THEORIES EXPLAINING STRESS AND ANXIETY

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Psychoanalytic views

 Freud was an acute observer. However, at times he seemed to have weird ideas, so much so he was ridiculed by his peers. But when his ideas are thoroughly understood, they often do not seem so odd. For example, he thought that we experienced "birth trauma" as we were painfully and abruptly squeezed from our warm, safe, dark, quiet place in mother's womb into a cold, demanding, changing, confusing, dangerous world. Weird? Maybe. Maybe not; new newborns are much more aware than we once thought they were. Freud felt birth was our first stressful experience and that it influenced later experiences, like when we were traumatized by mother leaving us for a few hours at age 10-months or being terrified at age 3 when we thought we were lost in a store. Surely earlier experiences affect later ones; our feelings of helplessness, of "something awful is happening," of overwhelming fear could be traced, in part, back to birth.

 As the first psychotherapist, starting over 100 years ago, Freud treated many patients with fears and anxiety reactions. He wondered how these emotions could be explained. His explanation started with an infant innately driven by its "id" to eat (from mother's breast), to eliminate, to be comfortable, to be held and loved, and to be touched and have sensual stimulation. If those needs were not met, the child experienced anxiety (a mild form of the first stress--the birth trauma). To meet sexual (love) and death (aggression) needs and to relieve the anxiety, a part of the id develops into a second part of the child's personality, a thinking, reasoning, perceiving, self-controlling part, called the "ego ." The ego devises many ways of coping, of meeting its needs, of surviving. One means of coping could be to become unusually close and dependent on one parent--a daddy's girl or a mommy's boy. Or it might be to develop a fear of the dark that justifies demanding that a parent put you to bed and stay there until you are asleep. Or another way may be to become "sickly" to gain attention and love. All these things help us feel less scared. As adults, the ego is still handling "neurotic anxiety" by using "defense mechanisms" and by developing fears and phobias (substitutes for the real concerns), psychosomatic disorders, compulsions and excessive orderliness, obsessions and excessive worries. All of these neurotic symptoms help control or make up for the basic anxiety of not getting the love, security, and sensual touching we want. That's not too weird a notion, is it?

 Understanding how we handle neurotic anxiety was only part of Freud's task. Freud treated patients with great guilt who had never done anything wrong; he saw sexual-attention hungry children deny their sexual interests (remember this was the Victorian era); he saw 5 and 6-year-olds who had a crush on one parent become more and more like the other parent. So, he adopted the idea from ancient Greek literature of "Oedipus and Electra Complexes:" we are in love (whatever that means to a 3 or 4-year-old) with one parent but this is real scary because the other parent might get jealous and hurt us, including quit loving us or physically hurt us (castration anxiety!). How do we handle this scary, threatening situation? With a clever stroke of genius! We join forces with the competitor, we start using the same sexed parent as a model. By joining the enemy we have avoided the war; by identifying with the same sexed parent we have found a means of controlling the dangerous (and thus scary and evil) impulses (sexual attraction and hostility) within us. Soon, we no longer crave physical contact with the parent of the opposite sex; boys of 8 or 10 want to be like their dads; girls like their moms. Young boys start to think girls are yucky and a secret voice inside may be saying, "Whew! Thank goodness I'm safe; I'm out of that scary triangle with mommy and daddy."

 Part of the process of identifying with the same sexed parent is the internalization of values, the development of a conscience which Freud called the "superego ." The superego, the part that makes us good and considerate of others, is an outgrowth of the interactions that many people consider so wicked--the Oedipus or Electra Complex. Because we, as young children, have known birth trauma, overwhelming fear and a sense of utter helplessness, and because we so desperately want love, we handle our fears by developing at age 5 or 6 a set of rules to live by that will help us become a good boy or a good girl. Rules such as: you should not get angry at your little brother and try to kill him...or even think of it. You should not wish you had mommy or daddy all to yourself because the other one would have to die...and you can't think about that, it might come true. You should not do sexual things, like try to suck mommy's breasts or feel daddy's penis...and you shouldn't even think about dirty, nasty acts or parts of the body. All these "shoulds" come from the superego part of your personality.

 And so it is, according to Freud, that the savage beast within is tamed by the ego and superego. And so it is that humans become civilized. But, by the same taming, controlling mechanisms, we are tormented. The superego makes demands that directly conflict with the id; it generates guilt and shame when we do immoral things and even when we have unacceptable urges or thoughts and maybe even when we have unconscious urges. Freud called this "moral anxiety." Much of our depression and low self-regard, perhaps our fear of success and free-floating anxiety, may come from this source.

 Freud's notions of the mind have had a profound effect on how we humans see ourselves. We will never be the same again. Few minds have had such wide influence as Freud's. From anxious, tormented, sick people (and from his own self-analysis), he conceived the mind as a complex collection of dynamic, constantly struggling forces trying to control one's life. There are three major parts of our personality: first, the id, which includes the physical or sexual or love instincts and the death or destructive instincts. The id wants to have all kinds of fun, now! Also, it would like to destroy whatever got in its way.

