Sources of Suffering

Fear, Greed, Guilt, Deception, Betrayal, and Revenge

Salman Akhtar

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429919398
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book seeks to underscore the multifaceted ways in which we encounter suffering in clinical and social settings. The fear, greed, and guilt cause an individual to suffer privately, while the deception, betrayal, and revenge lead others to suffer.

PART I

SUFFERING TOLERATED

CHAPTER ONE


Fear

Fear is ubiquitous. All of us experience it at one time or another. The sound of footsteps approaching us from behind in a dark alley, an unexpected visit to the city morgue, eye contact with a large alligator in the zoo, and a precipitous “fall” of a rollercoaster can all give us goose bumps of terror. We shriek, scream, or simply become paralysed with fear. We readily recognise its dark arrival in the pit of our stomachs and feel its movement in our blood.

But do we understand the actual nature of fear? Do we know the purpose it serves? Do we agree upon the circumstances under which it is “normal” to be afraid? And, when does fear become abnormal or morbid? Is fear to be avoided at all costs or can this bitter gourd of emotion be transformed into a sweet mango of cultural delight? Questions like these suggest that fear is simple and self-evident only on the surface. Examined carefully, it turns out to be a complex and nuanced phenomenon.

Fear

Webster’s dictionary defines fear as “an unpleasant, often strong emotion caused by anticipation or awareness of danger” (Mish, 1998, p. 425). While the source of the threat is not identified, the tone makes it clear that the danger referred to resides in external reality. Fear, in other words, is a dysphoric reaction to an actual object (e.g., a wild animal, a knife-wielding drunkard), event (e.g., an earthquake, a stampede), or situation (e.g., watching a horror movie, losing control of a car on an icy road) that is felt to be threatening. The extent of dysphoria in the face of approaching danger varies and four levels of fear’s severity are identified in the English language: (a) apprehension, which refers to a mild anticipation of a bad occurrence; (b) dread, which blends the conviction that one is facing danger with a powerful reluctance to encounter the scary object or situation; (c) panic, which denotes an overwhelming sense of being scared, coupled with alarmed hyperactivity (e.g., pacing, running away) and physiological arousal (e.g., increased heartbeat, laboured breathing); and (d) terror, which signifies an extreme degree of consternation, a feeling of doom, “catastrophic aloneness” (Grand, 2002), and psychomotor paralysis.

The fact that fear is ubiquitous in the animal kingdom suggests that it is a “needed emotion”, that is, one that is important for the organism’s survival and functioning. For all living beings, including humans, the emotion of fear serves as a protective device; it warns them that some danger is approaching and they had better undertake measures to avoid it. This could be in the form of actively combating the “enemy” or rapidly escaping from it, meaning the well-known “fight-or-flight” response to threats.

Some fears are widespread over the animal kingdom and seem “hard-wired”. Others are the result of developmentally unfolding, epigenetic sequence of fantasies that are specific to human beings. Among the former are fear of loud noises, sudden and jerky movements, looking down from heights, and animals that have fangs, claws, sharp teeth, and can jump or move at great speed (Abraham, 1913a; Akhtar & Brown, 2005). Present from birth onwards and persistent throughout life (even if in attenuated forms and at a preconscious level), these fears give testimony to man’s essential kinship with animals since their function is self-protective and oriented towards survival. Among the latter are the developmentally derived fears of loss of love objects, loss of love, and castration (Freud, 1926d); fear of death joins this list somewhat later during the course of psychic development. These “hardwired” and developmentally derived fears exist in both sexes though there is some evidence (Horner, 1968; Miller, 1994; Symonds, 1985) that, owing to socialisation patterns and internalised cultural biases, fear of becoming alone and fear of success are somewhat more prevalent among women.

Another point needs mention here. The experience of fear is mediated through two different routes: a shorter, rapid, and subcortical route which goes directly through the amygdala and a longer, slower, and more complex route that includes hippocampal and cortical participation (Damasio, 1999; Emanuel, 2004; Pally, 2000). Each route has an identical output: a fear response. However, the shorter route lacks the benefit of contextual information that the longer route provides. As a result, the shorter route produces a direct and simple fear response which can be tempered or even entirely inhibited by the longer route. The profound implications of this for psychic development and for therapeutic intervention are nowhere better illustrated than in the “visual cliff” experiment devised by Gibson and Walk (1960).

