We usually agree with the definition that anxiety is the fear of the unknown. There is a clear consensus that the concept anxiety is reserved for the fear of something unknown whilst stress or phobia is usually used to describe our reaction to something known – whether real or imagined.
Anxiety is sometimes substituted for stress and it is a normal response to a real or potential external threat. Left in the wilderness without preparation or the necessary gear is certainly a fear of the unknown: how are we going to survive, what do we need to do in order survive are examples of it. Being left alone with a tiger in the room is certainly not fear of the unknown; we know very well what is going to happen next and we can see ourselves in the dish of the big cat. Are we stressed? We certainly are, as well as overwhelmingly anxious.
These are a few examples and what is the common denominator to the anxiety – the stress – the fact that these are all existential external threats: we are certainly fearful of the tiger and anxious about the outcome of the exchange.
The emphasis is both in the “external” and in the “existential” element of the threat.
This anxiety is what we know as the fight or flight response; a normal psychological response expressed in a physiological equation preparing our body to address the danger by drawing adrenaline into our system and filling ourselves with energy which enables then quick responses.
This is an essential mechanism for survival; it is also fine-tuned: too little and we don’t have the energy to fight back, the speed to run away from the tiger or the resourcefulness to find solutions in the wilderness; too much and we become “paralysed by fear”.
An additional emphasis should be drawn on the “essential” need for such a mechanism. Survival is the aim and we use our innate resources to ensure this.
But what happens when we are anxious without an external trigger or when we recognise that the anxiety we experience is not proportional to the event we are facing? We all know this feeling; we all have experienced this in our lives. Where does this anxiety come from and what does it serves us for – if at all?
If this is a common human experience it would then be correct to say that unless we all suffer from an “innate defect”, it is intended to warn us, to help us, to prepare us for an imminent danger but then, what is this danger about? This is not an external one as in the previous examples; it is therefore an internal one but what is it about?
In order to be able to address this question we need to take a deep breath in and dare to walk into the world of the psychology – the soul – and even further into the spiritual realm.
But before doing so let us address for a moment the physical world, our body.
There are physical conditions such as hyperthyroidism, dysfunctions of the adrenal glands, even disbalance of the microbiota – the bacteria that we all have in our guts – which can be responsible for anxiety. Anxiety can also be the (only and/or first) symptom associated with lack of vitamins such as D, B6, B12 or minerals (Zinc, Magnesium, etc) and other disorders associated with nutritional problems. In summary, anxiety can be associated with physical illnesses and we must look into these dysfunctions before we approach the psychological or spiritual real in search for answers and explanations.
It is true that in Anthroposophical medicine we address physical disorders in an holistic way and we look at the soul and the spirit – rightfully so – in order to find the explanations and the treatments. However, we always identify first the physical components of the clinical presentation before we embark in the holistic observation and treatment. And rightfully so: we want to give B12 to someone who lacks it, or address a Candida infection of the guts with almost immediate results rather than to address the psychological or the spiritual elements of the presentation as an alternative way. This approach certainly does not rule out the psychological and spiritual considerations of the presentation if we truly want to deliver an holistic intervention; it simply organises the priorities of our intervention.
However, not all the anxieties have a physical substratum; most of them in fact do not have it and once we have ruled it out, then the hard work is ahead of us. I say hard work since psychological and spiritual issues demand an active involvement of the patient, a clear intention to address the issues and the will to make it happen.
We all experience the drama of separating from our mother, first at birth and later on – around the age of 7-8 with the discovery of death, the realisation that we are mortals. We do not experience it first as our own death but that of our parents and the anguish we experience is related to the questions we have about our own survival if they were to die. We not only experience anxiety but also sadness, a sort of normal depression. This slowly evolves into realising our own death around the adolescence but this feeling of individuality is compensated by our normal striving to become independent. This is another crucial period in our psychological development.
