Dr. David Trappler

Psychiatrist & Jungian Analyst

Anxiety becomes a disorder when it lays one low at times when you need to be functional, and it can be paralysing even when one is alone. It is the primordial response to survival in the face of significant threat, and without it we could not respond appropriately to real danger, however in the psychiatric setting it is disabling. With experience, the various anxiety disorders can potentially offer deep insights into one’s psychological structures and defence mechanisms.

The body is designed to respond at a survival level to threat or danger, with this most primitive of  instincts, experienced subjectively as the emotion of anxiety.  Adrenalin and other neurotransmitters and hormones are let loose in the blood to create various somatic or bodily responses. If the threat is literal, the “flight or fight response” is appropriate, since one needs to prepare oneself to face the reality of a real challenge to survival. If however the threat is symbolic, then one needs to examine the psychology of the situation, even though most psychiatrists today will just tell you it is an inherited disorder requiring medication.

In the face of crippling anxiety, an opportunity exists to loosen the “adrenergic grip”, and expand one’s “consciousness” through an awareness of our emotions either triggered in reaction to a particular situation, or if “free floating”, to explore internal dynamics. One would need to learn how to “dis-identify” from the anxiety, and “objectify” it through an image. Jung claimed that behind every emotion lay an image, and this needed to be found through active imagination. He went on to suggest that if instinct is like the infra-red side of the light spectrum, then image would be the ultra-violet opposite end.  Where instinct drives behaviours in an un-reflective or un-examined way, image is  reflective and enables us to capture the experience and hold back from its pull.  Image offers the pause in time to reflect on the instinctive reaction, and respond rather than react to the world.

For example, anxiety gives one the opportunity to examine one’s persona or outer mask; created to mediate between the inner self and the outer collective, or the essential self and the social self. In an anxiety state, one may ask what is challenging the persona and creating a psychic split, which is disturbing one’s inner equilibrium?

The persona is a “face” that one shows to outer reality and should be dynamic and creative, allowing the individual to reveal authenticity and individuality, whilst also accommodating and adapting to conventional standards. Identification with a persona leaves the individual personality inflexible, controlling, unspontaneous, and impenetrable. In effect such a personality has in fact lost individuality by having resorted to a role defined by collective standards. When someone has developed a rigid and ossified persona, they often cause anxiety in others, who feel restricted and judged. The persona-person themselves may not be aware of their own internal anxiety yet, but tensions are building up, which could explode into a panic disorder or manifest more insidiously with dynamics of control over others and in one’s own life.

An “inner” face, as opposed to the outer face or persona, adapted to the inner reality of an individual or one’s to one’s “interiority” is the “soul-image”, named by Jung as the anima in a man, or the animus in a woman. This anima often stands in sorry contrast to the dazzling persona. This means that one can meet someone who has the most intimidating, organised and even impressive way of relating to the world, but who is stricken by moods and maladies in the most sentimental and demanding manner in private. Perhaps only the spouse and children have to encounter this other side, since the perception of others to this person, as a result of an over-developed and rigid persona, is one of social confidence and consistency!

The psychical symptoms of anxiety are various degrees of bodily (or somatic) reactions to adrenalin Somatic symptoms include dilation of the pupils; the skin sweats; the mouth becomes dry; breathing gets shallow and  rapid and the heart thumps in the chest. The feeling of “butterflies” in the abdomen can be associated with diarrhoea, dyspepsia and bloating. The muscles tighten across the small joints causing tremor and tension, and can lead to agitation and restlessness. When you are lying in bed at night with restless legs, arched feet and back and tension prevails, your chances of sleep are negligible. The anxiety feeds on itself, and you become ill. Chronic anxiety depletes your energy and makes you question your sanity. You can easily confuse this with depression or indeed a clinical depression may set in.

Psychiatrists consider severe and persistent anxiety, that interferes with normal daily functioning, to be a mental disorder that can manifest in different ways. The common categories of anxiety are a generalised anxiety disorder,  panic attacks, obsessive compulsive symptoms or phobias.The medical model of thinking regards the cause to be an abnormal physiological balance in specific anatomical sites in the brain, genetically coded and requiring medication. Sophisticated medications are available to ablate the symptoms. But does one then need to be medicated for life?

