ANXIETY
Anxiety is a many clothed horse. It presents in as many ways as life presents itself. However anxiety presents predominantly in three characteristic ways. These are acute anxiety, chronic anxiety and subliminal anxiety.
“Anxiety is fear! That is of course an oversimplification. A slightly more accurate rendition would be that anxiety is our reaction to fear”.
Acute anxiety is the most common experience of anxiety. It is what most ordinary people relate to when you say the word anxiety. It is a feeling of intensely unpleasant discomfort that arises most commonly when you have to face a situation that you would rather not. Often you feel hot and sweaty and your heart starts pounding uncontrollably in your chest. You find it difficult to concentrate on what you are meant to be doing or saying. You feel sick to your stomach. You feel an urgent need to rush to the toilet. Often you feel that you cannot breathe and when you do somehow you feel that you are not getting sufficient oxygen. You might have something like “thirty seconds of frozenness” or you might in that thirty second period simply have no understanding at all of what is occurring. Given a choice you would immediately run away and you might try to escape anyway. Rushing thoughts that you can’t get rid of intrude into your consciousness. You feel stressed. You feel depressed. And it goes on forever. In reality for most people acute anxiety like this lasts for only a few seconds or minutes at most. These few seconds or minutes feel unfortunately far worse than one could possibly imagine. For many it is the most painful and most devastatingly bad experience of their lives. Sometimes symptoms like breathlessness and heart palpitations are so strong that people believe that some catastrophic event is about to occur. They believe sometimes that they are about to die. Subjectively acute anxiety feels like it is never going to end It feels like the mental anguish, the psychological pain, will last forever.
The fear of this actually being the case is so intolerable than many cannot bear it. The intensity of an anxiety attack can be so great and so debilitating that many people believe they will not survive the experience. They descend into the most terrifying episodes of despair. Some unfortunately are so affected that they act out their anguish right there often sadly in the most destructive ways. Most people attempt to commit suicide not because of depressive illnesses. They do so because of the intolerable pain that anxiety brings. This anxiety may be associated with other psychiatric illnesses but often in fact is the primary disorder.
Chronic anxiety is the second most commonly experienced form of anxiety. It most often presents as chronic worrying about matters that appear ostensibly to be of limited concern. It is worrying about things in a constant ongoing manner that is clearly out of proportion to the issue at hand. In this situation the worrying cannot be simply removed from one’s mind no matter how hard one tries. It goes on and on for days weeks and months. And often when it does finally stops another worry simply takes its place. This new worry then circles around and around in your head producing further fearful thoughts and more distress. This is a cycle of rumination that leaves you exhausted, distracted, weak and feeling completely out of control. The worries about one thing often are displaced onto another related worry and it seems almost impossible to free oneself from the ongoing concern. This is disconcerting to the sufferer who feels helpless and powerless against the onslaught of thoughts and becomes ultimately a source of great exasperation to those attempting to help the anxious person stop what to them is clearly unrealistic thinking. They feel as certain that the person with the anxiety has some conscious control over the process as the sufferer feels certain they does not. The truth unfortunately is that the sufferer is right. They often simply do not have the ability to detach themselves from process of anxiety that brings such inevitable suffering.
This clinical picture is sometimes termed generalised anxiety as it is not specific to one particular thing or circumstance even where it is precipitated or propagated by a specific trauma. It is the predominant reason for chronic stress in people and can often lead to obsessional thinking and compulsive behaviour patterns. Chronic anxiety sufferers often become fixated on a particular thought which intrudes on their minds and simply will not stop. Sometimes this leads to compulsive repetitive behaviours which are an attempt to temporarily decrease the fearful and worrying thoughts. These behaviours can be limited in the length of time that relief from anxiety results.
Subliminal anxiety is the third form of anxiety. It has the distinction of being the least recognised form of anxiety somewhat ironically in that it affects the greatest number of people who see psychiatrists.
In order to understand what subliminal anxiety is one has to have some understanding of how pathological anxiety is generated. Anxiety is a multi-layered entity each layer adding to an underlying anxiety until ultimately anxiety bursts forth upon our consciousness and we are often shocked by the intensity of our awareness of it.
The lowest layer of anxiety is normal baseline anxiety. This exists in everyone. All of us suffer from anxiety just in different ways and in relation to different things. Anxiety is normal. It is a basic survival mechanism, an automatic emotion that is produced whenever we feel our survival is at risk. It is a primordial reaction which prepares you to do whatever you need to do in order to ensure that you do not become prey; that you survive.
