Anxiety generally refers to both a state of mind (an intense unease, apprehension and worry) and bodily states characterised by breathlessness, muscle tension, nausea, headaches, stomach cramps and dizziness. Anxiety can be free-floating and constant (generalised) or acute and temporary (panic).
Anxiety is something we seek to avoid at all costs. Outside of our awareness we can develop symptoms that serve to protect us from anxiety. For example, a phobia transforms anxiety into fear by attaching anxiety to a very specific object: spiders, snowmen, buttons, open spaces – almost any object or situation can be used to form a phobia. Anxiety appears first and phobia is formed as a protection.
This is why a quick removal of the phobia is rarely successful since it leaves you without the protection your phobia provides from anxiety – you are then likely to develop another symptom to compensate.
Obsessions and compulsions – also referred to as OCD – offer another protection from anxiety. Obsessions involve particular ideas or patterns of thought – sometimes absurd or unreasonable in nature – that recur, often relentlessly. Compulsions require us to perform actions – sometimes against our will – that may be repetitive and absurd or trivial: like having to check several times that a door is locked. OCD may also be accompanied by a strong sense of guilt or perpetual hesitation that lead to a state of confusion, limbo, meaninglessness or lack of direction in life. As with phobias, OCD serves as a protection from anxiety: anxiety appears first and OCD forms in response.
If OCD sees the return of the repressed in the mind and behaviour then what are often referred to as psycho-somatic illnesses indicate the repressed has returned in the body. Psycho-somatic illnesses are very real bodily pains or disorders for which a GP can find no organic cause. Some pains or illness may relate to a web of beliefs centred around food, body weight, body shape and self-esteem that serve to shield us. The most frequently mentioned are anorexia and bulimia. Bulimia involves repeated episodes of binge eating followed by purges or exercise to compensate.
Self-harm involves injury to the physical self that may begin as a coping strategy to relieve the build up of anxiety or of feelings and beliefs that may otherwise become overwhelming. Over time the frequency and severity of self-harm may increase and give rise to other medical conditions. Therapy can reduce reliance on self-harm as a coping strategy.
Depression describes a range of experiences that can vary in intensity and frequency – feelings of worthlessness, loss of confidence, loss of sex drive, loss of concentration, loss of purpose, thoughts about death and suicide. As this brief description may suggest, depression often forms in response to a significant loss – of a person and a relationship, of a belief or ideal, or of something that may not be so obvious or apparent.
For some, depression can alternate with feelings of elation or mania that may also involve delusions. Delusions can range from a single idea to beliefs which come together to form a complex pattern as in paranoia.
There is no such thing as a ‘normal’ sexual orientation or gender identity, and sexuality is not something that may remain the same throughout your life. This can be both exciting and also a source of unsettling questions that have enabled many to go on to identify as lesbian, gay, bisexual, transgender, queer or LGBTQ+
Psychotherapy and counselling enable you to change your relationship to your symptom. Instead of emphasis being placed on symptom removal, therapy enables you to address the underlying cause your symptom shields you from.
Once psychotherapy is working, the symptom usually fades in importance as whatever it has been protecting you from alleviates. You in turn can experience a deeper level of self-acceptance, greater freedom to make decisions and an increased ability to live life more fully in the present.