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Unraveling Anxiety’s Tangled Knot
By: Robert Gerzon, LMHC
Adapted from Finding Serenity in an Age of Anxiety © Robert Gerzon
We are living in an unprecedented Age of Anxiety. Our individual lives, our families, our neighborhoods — all float upon a vast, roiling sea of deep cultural anxiety. The juggling act of making time for work, family, friends and community activities becomes ever more demanding, and just when it starts to feel manageable another ball is thrown in. For me, as for most of my clients, friends and colleagues, the Age of Anxiety is no abstraction — it is scribbled all over our calendars and appointment books.
Anxiety disorders are the number one mental health problem in America, affecting one out of six Americans each year. During the last few years the word anxiety has escaped the bounds of psychology and leaped into the larger social, economic and political arena. Our minds are oversaturated with contradictory worldviews. Anxiety thrives on this uncertainty and confusion.
The ability to utilize anxiety effectively may prove to be our most essential skill to survive and thrive the challenges of life in the twenty-first century. Our collective response to this raging cultural anxiety may determine whether we descend into a violent and destructive divisiveness or evolve to a new level of human society.
Clues to anxiety’s secret
When I began to look at my own life, I saw that I had been dancing with anxiety since the day I was born, sometimes evading and avoiding it, sometimes attracted to it, but always interacting with it. Over the years, I became more conscious of my own anxiety and learned to use it as a guide and teacher. As a holistic psychotherapist, I specialized in treating anxiety and found that it held the key to psychological change.
How we respond to the basic feeling of anxiety determines our character and our personality. For example, Aaron becomes paralyzed when faced with making a commitment to Sue because the prospect of marriage fills him with anxiety. Phil and Tamara have serious relationship problems because they respond to their own anxiety in ways that trigger the other person’s anxiety. Larry is addicted to alcohol because he uses it to numb his anxiety. Jenny has chronic headaches and Ron has heart problems because internalizing their anxiety has taken a physical toll over the years. Maria is depressed and has low self-esteem as a result of years of dysfunctional responses to anxiety.
Freud put anxiety on the map for the modern world, observing that “anxiety is a nodal point, linking up all kinds of most important questions; a riddle, of which the solution must cast a flood of light upon our whole mental life.” The existentialist philosophers saw anxiety as the shadow cast by consciousness itself. Paul Tillich, in The Courage to Be, wrote, “The basic anxiety, the anxiety of a finite being about the threat of nonbeing, cannot be eliminated. It belongs to existence itself.” In its deepest sense, anxiety is the shadow cast by human consciousness. It came into being the moment Adam and Eve ate the apple. When I first realized this, I revised Descartes’ famous dictum to read: “I think, therefore I am…anxious.”
Since anxiety is a natural, even a sacred part of life, we need to learn how to become anxious about the right things in the right way, one that leads to personal and spiritual growth. Unfortunately, many current therapies are directed toward merely reducing stress and anxiety. But if, as the existentialists observe, anxiety is life being aware of its own aliveness, then the only way to reduce our anxiety is to become less alive, to numb ourselves to life. In fact, our problem as individuals and as a society may not be that we are too anxious, but that we are not anxious enough, and we are not anxious about the right things.
I found that current approaches to treating anxiety missed the mark for me and for most clients today. Pharmacological and behavioral approaches address only the more superficial and symptomatic aspects of anxiety’s mysterious presence in human life. As Jerrold F. Rosenbaum, M.D., Associate Professor of Psychiatry at Harvard Medical School, Chief of Clinical Pharmacology at Massachusetts General Hospital and noted anxiety expert, observed, “Despite the array of effective psychotherapies and pharmacotherapies for anxiety disorders, persistent distress is more the rule than the exception.” Relapse is common and anxiety’s message in the person’s life is seldom heeded.
I began to search for a more holistic approach. Dietary change (especially reduction in caffeine consumption) and regular exercise play a useful and sometimes crucial role in lessening anxiety. Herbal supplements sometimes offer effective help. I also teach my clients how to meditate and become more aware of their bodies. I’ve found that doing therapeutic breathwork allows clients to change their anxiety-producing breathing patterns, providing a way to dramatically reduce the habitual, biological level of anxiety without medication while healing core emotional blockages.