For me, anxiety is like a red light flashing on the dashboard of the car. Something is “out of synch” and needs attention. Anxiety means I am either misrepresenting myself in a public situation and subliminally calling my own bluff; or lying to myself about my own life in a way I previously avoided or denied in a most convincing and “successful” manner. Defence mechanisms, previously well established and intact, become weakened and obsolete. Unmetabolised, unconscious complexes begin to break through into consciousness, often in a subliminal way, and disrupt the equilibrium of the personality.

If the “body logic” sets in, and the brain pathways responsible recalibrate the adreno-hypothalamic axis, thereby raising basal levels of adrenalin, to a new elevated “norm”, then the condition becomes autonomous. You may regard yourself as having adjusted maturely to the demands and responsibilities appropriate to life, but in reality you are living with anxiety and stress and you are disconnected from your authentic self.

I want to challenge the assumptions that allow one to live in states of anxiety or stress, by either just accepting them as inevitable shameful symptoms or by developing poor self-worth or even by compensating and resorting to hyper-functional behaviour, and learn to say NO to living an inauthentic life based on old scripts, and YES to discovering your own real personality. To re-evaluate old patters, and retrain inner voices from declaring you a “failure”; or “immature” or weak and sick, one needs to be aware of the cognitive distortions one has learned from unrecognised complexes. These old “voices” that set standards and pass judgments inside us, are called negative introjects, and have developed from early formative experiences that have shaped our inner world.

Anxiety driven thoughts are recurring and circular, self-centred and unimaginative. Behaviours become stereotyped and attitudes entrenched.  “Fear –based” emotion becomes  the norm, negativity prevails and one is driven into an uncreative, restricted and unimaginative world, that is over-personalised, subjective and blinded by the concrete and literal contents of everyday events. We may even form little groups, seeking alliance with others who are also living in fear and mediocrity, in order to avoid loneliness and marginalisation.

To break this bizarre and inappropriate response to perceived danger requires a new relationship with the self. With the aid of a therapist, one identifies the lies one is caught up in and one can become enabled to live more in “synch” with ones’ totality or wholeness. It is not an easy journey, as you will fight the therapist and tell him he is no good or that he too is persecuting you! But in an environment of openness and trust, where corrective emotional experiences can take place without power games, (the therapist has been well analysed and doesn’t contaminate the therapy with their own complexes or take the attacks personally), makes it possible to just look squarely into one’s own being and say, listen, my life has been a lie! Either within oneself, or within my marriage or career, or in other realms and relationships. Why deny it? We all do it? There is no shame in the lies, only the pitiful defensive ploys elaborated to conceal them.

So the persona is examined and adjusted and the relationship with the self is re- negotiated. Medication may help in the short to medium term depending on how long the charade has gone on for. If symptoms of dysmorphophobia have set, or eating disorders, or obsessive compulsive behavious, then more time will be needed with medication; if it’s simple phobias or panic disorder that has come to undermine one’s dignity, then less time will be needed on medication. But, to reconnect with the essential self, in depth-psychotherapy, is the route to go. The prognosis is very good, since it is not just remission that can be achieved, but transformation; and not just a return to normal functioning, but claiming a life with increased consciousness and  sense of purpose. A richer and more authentic life!

A patient recently presented herself to me in therapy with crippling anxiety; after careful discussion I told her that it seemed her anxiety was masking repressed rage. After confronting her dependent and manipulative (recently) widowed mother, her “anxiety” lifted. It was not my genius that cured her, but the therapy setting which allowed us to both reach this insight. Her anxiety disappeared immediately and she set up new boundaries in her new social situation and opened up the new dynamic with her mother, resisting the guilt-ridden fostering of her mother’s dependence and allowing both personalities to evolve into the new chapter of their lives. Of course behind these emotions lay deeper issues in her relationship with her late father and the parental marriage, but those narratives were explored unencumbered by anxiety symptoms or the need for any medication.

More Notes of Interest
Alcohol Abuse
What one tries to achieve with patients who drink too much, is to encourage them to have a more conscious relationship with alcohol. I have great respect for the 12-step programme, but one needs to refrain from a “one size fits all” approach when dealing with the complex issue of people’s relationship with alcohol.
Bipolar Mood Disorders
We all have moods that affect our functioning to some extent. When fluctuating moods or changes in psychic energy become a regular part of our lives to the extent that they interfere with our quality of life, or impair our social or occupational functioning, it may then be that we are on the spectrum of a “bipolar mood disorder.”