A philosophical cure for fear and anxiety

“Anxiety” said the philosopher Søren Kierkegaard, “is the dizziness of freedom.” What could he have meant by that?

Anxiety can be defined as “a state consisting of psychological and physical symptoms brought about by a sense of apprehension at a perceived threat.”

Fear is similar to anxiety, except that with fear, the threat is, or is perceived to be, more concrete, present, or imminent.

Fear and anxiety can, of course, be a normal response to life experiences, protective mechanisms that have evolved to prevent us from entering into potentially dangerous situations and to help us escape from them should they befall us regardless.

For example, anxiety can prevent us from coming into close contact with disease-carrying or poisonous animals, such as rats, snakes, and spiders, from engaging with a much stronger or angrier enemy, and even from declaring our undying love to someone who is unlikely to spare our feelings.

If we do find ourselves caught in a potentially dangerous situation, the fight-or-flight response triggered by fear can help us to mount an appropriate response by priming our body for action and increasing our performance and stamina.

In short, the purpose of fear and anxiety is to protect us from harm and, above all, to preserve us from death—whether literal or figurative, biological or psychosocial.

On the other hand, severe or inappropriate anxiety can be maladaptive, preventing us from doing the sorts of things that most people take for granted, such as leaving the house or even our bedroom. I once treated a patient with an anxiety disorder who, to avoid ever having to leave his bedroom, urinated into a bottle and defaecated into a plastic bag.

Such pathological anxiety is very common and often presents in one or more distinct patterns or syndromes, such as phobia, panic disorder, or post-traumatic stress disorder (PTSD).

As with the adaptive forms, these pathological forms of anxiety can be interpreted in terms of life and death. Common phobias such as arachnophobia (spiders), ophidiophobia (snakes), acrophobia (heights), achluophobia (darkness), and brontophobia (storms) are all for the sorts of dangers that commonly threatened our ancestors. Today, man-made hazards such as motor cars and electric cables are much more likely to strike us, but most phobias remain for natural dangers, presumably because man-made hazards are too recent to have imprinted themselves onto our genome.

Panic disorder involves recurrent panic attacks during which symptoms of anxiety are so severe that the person fears that he or she is suffocating, having a heart attack, or losing control. Very soon, the person develops a fear of the panic attacks themselves, which in turn sets off further panic attacks. A vicious cycle takes hold, with the panic attacks becoming ever more frequent and severe and even occurring “out of the blue.”

As with phobias, the ulterior fear in panic disorder is of death and dying, as it is also with PTSD, which is a reaction to a traumatic life event, such as a car crash or physical or sexual assault. Common symptoms of PTSD include anxiety, of course, but also numbing, detachment, flashbacks, nightmares, and loss of memory for the traumatic event.

The symptoms of PTSD vary significantly from one culture to another, so much so that PTSD is sometimes thought of as a “culture-bound syndrome.” Culture-bound syndromes are essentially culture-specific anxiety disorders, which, again, like all anxiety disorders, can easily be understood in terms of life and death.

Dhat, for example, seen in South Asian men, involves a sudden fear about the loss of semen in the urine, whitish discoloration of the urine, and sexual dysfunction, accompanied by feelings of weakness and exhaustion. Dhat may be rooted in the old Hindu belief that it takes 40 drops of blood to create a drop of bone marrow, and 40 drops of bone marrow to create a drop of semen, and thus that semen is a concentrated essence of life.

In addition to fear and anxiety and their pathological forms (such as phobias, panic disorder, etc.), there is a more abstract or philosophical form of anxiety that has been called “existential anxiety.” While fear and anxiety and their pathological forms are grounded in threats to life, existential anxiety is rooted in the brevity and apparent meaninglessness or absurdity of life, that is, in a kind of metaphorical death.

As I argue in my new book, Heaven and Hell: The Psychology of the Emotions, existential anxiety is so disturbing that most people avoid it at all costs, constructing a false reality out of goals, aspirations, habits, customs, values, culture, and religion in a bid to deceive themselves that their lives are special and meaningful and that death is distant or delusory.

Unfortunately, such self-deception comes at a heavy price. According to the philosopher Jean-Paul Sartre, people who refuse to face up to “non-being” are acting in “bad faith” and living out a life that is inauthentic and unfulfilling.

Facing up to non-being can bring insecurity, loneliness, responsibility, and, consequently, anxiety, but it can also bring a sense of calm, freedom, and even nobility. Far from being pathological, existential anxiety is a necessary transitional phase, a sign of health, strength, and courage, and a harbinger of bigger and better things to come.

For the philosopher and theologian Paul Tillich, refusing to face up to non-being leads not only to inauthenticity, as Sartre had said, but also to pathological (or neurotic) anxiety.

In The Courage to Be, Tillich writes:

He who does not succeed in taking his anxiety courageously upon himself can succeed in avoiding the extreme situation of despair by escaping into neurosis. He still affirms himself but on a limited scale. Neurosis is the way of avoiding nonbeing by avoiding being.

According to this striking outlook, pathological anxiety, although seemingly grounded in threats to life, in fact, arises from repressed existential anxiety, which itself arises from our uniquely human capacity for self-consciousness.

Facing up to non-being enables us to put our life into perspective, see it in its entirety, and thereby lend it a sense of direction and unity. If the ultimate source of anxiety is fear of the future, the future ends in death; and if the ultimate source of anxiety is uncertainty, death is the only certainty.

It is only by facing up to death, accepting its inevitability, and integrating it into a life that we can escape from the pettiness and paralysis of anxiety, and, in so doing, free ourselves to make, and get, the most out of our lives.

This esoteric understanding is what I have come to call “the philosophical cure for fear and anxiety.”