As I gained more experience with what works to heal anxiety, I continued to focus on unraveling what Freud called the “riddle of anxiety.” From anxiety’s tangled knot began to emerge three distinct yet related strands — one toxic, one natural and one sacred. From this insight I developed a simple model for treating anxiety effectively — one which according to Dr. Rosenbaum offers “a new understanding and reframing of anxiety as a stimulus for growth and an opportunity to achieve wisdom.”
I realized that anxiety itself is not the problem — it is a crucial warning and activation system that evolution built into our mind and body for self-preservation and growth. Our response to anxiety is the root of the problem. We become confused and don’t know how to react because we lack a model for separating out the different strands of anxiety — and they each require a dramatically different response.
Toxic Anxiety is a false alarm and needs to be turned off. Natural Anxiety warns us of real dangers and requires us to take effective action. Sacred Anxiety invites us to face the deeper questions in life and asks us to accept those things which we cannot change. I found that whenever anxiety arose in my life or in a client’s experience, untangling anxiety’s knot enabled effective responses instead of the common dysfunctional reactions such as denial, worry, panic, paralysis, displacement and projection.
I began to research each form of anxiety more thoroughly. From medicine and psychology came the type first studied by Freud — the unhealthy kind that he called neurotic anxiety and that I term Toxic Anxiety. This was the type of anxiety I saw in my clients and had experienced during my life as worry, self-doubt, panic and hopelessness.
Toxic Anxiety has been called the “fear of fear itself,” or “being anxious about being anxious.” Toxic Anxiety develops when we refuse to face anxiety. This refusal, whether conscious or not, causes our real anxieties to go underground and then to rise up again in highly destructive forms. Toxic Anxiety’s relentless pursuit may eventually push its victims into the realm of the psychotherapist’s office, the hospital and the courtroom. It has its origin in our past: genetic tendencies, past conditioning, past traumas, past experiences of unresolved anxiety. The specific forms and habits of Toxic Anxiety are often handed down from one generation to the next. This is the form of anxiety that today’s psychologists and psychiatrists may diagnose as an anxiety disorder, mood disorder, substance abuse, or some other category of mental dysfunction. Toxic Anxiety begins to lose its power over us the moment we find the courage to turn and face it instead of running from it.
In the realms of popular “success” literature, the human potential movement and traditional folk wisdom I found the healthy strand of anxiety. Here anxiety — often called fear — was not pathologized but was considered to be a human emotion that need to be mastered and channeled into achievement and personal fulfillment. This second type of anxiety is a normal part of the dangers, challenges and uncertainties of everyday life, so I called it Natural Anxiety. Freud classified this reality-based form of anxiety as “objective anxiety” and Rollo May called it “normal anxiety.”
Natural Anxiety is rooted in the awareness of our status as vulnerable biological organisms whose well-being can be threatened in countless ways. Natural Anxiety springs from what Shakespeare called “The heart-ache and the thousand natural shocks/ That flesh is heir to.” When the biological instinct for self-preservation collides with the recognition that life comes with absolutely no guarantees, the inevitable consequence is Natural Anxiety. Natural Anxiety includes the healthy alertness and activation that positive challenges and opportunities evoke. I recognized Natural Anxiety in my own life as the realistic fears of actual dangers and the enlivening kind of anxiety-excitement that accompanied times of growth.
For many years, I had been fascinated with yet a third strand of anxiety which winds through all the world’s philosophical and religious traditions — existentialist angst and the religious “fear of God.” This was anxiety on a cosmic level, an anxiety that could not be medicated away or channeled into material success. It was the spiritual, existential anxiety that I had become aware of as a child and never had a name for. It concerned the ultimate anxieties of life — death, life after death and the meaning and purpose of our lives. This I called Sacred Anxiety.
