Anxiety as Symptom and Signal

Steven P. Roose, Robert A. Glick

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134882779
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychologie appliquée

The concept of anxiety has long held a central place in psychoanalytic theories of mind and treatment. Yet, in recent years, data from the neurosciences and from pharmacological studies have posed a compelling challenge to psychoanalytic models of anxiety. One major outcome of these studies is the realization that anxiety both organizes and disorganizes, that it can be both symptom and signal. In Anxiety as Symptom and Signal, editors Steven Roose and Robert Glick have brought together distinguished contributors to address these different dimensions of anxiety. A section of original papers on "Anxiety as Symptom" covers evolutionary, neuroanatomical, genetic, and developmental perspectives. A complementary section on "Anxiety as Signal" focuses on the meanings and functions of anxiety in the clinical process; contributions address anxiety in its ego-psychological, intersubjective, and relational dimensions.

The illuminating, readable collection will broaden clinicians' awareness of the diverse research findings that now inform our understanding of anxiety. No less importantly, it will deepen their appreciation of the richly variegated ways that anxiety can shape, and be shaped by, the clinical process.

1	Freudian and Post-Freudian Theories or Anxiety

Robert A. Glick

In 1932, the aged father of psychoanalysis wrote his New Introductory Lectures in Psychoanalysis. Too old and infirm to speak in public, he wrote in his conversations with posterity the following encouragement to those of us struggling in the field:

What people seem to demand of psychology is not progress in knowledge, but satisfactions of some other sort; every unsolved problem, every admitted uncertainty is made into a reproach against it.

Whoever cares for the science of mental life must accept these injustices along with it [Freud, 1933, p. 6].

In the development of affect theory (Shapiro and Emde, 1991), anxiety has been clinically and theoretically central, both as an affect and as a signal. An inescapable life experience, anxiety can painfully dominate and impoverish life. Yet as a signal of danger, rooted in our evolved psychobiology, anxiety gains deeply influential and adaptive, real and imagined, and conscious and unconscious meanings throughout our individual experience.

My purposes in this chapter are to explore the meanings and functions of anxiety in the evolution of psychoanalytic theory or theories and to suggest some of the challenges to those theories from infant development studies, neuroscience, and clinical process. In so doing, I hope to set the stage for the chapters that follow, examining both the history of psychoanalytic ideas and issues and the crucial influences on modern psychoanalytic understanding.

During the century since Freud's earliest conceptualization of hysteria up to the current theoretical pluralism, our understanding of anxiety has dramatically evolved and changed. As I shall describe, theoretical concepts began with energies and mechanisms and with forces and agencies and have come to include the relations of selves and objects. At its core, the problem of anxiety deals with the nature and locus of threat to self or other; for the clinician and the theoretician, the question remains: the danger of what and whom?

Models of anxiety have always guided clinical psychoanalytic process. Using versions of the aforementioned question, analysts use theory to understand and interpret the mental life of a patient. However, there has been at times an ambiguously self-serving relationship between clinical observation and explanatory theory: the ways in which experience and explanation shape each other can include the danger of discovering what one seeks to find and of finding what one needs in order to confirm a theory. In addition, knowledge from outside psychoanalysis, from both the neurosciences and the social sciences, has not been easily integrated into psychoanalytic theoretical models.

Confronting all theories of anxiety, since the time of Freud's earliest efforts and remaining challenges today, are the dialectical relations of brain and mind and of constitutional and accidental. As suggested by this volume's title, Anxiety: Symptom and Signal, anxiety is both a disorganizer and an organizer in psychic development and in mental life; while as an affect anxiety painfully disrupts an individual trying to cope with overwhelming threat, anxiety as a signal reflects processes of internal appraisal and internal communication within the mind.