This experiment consists of having the glass floor of a room papered, from below, with a chequerboard design up to its midpoint. As a result, the first half of the floor does not appear any different from ordinary floors but, as the paper affixed from below runs out, the floor suddenly appears threatening due to the depth perception through the transparent glass. The point at which the transparent glass begins is the “visual cliff”. Now, a toddler is placed on the papered end of the floor and his or her mother is asked to watch him from across the room. The toddler begins to make his way towards her but abruptly stops at encountering the “visual cliff”. If the mother remains impassive, the child does not move forward. However, if the mother smiles, spreads her arms, and vocally encourages the child to come to her, the child crawls or walks over the transparent glass. Mother’s loving support activates the hippocampal-cortical system that dampens the fear aroused by the amygdala-sponsored pathway mentioned above.

While this is a salutary consequence of environmental modulation of “hard-wired” childhood fears, adverse and even sinister interplays of childhood vulnerability and caregiver input also exist. Children (more so than adults) need company and

… their needs for attachment experiences and even moments of intimacy will lead them to shadow, seek out, and submissively engage the parents who, for the most part, cause them pain and disappointment. Their avidity for exploration and assertion will lead them to follow a ball out into a dangerous street, climb up an unstable support, or put fingers in electric plugs. Their love of sensual enjoyment from fondling, kissing, and rocking will result in their participating in sexually over-exciting play or overt seductions by older children and adults. The pleasure of social contact will expose older children to the smiling-faced inducements of a kidnapper, and the same desire coupled with greed leaves adults exposed to psychopathic salesmen and con men. Thus, parents must inculcate a sense of danger as an active educative effort. (Lichtenberg, 1991, pp. 396–397)

Such nuanced interplay of “nature versus nurture” variables in the genesis and modulation of fear undergirds the epigenetic unfolding of phase-specific fears throughout childhood development. “Natural” fears of starvation and physical injury are given specific “human” colouring via the potential danger of anaclitic betrayal and loss during infancy, castration and genital mutilation during early childhood, and moral anxiety (the internalised consequence of the preceding fear) during later childhood and adolescence (Freud, 1926d). Still later, in the course of adult life, fear of death appears on the psychic horizon; multiply determined and culturally variable, this fear combines fears of physical infirmity, separation from love objects, and loss of self (Akhtar, 2010; Chadwick, 1929; Freud, 1923b; Hoffman, Johnson, Foster & Wright, 2010; Natterson & Knudson, 1965; Zilboorg, 1943).

Anxiety

Fear and anxiety share some characteristics. Both evoke a sense that something bad is about to happen. Both are unpleasant and undesirable experiences. Both can serve as alarms and thus protect us from danger. However, in other ways, the two experiences are different. Fear is a response to external danger; anxiety to dangers emanating from the internal world. As early as 1895, Freud noted the relationship between “unpleasure” (not yet delineated as anxiety) to earlier painful experiences. He wrote:

If the memory image of the hostile object is in any manner freshly cathected (e.g., by fresh perceptions), a condition arises which is not pain but has a similarity to pain. It includes unpleasure and the inclination to discharge corresponding to the experience of pain. Unpleasure is released from the interior of the body—is freshly provoked—by the cathexis of memories. (1950a, p. 381)

Thirty years later, Freud (1926d) published his major work on the problem of anxiety and restated this thesis. However, this time, he linked the cathexis of previous traumata and their memories to the specific affect of anxiety. He stated:

Anxiety is not newly created in repression; it is reproduced as an affective state, in accordance with an already existing mnemic image. If we go further and enquire into the origin of that anxiety—and of affects in general—we shall be leaving the realm of pure psychology and entering the borderland of physiology. Affective states have become incorporated in the mind as precipitates of primeval traumatic experiences and when a similar situation occurs, they are revived like mnemic symbols. (p. 93)

In the same contribution, Freud also delineated the seminal “danger situations” causing anxiety. These included threats of (a) loss of a love object, (b) loss of the love object’s love, (c) castration, and (d) moral condemnation from within oneself. “Each situation or danger corresponds to a particular period of life or a particular developmental phase of the mental apparatus and appears to be justifiable to it” (p. 146). Some “danger situations” lose their evocative power as the individual matures while others survive by acquiring more up-to-date forms. Still others (e.g., superego’s attack) accompany people throughout their lives. “Danger situations” mobilise anxiety and set ego defences in motion. This is “signal anxiety”. It contrasts with “automatic anxiety” that results from the ego being overwhelmed by threats from within. The feeling in anxiety that something bad is about to happen is due to the ego’s sense that one might give in to id impulses that would lead to physical harm, others’ disapproval, or rebuke from one’s own conscience. However, since the impulse in question is almost always repressed, the nature of danger felt remains vague. This explanatory model, however, applies only to what is generally called “neurotic anxiety”. It does not address anxiety that presumably arises from the infantile era where a coherent ego and hence a wishful intentionality is not yet in place. In such anxiety, the dread is not of an instinctual breakthrough but that of psychic “breakdown” (Winnicott, 1974). Variously termed “psychotic anxiety” (Klein, 1932), “unthinkable anxiety” (Winnicott, 1962), and “annihilation anxiety” (Hurvich, 2003), such dysphoria threatens to disorganise mental functioning altogether. Elsewhere, I have noted the main characteristics of this anxiety.