Sacred Anxiety arises from the indisputable fact that, no matter how successful or charmed our life may be, one day our body will cease to function and we will die. Of all earth’s creatures, it is only we human beings who carry this fateful knowledge with us along each step of our life’s journey. The awareness of our own death is the gateway from Natural to Sacred Anxiety. While Toxic Anxiety fights phantasms of the past and Natural Anxiety deals with the challenges of the present, Sacred Anxiety confronts the unknown and uncertain future and life’s ultimate questions.
We enter Sacred Anxiety’s terrain when we confront the reality of death and when we grapple with issues that relate to our most basic values and beliefs: the very meaning and purpose of our life. Every religion and philosophy is an attempt to minister to our Sacred Anxiety. A divorce, a serious illness, a major decision, the death of a loved one, a serious setback, a midlife crisis — all provoke anxiety at the deepest stratum of our being. This is the spiritual level of anxiety that most psychotherapies and all medications fail to address, leaving the conventionally counseled, medicated individual feeling even more confused and disheartened about why they are “still anxious.”
Sacred Anxiety is anxiety about the “Big One” — about the dread of death the mystery of life and our encounter with the ultimate, or God. Sacred Anxiety has two paradoxical aspects: Death Anxiety symbolizes our dread of dying and nonexistence, while Life Anxiety represents our trepidation of living with full, sensual aliveness, authentic self-expression, and passionate commitment to our dreams. Sacred Anxiety is the essence of our humanity; our response to it is the key to our personal and spiritual growth.
Sacred Anxiety brings us into the realm of ethics, philosophy and religion. Kierkegaard, writing about this spiritual anxiety, wrote: “This is an adventure that every human being must go through — to learn to be anxious in order that he may not perish...Whoever has learned to be anxious in the right way has learned the ultimate...the more profoundly he is in anxiety, the greater is the man...Then anxiety enters into his soul and searches out everything and anxiously torments everything finite and petty out of him, and then it leads him where he wants to go...[Thus] the individual through anxiety is educated into faith.”
I saw that a lack of clarity regarding these three types was at the root of our difficulty in dealing with anxiety. Fortunately, distinguishing these three strands from each other and relating them to each other enables us to begin unraveling the riddle of anxiety. Understanding that there are actually three distinct types, and that each requires a different kind of response, is crucial to mastering anxiety and finding serenity. As I employed this deceptively simple concept in my own life and taught it to clients and workshop participants at Harvard Community Health Plan, I found that it possessed the power to liberate people from the tyranny of anxiety.
I have found that the power of this model to comfort and empower anxious clients is dramatic. Sharing this with a client turns anxiety from a shaming, terrifying monster into a dragon that can be tamed — and a guiding angel that can be embraced.
Portraits of Anxiety
Every one of us experiences a mixture of the three types of anxiety. In the clinical vignettes that follow, the various guises of anxiety assume human faces. I am continually amazed at how easily we can become entangled in anxiety, and how through the choice to become aware we can begin to separate anxiety’s three strands and use them for healing and growth.
Janet
Janet, forty-eight, graduated from college with a degree as a librarian and worked at a local library. She consulted me because she wanted to learn better ways of dealing with the stress and anxiety in her life. An escalating problem with her 17-year-old daughter Cathy had prompted Janet to seek help. Cathy, who had been staying out late, was using alcohol and marijuana, and was becoming increasingly uncommunicative. Janet’s concerns about Cathy had intensified her tendency toward excessive worry. She said that the situation was “putting her over the edge,” and she was now suffering from insomnia on a nightly basis. In the morning she awoke feeling tired and depressed and her performance at work was being affected. Janet’s occasional migraines had also become more severe. She had gained fifteen pounds over the past year. “I just don’t feel very good about myself and I don’t know why,” she told me, but her voice betrayed an anguish that went deeper than the concerns she was describing.
Janet was in a quandary about Cathy’s behavior, and she felt that she was worrying about her all the time. Her older child Larry, who would soon be graduating from college, had never behaved this way as a teenager. Janet and her husband Roger had taken Cathy to a counselor who specialized in adolescents, but Cathy had stopped going after three sessions, stating that they were “a waste of time.” The counselor had told Janet and Roger that Cathy’s behavior seemed to be “within the range of normal experimentation for her peer group.” This neither reassured them about Cathy’s behavior nor gave them confidence in the counselor.