 Second, the ego develops from the id. By using reason and contact with the external world, the ego tries to satisfy the id's needs as much as possible without alienating the sources of love. Of course, the ego has to conceal many of its purposes; that is, they must be accomplished secretly or unconsciously in a disguised form. This is especially true after 5 or 6-years-of-age because the third force has now come into being--the superego.

 The superego demands that we be good; otherwise, it causes us to feel guilt, shame, and anxiety. The ego has the task of negotiating between the id and the superego. Of course, they never agree. The ego can find a few ways for the id to have a thrill and still avoid chastisement from the superego. It isn't easy, but unconscious manipulations, denial, fooling ourselves, irrational thinking, etc. help one part of our personality deceive the other two parts. Furthermore, the ego must rationally deal with the world, i.e. deal with questions like: what am I capable of doing, what resources can I make use of, how will other people react to my actions, how can I handle their objections, etc., etc. Clearly this boiling cauldron of powerful, unconscious, conflicting forces inside each of us would create stress, right?

 Freud saw anxiety as a signal of danger. What danger? The threat of these childhood memories and urges and fantasies coming into our consciousness or actually being carried out. Events that happen to us as adults might set off an old repressed urge or fear, such as losing love. Immediately, we become anxious--often without knowing why. To prevent anxiety, all of us develop massive defense mechanisms to keep hidden the "true" causes of our childhood fears, urges, and shames. Thus, a psychodynamic therapist would assume that an agoraphobic patient is symbolically terrified by a loss of love or separation from a caretaker at home (maybe the birth trauma or castration anxiety or loss of mommy or daddy's love through the identification process or an actual lost of love due to divorce, etc.). In short, our irrational adult fears and phobias are neurotic ways of continuing to cope with childhood traumas. They are manifestations of our earliest conflicts and stresses.

 Freud wrote 33 volumes, mostly about anxiety. He was a good writer. Decide for yourself, on the basis of knowledge and reading his books, how much you will believe of Freud's theories. It is important to realize that you don't have to agree with everything Freud said in order to find some wisdom in his writings. You don't have to accept birth trauma or the Oedipus complex and castration anxiety before you can believe in defense mechanisms. Indeed, almost all insightful readers will say, "Oh, I do some things like that," after reading about defense mechanisms.

The defense mechanisms

 Freud's daughter, Anna, who did psychoanalysis until she died in 1982, summarized several ego defenses in The Ego and the Mechanisms of Defense (1936). As noted above, the ego protects itself from three threats: (l) the id, because the urges from the id can become so strong that they overwhelm the ego, bringing with them irrational chaos. Thus, we might panic if our sexual or brutally hostile urges popped into our conscience. (2) The outside world or real danger. For example, the ego would realize that a child's parents staunchly forbid any aggression; thus, showing the slightest hint of murderous urges to them would produce severe anxiety. Likewise, a fear of driving recklessly or of being rejected by a lover may have a certain basis in reality. (3) The superego is a threat to the ego too. The basic duty of the ego is to find some satisfaction for the id. If the superego detects any immoral aspects in our behavior, there is hell to pay in the form of self-censure and guilt. The ego tries to avoid this discomfort. But, keep in mind that, according to Freud's original theory, the ego defenses are successful only so long as the conscious part of the ego is unaware that another part of the ego is defending itself! Uncovering some of your ego defenses may be interesting fun, but your defenses against really threatening urges or ideas are not likely to disclose what they are doing to your conscious awareness.

 Anna Freud used the defenses as hints of the repressed, scary impulses (instincts) that were underlying the patient's troubles. For example, the goodie-goodie 5-year-old dethroned king, who never shows anger towards his younger sister, his competitor, is assumed to be hiding his sibling rivalry. The defenses can also give us insight into our own mental processes--sometimes mental gymnastics or contortions. All defenses involve distortions of reality; they are ways of feeling better by fooling ourselves. If we realized these defenses in our lives, we might handle reality better. Almost all adjustment books mention these defense mechanisms, even the writers who are arrogantly critical of Freud. An excellent text about Sigmund and Anna Freud and the ego defenses is by Christopher Monte (1980).

 Repression: shoving thoughts and urges that are unacceptable or distressing into our unconscious. This is what happens to the unacceptable urges of childhood--the ego represses them. Taboo ideas, like incest, would probably never get into consciousness or, if they got there, they'd be quickly repressed. Sometimes dreams or slips of the tongue or attempts at humor reveal our unconscious motives. For example, if a teacher ridiculed you in class, you might dream he/she had a horrible auto accident. Or, trying hard to say something nice to the teacher a few days later, you comment after class, "each of your lectures seems better than the next." Or, if you were unfortunate enough to be asked to introduce your former teacher at a symposium and said, "I'd like to prevent--huh--I mean present Dr.___," some might guess the truth. All these speculations about repressed feelings are just guesses.

