Existential and Neurotic Anxiety – The Existential Approach
Essay for the Existential and Human Issues (PST 1010) for the MSc in Psychotherapy
Studies
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The first reference to anxiety was in the Book of Genesis with the infraction of God’s Will by Adam
and Eve, who experienced and expressed a meta-lapsarian self-consciousness which led to anxiousness. Genesis 3:7 (Mourtziou, 1998) says their eyes opened and they realized they were naked. A
careful study of that verse reveals that Adam and Eve were brought to face an image of them-selves,
so appalling to the eyes of their consciousness, that without delay, they tried to cover the ugliness of
their abysmal psyche. Their subsequent anxious reaction was an immediate and rash disappearance
into the woods. Fear and hiding interlock with the basic psychology of the unconscious: fear and
anxiety.
Anxiety is volatile in terms of context, significance or concept. However, or Psychiatry it is a diagnosis for pharmaceutical treatment, for psychoanalysis a matter of the unconscious intra-psychic processes, and for CBT, learned behaviors as a result of specific environmental stimuli. All approaches
have treated anxiety as a symptom - or worse a disorder – linked to fixed internal mechanistic or
cognitive processes and interpretation - rather than the inescapable truth of a unique human existence.
Freud (Green et al., 1992) defines anxiety as a successful or unsuccessful intervention of the Ego’s
defensive mechanisms when in the face of danger. Anxiety is a signal conveyed by the Super-Ego, as
unacceptable elements come out of the structural essence of the Id, and threaten to invade the conscious field. Those elements are of sexual or aggressive context, include the prospect of punishment
or loss of the “object of love”, and do not invite a psychoanalytical interest unless they acquire the
character of an obsession, hysteria or phobia.
Ontologically, we try to preserve our thrown-in-the-world (Heidegger, 2010) existence, always knowing we will one day seize to exist. This throwness is conveyed as a sense of alones or desolation in
the world (inauthenticity), but also as freedom to choose the who(s), the what(s), the how(s), and
the where(s) in our lives. Freedom is an unbearable gift as it calls for sole responsibility of choices
made over the losses accompanying them. No one can make our choices, guarantee results or assume responsibility on our behalf and in the end no one can die for us (Yalom, 1980). All these ontological givens permeate every human being’s existence, and are inescapable. In our primordial need
to feel secured in a life which is anything but, values and meanings are established to allow an elusive sense of control over the paradox of a meaningless and volatile life accompanied by the threat
of death. May says anxiety is directly related to a threat of the values a person carries within “essential to his existence and consequently, to his security as a personality” (1996a, p. 206), and being.
The threat of becoming a non-being, as per Kierkegaard (1980) and May (1996b), brings us into a
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state of anxiety. In a sense, our constructed values and worldview may be the “symptom(s)” of our
ontological insecurity from which we cannot escape.
May (1996a), differentiates normal to neurotic anxiety. Normal anxiety is “not disproportionate to
the objective threat“(p.209), is in no need of “neurotic defense mechanisms” (p.209), and is consciously managed. It is therefore “…an expression of the capacity of the organism to react to
threats” (p. 216). Bugental (1981) describes anxiety as “an intrinsic part of human experience”
(p.65), our ontological insecurity exposed through anxiety can be treated as part of our being, a fact
we need to look right into the face courageously (Kierkegaard, 1980).
Neurotic anxiety is exaggerated in proportion to the threat, includes complex intra-psychic conflict
and repression, defense mechanisms and “symptoms” (May, 1996a, p. 214), or more precisely “ontic
variables” (Spinelli, 2007, p.77). The neurotic cannot face uncertainty courageously and recurs to
various forms of defenses to alleviate it. “The neurotic is one who has settled for a fixed, though a
limited and unrealistic self- affirmation” (Tillich, 2000, p.173). Unfortunately, most psychotherapeutic approaches target the elimination of these defenses and completely disregard the ontological
concerns permeating them.
Existential anxiety is “that in the face of which anxiety is anxious is nothing ready-to-hand within-theworld” (Heidegger, 2010, p.231), it’s objectless. It’s not directed to a specific thing or suppressed
unsatisfied laws of desire; it’s not a learned behavior, nor a disorder, but it can be expressed through
them. It is the force of life which permeates every existence and brings it face to face with its
aletheia. Anxiety reveals other possibilities to the Dasein (Heidegger, 2010) which have not been
apparent but only in the gap where a person’s everydayness disintegrates from its illusions of security, and Dasein meets with the freedom of becoming a potentiality. Kierkegaard (1980) parallels a
freely acting human being to anxiety. It’s essential to acknowledge anxiety as the door into the world
of a person’s being with an “authentic potentiality” (Heidegger, 2010, p. 232) rather than an impediment. May (Schneider, Galvin & Serlin, 2009), exclaims that anxiety’s presence is vital in therapy.
Through it the unique world of the individual and his existence are revealed.