As Janet and I worked together, I learned more about her background and her current life. She described a normal, mostly happy childhood. Her father was an accountant for a large firm, and she remembered him as good provider, though strict and judgmental. “He expected everything to be done his way — or else.” Janet’s mother was kind and nurturing but unassertive: “She was a saint. She never got angry. Maybe she should have sometimes.”
I asked about her relationship with her husband. “It’s OK, I guess, we don’t fight. But we don’t talk much, except about the kids and the house and so forth.” She said that Roger wasn’t much help in resolving the problem with Cathy because he tended to lose his temper with her and just make things worse. She wished he would help out more around the house, and she wondered what their relationship would be like when Cathy left for college in a year — assuming that Cathy managed to keep her grades up this year so she could gain admittance to a college.
Like many people suffering from anxiety, Janet was confused and conflicted. Her typical inner dialogues went something like this: “I’m worried about Cathy. I need to get her to change her self-destructive behavior, but nothing I’m doing is working. She just won’t listen to me. Roger isn’t much help and that irritates me. Well, maybe that counselor was right and I’m just overreacting and being a worrywart. I should just try to stop worrying so much and lose weight and take care of myself for a change.” A few hours (or minutes!) later, the same debate would begin again. Janet’s mind went around in circles, leaving her dizzy and confused. Her behavior cycled from frustrated outbursts to trying to ignore the problem, to overeating and battling insomnia.
I began helping her by explaining that she was caught in tangled knot of anxiety and that she could begin to regain a sense of control in her life by separating out the three strands of anxiety. We identified her Toxic Anxiety symptoms and the need to develop self-calming skills for dealing with them. Setting that aside for the moment enabled Janet to see that much of her anxiety was natural. She faced some very real problems in her family relationships. This normalized her feelings of anxiety and she began to understand that the positive purpose behind her unrelenting anxiety was to make sure that she faced the situation and responded to it effectively. Janet recognized the Sacred Anxiety in her situation involved deeper issues for her including her own mid-life crisis of meaning and purpose as she approached the “empty nest” phase of her life.
Janet, like many other clients I have worked with, experienced immediate improvement in her symptoms simply from being able to see her anxiety in a way that made common sense and provided realistic hope for mastery of the situation.
Together we continued to separate out the strands of anxiety that had become so tangled in her mind. The toxic level of her anxiety included the insomnia, overeating and worry. It was rooted in her tendency to “stuff” her anxiety and blame herself for Cathy’s problems or “dump” her anxiety by blaming Cathy for misbehaving and Roger for being uncooperative. Then she would feel guilty and confused and behave in ineffective ways.
I trained Janet in several effective relaxation and meditation techniques which she began practicing regularly. Within three weeks she was sleeping more soundly and feeling better in general. She also learned how to deal with worry and negative thinking by using a cognitive self-talk technique I call Creative Inner Talk. She began to reprogram the negative voice that blamed her and accused her of being a “bad mother.” She learned to calm herself, and even more important, how to stop her “Anxious Chatterbox” from creating unnecessary anxiety in the first place.
Janet began using Creative Inner Talk to develop the habit of self-awareness. As Rollo May observed, “...just as anxiety destroys our self-awareness, so awareness of ourselves can destroy anxiety. That is to say, the stronger our consciousness of ourselves, the more we can take a stand and overcome anxiety.”
We developed strategies to address Janet’s Natural Anxieties. She was relieved to have her legitimate concerns validated. Worrying every night that Cathy was in a car accident was neurotic, but her concern about Cathy’s changed behavior was very realistic. Janet had good reason to experience the Natural Anxiety she felt about her daughter, about her own physical and mental condition, and about the lack of intimacy and communication in her marriage. These were real problems that required effective responses, and I helped her to develop strategies for communicating with both Cathy and Roger that got their attention. She stopped criticizing and blaming and began to listen more and communicate more effectively.