 Repression must be distinguished from suppression and withdrawal. Suppression is more conscious and deals with unpleasant but not usually utterly despicable acts or thoughts. Examples: You may want to forget a bad experience or an unpleasant chore to be done (a term paper to write or expressing sympathy to a friend whose mother has just died). You just forget to do things or you may deliberately try to think of other things so you can "settle down" and function better. It may, indeed, be rational to worry about one thing at a time (suppressing the other worries) and to withdraw from a stressful situation. Counting to 10 before acting in anger is another good example of brief suppression.

 Dissociation: includes processes closely related to repressed and distorted perspectives or memories (see the discussion in Trauma above). Dissociation (or something like it) occurs in several forms, ranging from very common occurrences, like "spacing out" or quickly forgetting an embarrassing moment, to very pathological conditions, like flashbacks, Multiple Personality Disorder (now called DID), or Dissociative Amnesia. It seems to be the nature of the human mind to select a preferred point of view or theory or "the right way" to do things. Once you know or "feel" what is "right," then most different opinions or ideas seem wrong to you. This tendency to accept one side (point of view) results in rejecting many other perspectives, even if each perspective holds some truth that might contribute to understanding/solving a problem. This is called right/wrong or either/or or black/ white or good/bad thinking. In effect, we lose track or discount a little part of reality (in order to hold the belief that we know the truth). If people know you believe one thing, they tend to assume you disagree with the opposite. Examples: if you believe in practical courses, they assume you are anti-academic; if they know you recommend psychopharmocology, they assume you do not advocate psychotherapy; if they know you are a strong advocate of self-reliance, they assume you seldom vote for a Democrat.

 Usually strong trauma, intense pain, or an identity crisis is associated with major dissociation. Combat may produce "battle fatigue" or Post-Traumatic Stress Disorder. Awful accidents, near death experiences, death of loved ones, physical or sexual abuse, severe humiliation, and unbearable losses can lead to memory losses, intense emotional reactions as if you were suddenly back in a traumatic crisis, numbed feelings (e.g. cutting themselves without feeling it), depersonalization (robot-like, "I know what is happening but it doesn't seem like me"), two or more "personalities" inside trying to control the same person, confused or Fugue states, etc. All these reactions serve as a defense against pain, fear, helplessness, panic, and other intense feelings or ideas. It is as though, under stress, our normal stream of consciousness fails to integrate all of our thoughts, emotions, somatic sensations, sense of identity, and knowledge of what happened. Thus, one may remember what happened to them but forget how they felt. Compared to repression, in dissociative reactions memories are splintered and distorted, not just lost. Indeed, there is often a repetition compulsion to repeat some part of the traumatic experience, experiencing it over and over. We have already read about dissociation in Trauma above and we will read more about it in Suicide in chapter 6 and in discussions of serious pathological states in chapter 9.

 Denial: refusing to admit or face a threatening situation. Denial can be unconscious as when a dying person refuses to admit what is going to happen or when a person with a heart condition denies that their overeating or smoking is of any consequence. Denial can be semi-conscious as when a person refuses to see any problem in a relationship when it is pretty obvious to everyone else. Denial is probably quite conscious when a post-puberty young man of 13 says, usually with a grin, "I'm not interested in girls."

 Research (Roth & Cohen, 1986) has shown that there are two major ways to cope with stress: (a) avoiding, repressing, looking away, forgetting, escaping and letting someone else be responsible or (b) approaching, learning more, obsessing, being vigilant, and taking charge of planning what to do. The first way (denial) reduces stress; the second way (sensitization) increases our chances to cope. We all use both ways, although we may tend in general to be avoiders or approachers, while in specific situations, like facing surgery, we each have our favorite way of coping. Which is the better way?

 Denial is probably better when the situation is out of your control (a sudden crisis or in surgery) and approach better when you can do something about the situation (avoid or lessen a problem). The disadvantages of each way are: more stress and useless worry for the approachers, and more failures to act and lack of awareness for the avoiders. As you can see, ideally we would use both avoiding and approaching ways of coping with a particular stress over time. This knowledge about denial is gradually being gathered (Breznitz, 1983). For instance, Lazarus has found that patients facing surgery who deny the dangers and have a false sense of security have a better post-operative recovery (Derlega and Janda, 1981). However, many patients could have avoided surgery in the first place by carefully attending to their health. Thus, denial lets us eat lots of fat, relaxes us during our heart attack, and then again interferes with our taking care of serious health problems

 Regression: resorting to earlier ways of acting or feeling, although it is no longer appropriate. Examples: Throwing a temper tantrum like a 3-year-old at age 18. Under stress an adult might curl up in bed, suck their thumb, and clutch their old teddy bear. A 23-year-old experiencing serious financial difficulties might feel an urge to return to his/her parent's home and let them take care of him/her. These are not planned actions; they are old habits that return automatically.


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