Primitive humans only had fear. As these humans evolved over the past two million years their brains developed sophisticated mechanisms which awakened awareness systems and had greater survival value for us. These brain systems could become aware of these fears and react to them. The reaction of awareness of our fears is anxiety. We could simply say that anxiety is our brain’s reaction to fear, which of course it is. In practical terms though in a contemporary brain this means that anxiety and fear have become essentially one experience to us. We experience fear and we feel anxiety in relation to that. Fear has become anxiety, and fear exists everywhere in our lives. We are born fearful. creatures. In fact even before we are born we feel fear. Anxiety exists everywhere in our lives all our lives.
Our prevailing level of anxiety could therefore be considered normal anxiety. Superimposed upon we have layers of anxiety that could become integrated with our character or personality. This we call characterological anxiety and representing the way anxiety characteristically encourages or even forces one to behave.
Overlying the layer of characterological anxiety is the uppermost layer of anxiety. This is imposed by the presence of a psychiatric illness itself. By definition this layer may therefore be present or absent. All psychiatric disorders have anxiety as their final common pathway meaning that anxiety is manifested in every single diagnosable psychiatric disorder only to a lesser or greater extent. Schizophrenic patients for instance may appear externally very calm or unresponsive but when investigated are found to be extremely over stimulated and tense internally. This results in a great deal of internal and when released external angst in their behaviour.
Anxiety is omnipresent relevant and consequential in the entirety of the spectrum of psychiatric disorder. It makes up a major part of the presentation of every psychiatric illness whether this is schizophrenia, bipolar disorder, personality disorder, addiction disorders, autistic spectrum disorder, attention deficit hyperactivity disorder or of course primary anxiety disorders themselves. It seems however that this anxiety is invisible. Once a primary diagnosis is made anxiety more often than not is simply disregarded. The fact that in reality that anxiety often has as great an influence on the way these disorders manifest, present and progress as the primary illness itself is basically ignored or overlooked. Ironically the psychological pain that is the dis-ease in psychiatric illness in actual fact comes mainly from this anxiety. The uncomfortable reality apparently invisible to many is that anxiety is the predominant agent responsible for the majority of discomfort and pain in all psychiatric conditions. Alleviation of this anxiety-pain is rarely given priority in the treatment of such conditions.
Anxiety is a many clothed horse. It presents in as many ways as life presents itself. However anxiety presents predominantly in three characteristic ways. These are acute anxiety, chronic anxiety and subliminal anxiety.
“Anxiety is fear! That is of course an oversimplification. A slightly more accurate rendition would be that anxiety is our reaction to fear”.
Acute anxiety is the most common experience of anxiety. It is what most ordinary people relate to when you say the word anxiety. It is a feeling of intensely unpleasant discomfort that arises most commonly when you have to face a situation that you would rather not. Often you feel hot and sweaty and your heart starts pounding uncontrollably in your chest. You find it difficult to concentrate on what you are meant to be doing or saying. You feel sick to your stomach. You feel an urgent need to rush to the toilet. Often you feel that you cannot breathe and when you do somehow you feel that you are not getting sufficient oxygen. You might have something like “thirty seconds of frozenness” or you might in that thirty second period simply have no understanding at all of what is occurring. Given a choice you would immediately run away and you might try to escape anyway. Rushing thoughts that you can’t get rid of intrude into your consciousness. You feel stressed. You feel depressed. And it goes on forever. In reality for most people acute anxiety like this lasts for only a few seconds or minutes at most. These few seconds or minutes feel unfortunately far worse than one could possibly imagine. For many it is the most painful and most devastatingly bad experience of their lives. Sometimes symptoms like breathlessness and heart palpitations are so strong that people believe that some catastrophic event is about to occur. They believe sometimes that they are about to die. Subjectively acute anxiety feels like it is never going to end It feels like the mental anguish, the psychological pain, will last forever.
The fear of this actually being the case is so intolerable than many cannot bear it. The intensity of an anxiety attack can be so great and so debilitating that many people believe they will not survive the experience. They descend into the most terrifying episodes of despair. Some unfortunately are so affected that they act out their anguish right there often sadly in the most destructive ways. Most people attempt to commit suicide not because of depressive illnesses. They do so because of the intolerable pain that anxiety brings. This anxiety may be associated with other psychiatric illnesses but often in fact is the primary disorder.
