The Role of Anxiety in Schizophrenia

According to recent investigations, we have come to view schizophrenia more and more as a way of life, a particular mode of being-in-the-world, and less and less as a specific disease. It has to be grasped holistically in the perspective of one particular individual concerned. One of the best ways to gain understanding is the phenomenological approach. In letting the process unfold itself, it becomes apparent that the entire life of the schizophrenic is dominated by very profound anxiety. According to Horney, “anxiety is the dynamic center of neurosis,”¹ and we might add, of schizophrenia as well. Both types of patients experience “basic anxiety which is inseparably interwoven with a basic hostility”² and a feeling of helplessness and isolation. However, there is a world of difference between the amount, nature, and consequences of the anxiety in the neurotic and in the schizophrenic patient. Whether the anxiety of the latter is merely quantitatively increased or qualitatively different, is controversial and besides the point, for we know that at a certain point quantity changes into quality. What does count is the effect the anxiety has on the individual. While in both cases the patient is trying “to come to terms with the world despite of his defects”³ or handicaps, the neurotic is able to build up a fairly effective defense system, while the schizophrenic is less able to do so. He is overwhelmed, confused and sometimes paralyzed by his anxiety and the resulting insoluble conflicts, all of which cut him off from his center, his self. Goldstein speaks of being in a “condition of isolation” and draws a parallel between the schizophrenic and the brain-injured patient, whose nervous system “is divided into parts, each of which functions in isolation from the rest.”⁴ As to the self of the schizophrenic, he has less of a sound self to fall back upon than the neurotic patient, but more of a self than the organically impaired patient. In his attempts to defend himself aga