The Meaningfulness of Anxiety

Enrico Gnaulati, PhD
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According to one of the most reputable surveys of its kind, the National Comorbidity Study Replication (NCS-R), almost one in five Americans has met the criteria for an anxiety disorder over the past year, and an estimated one in three people will experience an anxiety disorder in their lives. Bearing in mind that in 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) estimated lifetime prevalence rates of anxiety disorders in the 2 to 4% range, it is safe to say that the diagnosing of anxiety disorders has spiked in recent decades. On college campuses, anxiety has even surpassed depression as the central mental health issue identified by students. Several years ago a large Pennsylvania State University study revealed that more than half of students seeking services through campus health clinics named anxiety as a significant concern. Is it possible that rising rates of anxiety disorders speak to a widespread lack of appreciation for expectable levels of anxiety that are part of human variation, or a pathologizing of innate and normal anxious traits?

Moreover, in the mental health field have we moved too far away from presupposing that anxiety signifies repressed emotions in need of acknowledgement and fuller expression, as well as ignored needs for greater meaning, purpose, and personal fulfillment, instead favoring a medical model approach that simply categorizes anxiety as a symptom of a disorder, which drives the diagnostic numbers upwards?

Homo sapiens is an anxious species, for good reason. We are wired to be “better safe than sorry”—to be biologically primed to expect danger where it probably doesn’t exist so as to preemptively act protectively on those more rare occasions where danger does exist. Many common phobias and obsessions probably would have had prehistoric survival value, but in our modern technological society are more of a nuisance. Fears of snakes, spiders, insects, germs, strangers, heights, unfamiliar foods, and dark enclosed spaces once kept more humans alive to pass on their genes. Fear of flying affects anywhere between six and twenty-five percent of people. It’s understandable that so many people would dread stepping on an airplane given that the experience taps several core perennial human anxieties: being situated at an extreme height where falling would result in certain death, and entrapment in an enclosed space where movement is restricted and escape impossible.

To call fear of flying “aviophobia” and categorize it as the product of a disordered brain, or an irrational mind (given how safe flying actually is), devalues the distal fears that our brains were effectively wired to cope with. A meaningful approach to fears of flying—one that is brain-based, from an evolutionary standpoint—would accept that it is unnatural for us to step onto an airplane to begin with, and that those who dread and avoid the experience will need to avail themselves of whatever coping mechanisms and psychoactive substances that have proven useful, through personal experimentation, to override their natural anxiety.

Similarly, take social anxiety. In ancient environments there would have been survival value in avoiding talking with strangers and reserving one’s trust for close intimates. Dread of public speaking in front of others poised to exploit your weaknesses for gains in social status and group hierarchy would have been reasonable. Extrapolating from this, it is arguable that we humans are genetically pre-programmed to prefer socializing with known intimates rather than unknown strangers, and, unless absolutely necessary, to avoid speaking in front of a crowd where one’s social status, desirability, and attractiveness are being scrutinized. Some of us, more than others, have dispositional traits that leave us feeling exposed to judgment and negative evaluation in unfamiliar social situations. This is an ancient fear. This realization should help govern an approach to mild-to-moderate cases of social anxiety where, for pragmatic and social justice reasons, coping skills are provided to individuals whose traits disadvantage them in situations that are unavoidable for occupational, educational, or relationship-preserving reasons. This is altogether different from medicalizing social anxiety as the product of a disordered brain or mind, and shunting the person into treatment for a disorder.

When anxiety is reduced to a symptom to be medicated away, or an aberrant emotion based on cognitive distortions in need of correction though cognitive behavior therapy (CBT), the all-important representational value of that anxiety can be lost. From an existential-humanistic standpoint, anxiety can signal an urgency to heed unfulfilled personal longings, untapped creative ventures, needs for clearer meaning and purpose in one’s professional life, and desires for greater compatibility in one’s love life. Anxiety can be a clarion call from the client’s better self, a nagging inner tension that will persist until real-life changes are made that attend to deeper needs for meaning, purpose, creativity, and relational emotional depth and connection.

