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Anxiety: The Repetition of Past Pain

Leanne Hoffman

Anxiety is a quintessential human experience. It spans a broad range of experiences from a stressful day at work all the way to debilitating agoraphobia (fear of going out). Despite being an almost universal coping mechanism, it is a deeply harmful one, being highly sadistic, futile and limiting our ability to experience joyful emotions.

Anxiety is often a psychological issue based on imagined rather than real threats, where we try to prevent past losses or pain recurring by projecting them forward. As Seneca put it “to err is human, to persist [in committing such errors] is of the devil”

I think the umbrella analogy works well to explain this.  It rained and you were caught out with no coat leaving you cold and miserable.  You decide that to avoid feeling this way again, you will always walk around with an open umbrella, just in case.  Now you exist under the umbrella of rain.  You live a life of constant anticipation of rain forgetting that umbrellas can stay shut until needed, and that if you get wet, it may not feel pleasant, but you can go home, change, it is manageable.  You cannot stop the rain (pain and loss) but it can be managed or endured.

For myself, my patients and clients, I am often painfully struck how this way of coping defies rationality, as now the thing you want to get rid of is locked in.

 “We start dress rehearsing tragedy in the best moments of our lives in order to stop vulnerability from beating us to the punch.  We are terrified of being blindsided by pain, so we practice tragedy and trauma.  But there is a huge cost”. (Brene Brown, Atlas of the Heart).

Freud coined the idea of repetition compulsion which he defined as “the desire to return to an earlier state of things”.  This is where traumatic events get pushed below the surface of consciousness as they feel unbearable, or unmanageable but are repeated in the present moment in disguised ways.

Here is a fictional example:

Ally is bullied mercilessly at school. With little parental or school support this causes him to make sense of what is happening by inferring that there is something wrong with him.  This belief is his way of rationalising why he has been marginalised and felt rejected. It is common for children to blame themselves for distressing events as a way to manage the pain e.g. better to feel in control of what has happened rather than powerless.

But after he leaves school, Ally retains the coping mechanism of anxiety stepping in at all social interactions to put him on guard against upsetting people or getting things wrong.  Physiologically he is flooded with adrenaline and cortisol leading to raised heartbeat, flushing, feeling anxious making him more – not less – prone to tripping up.  This is all evidence to him that there is something wrong with him and he is unlikeable, and with repetition this feeling becomes an unchallenged fact; we are terrible scientists when it comes to ourselves, turning subjective feelings into objective facts.  With no counter voices, Ally’s internal critic can mushroom, and he will believe that his anxiety is needed to keep him hyper alert to future rejection.

The irony is that we are living with what Bessel van der Kolk refers to “as if”, where our body responds as though we have portalled (think Harry Potter) back in time to the child experiencing the initial pain.  Emotions work like music; as with joy, pain can transfer us to our younger selves, discarding our adult coping strategies and options.

Paradoxically the brain – our centre of learning and evolution – is incredibly complacent when it comes to feelings.  It may require guided therapy or coaching to help people realise that their childlike coping mechanisms may be counterproductive. However, “the body keeps the score” (Bessel van der Kolk) and despite our best efforts can act independently even when we cognitively become aware of our patterns.

This is a small example but one that has really stayed with me.  I was dog walking but got distracted and did not notice that the dog had started pestering some picnickers and eating their food. The people were rightly annoyed but despite my apologies they started shouting, swearing and throwing food at me. I could feel my heartbeat raise as I went into fight/flight though mostly freeze mode.  It was an unpleasant encounter, where I felt both shame and indignation but I soon forgot about it…..  A month later I was out running (dogless) and suddenly felt highly anxious for no apparent reason. I paused and looked around; I was at the same spot.  Quite clearly my body had not forgotten and was trying to protect me from causing further harm despite the lack of a dog or any picnic.

I am writing this piece as I feel genuinely saddened at the farcical and counterproductive nature of anxiety. It is probably the most common issue I encounter as a psychotherapist – but it is hard work to tackle.   Therapy does help, it builds awareness and slowly the body catches up with the intellectual understanding though we are unlikely to be “cured” as such.  My work as a therapist on medical trials with psilocybin (magic mushrooms) combined with psychotherapy are looking promising in this area.  For some participants it reduces anxiety as the body and brain learn to challenge ingrained habits.  This emotional spring cleaning can help to dismantle old strategies for trying to keep us safe, replacing them with healthier, more appropriate beliefs about self, others and the world.  Once we realise that loss and sadness are bearable and manageable, then anxiety can take a back seat allowing space to experience a wider spectrum of emotions without fear of threat.

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