Anxiety Part One: “What It’s Like”

“In the time of chimpanzees,
I was a monkey.” - Beck

I

Emotions are tricky - they’re like colors. Understanding facts about colors doesn’t seem to give us all the information. I can be raised in a darkened room and be taught about wavelength of light, additive color theory, subtractive color theory, the history of the use of color and pigment in art and photography. Yet, once I leave the darkened room there’s still information in what it’s like to experience the color. Philosophy calls these individual bits of subjective experience “qualia.”

Discussing the “what it’s like” of experience activates the self-observer and works to increase self-awareness. Bernard Beitman describes increasing the capacity for self-awareness as one of the core processes of psychotherapy. Cognitive Behavioral therapists call it identifying thoughts, feelings and beliefs. Psychoanalysts call this development of awareness “insight.” The development of self-awareness is not circumscribed to psychotherapy. Buddhists see it as a practice called mindfulness. The Stoic philosopher Marcus Aurelius described self-seeing and self-analyzing as a virtue of the rational soul.

There is a well of knowledge to be gained in exploring what it’s like. This is not information we can quickly teach or transfer. I sometimes like to think this kind of knowledge is difficult to transfer because we find it hard to remember what it’s like to not know. But it’s actually that this knowledge is experiential, a posteriori knowledge that can only be gained by having a number of experiences which contrast with each other. Experiential knowledge can be large and conceptual, making it difficult to transfer because “concept shaped holes can be impossible to notice.”

If I were anxious, would I know it? Perhaps I notice some parts of anxiety but not others. It’s also possible that I can go without naming my experience “anxiety” due to a conceptual bucketing error. I could be misconstruing anxiety as something only people with more serious problems experience. Fear, stress and anxiety are music that every human mind performs. Since everyone experiences them, it can be difficult to tell what it would be like if I was experiencing these more often, more intensely, or for longer periods of time than others. When we don’t notice anxiety, we are acting like the proverbial fish who incredulously asks, “what the hell is water?”

II

When I instruct people to look for anxiety, it often feels counter intuitive to even begin this exploration. “Didn’t I learn this in kindergarten? I saw the poster with the drawings of the feelings! Since then, I’ve been commander of my ship. I sit at the control panels of my mind and have a perfect readout of the quality of my mind. Accurate. Clear. Discrete.”

And yet, we observe again and again that it is possible to be unaware of one’s emotional experience. I’m sure you’ve met someone who is unaware of their present emotions. They sound like this: “ANGRY? I’m not ANGRY!”

This occurs because our attention tracks a limited amount of our conscious perceptions and thoughts. We do not and cannot keep track of all the things which contribute to our emotional states. In The Feeling of What Happens, neuroscientist Antonio Damasio puts it like this,

“[W]e often realize quite suddenly, in a given situation, that we feel anxious or uncomfortabie, pleased or relaxed, and it is apparent that the particular state of feeling we know then has not begun on the moment of knowing but rather sometime before. Neither the feeling state nor the emotion that led to it have been "in consciousness," and yet they have been unfolding as biological processes.” (p 36)

It is possible to be unaware and it is possible to gain awareness. This ability of monitoring and discerning feelings in ourselves and others is referred to as Emotional Intelligence (EI) or Emotional Competence (EC). These research programs are tied to the idea that it’s possible for us to be unaware of what we’re feeling. And while most therapists probably accept the concept of Emotional Intelligence/Competence uncritically (it’s one of the things we all try to cultivate in psychotherapy), there are interesting claims and controversies that I will have to leave to explore in another series of posts.

III

Anxiety is a fear, worry or dread about what might occur. The quality of anxiety can be similar whether the threat is physical, social or emotional. It’s an internal tension and uneasiness. It modulates our behavior in a complicated way. It can help us avoid frightening situations, it can motivate us to work on our goals, or it can impair us from being able to move and act in the world. It becomes a problem when it feels out of control, overwhelming, out of proportion to the situation, and interferes with living.

It’s common to discover anxiety problems in children, who don’t have the same practice naming their feelings, by observing their expression of the somatic symptoms associated with anxiety:

“They appear uneasy, seeming at times to be uncomfortable inside their own skin. Commonly, these youngsters report profuse sweating, light-headedness, dizziness, muscle tension, stomach distress, increased heart rates, breathlessness, and bowel irregularities. … They may say that they feel “fluttery” "or “jittery” or “jumpy.” We have heard youngsters report anxiety by saying they feel “yucky” or “weird” inside.” (Clinical Practice of Cognitive Therapy with Children and Adolescents, p 218)

In adults the altered quality of thoughts that comes with anxiety is more frequently noted: rumination, a mental focus that’s hard to tear away from the distressing thought; perseveration, mentally revisiting the same worry over and over; cogitation, obsessive consideration about what could happen. These qualities of anxiety are part of what leads to having difficulty concentrating or functioning in certain situations or during certain periods.

Adults still have the physical symptoms of anxiety but describe them differently than children. Anxious adults have muscle tension and feel keyed up or on edge in ways that leave them exhausted and sore. They sometimes complain of digestive problems and headaches. They may have a hard time turning off the thoughts to get to sleep. The unpleasantness of anxiety symptoms contribute to the development of avoidance of the subject of the worry.

Since anxiety is an emotion that everyone can and does experience to varying degrees, it’s easy to lose track of just how unpleasant and disabling anxiety can be. Anxiety disorders are common mental health issues, affecting ~10% of the population of western countries but they are highly treatable.

There’s a big question regarding what’s psychologically normal and what’s a problem. In the US, the nosological manual we use to divide up and categorize pathology is the Diagnostic and Statistical Manual of Mental Disorders. The Fifth Edition (DSM-5) of this manual was released in 2013 and its Anxiety Disorders section covers phobias, social anxiety, generalized anxiety and panic. The various anxiety disorders are united by feelings of anxiety or fear but distinguished by the particularities of how these feelings present. Some are related to exaggerated fear, as experienced by those coping with phobias and social anxiety. Other presentations, like generalized anxiety, involve a sort of continuous “anxious misery,” while panic disorder is characterized by discrete, short attacks of anxiety that can become a subject of fear themselves.

I find one of the criteria for Generalized Anxiety from the DSM strangely comforting in its brevity: “[I find] it difficult to control the worry.” (DSM-5 p 222)

The DSM-5 makes the distinction between fear and anxiety by stating, “Fear is the emotional response to real or perceived imminent threat, whereas anxiety is the anticipation of a future threat.” (DSM-5 p189) That is to say that fear requires a cue, but anxiety does not. The two states are qualitatively similar, both involve responses to threats, increased tension in the body and similar changes to qualities in our mind like attention, but we can be anxious with little but our own thoughts. Pensive regret and feelings of foreboding that lead my body to freak out can happen when I’m all by my lonesome. These negative emotions and autonomic arousal is what is presenting in an exaggerated form in generalized anxiety and panic disorder. So while there’s disagreement about how to divide them up and clump them together, for the purposes of exploring anxiety, we’ll start with clumping.

These disorders are related through underlying brain circuits, physiological responses, behavioral responses, and qualitatively similar subjective experiences. It’s helpful to distinguish these factors as they do not necessarily all act in perfect concert. In follow up posts, I’ll be discussing theories of emotion, neurobiology, personality, epidemiology, historical perspectives, adaptiveness, and treatments in the hopes of gaining a deeper understanding of what it’s like and how to cope with being an anxious ape like myself.

“Insofar as we're smart enough to have invented this stuff and stupid enough to fall for it we have the potential to be wise enough to keep the stuff in perspective.” - Robert M Sapolsky