Anxiety

In 1935 the social psychologist R.R. Willoughby asserted, "Anxiety is the most prominent mental characteristic of Occidental civilization" (cited in May, 1977, p. 16). Anxiety continues to be a prominent component of life in many Western cultures. Hocking and Koenig (1995) estimate, for example, that 10-20% of elderly hospital patients have anxiety symptoms, either as a consequence of medical illness, psychiatric illness, or a response to stressful events. Yet from a theological perspective, anxiety is inherent in human nature, attributable to the capacity for self-awareness and the inevitability of death.

Anxiety versus fear Anxiety has been an important topic in the psychological literature for a number of years. Nutt and colleagues (2001) explain that, medically, during the first half of the 1800's individual physical symptoms now associated with anxiety disorders were associated with specific diseases of the heart, inner ear, gastrointestinal system and other systems of the body. The mental component of anxiety, alternatively, was usually viewed as part of the melancholic state. Rollo May's book The Meaning of Anxiety, initially published in 1950, marked the first attempt to examine anxiety from biological, psychological, philosophical, and cultural perspectives. In his foreword to the revised edition (1977), May notes that while only two books had been written on the subject of anxiety prior to 1950, at least 6,000 studies and dissertations appeared over the seventeen-year intervening period. As May put it, "Anxiety has certainly come out of the dimness of the professional office into the bright light of the market place" (p. xiii). While psychological and medical interest in anxiety remains high, theological interest apparently has waned, particularly with the passing of such existentialists as Paul Tillich and Soren Kierkegaard. In their place, spiritually-oriented psychologists and psychiatrists such as M. Scott Peck and Robert Gerzon, to name a few, have taken up the challenge of addressing the modern problem of anxiety.

May (1977) offers the following definition of anxiety: "Anxiety is the apprehension cued off by a threat to some value that the individual holds essential to his [sic] existence as a personality. The threat may be to physical life (the threat of death), or to psychological existence (the loss of freedom, meaninglessness). Or the threat may be to some other value which one identifies with one's existence: (patriotism, the love of another person, 'success', etc.)" (pp. 205-6). The mental states of fear and anxiety, May points out, are frequently confused. Fear, May clarifies, is a reaction to a specific danger, while anxiety is a diffuse apprehension, causing feelings of uncertainty and helplessness. Collins and Culbertson (2003) concur that anxiety is a "nonspecific emotion," which may be produced by worry,

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tension, or conflict. Robert Gerzon (1977) in turn distinguishes fear in terms of the feeling of arousal experienced in response to a clear and present danger in the external environment, whereas anxiety is the feeling of arousal experienced when an abstract unknown danger is perceived, often in the form of a possible future threat. All fears, states Gerzon, begin as anxieties. Before a particular source of threat can be identified, a generalized anxiety alarm signals imminent danger. Hence, while fear is anxiety that has found a realistic object, for Gerzon anxiety is experienced in relation to an unknown, abstract "nothingness."

The term "stress" is commonly used to describe feelings of anxiety and feeling overwhelmed. It should be pointed out that anxiety is not necessarily pathological; rather, it can be seen as the body's normal warning signal in response to distressing or dangerous situations. If internal or external stresses become too great, however, or if the adaptational capacity of the person is developmentally or constitutionally limited, then his or her coping capacity becomes overwhelmed and anxiety becomes more prominent (Collins and Culbertson, 2003).

Normal and pathological anxiety This raises the question, When does anxiety become pathological? The mental and physical symptoms currently included under anxiety disorders have been observed for centuries. Existentially, anxiety is inherent in the human condition. A common form of normal anxiety emerges from human contingency: human beings are vulnerable to nature, sickness and fatigue, and eventually to death.

