Anxiety Is a Mask and a Symptom, Not Just an Evolutionary Signal

Anxiety disorders are on the rise. The impact of COVID has substantially increased the numbers of individuals seeking help for mild to debilitating anxiety. Current mental health theory and treatment focus on eradicating anxiety, more commonly, though naively referred to as fear or stress. The effects of anxiety often debilitate or cause some degree of physical and psychological distress in a patient.

It is increasingly difficult for people in developed countries to endure, accept, understand or integrate difficult emotions and mood states. We live in a quick-fix culture and seek immediate relief through sometimes positive behaviors, like exercise or meditation, and sometimes self-destructive means, like substances, porn, and shopping. The point is that anxiety is to be rid of or avoided.

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Psychologist Tracy Dennis-Tiwary countered the negative associations anxiety has received for the last six-plus decades, since the decline of psychoanalytic thinking began in the late 1960s.

"We've convinced people that anxiety is a dangerous affliction and the solution is to eliminate it, as we do with other diseases." Denniss-Tiwary wrote in a recent article in the Wall Street Journal. "The problem is that we don't understand how to respond constructively to anxiety."

Dennis-Tiwary examines anxiety through an evolutionary lens as a response to uncertainty and a call to action, or at least survival. Anxiety is an organic reaction that requires a strategy for response. Anxiety is also a handy tool for understanding what makes us tick. It is a guide, mask, and symptom to the unconscious layers that require a deeper understanding of the messages it conveys.

Psychodynamic theory, which focuses on the mind's unconscious, considers anxiety as a messenger that guides the therapeutic process into an individual's inner life. "What meaning does anxiety have?" and "Why has the individual employed its use?" are usual curiosities for the therapist. Cognitive awareness, acceptance, and strategies to lessen or curtail anxiety are valuable and practical. However, these approaches predominantly reduce anxiety to a strictly organic function in response to stress or fear about an upcoming or imminent situation.

For instance, a person who is terrified to fly for fear of the plane crashing to the ground perceives and makes a judgment (a cognitive function) that planes have serious malfunctions from time to time. The psychodynamically-oriented therapist sees the fear of airplanes as merely the overt or manifest content of the individual's distress; planes are the vehicles to access anxiety, and anxiety is the visceral proof that something deeper is occurring inside the mind of the individual.

Perhaps the individual fears success, or feels guilty for outdoing other family members. Feeling afraid of something external, like a plane is often more comfortable than feeling competitive, angry. or desirous.

Cognition tells us that, "yes, something bad can happen," the plane can have a malfunction. Analysis tells us that we have only just begun to understand the meaning and purpose of anxiety in the individual's life; it is beyond a natural and evolutionary component of being human or exclusively related to current or future events and experiences.

There are many types of anxiety and theories about it. Reducing it to a solely cognitive function diminishes its breadth to guide our inner world and unconscious process.

The mental health community spent many years seeking the gene that caused eating disorders: those who kept a clinical curiosity but mostly shook their heads in disbelief were proven correct. There is no gene that "causes" eating disorders. The studies on identical twins separated at birth who later developed anorexia did so due to a genetically inherited medical condition whose symptomatology included anorexia, but not due to a psychological refusal to eat for fear of getting fat.

We now see eating disorders as complex. Studies over the recent decades have found a potential for a genetic influence on anxiety and depression, which stacks the deck, along with other psychological and relational factors, for someone to develop an eating disorder. But keeping an open-door policy regarding the etiology of depression and anxiety is a tenet of analysis; psychological distress is multi-determined.

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Biological factors contribute to anxiety, and anxiety is directly linked to eating disorders. Eating disorders are symptoms, just like anxiety: they signal to the individual to pay attention to psychological issues and feelings trying to find a way to be expressed, on the one hand, while simultaneously hiding the truth—or what lies underneath. Both the eating disorder and anxiety are adaptations, masks, and gatekeepers.

Many individuals with eating disorders are prescribed anti-depressants with particular anxiety-reducing properties. However, these medications do not directly affect the eating disorder but target anxiety and depression, which typically co-occur with an eating disorder.

The buck does not stop there.

Most evidence-based treatments, including CBT, DBT, and ACT, treat anxiety as a root cause of many mental health ailments. DBT and ACT, in particular, encourage people to accept their thoughts and all emotions rather than denying them or feeling guilty for them. CBT works primarily to shift cognition out with the bad and in with the new, and to promote behavioral change.

What ticks below?

Elevating anxiety to higher ground as organic to being human and as a warning signal adds an understanding missing from psychological literature. However, understanding the vicissitudes of anxiety and its multifunctions remains the language of analysis.

Other motivational factors prevail; in this regard, anxiety is merely the messenger. Anxiety may be an adaptation, like temperament, thereby disputing the claim that anxiety and temperament are inherited, like the fixed and genetically pre-determined color of one's eyes. Most analysts agree that anxiety and temperament can be "handed down" through learning, a cognitive function. Like learning how to brush one's teeth, children learn and witness how parents react and comport themselves in simple and complex ways.

Viewing the eating disorder as a metaphor or symbol, which parallels the individual's life and relationships, is second to none when treating it through a psychodynamic frame. Through this lens, anxiety represents the expression of individuals' attempts to cope with complex psychological states, much like the eating disorder itself. Eating disorders like anorexia, bulimia, compulsive eating, and attendant anxiety may be the initial or only signs of conflict beyond the physical manifestations of food and body-related symptoms. Although eating disorders work to soothe anxiety, the anxiety quickly returns, reminding the person that perhaps the anxiety is trying to deliver a more profound message, a clue to something else requiring attention.

Humans are hard-wired to feel anxiety; we need to be careful when crossing the street. However, not seeing the complexity and the richness of anxiety and its other uses is a disservice; anxiety is a guide toward our inner world and true motivations and feelings. Knowledge is power, and it is the kind of knowledge fueled by genuinely knowing what drives the bus that enables proper self-care, authenticity, and leadership. Anxiety can help guide decision-making in many areas when truly embraced and understood well beyond its evolutionary purpose.