Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012

Psychoanalytic theories of anxiety
Theories of anxiety

As we saw in Chapter 1, the term ’anxiety’ was rarely used by doctors and scientists until the 20th century. As interest in anxiety has grown, however, an increasingly rich and varied body of theoretical work devoted to understanding it has developed. In this chapter, we look at four key perspectives on anxiety, progressing from ideas that date back to the end of the 19th century to the most recent developments:

• psychoanalytic

• behavioural

• cognitive

• neurobiological

The deeper we penetrate into the study of mental processes the more we recognize their abundance and complexity. A number of simple formulas which to begin with seemed to meet our needs have later turned out to be inadequate…. Here, where we are dealing with anxiety, you see everything in a state of flux and change.

Sigmund Freud, ’Anxiety and the Instinctual Life’

An influential historical figure in the study of anxiety was the founder of psychoanalysis, Sigmund Freud (1856—1939). Freud trained as a medical doctor at the University of Vienna, specializing in neurology (the study and treatment of disorders of the nervous system). By the 1890s, Freud had come to believe that the symptoms displayed by many of his patients were the product, not of disease of the physical nervous system, but rather of their failure to deal with invisible, unconscious, and primarily sexual psychological drives. This insight became the cornerstone of psychoanalysis, which remained the predominant form of treatment for psychological problems in Europe and the United States until at least the 1970s.

Freud’s interest in anxiety was marked by the publication in 1895 of his paper, ’On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description “Anxiety Neurosis”’. As the title indicates, the principal purpose of this paper was to distinguish what Freud called ’anxiety neurosis’ (Angstneurose) from other forms of nervous illness (or neurasthenia).

What were the symptoms of ’anxiety neurosis’? Freud listed:

• Irritability.

• Deeply engrained and distressing pessimism; the belief that disaster is just around the corner. Freud called this trait ’anxious expectation’.

• Panic attacks, often involving physical symptoms such as difficulty breathing, pains in the chest, sweating, vertigo, and trembling.

• Waking up at night in fear.

• Vertigo, in which the individual experiences ’sensations of the ground rocking, of the legs giving way and of its being impossible to stand up’.

• Phobias.

• Feelings of nausea, ravenous hunger, or diarrhoea.

• Tingling of the skin (pins and needles) or numbness.

Freud argued that, unlike other nervous illnesses, anxiety neurosis was caused by the failure to properly satisfy the build-up of sexual excitement. By way of example, Freud cited the cases of ’intentionally abstinent’ men and women; men ’in a state of unconsummated excitement’, for instance if they were engaged but not yet married; and women ’whose husbands suffer from ejaculatio praecox or from markedly impaired potency … [or] whose husbands practise coitus interruptus or reservatus’.

Rather ironically, given that psychoanalysis is all about the primacy of the mind, in 1895 Freud believed that anxiety was caused by physical factors. Sexual excitement certainly had a profound influence on the psyche, triggering the desire for sexual satisfaction, but its essence was physiological. In men, Freud argued, it consisted of ’pressure on the walls of the seminal vessels’. Freud thought an analogous process took place in the case of women, though he didn’t know what this might be.

Freud’s views on anxiety, however, evolved considerably over the decades. His later position is summarized in ’Anxiety and Instinctual Life’, a lecture he gave in 1932. Neurotic anxiety still has its roots in sexual energy, but this energy is now seen as fundamentally psychological rather than physical.

You may have noticed the use of the term ’neurotic’ here. This is because by now Freud was distinguishing between anxiety as a justified response to real danger, and so-called neurotic anxiety, which is excessive and irrational. Realistic anxiety arises from threats in the external environment; neurotic anxiety arises from within, though we are unaware of its true cause. Realistic anxiety helps us; neurotic anxiety can make our life a misery.

Key to Freud’s theory of anxiety is what he called the id, a wild and primitive psychic reservoir of instinctive desires. The job of managing and controlling these desires, which are buried deep in our unconscious, falls to a second part of the Freudian psyche, the ego. When the ego fails in this unenviable task, neurotic anxiety results, and the desire is thereby repressed. Freud also suggests that our episodes of anxiety recall our first encounter with danger: the trauma of birth. Each anxious fear we experience is an echo of this fundamental event.

Freud’s mature theory of anxiety is illustrated by one of his most famous case studies: that of Little Hans. Hans was a five-year-old boy who developed a fear of horses. Freud, working principally from information communicated by Hans’ father, argued that Hans’ horse phobia was in reality a fear of his unconscious sexual desire for his mother and the retribution from his father that he unconsciously anticipated. The ’unacceptable’ fear — unacceptable because resulting from an Oedipal infatuation with his mother — is transformed into a more acceptable phobia. The neat distinction between realistic and neurotic fears is thereby overturned: Freud shows that at the root of every neurotic anxiety is the fear of an external danger (in this case punishment, possibly by means of castration, at the hands of the father).

Freud was undoubtedly one of the most influential thinkers of the 20th century, yet his ideas are now deemed more or less irrelevant by scientists. As the psychologist Stanley Rachman has written: ’The entire enterprise, including the theory of anxiety, is rich in theorizing but lacking in methodological rigour and deficient in facts.’