She began to address her own anxiety first and blame Cathy less. “I feel like we’ve opened up the lines of communication some more,” she told me. “We still don’t see eye to eye on everything, but at least we’re able to enjoy each other’s company again and agree on some basic ground rules.” Janet became more assertive at home and found that she had a great deal of power that she hadn’t been using. “Roger’s agreed to go with me to an evening workshop on parenting teenagers that’s being offered at Cathy’s high school,” she told me.
I had taught Janet some effective techniques for entering the meditative state and she had been practicing meditation at home (using a CD I recorded) to relax and enhance her self-awareness. We also employed the meditative state during our counseling sessions so she could access the deeper parts of her mind. Janet was genuinely interested in getting to the root causes of her issues.
During meditation she realized for the first time that at the bottom of her various anxieties about Cathy was an extremely negative fantasy: “I imagine that Cathy’s going to die in a car accident and I’ll feel terribly guilty the rest of my life for being a bad mother who failed to protect her daughter.”
Janet realized that in order to ward off this horrible fate, she tried to control Cathy’s behavior as much as possible. I asked her to imagine herself in Cathy’s place in order to understand how this felt to her.
Speaking from Cathy’s perspective, Janet said, “Mom, when you try to run my life it makes me feel like you don’t have any confidence in me and that you think I’m a bad daughter.” For the first time, Janet was able to see the negative feedback cycle that anxiety had set up between them.
As her daughter was growing more independent, Janet was being forced to realize that Cathy’s life was beyond Janet’s control. She could no longer control her environment or her activities in the way she had when Cathy was younger. Janet needed to let go of what was beyond her control and accept the possibility that Cathy might make choices in her life that were not to Janet’s liking. I helped her to see how her worry stemmed from her deep love for her daughter, and that she could find healthier ways of expressing her caring and affection. She also realized how her father’s critical temperament and her mother’s passivity had affected her own personality.
Janet began to probe the strand of Sacred Anxiety that ran through her relationship with Cathy. Trying to control what is outside of one’s sphere of control is a formula guaranteed to produce worry and anxiety. On a deeper level Janet needed to accept the existential reality and ever-present possibility of death. To accept this Sacred Anxiety of the unknown is a challenge, but when we let go of trying to play God, it leads to acceptance and peace. Using visualization techniques, Janet began to replace her anxiety-producing model of a hostile, dangerous universe with one that is spiritually safe and loving.
In subsequent meditation sessions Janet faced her image of a harsh, condemning God who would blame her if Cathy died or chose a life that was contrary to Janet’s values. In this sense, Janet’s Sacred Anxiety had to do with the anxiety that she would have to feel bad about herself forever, a kind of psychological “damnation.” She became aware of how guilt-oriented the religious training of her childhood had been, and how she could now choose to replace it with a loving and forgiving God who was more in harmony with her own values and beliefs. Taking responsibility for creating our own image of God is one of the most important tasks of adulthood. Until we do so, our childhood programming is still governing our behavior, whether we want it to or not.
In later sessions with me and through her own meditations, Janet was able to listen to her body more clearly. “I notice I’m not censoring myself as much. I’m telling people how I feel about things. And I’ve begun to lose weight, just by not snacking and nibbling whenever I feel anxious.” The frequency and severity of her migraines were also greatly reduced. Cathy and Janet found they shared an interest in art and took a painting class together at a local art center. Both were able to communicate their needs and their “bottom lines” to each other, and they managed to reestablish a sense of caring and connection that was far from problem-free, but vastly more satisfying than their previous anger and arguments.
Roger agreed to work with Cathy on her college application process. Janet and Roger began to go out for dinner and movies again and to talk about their relationship and their future plans. At our twelfth and final session Janet told me: “I never realized anxiety could be so interesting. If I hadn’t had all that anxiety I would never have taken the time to do this work. Since the Toxic Anxiety is so much less now, I feel I have much healthier ways of dealing with the Natural and Sacred levels. I’ve actually volunteered to take an active role in our library system’s reorganization process — something anxiety would have kept me from doing before.”