… (i) it originates in early infancy; (ii) it can, however, be reactivated by later phase-specific anxieties; (iii) a combination of excessive constitutional aggression and severe traumatic experiences leads to ego weakness which, in turn, increases the vulnerability to such anxiety; (iv) it might exist in pre-verbal forms or might acquire retrospective fantasy content from later developmental phases; (v) it is generally associated with propensity towards psychosis but might also underlie non-psychotic conditions especially those of addictive, psychosomatic, and perverse varieties; and, (vi) it mobilizes defenses that are particularly recalcitrant. (Akhtar, 2009, p. 22)

Regardless of whether it is “neurotic” or “psychotic” in nature, the intrapsychic origin of anxiety also precludes its control by physical flight; one can run away from fear, not from anxiety. Fear and anxiety are thus both similar and dissimilar. The phenomenological terrain is further muddled by the fact that the two often coexist. External threats are played up by internal vulnerabilities and intrapsychic threats can readily be externalised. Some admixtures of fear and anxiety are commonplace, others curious.

Phobia

By itself, fear is a rational response and therefore poses few problems. When it gets fuelled by anxiety in a regressive blurring of external and internal realities, difficulties of clinical proportions begin to arise. The most well known among these conditions is phobia. A term derived the Greek word phobos (meaning flight, dread, and panic), phobia stands for “marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation” (DSM-IV-TR, 2000, p. 449). In effect, both anxiety (internal danger) and fear (external danger) coexist within phobia, although in their pure forms, anxiety and fear are quite different (see Table 1). Phobia is distinct from fear because it is out of proportion with the situation in reality. Indeed, a fear must meet the following criteria in order to qualify as a phobia: (i) it should not be age-specific, (ii) it should not be widely accepted as normal within a culture or subculture, (iii) it should be noticeably out of proportion with the plausible danger from the object or the situation, (iv) it should result in impairment of psychosocial functioning, (v) it should be associated with active avoidance of the dreaded stimulus, and (vi) such avoidance should provide symptomatic relief.

Table 1. Fear, anxiety, and phobia.

Variables	Fear	Anxiety	Phobia
Source	External	Internal	Externalised
Risk	Actual	Unknown	Imagined
Threat	Clear	Vague	Clear
Danger	Plausible	Implausible	Exaggerated
Avoidance	Helpful	Futile	Helpful
Prevalence	Universal	Limited	Limited

Phobia also needs to be distinguished from the paranoid fear insofar as there is no motive assigned in phobia to the frightening object; the statement “I am afraid of pigeons” represents phobia and the statement “Pigeons are out to get me” represents paranoia. The former is the result of displacement, the latter that of projection.

Phobias can be of many types, as is attested by the profusion of specific phobias with Greek prefixes,¹ and many classifications exist. While a bit older, the classification by the British psychiatrist, Marks (1970), seems not only to be valid today but perhaps most sensible. According to him, phobias can be grouped into the following categories:

• Agoraphobic syndrome: is the commonest variety, constituting about sixty per cent of all phobias. The agoraphobic patients have fears not only of open spaces but also of shopping, crowds, travelling, and even of closed spaces. Other neurotic symptoms including panic attacks, dizziness, compulsive rituals, and feelings of depersonalisation are also often present. Most agoraphobics are women and the majority develop their symptoms after puberty.

• Animal phobia: constitutes the most clear-cut variety of phobia but, in its pure form, is infrequently encountered in clinical practice. The symptom usually develops at the onset of latency, that is, around six to eight years of age. There is little tendency for its “generalisation” and there is little tension in the absence of the phobic object.

• Social phobia: involves fear of public speaking, blushing, shaking, writing, eating, drinking, vomiting, or becoming incontinent in public. It occurs with equal frequency among men and women and usually starts after puberty, with a peak of incidence in the late teens.

• Miscellaneous specific phobias: start any time in life and persist fairly consistently. The phobi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the Author
• Introduction
• Part I: Suffering Tolerated
• Part II: Suffering Inflicted
• References
• Index