On Understanding and Treating Anxiety and its Derivatives

In moving from the discussion of a general theory of affects to focusing on the specific affect of anxiety, we are turning to the affect which, in conjunction with Freud's (1926) classic monograph on the problem of anxiety and even in the decades before that although in a more ambiguous way, has been traditionally considered the nucleus of the neurosis. 'A nodal point', to quote Freud (1917), 'the fundamental phenomenon and main problem of neurosis' (Freud, 1926). At the last Congress in London, on what has and what has not changed in psychoanalysis, I suggested (Rangell, 1975) that this is still the case.

I should like to start this discussion by reaffirming this point of view. At this Congress, however, devoted to a study of affects, I wish to fortify this assertion by adding a theoretical perspective on the relationship of anxiety to other affects of unpleasure which also play a role in pathogenesis. A number of recent contributions, both to the theories of affect and anxiety, have pointed out that signal anxiety should be expanded to include signal affect in general (Schur, 1967); (Klein, 1972); (Rangell, 1973) and that the role of affects in conflict and psychopathology should be widened to include the spectrum of unpleasure rather than anxiety alone (Brenner, 1975). In spite of these expansions of clinical theory, none of these additions to the understanding of clinical phenomena should, in my opinion, be allowed to crowd out the special role of anxiety in the intrapsychic series of events leading to defence and subsequent neurosis.

In brief, and only to the extent that this immediate delving into theory will be relevant to the clinical situation, I would like to offer the following explanation of the microscopic sequential relationships which, I believe, takes place during the intrapsychic process (Rangell, 1969), i.e. the unconscious cognitive and affective scanning process which preced