Understanding the anxiety triad and doing the appropriate work on each level allowed Janet not only to reduce or eliminate many of her anxiety symptoms, but also to resolve the real-life developmental issues that she faced. Because she was willing to deal constructively with her Natural Anxieties about her daughter’s growing independence and the transitional midlife phase of her own life, Janet’s psyche no longer needed to divert that anxious energy into psychosomatic symptoms. She went even deeper and began a very useful process of midlife psychological house cleaning by examining her subconscious programming and consciously choosing to face the underlying spiritual and existential anxiety about her own relationship to life, death and God.
Bill
Bill was thirty-three and a respected physician at a teaching hospital. He had important responsibilities and told me at our first session that he felt tense and stressed most of the time. He had always liked to party as a way to relieve the stresses of his life, but lately he’d had to admit to himself that his drinking had become a problem. By using his will power, he was able to stop drinking for two or three weeks, but he invariably started again.
Two recent incidents disturbed Bill enough to seek counseling. “Last month I misdiagnosed a simple problem and put a patient through a grueling battery of unnecessary and risky tests,” he told me with obvious shame. “I know it’s because I was doing some heavy drinking.” The second incident had occurred the previous week while Bill was driving his girlfriend, Beryl, home. “She asked me to slow down, and I just snapped. I lost my temper totally and nearly had an accident.” He was shocked at his own behavior and apologized afterward, but Beryl had told him that she wouldn’t go out with him again until he stopped drinking.
Bill knows his problem has gotten out of control, but knowing it just makes him want to have a drink. He has also begun abusing some prescription drugs. “I can’t believe that in spite of all my medical knowledge I’ve managed to become a substance abuser.” His confusion and pain were evident.
It was immediately clear to me that Bill was a very caring and sensitive person. His initial reserve vanished quickly and he was relieved to be able to talk about his life. I asked him why he had become a physician. Bill told me that he had grown up in a blue collar immigrant neighborhood. The family doctor was one of the few professionals with whom he came in contact; Bill worshipped him and was inspired by the goal of learning the art of medicine.
As a child Bill was very bright and took the bus each day to a special school for the gifted in an upper middle-class neighborhood. He had begun to drink in high school to relieve his social anxiety before parties.
Bill’s father, Tony, was a mechanic and a heavy drinker; he would often come home drunk. Bill remembers becoming quite skilled at an early age in “diagnosing” his father’s condition upon arriving home; if Tony had been drinking, Bill would do his best to stay out of sight to avoid becoming the object of his father’s volatile temper.
Even though he went on to graduate at the top of his medical class, Bill told me that he secretly feared that he was “not as good” as the mostly middle- and upper-class people who were his peers: “I feel like I’ve been fooling everyone for years and that sooner or later I’m going to be exposed for who I really am — a stupid drunk from the wrong side of the tracks.”
Every day Bill lived with this anxiety, barely able to keep it below the surface. Earlier in his life this anxiety drove him to excel in school and prove he could be better than the other kids. Now he found that looking at the impressive degrees hanging on his office wall can’t quiet the tormenting inner voices of self-doubt nearly as well as alcohol can. Bill also had been battling increasingly frequent bouts of depression during the past year. When he drank he felt good about himself — for awhile. But the drinking problem had just added to his anxiety. “I know it’s only a matter of time before someone at the hospital finds out I’m abusing drugs and alcohol.”
Through our counseling work together, Bill began to understand the anxiety-addiction connection in his life. As he learned about the three levels of anxiety he was able to see that he was drinking in order to relieve the Toxic Anxiety regarding his basic self-worth. He had been mentally conditioned by his father’s example (and the larger culture) to use alcohol as “medication” to relieve anxiety symptoms. For Bill, as for many men, it was hard to admit to having feelings of anxiety and self-doubt. It was easier, and seemed more “manly” as a teenager, to drown those feelings in alcohol.
Bill had also been mentally conditioned as a child to maintain a state of hypervigilance in order to cope with his father’s temper. Many children of alcoholics grow up with chronic daily anxiety, never knowing what mood a parent will be in. Children of alcoholics (and other unstable home environments) literally train themselves to be anxious because they soon learn that being extra alert is an effective strategy to avoid painful negative experiences with their parents. Expecting the worst is a reasonable response in such an environment and it’s often adopted as an effective survival skill.