COHERENCE IN FREUDIAN AND POST-FREUDIAN ANXIETIES

The concept of anxiety as an intrinsic adaptive reaction to danger originates not with Freud but with Darwin. By 1895, Freud (1895a,b) had concluded that the syndrome of anxiety hysteria—made up of conversion symptoms and phobias—had a psychological etiology, as a neuropsychosis of defense, and that it was a response of the mind to the threatened return of unpleasant emotions linked to unacceptable sexual memories. These were warded off and denied access to conscious awareness by means of repression, a psychological dynamic force. Anxiety emerged as the energic component of forgotten, repressed sexual ideas. Having the patient overcome amnesia and remember was both consistent with the etiological theory and effective as a treatment. In contrast, the syndrome of anxiety neurosis, comprising severe anxiety states and panic attacks, was a form of current or actual neurosis. Freud thought they had a somatic etiology; that is, the psychological experience of the somatic sexual drive was not fulfilled. For example, in coitus interruptus, when sexual excitation results in discharge, it never achieves adequate psychological satisfaction.

Freud always retained his deep respect for and fascination with the unknowable constitutional or biological determinants of anxiety; nonetheless he turned his attention to the psychical forms of anxiety that embodied the neurotic workings of failed repressions. Anxiety was for Freud both an affect and a metabolic product of sexual drive that had escaped repression but not achieved conscious satisfaction. The inadequately repressed libido would undergo a toxic modification into anxiety, “as vinegar is to wine” (Freud, 1905, p. 224). For Freud, the mind was ultimately a homeostatic and transformational system for the management of the psychic energy that flowed from the drives. The mental apparatus was governed by two regulatory principles: the homeostatic constancy principle, which sought to maintain a steady, low level of energy in the system, and the transformational pleasure–unpleasure principle, wherein increases of excitation are experienced as unpleasureable and decreases as pleasurable. Psychic dangers arose when the mind must safely contain or discharge the forces of unacceptable desires.

Within the next two and a half decades, psychoanalysis evolved into its true, high-classical form. With a sense of visionary passion, Freud and his disciples believed they were in possession of a revolutionarily new epistemological tool and scientific instrument that could both explain and explore virtually all aspects of human experience: character, illness, health, morality, religion, anthropology, history, and creativity. The repressed, wishful, infantile unconscious was the source of our lowest and highest qualities. Repressed unconscious wishes—derivatives of the unknowable instinctual drives—were recognized as the dangers—as the potential threats to the ego—whose principal task was the safe and acceptable expression of infantile sexuality. In the analytic situation, anxiety served as a beacon leading to the unconscious drives. Freud looked for it in his patients and offered them insight into its problematic, instinctual sources. Understanding of the sources would relieve the anxiety. Because his primary interest was in the drives, Freud had yet to appreciate the role of anxiety as an organizer and as an adaptive mental signal.

By 1926, the growth of psychoanalytic clinical experience and the limited explanatory power of the reigning theories prompted Freud's epic reformulation of anxiety theory. Freud (1926) set out much of what therapeutic process had taught him about the ego, the superego, and the unconscious structure of the major neuroses, the nature of defense, and the centrality of the Oedipus complex. He redefined the dynamic roles of anxiety—first, as a signal of danger, and second, as the initiator of defensive response. Originally, anxiety was the result of defensive response. Once Freud had defined the ego as the central executive agent of the mind, the signal function adaptively monitored the internal and external worlds for dangers. The ego samples the instinctual drive derivative—the wishful impulse—that threatens to evoke a dangerous situation of excessive excitation. Thus inoculated with the unpleasurable consequences of sampling a wish fulfillment, the ego draws on its individual and phylogenetic history of danger, invoking a defense mechanism to prevent the expression of the threatening impulse in action or in consciousness. Signal anxiety thus becomes the ego's most essential tool; signal anxiety makes it possible to remember, think, fear, and arbitrate drives, punishments, ideals, and reality. Imposing that central organizing role of anxiety onto his theories of psychological development—themselves portrayed as a series of dangers and potential trauma—Freud (1926) outlines the progression of possible anxieties:

The danger of psychical helplessness … when his ego is immature; the danger of the loss of object … when he is still dependent on others; the danger of castration …; and the fear of the super-ego to the latency period. Nevertheless, all these danger-situations and determinants of anxiety can persist side by side and cause the ego to react to them with anxiety at a period later than the appropriate one [p. 142].

