory of abuse no longer rules the limbic system. A new play is written that is grounded in authenticity and love. The limbic system is then responsive to a different reality and the anxiety is deactivated. This is also how the therapy of trauma operates.
Keep in mind that we are dealing with human beings here. When one has been damaged, it always leaves scars. The old memories are still lurking there, available to be activated. One learns, when the anxiety returns, to use it as a signal to pay attention and — hopefully — recover from it. A few years after therapy was over, Eddie wrote me a letter. Things had gone well, and he had gotten married to his new girlfriend. It was a loving relationship. He had fallen into a pit of suspiciousness and jealousy, and he wanted to check in with me. His letter continued: “Here’s what you would say to me …” He then spelled out quite accurately what I would, in fact, have said. Then he concluded the letter: “I don’t really need to come see you now. As I wrote this letter, it allowed me to remember you remembering me, and that was what I needed. I just needed to touch base with that, and I just did.”
When an event triggers a reactive symptom of anxiety, it is not that difficult to deal with. This is often accomplished during the psychotherapy evaluation. It usually is caused by a suppressed rage by someone who is uncomfortable with his anger. By giving permission for the anger in such a patient, the anxiety dissipates. The real issue, however, is the underlying susceptibility to anxiety which has become built into the personality. The more the aggression has been systematically suppressed in an abused patient, the more deeply one must go to explore and mourn the pain of abuse and deprivation. I’ve had patients who would say about a person they are enraged at, “I’m really worried that so-and-so is flying tomorrow, I hope that nothing happens to the plane.” This is quite far from the patient who says, “I wouldn’t want to do anything myself, but I kinda hope that something does happen to the plane.” And then, “I’m mad and I’d like to decimate him myself!”
When the limbic system has been overwhelmed by traumatic memories, it is a symptom of abuse that one has endured. The symptom tells us we need to address the underlying damage in a real way. Anxiety, like depression, results from the aggression of a hidden, ongoing internal war. Anxiety symptoms are simply behaviors that people with a passive, introverted temperament arrive at when they follow the mappings of their experience. (see “The Creation of a Bully, The Creation of Anxiety: How an Active or Passive Temperament orients our personality”) This is parallel to similar mappings that generate so-called depression in people who have a predominantly Internalizer temperament. (see – ‘Smashing the Neurotransmitter Myth.”) There are other temperamental combinations that with trauma can also generate anxiety. Anxiety is a symptom – signifier – that alerts us to the fact that there is something problematic in one’s damaged “play.” What needs to be treated is the damaged play, not the signifier. We need to heal the damage in psychotherapy; not mask it and — and thus grow it — with a drug. This symptom always points to a human problem which exists in the patient’s theater of consciousness, and needs to be dealt with by mourning and then by rewriting – and rehearsing – a new play.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.