We also discussed the possibility that Bill may have been genetically predisposed to become addicted to alcohol (Tony’s father had also been a heavy drinker). As part of our treatment strategy Bill joined a support group for health professionals with addictive behaviors.
“I discovered I’m not the only doc who has problems with substance abuse,” he said. “I’ve made an agreement with myself that if I start to drink again I’ll immediately inform the hospital and request professional supervision for my cases. I’ve also started to make time nearly every day to play racquetball with some friends. It really helps me burn off the day’s tensions.”
Through counseling, Bill was able to learn healthier ways of responding to his feelings of “not being good enough.” We worked with the A+ Formula and positive Inner Talk and Bill began to see that he had been repeating many of the negative things his father used to say to him, such as, “You’re a worthless good-for-nothing,” and “You’ll never amount to anything.”
Bill observed that the Natural Anxiety in his life centered on two main areas — his profession and his relationship with Beryl. In the past his Natural Anxiety had become tangled up with his Toxic Anxiety. When a patient did not get well, Bill often used it as evidence that he was not “good enough.” We spent several sessions exploring how Bill could deal with the anxiety inherent in making daily decisions that dramatically affect the health of other human beings.
“I’ve always second-guessed my decisions — often late into the night, tossing and turning in bed. Now I’m trying to use this anxiety in a positive way. Rather than letting it gnaw away at my self-esteem, I’m starting out with a basic feeling of being a ‘good enough doctor’ and using my anxiety to sharpen my diagnosis by looking at each patient from several points of view before making a treatment decision.”
Bill also had Natural Anxiety about the direction of his relationship with Beryl. “She’s interested in getting married and I feel hesitant. I don’t know if it has to do with her or just my own issues with intimacy and commitment.” Bill spent several sessions working on this problem, detoxifying the relationship anxieties that stemmed from his childhood experiences. He was able to enjoy a more authentic relationship with Beryl and begin a fruitful dialogue about marriage.
Bill had taken the Anxiety Personality Test I developed and was not surprised to find that his highest score was as the “Controller” personality. Bill was not a conventionally religious person, but he was able to relate to the notion of Sacred Anxiety as the need to surrender to what is beyond his control. The first thing he realized was that he needed to let go of his tendency to “play God.”
“As a doctor I’m constantly battling disease, and death is my ultimate enemy. When a patient dies, it makes me feel like I’ve lost the battle. That makes me anxious because I have such a need to be able to control everything,” he admitted. “I need to do every possible procedure even when the situation is hopeless. Otherwise I feel guilty that I didn’t do enough.”
Through our discussions and through specific guided meditations, Bill was able to come to a more realistic acceptance of death and the natural limits of his power as a physician. “Since I can relate to death less as a personal enemy, I find that I’m able to choose more appropriate treatments strategies for terminal patients by talking honestly with them and their families. I don’t let my anxiety make me talk them into trying one more heroic intervention if they are ready to go.”
Near the end of our work together, Bill said to me, “I realize that my anxiety conditioning as a child has actually helped me to be a better doctor. I notice things about a patient and notice them more quickly than many of the other doctors. I’ve learned to use my ability to visualize ‘worst case scenarios’ in a positive way.”
Smiling, he added, “When I confided to one of my racquetball buddies that I had an anxiety problem, he said, ‘Well, believe me, I’d rather have a doctor who’s an anxious perfectionist than one who’s happy-go-lucky.’ ” I agreed wholeheartedly.
I have found in my own life and in my work with my clients that anxiety can become a marvelous teacher. As Kierkegaard noted, growth-oriented individuals learn to make anxiety work for them instead of against them. Such a person “remains with anxiety; he does not permit himself to be deceived by its countless falsifications...Then the assaults of anxiety, even though they be terrifying, will not be such that he flees from them. For him anxiety becomes a serving spirit that against its will leads him where he wishes to go.”
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