A (very) brief history of anxiety
What is anxiety?
The English word ’anxiety’ has venerable roots. Like its European cognates angoisse (French), Angst (German), angoscia (Italian), and angustia (Spanish), anxiety originates from the ancient Greek angh, which can be found in the ancient Greek words meaning ’to press tight’, ’to strangle’, ’to be weighed down with grief’, and ’load’, ’burden’, and ’trouble’. It’s easy to detect the echoes of these feelings in the generally unpleasant experience we call anxiety. Angh subsequently made its way into Latin terms such as angustus, ango, and anxietas, all of which carry connotations of narrowness, constriction, and discomfort — much like another Latin term that has become part of modern medical terminology: angina.
Ancient though the word ’anxiety’ may be, it was rarely employed as a psychological or psychiatric concept before the late 19th century, and only became widespread over the course of the 20th century. Aubrey Lewis has noted that 3 academic articles on ’anxiety’ were listed in Psychological Abstracts in 1927; 14 in 1931; 37 in 1950; and 220 in 1960.
Not that there’s any evidence to suggest that the experience of anxiety (as opposed to the use of the term) was any less normal and widespread than it is today; it would be astounding if it were. Feelings of panic and fear, and the physical changes that often accompany them such as trembling, palpitations, and faster breathing, are regularly described in literary, religious, and medical writings throughout the centuries.
However, these sensations were seldom referred to as ’anxiety’. Moreover, they were usually explained as the product of moral or religious failings, or of organic physical defects or illness. The 18th and 19th centuries saw a huge rise in interest in ’nervous illnesses’, but the symptoms of what we would today describe as anxiety were regarded as essentially physical in origin. Scientific debate focused on the question of which particular physical problem was responsible.
For example, the eminent mid-19th-century French psychiatrist Bénédict Morel (1809—73) argued that symptoms of anxiety were triggered by disease in the nervous system. The influential Hungarian ear, nose, and throat specialist Maurice Krishaber (1836—83), on the other hand, believed that anxiety was caused by cardiovascular irregularities, a problem that could be rectified by the consumption of caffeine. (Given that caffeine is now known to increase feelings of anxiety, Krishaber’s recommended remedy is rather ironic.) And Moritz Benedikt (1835—1920), a professor of neurology at the University of Vienna, attributed the dizziness often experienced in panic attacks to problems in the inner ear.
The meteoric ascent of the term ’anxiety’ began only with the publication in 1895 of a ground-breaking paper by Sigmund Freud (1856—1939), the founder of psychoanalysis. Under the pithy title ’On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description “Anxiety Neurosis”’, Freud argued that anxiety should be distinguished from other forms of nervous illness (or neurasthenia).
Freud, of course, wrote in German. James Strachey, who translated Freud’s works into English, was acutely aware of the problems caused by rendering the German Angst as ’anxiety’: ’[Angst may] be translated by any one of half a dozen similarly common English words — fear, fright, alarm, and so on — and it is therefore quite unpractical to fix on some simple English term as its sole translation.’ The usage, however, stuck.
The central position that the term ’anxiety’ holds in psychological and psychiatric thinking today is largely a legacy of Freud’s work on the topic, though Freud’s theories on the matter are now largely discredited, as we’ll see in Chapter 2. But other influences were at work too. One of these was the revival of interest in the mid-20th century in the work of the Danish philosopher Søren Kierkegaard (1813—55), and specifically his concept of Angst, an anguished dread triggered by the awareness both of our freedom to act and of our responsibility for those actions. Kierkegaard, and his thinking on Angst, was an important influence on prominent existentialist philosophers such as Jean-Paul Sartre (1905—80) and Martin Heidegger (1889—1976), though their idea of Angst was far removed from what psychologists today would define as anxiety.
Then there was the very visible epidemic of shell-shock caused by the First World War. Few indeed must have been the communities in the UK that did not include someone clearly suffering from severe psychological problems as a result of horrors endured during the conflict. (Today, these men would be diagnosed not with shell-shock but with post-traumatic stress disorder, which you can read more about in Chapter 10.)