Yalom (1980) asserts it’s dangerous to treat anxiety as a result of mystical unconscious conflicts and
brings the example of a woman’s evident ontological anxiety and fear of death being interpreted as
suppressed homosexual tendencies and a death wish to allow reunification with the “homosexual
beloved” (p. 55). Treating anxiety as a symptom of past unconscious conflicts can lead to an unparalleled deviation from the Dasein’s unique truth and a prohibition to possibility. Psychoanalysis rejects the conscious and primordial understanding of man’s finiteness; death is not experienced
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hence its signification is unheeded in therapy (Green et al., 1992). The unique worldview of every
existence is subjected to mechanistic models concerning only a past. A client I had once said “I know
I have to talk about my abuse, but truth is there is no truth! I cannot recall the way I exactly felt
when it happened, nor can I talk about it but only from where I am now!” The past is perpetually
changing as we do while ontological concerns may form symptoms as expressions of one’s essence,
existence and identity (Laing, 1990).
Anxiety is a distinctive opening to a worldview. There are no techniques to alleviate it, no diagnosis
to allow a pseudo-control over it, no categorization of its expressions. It is a fact of human living
which once journeyed through becomes apocalyptic of a person’s presence in this world. The “why”
becomes a “why not” (Heidegger & Boss, 2001), without assumptions, pre-dispositions and personal
desire to affirm theories. Anxiety becomes a possibility illuminating distinctive expressions of a living experience, and identifying new ways of courageously embracing an uncertain life encompassing
a definite death.
The therapist validates the client’s existence, experience and uniqueness, is open
to who he is and what he says as if it is the first time they meet, every time, allows the presence of
uncertainty, becomes an example of living with it (Spinelli, 2007), all with being fully engaged in every session.
Jake, a single 32 years old graphic designer, came to see me about a year ago after discontinuing his
4-month psychoanalytical therapy. Jake was experiencing panic attacks, sometimes feeling so
dreaded of them that he spent 2-3 days in the comfort of his bed. He was profoundly angry with his
previous therapist because ‘he kept telling me I am a classic hysteric who will need medication pretty
soon!!!’ Jake said he did not trust anyone anymore and the only reason he came to me was because
of a friend’s suggestion. Realizing trust had to be established I decided to let Jake take control of our
initial sessions where he kept attacking his old therapist and expressing his disappointment in the ‘so
called therapies’. After 4 weeks Jake settled and told me he felt I was very kind and discreet to let
him defuse his anger without judgment, said he was sorry he put me through this and that he really
needed help.
That’s when he started talking about his panic attacks.
As Jake was unfolding his story, he said his mother died when he was 8; he ‘never got over it but
managed to move on pretty soon’. He did not have any ‘real friends’ nor did he believe in friendships. The first time he had a panic attack was when his partner asked him to move in with him.
Jake broke off the relationship then.
While saying this he cried and said he missed ‘a pretty good
chance to be happy’. I stayed with him for a while till he broke silence and said he really thought he
was fine with that till now. I asked Jake what he thought changed now and he said ‘I don’t know!
It’s like I am left without anything to hold on to anymore!’ Jake did not feel he had any more de4|P a g e
fenses to help him handle life. Van Deurzen (2010) says neurotic anxiety reveals the ontological realization of inadequacy and failure to life.
In the subsequent sessions Jake spoke about his panic attacks and tried to gain an understanding of
them through long descriptions of the incidents. I often asked him to take some moments relaxing,
locating and naming, if possible, the emotions he felt on his body attempting to enable a holistic
mind and body perception of what was happening. He said that was the first time he felt as if the
anxiety attacks were part of him rather than ‘something which comes out of nowhere’
That was when he started talking about his mother’s death, his intense pain, ‘long forgotten but always present sorrow’, and his unanswered questions about death to his devastated and distant father. Jake’s real first anxiety was experienced when he was 9, as he later remembered, as a terror of
death however disregarded by his father, leading Jake to denying, suppressing and ‘forgetting about
it’. When he faced the dilemma of taking an enormous step towards commitment with a partner,
his abrupt ending of the relationship revealed his relational world (Mitsein), an isolated world, influenced by his father’s refusal to look at Jake’s fear and his mother’s betrayal through death.
Jake talked about his death anxiety and felt ‘relieved and close to’ me when I carefully and intentionally disclosed my concern on my finiteness. Jake felt ‘more trust and belongingness’.
There is much work to be done but Jake’s anxiety attacks are not occurring as often, he started seeing someone romantically and he made ‘good friends’ with a co-worker.