While anxiety may be inherent in the human condition, both psychotherapists and theologians distinguish between pathological and normal forms. Tillich (1952), for example, argues that pathological anxiety is a state of existential anxiety under special conditions, namely, the inability to take anxiety upon oneself courageously and instead escaping into neurosis. May (1977) characterizes neurotic anxiety as follows: 1) is disproportionate to the objective danger, 2) involves repression (dissociation) and other forms of intrapsychic conflict, 3) is managed by means of inhibitions, symptoms and varied neurotic defense mechanisms. Gerzon (1997) differentiates between three types of anxiety - natural, toxic, and sacred. Natural anxiety is rooted in the awareness of our status as vulnerable biological organisms, toxic anxiety has its origins in the past, and sacred anxiety arises with the awareness of inevitable death, leading humans to question the meaning and purpose of life. Finally, Marshall and Klein (2003) point out that the presence of distress or impairment is necessary but not sufficient to the definition of disorder. Normal emotional processes such as intense fear or grief, for example, can result in both. DSM-IV therefore states that disorder must not be merely an "expectable" response, but must represent "dysfunction" in some way. Thus, pathological anxiety causes dysfunction.

Existential anxiety These definitions of normal and pathological anxiety alert one to the inevitability of anxiety in human life. Moreover, fast-paced modern urban living adds to the mix a sense that time has become a scarce resource.

88 Creativity, Spirituality, and Mental Health

The most common complaint, for example, that Gerzon hears in his practice is that clients do not have enough time: "We dread running out of time. We experience time as a scarce commodity; even people who are financially wealthy often suffer from time poverty. Existentially we know that one day we will truly run out of time. Death is the ultimate deadline, the dreaded Day of Judgment" (p. 253). People dread running out of time because they know they will. Consciousness of mortality marks the human condition. Yet day-to-day living in the full knowledge of death provokes anxiety. Several theologians/ psychotherapists frame this issue existentially - how can one live a full life in the knowledge that one day it will end?

Paul Tillich (1952), for example, distinguishes three types of existential anxiety: the anxiety of death, the anxiety of meaningless, and the anxiety of condemnation. Every human being faces finitude, doubt, and guilt. Soren Kierkegaard (1980) highlights the "anxiety over nothing," "that pregnant anxiety that is directed toward the future and that is a pristine element in every human being" (p. xiii). Gerzon argues that anxiety is inherent in human consciousness, because as humans we are aware of our own life and death. Similarly, Ernest Becker (1973) argues that modern humans are drinking and drugging themselves out of awareness or spending their time in the acquisition of things. Anxiety keeps us going, but in his view it does so dishonestly.

In sum, certainly one cannot avoid daily stressors: life demands that humans learn to cope with them. As stated, however, sometimes stressors beyond one's control become too much to handle - the job becomes overwhelming, the marriage becomes abusive, a parent has a stroke or is diagnosed with a terminal diagnosis, a child is killed or seriously injured. Previous coping mechanisms fail, and the individual develops what May calls a neurotic response. In addition, the onset of the twenty-first century has been marked by anxiety inducers such as terrorism, tsunami, hurricanes, and financial instability, not to mention competition for scarce resources such as oil and water. Urban life contributes such factors as pollution, violence, traffic, and an increasing gap between rich and poor. It is no wonder that anxiety is a problem in our modern age.

As mentioned, an existential view understands anxiety as an inevitable aspect of existence (van Deurzen, 2005). Cohn (1997) describes the 3-fold ground for the inevitability of anxiety:

1. our thrownness into a world we did not choose

2. the necessity to make choices, the outcomes of which are never certain and
which mean rejecting alternatives

3. the realization that life moves inevitably towards death

Moreover, the predominant view of anxiety in modern culture is to view it as a disorder (Kirkland-Handley and Mitchell, 2005). What is rarely considered is that the anxiety we try to control or eliminate might point to a life situation that needs to be addressed and to a potentially more authentic way of living. In this

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regard, anxiety can be viewed as an indicator of the level of a person's awareness (van Deurzen, 2002), an awareness of the realization of the basic freedom that he or she possesses.