A 50-year old woman of German descent, a long-time convert to Islam and fervent Sufi practitioner, consults for depression. After several months of treatment, she begins to realize that she doesn’t know who she is or where she is going in life after a conflict occurs at her workplace. She then dreams that she is in her mother’s house and the door to her mother’s room is locked. She makes her way in nevertheless and finds that all her clothes are in her mother’s closet and she doesn’t like any of them! We interpret the dream together and realize that her mother has “swallowed up” her identity. This is the anxiety of disintegration. She has to reclaim her own choices and tastes in order to feel at peace, perhaps possible for the first time in her life.

Other forms of anxiety in this hierarchy in ascending order of sophistication are:

1) Persecutory anxiety (fear of the hostility of the other)

2) Separation anxiety (fear of the loss of the other)

3) Fear of the loss of love (fear of disapproval or rejection) A mature woman has begun a relationship late in life with a very affable younger male who happens to have an attention deficit disorder. She enters my office one day very upset. Her partner had promised to trim a hedge at their home but completely forgot to do so. The hedge is not the problem but rather the conclusion she had arrived at that he must not care about her since he keeps forgetting his promises. For this type of situation, psychologists do groups for the partners of those suffering from attention deficit disorders. My client had to understand the difference between the act and the intention. The behavior was the symptom of a disorder rather then a deliberate act of malice. Once she let go, briefly at first, of her conviction of being unloved ,the couple’s relationship became viable once again.

4) Castration anxiety (losing one’s power or one’s capacity)

It should not be difficult for the reader to relate to any or all of these forms of anxiety. At this point, the reader may find it useful to think of situations in which he or she has experienced or witnessed others experiencing these various forms of anxiety. In fact, anxiety is ubiquitous in our lives. We can see it at a very young age in schools and daycares when children are separated from their parents. We can see it when we undertake a new job or project and are afraid that we will not succeed. And we can see it when we fail to live up to our own moral standards. In the section on social factors, we will look at how contemporary society generates an overabundance of anxiety-provoking situations.

OTHER PSYCHOANALYTIC THEORIES

Melanie Klein, one of the foremost disciples of Freud, developed a substantially different view of anxiety and of psycho-dynamics in general. In her theory, aggression and hostility play a greater role than sexual instincts in child development and in the development of symptoms. Klein worked with an object relations model that put emphasis on the infant-mother relationship and specifically on the breast as a symbol.

As this infant-mother relationship contains inevitable frustrations and disharmonies, the “death instinct” comes into play, according to Klein’s theory, as the child reacts with overwhelming feelings of hate and destruction. The child then projects these hateful feelings onto the mother who then becomes the feared persecutory object. The helpless and undersized child is now in enemy territory next to the “bad breast” of the mother. One can just imagine the anxiety thus generated.

According to the Kleinian theory, after this “paranoid-schizoid” phase, the child develops “depressive anxiety” and moves into the “depressive phase” of development. Here, the child begins to experience loss (the weaning process) as well as guilt and remorse because of his previous hostility and destructiveness. The child then compensates by offering gifts and attempting to charm his parents.

Harry Stack Sullivan introduced a more interpersonal and social model to his analysis. For him, anxiety arose primarily from anticipated disapproval from significant people in early life, most notably the mother. Anxiety arises from the emergence of unacceptable thoughts and feelings that elicit the expectation of punishment or of the loss of love and approval. Human beings will do almost anything to achieve a state of security that comes from the approval of others, according to Sullivan’s theory.

Freida Fromm-Reichman, one of Sullivan’s main students, added that a small but optimum level of anxiety is essential to promote human innate tendencies toward growth.

Karen Horney, another important theorist in the field of anxiety, emphasized the intensity and ubiquity of anxiety. She believed that drug addiction, “workaholism” and sexual promiscuity are attempts to control this intense anxiety. One of her important contributions was realizing the need to grapple with one’s hostile influences while maintaining one’s connection to others. This is one of the basic strategies often used in helping patients to deal with the outside world. For example, those who constantly need to “say it like it is,” end up in all kinds of social and occupational difficulties. Simply cutting off relationships in these situations does not constitute an adequate response, as this type of situation is unavoidable in most occupational and interpersonal contexts. As the saying goes “discretion is the better part of valor.” At times it is best to remain silent, especially when one is angry, if one hopes to maintain one’s social or professional circle. Otherwise anger may ruin it all.