It’s understandable how I cannot expand here to important details, however, the points are the following:

Jake’s experience with psychoanalysis left him crippled with further distrust and anger as he
was judged and labeled as a hysteric, whereas in our sessions he was able to slowly reveal
way of being-in-the-world through validation and acceptance of his experiences

His anxiety was not viewed as a physical or mental ‘sickness’, but an expression of his physical and emotional existence. Through embodiment he engaged in the body he is not the
body he has (Merleau-Ponty, 2005)

His inability to handle his ontological concern of death which was expressed via panic attacks was acknowledged, and given space to be expressed, allowing him access to a deeper
understanding of his way of being-in-the-world
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
My presence was without intentions of interpretation, correction, comfort or education towards change but a being-with. That established trust and openness, an I-Thou relationship
extended to the world

Through Socratic dialogue – not intervention or interpretation – Jake was able to remember
and look right into his forgotten pain, and trying to make sense of it he started realizing how
he was affected in his later life
Anxiety is our faithful companion to life and we need to embrace it. It’s a neurosis when we become
unavailable to its possibilities. As therapists we need to recognize, validate, appreciate and explore
anxiety, let alone our own anxiety(ies).
References
Bugental, J. F. T. (1981) The Search for Authenticity: An existential analytic approach to psychotherapy. New York: Irvington
Green, A., Aulagnier, P., Karapanou F., Laplanche, J., Enriquez, M., Potamianou, Α., Nicolaides, Ν.,
Rosolato, G., Pasche, F., Parat, K., David, C., Anzieu, D., Kastoriades, Κ.
(1992) Αφιέρωμα:
Πενήντα Χρόνια Από Τον Θάνατο Του Freud. (Feature: Fifty Years Since Freud’s Death) Αθήνα:
Βιβλιοπωλείον της «ΕΣΤΙΑΣ» (Athens: Estia)
Freud, S., Strachey J., & Gay, P. (1990) Inhibitions, Symptoms and Anxiety (The Standard Edition).
New York: W.W. Norton
Heidegger, M., Boss, M. (2001) Zollikon seminars: Protocols – Conversations – Letters. Trans. F.
Mayr. Evanston: Northwestern University Press
Heidegger, M. (2010) Being and Time. Tran. J. Macquarrie & E. S. Robinson. London: SCM Press
May, R. (1996a) The Meaning of Anxiety. New York: W. W. Norton
May, R. (1996b) Psychology and the Human Dilemma. New York: W. W. Norton
Mourtziou, I. (1998) (ed.) Η Παλαιά Διαθήκη-Διάγραμμα Περιεχομένου Τόμος Α' (The Old Testament – A diagram of content, Vol. A.). Αθήνα: Πουρναράς (Athens: Pournaras)
Kierkegaard, S. (1980) The Concept of Anxiety. Trans. R. Thomte. New Jersey: Princeton University
Press
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Laing, R.D. (1990) The Divided Self. Harmondsworth: Penguin
Merleau-Ponty, M. (2005) Phenomenology of perception. Trans. Routledge & P. Kegan London:
Routledge & Kegal Paul
Schneider, K. J., Galvin, J., Serlin, I. (2009) Rollo May on Existential Psychotherapy. Journal of Humanistic Psychology 49(4), pp419-434
Spinelli, E. (2007) Practicing Existential Psychotherapy: The Relational World. London: Sage Publications
Tillich, P. (2000) The Courage To Be. London: Yale University Press
Van Deurzen, E. (2010) Everyday Mysteries. London: Routledge
Yalom, I. D. (1980) Existential Psychotherapy. New York: Basic Books
Bibliography
Cooper, M. (2010) Existential Therapies London: Sage
Freud, S. (1963) Sexuality and The Psychology of Love New York: Collier
Safouan, M. (2005) Λακανιάδα: Τα Σεμινάρια Του Ζακ Λακάν 1953-1963 (Lacaniana: The Seminars
of Jacques Lacan 1953-1963.) Trans. Y. Oikonomou Αθήνα: ΚΕΔΡΟΣ (Athens: Kedros)
Van Deurzen, E. (2008) Existential Counselling & Psychotherapy in Practice London: Sage
Yalom, I. D. (2004) Το Δώρο της Ψυχοθεραπείας (The Gift of Therapy) Trans. E. Adritsanou & Y.
Zervas Αθήνα: Άγρα (Athens: Agra)
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Appendix A - Coversheet for all assessed work
NAME: REGISTRATION NUMBER: ……………………………..
PROGRAMME TITLE: MSc in Psychotherapy Studies – PTS 1010 Existential and Human
Issues
Declaration:
I have read and understand the rules in the student handbook relating to citation, referencing,
collusion and plagiarism.
I understand that plagiarism constitutes grounds for failure in any paper or assignment and
that plagiarism may result in failing the unit or the qualification as a whole.
I have submitted a copy of the assignment to Turnitin via the NSPC Moodle site. The result
was (Tick where applicable):
A. The Originality Report indicated a rating of 24% or less for the entire assignment, including references
B. The Originality Report indicated a rating of 25% or more for the
entire assignment and my explanation is as follows
Explanation
Signed
E. Konstantinou
Similarity
Reported in Turnitin Report: 7%
Date
09/02/2013
Date 09/02/2013
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