Within Freud's schema of profoundly influential terrors of childhood, the conceptual importance he placed on castration anxiety cannot be overstated. Castration anxiety links psychopathology and psychodynamics with theories of etiology, development, and structure and function of the mind. As the paramount organizing danger signal, castration anxiety sets in motion superego formation, guilt, conscience, morality, civilization, and neurosis. Through the therapeutic reconstruction of the history of infantile oedipal fixations and regressions, liberation from neurosis becomes possible. Patients are cured of neurosis once they understand the vicissitudes of their dangerous, wishful oedipal past. Signal anxiety guides the way to both the cure of the neurosis and the archaeological excavation of its sources.

At this point Freud's hunger for a profound unified theory of fundamental human nature seemed satisfied. Although his views of anxiety changed, Freud never gave up his conviction that repressed drives threaten our ego and our civilization. He believed that the history of the race and the history of the infant merged in the unconscious infantile fantasies of the neurotic adult. Likening himself to Sir Richard Burton, who discovered the source of the Nile, Freud thought he had found the biological basis for theories of mind, development, and psychopathology.

As a model of the mind, Freud's theory remained paternalistic and phallocentric. He had paid insufficient attention to the importance of mothering and the indelibility of early maternal, preoedipal experience. At that point Rank (1929) entered the scene with his theory of birth trauma. Rank, who had come to analysis from literature, envisioned the trauma of birth as the central organizing experience of anxiety. The primal real separation from the mother was for him the paradigm of all neurotic anxiety—not Freud's Oedipus complex. In Rank's formulation, all subsequent developmental fixations and regressions, including the Oedipus complex and castration anxiety, were secondary elaborations of the physical separation from the mother at birth. Clinical psychoanalytic process, according to Rank, would demonstrate in the transference the return of the repressed birth trauma and the singular role of the maternal authority prior to the paternal. Freud rejected that theory, which he regarded as a return to the abandoned theory of abreaction. The birth trauma represented an intolerable challenge to his sacrosanct doctrines of the primacy of the Oedipus complex, of the father's authority as the organizing force in mental life, and of the supreme paternal authority of Freud himself over one of his favorite analytic sons.

While Rank's theory offered an alternative biological (i.e., objective, scientific, theoretical) foundation, Rank's heresy posed political and conceptual problems. It reminded Freud of his struggle with Jung, whose defection from the primacy of sexuality as the scientific basis of psychoanalysis had been a bitter wound, and it stretched credibility, requiring a psychologically developed newborn. Much more important for the future direction of psychoanalytic thinking was Rank's (1929) (and Ferenczi's, 1924) anticipation of the importance of the preoedipal mother as a profound force on mental development, as a dynamic ambivalent unconscious object of the all-important drives, and as a paradigm for therapeutic analysis.

As a result of those contributions, Freudian coherence was gradually revealed to be inadequate to the larger spectrum of diagnoses and mental phenomena emerging as clinically significant. Several major theoretical fault lines, the kind of ambiguities and uncertainties that generated Freud's major ideological anxiety, would appear over the role and meaning of the real versus the fantasied and of trauma versus conflict and over the importance of oedipal experience and paternal internalization versus the preoedipal experience and maternal internalization.

Post-Freudian Anxieties

With Freud's death, there were to be significant tectonic shifts in the theories of essential psychic structure and of mental processes and contents; the metapsychological bedrock on which clinical experience was to rest would never again be so secure.

Following the path suggested by Rank, Klein (1964) radically redefined anxiety. Retaining anxiety as central, she argued for the importance of anxieties as signals of danger generated in the relationship with the internal maternal object over that of castration anxiety. Not only would Mother's importance usurp Father's, but aggression would take the place of libido as the core source of, and reason for, anxiety. Danger, still considered instinctual, was not quite economic or quantitative, as Freud postulated. It was no longer repressed libidinal excitation or unsatisfied sexual desire; “the danger arising from the inner working of the death instinct is the first cause of anxiety” (Klein, 1948, p. 116). With this, we leave the realm of psychophysics and enter that of mythic monsters.