There is also poignancy and practicality to Freud’s original conceptualization of anxiety as the global emotional outgrowth of thwarted sexual and aggressive urges. All too often in my clinical practice over the years, when I explore the underlying concerns of clients suffering panic attacks, something of a sexual or aggressive nature is being overlooked or denied. For instance, a 26-year-old male client of mine, whose social anxiety had been so debilitating that he dropped out of medical school, recently looked up his old girlfriend. He was coming out of a period of extreme social isolation and avoidance of any romantic involvement. For the first time in his life he began experiencing recurring panic attacks. Once we started to look at his fear of becoming sexually involved with and emotionally attached to his ex-girlfriend, put in a dependent position and engulfed and trapped by his possible sexual and emotional reliance on her (as well as the reverse), his panic attacks abated. Another client had a full-on panic attack in my office in the context of his ex-wife berating him over child support payments. During the subsequent session it became clear that his panic attack was really a stifled rage attack. He was furious at what he perceived as his ex-wife’s mischaracterization of him as greedy, when he had been, in actuality, generous in his child support payments, but feared giving voice to his fury in her presence.

In short, from an existential-humanistic and psychodynamic point of view, a healthy approach to anxiety would be to view it as signifying something of significance that is being emotionally disavowed, or that life-enhancing sources of self-fulfillment are not being attended to.

Another often-overlooked source of anxiety pertains to the tension, uneasiness, and self-doubt stemming from the mismatch between a person’s temperament, or predominant personality traits, and contrary evaluative expectations in their work and love lives. Perhaps the most classic case is that of the introvert who internalizes an extroverted standard of self-evaluation. This would be the person who under-appreciates his or her needs for solitude, introspection, learning through immersion experiences, communication through writing rather than speaking, deep conversations rather than small talk, and swallows whole the extroversion bias that exists in our culture—that people should ideally be gregarious, outgoing, fast talking, spotlight seeking, action-oriented, work best in teams and in freely accessible office spaces, and welcoming of strangers and novel stimuli. An introvert forced to exist in an extroverted world is a recipe for high anxiety. The antidote is to listen to the remedial significance of that anxiety—self-acceptance as an introvert and implementation of life habits that square with one’s needs for solitude, introspection, and socialization mostly with close intimates.

It’s in vogue these days to take a mindfulness approach to anxiety; to not indulge troubling thoughts, to see them as meaningless, to let them just be. Obviously, there’s a place for not engaging and concretizing anxious thoughts that are unanchored to realistic dangers. But perhaps we have gone too far. When the representational and functional significance of anxiety are viewed as irrelevant and ignored, people are deprived of self-knowledge sources that are inroads to lasting solutions to anxiety.

35 COMMENTS

  1. I have an alternative theory. I don’t believe people need therapy or drugs to relieve their anxiety. We need a tribe. Humans are tribal creatures and our modern lifestyles mean we pick up and move our families away from our home places, away from our communities and extended families and familiarities.

    It used to be this was primarily an issue for military families. But now very few kids go to high school in the same communities where they were born. Either because of parental moves for jobs or moves when the rent goes up, or any myriad of reasons.

    One well to do doctor family I knew moved the instant the youngest of three went off to college. So just as the eldest was graduating college and the youngest was going off to college, the parents first moved halfway across the country to Illinois, then a few years later off to Texas. The kids weren’t ever really sure where they would be going home on breaks and summers. And this family had taken care to keep all three kids in the same place from kindergarten to high school graduation. And now the kids, all graduated, are scattered about the country. And this is such a common story. I’ve known kids whose parent/s moved every couple of years, usually a thousand miles or more from the previous location. How do you form a tribe like this? Even if you’re moving within the same city to a different neighborhood because your rent has gone up too many times, it’s very difficult to form a cohesive sense of identity when our identities are so tangled up in our relationships with others and those relationships are so fragmented and regularly strained by distance.

    I have learned first hand that social media is a poor substitute for close local connections. And research suggests that few people make close friends after their twenties anyway. The older you get, the more likely you are to end up isolated in a new place. But this is so common now. Is it any wonder so many people are anxious and depressed, isolated and sick?

    Modernity and “civilization” are so often confused to mean the same thing, but I find little civilized about our modern lifestyles and posit that the anxiety and depression epidemic are a direct result of modern lifestyles. (And I’m not even touching on known issues like the awful diets westerners have adopted and the loss of species diversity in the microbiome which is without question effecting our mental wellbeing, or the fact that modern farming practices have wiped out soil health so our food starts off less nutritious to start with.)

    Sign me up to move into a cave and get away from this nonsense.

          • I would chose one of the caves that has the primitive drawings.There are some neat documentaries about them. Also the young adult novel City of Embrr used that theme. However utopias like Brookland and others have a very hard time surviving humans being humans. I would suggest an island so that several communities could try to thrive in parallel.
            Some monastic communities have and still are doing okay.
            Plum Village and the Taize folks also come to mind.
            Morris West “Clowns of God” trends and treads on this theme as well.
            L’Arche and Catholic Worker homes are another option.
            There are many relegious groups that use volunteers and offer communal or quasi communal living.
            Ah but past history at established places is an Issues for psych survivors.
            Lois Lowery ‘s “ Gathering Blue” is part of a cool quartet to read and comes with others choosing each other.
            It would be interesting to try to do something if money could be found. A three year plan of cave cliffs or whatever could give lots of information and help those of us cope with our empathy.