Chronic anxiety is the second most commonly experienced form of anxiety. It most often presents as chronic worrying about matters that appear ostensibly to be of limited concern. It is worrying about things in a constant ongoing manner that is clearly out of proportion to the issue at hand. In this situation the worrying cannot be simply removed from one’s mind no matter how hard one tries. It goes on and on for days weeks and months. And often when it does finally stops another worry simply takes its place. This new worry then circles around and around in your head producing further fearful thoughts and more distress. This is a cycle of rumination that leaves you exhausted, distracted, weak and feeling completely out of control. The worries about one thing often are displaced onto another related worry and it seems almost impossible to free oneself from the ongoing concern. This is disconcerting to the sufferer who feels helpless and powerless against the onslaught of thoughts and becomes ultimately a source of great exasperation to those attempting to help the anxious person stop what to them is clearly unrealistic thinking. They feel as certain that the person with the anxiety has some conscious control over the process as the sufferer feels certain they does not. The truth unfortunately is that the sufferer is right. They often simply do not have the ability to detach themselves from process of anxiety that brings such inevitable suffering.
This clinical picture is sometimes termed generalised anxiety as it is not specific to one particular thing or circumstance even where it is precipitated or propagated by a specific trauma. It is the predominant reason for chronic stress in people and can often lead to obsessional thinking and compulsive behaviour patterns. Chronic anxiety sufferers often become fixated on a particular thought which intrudes on their minds and simply will not stop. Sometimes this leads to compulsive repetitive behaviours which are an attempt to temporarily decrease the fearful and worrying thoughts. These behaviours can be limited in the length of time that relief from anxiety results.
Subliminal anxiety is the third form of anxiety. It has the distinction of being the least recognised form of anxiety somewhat ironically in that it affects the greatest number of people who see psychiatrists.
In order to understand what subliminal anxiety is one has to have some understanding of how pathological anxiety is generated. Anxiety is a multi-layered entity each layer adding to an underlying anxiety until ultimately anxiety bursts forth upon our consciousness and we are often shocked by the intensity of our awareness of it.
The lowest layer of anxiety is normal baseline anxiety. This exists in everyone. All of us suffer from anxiety just in different ways and in relation to different things. Anxiety is normal. It is a basic survival mechanism, an automatic emotion that is produced whenever we feel our survival is at risk. It is a primordial reaction which prepares you to do whatever you need to do in order to ensure that you do not become prey; that you survive.
Primitive humans only had fear. As these humans evolved over the past two million years their brains developed sophisticated mechanisms which awakened awareness systems and had greater survival value for us. These brain systems could become aware of these fears and react to them. The reaction of awareness of our fears is anxiety. We could simply say that anxiety is our brain’s reaction to fear, which of course it is. In practical terms though in a contemporary brain this means that anxiety and fear have become essentially one experience to us. We experience fear and we feel anxiety in relation to that. Fear has become anxiety, and fear exists everywhere in our lives. We are born fearful. creatures. In fact even before we are born we feel fear. Anxiety exists everywhere in our lives all our lives.
Our prevailing level of anxiety could therefore be considered normal anxiety. Superimposed upon we have layers of anxiety that could become integrated with our character or personality. This we call characterological anxiety and representing the way anxiety characteristically encourages or even forces one to behave.
Overlying the layer of characterological anxiety is the uppermost layer of anxiety. This is imposed by the presence of a psychiatric illness itself. By definition this layer may therefore be present or absent. All psychiatric disorders have anxiety as their final common pathway meaning that anxiety is manifested in every single diagnosable psychiatric disorder only to a lesser or greater extent. Schizophrenic patients for instance may appear externally very calm or unresponsive but when investigated are found to be extremely over stimulated and tense internally. This results in a great deal of internal and when released external angst in their behaviour.
Anxiety is omnipresent relevant and consequential in the entirety of the spectrum of psychiatric disorder. It makes up a major part of the presentation of every psychiatric illness whether this is schizophrenia, bipolar disorder, personality disorder, addiction disorders, autistic spectrum disorder, attention deficit hyperactivity disorder or of course primary anxiety disorders themselves. It seems however that this anxiety is invisible. Once a primary diagnosis is made anxiety more often than not is simply disregarded. The fact that in reality that anxiety often has as great an influence on the way these disorders manifest, present and progress as the primary illness itself is basically ignored or overlooked. Ironically the psychological pain that is the dis-ease in psychiatric illness in actual fact comes mainly from this anxiety. The uncomfortable reality apparently invisible to many is that anxiety is the predominant agent responsible for the majority of discomfort and pain in all psychiatric conditions. Alleviation of this anxiety-pain is rarely given priority in the treatment of such conditions.