Crucial here is a profound shift of emphasis. Freud had coined all the essentials: fear of loss of the object, guilt, aggression, and the death instinct. Klein's critical developmental chronology starts in the first months of life, years earlier than Freud's. In Klein's scheme, developmental anxieties arise in stages: there is the paranoid-schizoid position with its persecutory anxiety, including fears of the destruction of the ego/self by the devouring bad breast onto which infantile aggression is projected. Later, as the infant-toddler integrates split maternal representations, it attains the depressive position: the infant experiences depressive anxiety, fearing the destruction of the good, or at least ambivalently loved, object or its destructive retaliation.

The Kleinian vision of the mind has had profound impact on psychoanalysis. In Klein's theory as in Freud's second anxiety theory, anxiety remains an organizer. As in Freud, it is linked to the constitutional force of drive, now aggression more than libido. The Kleinian mind is composed of fantasied partial self and object relational units, of sexual parts and bodily products, not primarily agencies like id, ego, and superego in conflict. Kleinian anxieties signal the potential destruction of vital parts of one's internal world, more akin to mythic struggles than energic problems within a mental machine. In clinical reconstructions from the analyses of adults and children, these unconscious, nightmarish anxieties are evidence of developmental failures to resolve the universal, archaic, dangerous, and sadistic conflicts necessary for psychological growth. The nature and impact of the actual mother recede into the Kleinian shadows, behind the instinctual aggression. And role of the real object as influential in psychic development seems as secondary in Klein as it seemed in Freud.

While it is beyond my purpose here to review object relations theory (see Greenberg and Mitchell, 1983), I do note trends relevant to our interest in anxiety. Object relations theorists (e.g., Fairbairn, Winnicott, Guntrip) following Klein increasingly replaced the Freudian apparatus. Freud's mechanistic ego, with its structured set of functions constructed from incorporated need-satisfying objects, yields to a new vision of the self. Not easily defined, the self now refers to one's inner subjective experience. A larger, and more abstract, concept, the self is our unconscious and conscious sense of psychic agency, subsuming the processes of defense, identification, conflict resolution, and adaptation. Anxiety therefore reflects the state of the self, one's organizational integrity, and one's security and satisfaction. Crucial in that picture is the infant's relationship with the maternal object caring for it—gratifying and nurturing the growing I: self. Anxieties in this scheme point the way to real or imagined failures of the actual, real maternal object to protect and serve the infantile self. These early organizing anxieties set the stage for the meanings of danger in subsequent development. The vicissitudes of ties to the good and bad, gratifying and depriving maternal object are registered as fragmentation and separation anxieties of the ego-self, which in turn color all later dangers. For Klein, the dangers result from instinctually driven fantasies; for Fairbairn, Winnicott, and the others, the maternal failures are real, objective, and actual historical events. Absence of the protective and nurturant mother is the danger. A patient's anxiety signals structural defects in the ego/self, resulting from psychic deficiency states in development.

As elements of theories of the mind, the definitions of anxiety diverge. We stand at the junction of two major conceptual paths, each with differing goals and implications: Along one path, much of Freudian structuralism is a...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Contents
• Contributors
• Preface
• 1. Freudian and Post-Freudian Theories of Anxiety
• 2. An Evolutionary Perspective on Anxiety
• 3. Neuroanatomy and Neurotransmitter Function in Panic Disorder
• 4. Genetic and Temperamental Variations in Individual Predisposition to Anxiety
• 5. The Ontogeny and Dynamics of Anxiety in Childhood
• 6. Learning to Be Anxious
• 7. Anxiety and Resistance to Changes in Self-Concept
• 8. The Patient’s Anxiety, the Therapist’s Anxiety, and the Therapeutic Process
• 9. A Relational Perspective on Anxiety
• 10. Does Anxiety Obstruct or Motivate Treatment? When to Talk, When to Prescribe, and When to Do Both
• 11. Epilogue
• Index