          • I actually have books on how to build a sustainable, nature-friendly home called an Earthship. Was my dream to do that, but I would have to get somebody else (not Someone Else- she’s making lunch!) to do the excavating and swing the sledge. I could help construct the inner walls, though. Had though of creating a little village of Earthships, a community of like-minded weirdos like me.

            But I like the idea of a cave with ancient art already “installed” better.

          • LavenderSage, I am familiar with Earthships! My husband is somewhat obsessed with sustainable building design.

            Rachel, actually only somewhat kidding. The biggest thing stopping hubs and I from joining a commune is we are both chronically ill. Waiting on his Lyme test results now.

            JanCarol, I’ve got a flute, let’s jam!

            CatNight, I’m a huge Lois Lowry fan. I have not read the others you mentioned though. Monastic life is not for me, though I have considered going on retreat to one of Tich Nhat Han’s US based Plum Village counterparts. The closest I’ve ever come to a commune is a multi decade fascination with The Farm in Tennessee, which I learned about through my prenatal reading (Spiritual Midwifery). I think they’ve been one of the most successful non religious communes.

            As I said, I’m sort of only half kidding. I really do think there’s a deep need for alternatives to our current lifestyles.

          • omg KS- Spiritual Midwifery was one of my favorite pregnancy books! I had my second child at home, in fact. I dunno if I could do true communal living- I need my own space to do whatever the heck I want to in, and my own haven to retreat from other people, and from unwanted energies. But the cool thing about Earthships is that you can plan ahead for adding on a room, or build completely separate domes.

            Okay, we’ve got drum and flute covered- I can make us a stained glass windchime!

        • Living in a cave is far fetched. But sustainable building structures and off grid living could be done–even for the chronically ill.

          In my state, the best kind of alternative house materials would be cordwood, cement, and recycled materials. I could build a 400 square ft. house for $7000 or less. Heat it with a wood burning stove made from an oil drum.

          Recycle pop and beer cans to make solar panels for alternative energy.

          • Earthships start off by excavating a few feet of earth, and using trash tires to construct the outer wall, curved like a ‘C’ with the opening facing slightly southwest of south. Diameter can be from 12′ up to 20′ for each of these domes, which can be constructed to link together. You use a sledge hammer to pound the excavated dirt into the tires, creating what they call a “rammed earth dwelling” which is not only incredibly sturdy, but also serves to stabilize temperature. Inner walls can be made with bottles or cans and cement or adobe. The bottle walls are beautiful when the light shines through!

      • LavenderSage, I would have had both my babies at home if it had been allowable back in the 90s. One of the bravest women I know had a VBAC at home after a very traumatic birth rape that involved social services. My older sister had her youngest at home too. Why would anyone low risk not want to either do home birth or at least freestanding birth center? Hospitals are gross and having low risk deliveries in hospitals is dumb!

        As for communal living / intentional communities, I envision something more like a sustainably built small town rather than a true communal living style. It could be set up in such a way so that people have their own living spaces for their families but still make a commitment to making the town work for those living there in terms of labor division and especially resource sharing, which drives down costs. I have actively resisted my husband’s attempts to get us involved in anything truly communal but I do hope to (sooner rather than later) start or join an intentional community.

        • KS, I couldn’t find a midwife for my first birth, and though I did not experience the horrors I have heard way too often from other women, my infant was basically used as a teaching dummy (an unnecessary spinal tap!) so I was already fuming at hospital birth. First baby was almost 10 pounds, natural birth.

          So when I’m 7 months along with the 2nd baby, and they start pushing for major abdominal surgery instead of birth because that’s their policy with babies over 8.5 lbs(?!) and told me they’d get a court order to do it regardless of my consent, I fired them on the spot! Husband went to the library and got books on homebirth, which had lists of resources at the back, no internet back then (the 80s). So we called a medical supply house to order a birth kit, and they had a list of midwives. So I met my midwife when I was 8 months’ pregnant who helped me birth my 9-lb baby in my living room a few weeks later! No trauma of any kind, no fear-stoking coercion, my body encouraged to follow its wisdom– I gave birth crouching on my knees, which is the best position for a big baby because gravity assists. And her fee was $500 (yes, that’s 5 hundred, not thousand), not counting the 1 office visit to her back-up OB to confirm labs and the baby’s position (was breech when we met but my wise midwife had an easy and painless trick up her sleeve to get the baby to flip!), but he took my insurance. I would never advise giving birth in a hospital unless it was absolutely necessary. Pregnant women are the other class of people that docs routinely mistreat and infantilize.

