Anxiety Revisited

Anxiety is perhaps the most important single factor to be dealt with in psychoanalytic theory and practice. Exactly what the term anxiety means remains obscure. There is still much to be discovered about the causes of anxieties, mechanisms of production, physiological and subjective effects, phenomenological experiences, and, mostly, biological substratum. Present advances in physiological and neurochemical research offer a new look at anxiety. In this paper, clinical observations of differing reactions to various medications will be related to known physiological and analytical concepts of anxiety.

All analytic schools refer to anxiety as a consequence of psychic conflict, but differ as to the factors that create conflict and at what level the conflict occurs. In early Freudian theory,1 it was postulated that anxiety was caused by a damming up of libido, which was thus transformed directly into anxiety. In the revision of this theory, anxiety was considered the result of a conflict between instinctual (id) and prohibitive forces, whether the latter came from within the self (superego) or from without. Anxiety could be connected with an immediate danger such as separation, castration, body-image damage, and so forth, or it could constitute a protective mechanism, warning the person of impending danger. This protective mechanism was referred to as signal anxiety.

All other pioneers in psychoanalysis have emphasized the importance of anxiety. They differ primarily about what basic factors cause anxiety. For Rank, the anxiety of birth trauma became the core of his theory of development and psychopathology. For Sullivan, anxiety was engendered by a threat to “security operations” due to interpersonal, relational distortions. The existentialists describe existential anxiety, caused primarily by one's awareness of nonexistance or morbidity. The so called “third school” (Rogers, Maslow, Goldstein, etc.) see anxiety as a reaction to growth and change. Each of these pioneers i