How all this is related to anxiety? Well, the answer lies first in the idea that we all experience or have experienced the sense of peacefulness; this unique feeling is anxiety free. When we take a deep breath, even for a fraction of a second we feel at peace with ourselves and this feeling stems from the fact that we feel connected with ourselves. This ability to “connect” to ourselves – to feel “in ourselves” develops in the course of our early childhood and parents pay a central role; our parents are to us what the stick is to the young tree when we plant it: as the stick ensures that the tree grows up upright until it is mature enough to keep itself up, able to cope with the elements of the weather so our parents are there to help us to grow “upright” until we are independent enough to ensure it by ourselves. They do this trough their warmth, love, care and clear sense of their own confidence. If they are unable to do this, to offer to us what the “stick” provides to the tree, then we grow up feeling less confident, less centred, less able to rely on ourselves and as we have already seen, less able to rely on ourselves, less connected and therefore more anxious.
The more alienated we are from ourselves, the more the anxiety we experience.
Why? Because we feel in danger; in danger of not being able to take care our ourselves, hence the feelings of death are so close to the experience of anxiety. The threat is now not coming from the outside but from within us.
This description tries to capture in a nutshell the drama around anxiety and it also offers the basis for a psychological and as well as an anthroposophical formulation of it.
From the psychological perspective we can say then that the child does not develop fully the psychological tools needed to become truly independent and self confident since the parents do not offer a full and coherent psychological “scaffoldings”; from the anthroposophical perspective the lack or partial warmth of the parents in general and the mother in particular – do not provide the necessary medium for the “I-organisation” to completely incarnate and by doing so becoming the true conductor of the other three structures in the four foldness: the physical, the etheric and the astral. Interestingly, without the act of the conductor, the physical body via the kidneys ahs a deep influence on the other two bodies: the astral and the etheric. Overwhelming and incontrollable emotions manifested in panic attacks, loss of rhythm, disturbances in sleep, difficulties in concentration and doing, stem all from the “independent” activities of the three bodies without the organisation of from the “I”.
There is another element, which warrants our attention and which is unique to the anthroposophical observation of the human being: the individual in the society and the times the individual is living the present life. These thoughts unequivocally remind us of our own Karma and the evolution of humanity. Due to the limitations of this article I am not addressing the issue of personal Karma except in relation to the times “we chose” to live our present lives. We live in times, which already Rudolf Steiner described as materialistic and he correctly identified the challenges this would bring to society in general and individuals in particular, in order to be able to develop as free individuals.
The materialistic society “forces” us to buy things in order to feel good: we become what we own and by doing so we drift away from ourselves and this creates – as already seen – more anxiety. This – in a kind of vicious circle and as an addiction – leads us to buy more in order to quench the feeling of alienation and its anxiety leading unavoidably to more anxiety and an ever increasing need to have more material things. Screens, whether computers, smartphones or televisions have a similar effect on children, feeding them with ready done images that “feed” our need for sense-perceptions, and this instead of trying to find “inside themselves” the images, the percepts, the creative processes which make us – in a way – “being interested” in ourselves. How many times we hear children say: “I am bored…!!!”. Drifted away from themselves by ready-made images and ideas, children loose their ability to be creative – creativity being one of the beautiful expressions of being “in ourselves”, “connected to ourselves”. Whether or not Steiner education prevents anxiety later on in life is something, which needs to be thoroughly researched but certainly creativity is enhanced and with it the basic bricks for a healthier future.
Finally, some thoughts about therapy. There is nothing wrong in offering conventional medicine to individuals suffering from anxiety; not everybody has an holistic approach to life in general and diseases in particular. However, I strongly believe that it is our duty as doctors or therapist to share with the patient our understanding of the reasons (the aetiology) of the disorder from an holistic perspective. Whether it is the integrative medicine (microbiome/microbiota), the psychological or the spiritual/anthroposophical approach, we should always be able to address our patients’ deep needs and to discuss openly the different paths to treatment and recovery.