          I would love to be tapped to join an intentional community like you describe. It’s been my heart’s desire for many many years now to live in such a place. Where people could truly live, be themselves, bring their talents to bear, and share the wealth. Sustainable, off-grid, apart from the crazy that consensual reality has become. Actually bought some land, but it sits on a north-facing hill, so not an ideal spot for a solar home (sigh) but maybe could work if wind-powered too. Haven’t looked at that dream in quite awhile– the dust on it is thick.

          • As the waters rise (here in Australia, we all live around sea level) it would be lovely to have a sustainable eco retreat.

            I hate to say it, but actuaries are predicting massive movements of refugees – so – (since we are dreaming beautifully here) the need for defense – or secrecy – of our mountain retreat may be essential.

          • I am with you on this one. We’d never give birth at a hospital again, even though our first was “not too bad” by hospital standards, there was one little thing after another after another where they seemed bent on interfering with any and every aspect of the process. Two homebirths later, the difference was startling and difficult to describe to someone who hasn’t experienced it. Obstetrics is the one branch of medicine (besides psychiatry, though the brand “medicine” doesn’t really apply there) where perfectly healthy people are “treated” for entirely normal processes that are somehow regarded as being abnormal and dangerous. A hospital is a much more dangerous place to give birth than your home.

          • hey JanCarol, have you ever seen the show Doomsday Preppers? Youtube has a lot of the episodes. Those folks are serious about the security of their bunker locations! There are a lot of north-facing hills, so I haven’t given too much away, LOL.

            hey Steve,
            here’s one of those contrast moments for ya:
            So when I was just about fully dilated, but not quite yet feeling the push imperative, the midwife couldn’t locate the baby’s heartbeat. Here’s how the midwife handled that scenario. First, she reassured me that this was not a cause for alarm because babies move and twist. My water had not broken yet (never did actually ‘break’ with the first birth, either) and the amniotic fluid would indicate if the baby was in distress (very unlikely to be the case). She asked my permission to rupture the membrane during the next contraction to check. I consented to that, but it was unnecessary since my water broke on its own at the start of the next contraction, to which my midwife replied, “well how’s that for the power of suggestion!”
            Fluid was clear, baby was fine and out about a half-hour later, perfect apgars and all.

          • That’s how birth should be handled – assume things are normal unless there is some indication to the contrary, rather than assuming something will go wrong and constantly messing with the process and ultimately causing something to go wrong and saying, “See, I told you birth was dangerous!” So glad you had that “corrective” experience – not many people get to see birth the way it’s supposed to happen.

  2. I consider myself a natural scientist so I appreciate the effort by Enrico to consider a natural science perspective of anxiety; I also appreciate his allowing me to offer a different perspective. In contrast to the most fundamental principle of science- parsimony, I believe that Enrico is presenting an “Evolutionary Psychology” perspective of anxiety that lacks “parsimony.” Parsimony is the principle of Ockham’s razor: “all other things being equal, simpler theories are better” (“Fewer assumptions make better science”). “Evolutionary Psychologists” freely move from general evolutionary theory to explaining specific behaviors while they do not understand the process; making broad assumptions about the product of an unknown mental process is not science.

    Thereafter, Enrico shifts from a pseudo natural science perspective to a humanistic-existential perspective that describes anxiety as “signifying something of significance that is being emotionally disavowed, or that life-enhancing sources of self-fulfillment are not being attended to.” A simple evolutionary perspective seems like better science: anxiety is the negative feeling (emotion) of distressful experiences that promotes their avoidance.

  3. I missed seeing any mention of development in childhood, such as emotional neglect or abuse being related to adult anxiety. I’m sure there is a solid connection there. I think if there are disorders, they are in parenting and what happens in schools, and even churches.

    • Absolutely true, dfk, since huge percentages of the people labeled as anxious (and with all the “affective disorders” and “borderline”) today are misdiagnosed child abuse survivors.

      https://www.madinamerica.com/2016/04/heal-for-life/

      The reason for all this misdiagnosis of child abuse survivors is that the DSM is set up as a child abuse covering up system. Child abuse is not an insurance billable disorder, according to the DSM. So no “mental health professional” may ever bill any insurance company for ever helping any child abuse survivor ever, unless they first misdiagnose the child abuse survivors with the other billable DSM disorders.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      Covering up child abuse is the number one actual function of today’s “mental health professionals.” And this is known by the “wink, wink, nudge, nudge,” “zipper trouble” covering up, religious leaders as “the dirty little secret of the two original educated professions.”

      In other words, the religions have been utilizing the “mental health professionals” to cover up their “zipper troubles,” for … best I can surmise from my research … over a century. When the psychologists were in control of the “mental health industry,” they had the Freudian cover up.

      https://en.wikipedia.org/wiki/The_Freudian_Coverup

    • I agree that in most cases, “anxiety disorders” are fairly predictable developments from mistreatment or neglect of children by their caretakers. In fairness, the caretakers themselves are often suffering from their own childhood mistreatment, but that is the cycle we need to look at if we actually want to help reduce unnecessary anxiety in our world. Problem is, no one makes money off of treating children well.

      • Steve,
        It has been known for some time that family dysfunctionalities can create short and or long term issues which overlap with all the isms and basic structure of one’s life.
        Anxiety is just one manifestation of one human’s response to life- though I also would posit one’s temperament also plays a role but that interaction is like trying to figure out quantum theory- humans are not there yet.
        There once was an ancient emperor who devised an experiment using infants. Some where handled and touched others were not. The infants that were fed but not touched all died.
        Some folks say anxiety and fear can also be signals. I think this is also true. We are as humans are not in a very good space.
        I remember having a panic attack in the 1990’s and literally driving to an activist friend’s house out to state because I felt in my bones and soul as Miss Cavel would say from the Madeleine stories – Something is not right.
        She confirmed my sense and it was helpful to have had that interaction. Worth more than any, any minute or hour of talk therapy or any medication.
        So it is a very tangled trauma web we have all woven for ourselves.
        And so many are doing the see no evil, say no evil, hear no evil layers of denial.
        The rich created s scheme that really has greatly benefited them from insurance to Pharma ect ect
        And why would they stop what has worked so well?
        My sense as a child with benefits was despite the turmoil of the 1960’s there was still a modicum of human caring around me. If the neighborhood kids were playing ball in the street and a car came someone would always call heads up.If I was riding my bike and fell someone would – be it child or adult help out.
        There was a community fabric. In some places more in others places less but it was there.
        One of the negative fall outs of desegregation was the inherent problematic design flaw.
        School principals who were from the communities were not kept with the schoolchildren so part of the fabric was ripped that along with almost flaw designed other issues ended up hurting children and families instead of really really leveling the playing field.
        I just hope someday we can begin to turn around and undo and my guess is the need for so called “ help” will dissipate.

    • yeah, I think proximity maintenance speaks fairly directly to this issue and what happens when our hyper-independent-oriented culture insists that children wean off the safety provided by their attachment figures before they are able or ready. Heck, my wife and I still practice it for our son in his doctoral program to keep him grounded during the extreme stress he’s under. None of us ever outgrow the need for a safety net.

  4. I dunno. A turning point in my recovery from lifelong, disabling anxiety beginning in childhood (manifesting as a phobia I tried to control by not eating) was actually the abandonment of talk therapy searches for its meaning, coupled with the eventual discovery that much of the anxiety I experienced was due to the MTHFR genetic mutation (as demonstrated first through genetic test showing I had two copies of this mutation and then by an almost complete remission of anxiety after I started taking the bioavailable form of folate my body doesn’t efficiently produce). What we understand as anxiety disorders are most likely multifactorial in nature–some may be rooted in histories of trauma, some may be socially meaningful, but some may be almost entirely biophysical in origin.

  5. My anxiety used to be extermely disabling to me until I began to perceive the inner dialogue going on. Most often, the anxiety came from not believing in myself and for taking on and internalizing negative projections, which I no longer do take these on and have learned to individuate from negative group dynamics.

    Healing was about learning to trust my own judgment and sense of self regardless of anything, and to stay connected to my own truth over and above the projected judgments and opinions of others. That was the advantage of unwittingly hanging out with bigots/snobs/elitists/marginalizers and becoming the target of their prejudice because they did not like my truth. A true lesson in “whose reality is it, anyway?” It has never been my goal in life to climb that social hierarchical ladder. That’s neither my desire nor my reality.

    These days, when anxiety pops up, I dialogue with it in order to understand what it’s wanting me to see in that moment. That has become my practice now, to engage directly with the anxiety, given it is a part of me and my experience at that particular time. As this inner dialogue ensues, which tends to be very engaging, eventually everything I need to know in that moment comes to light and the anxiety turns into guidance and creative energy. Moving forward and personal growth happen automatically at this point.