A recent incident reminded me of the power of anxiety. The partner of a family acquaintance was seeking confirmation of a suspicion he held about a loved one. (This individual, whom I have never met, was neither a client nor a potential client.) He contacted me in a moment of panic hoping to gain certainty around a fear only he himself believed was true. The fear itself was not irrational and if true would have impacted me. For the individual, this fear was unbearable. The anxiety was palpable.  Afterward, I found myself continuing to ruminate on the experience. What exactly was this person looking for?

I am not in a position to make a diagnostic assessment of this individual, nor do I think one is necessary; rather, what follows is a brief exploration of this situation in order to reflect on the idea that anxiety is indicative of a discomfort with and a rejection of uncertainty.

What is Anxiety?

Clinical anxiety disorders affect a large number of people in the U.S. The typical estimate is that about 40 million of us, nearly 20% of the population, live with it. Anxiety differs for everyone, but there are some common manifestations: worry, avoidance, fear or panic, disappointment or sadness, and physical reactions like muscle tension, breathing difficulties, nausea, or increased heart rate. The causes of anxiety are multiple and difficult to pin down. Generally, anxiety is an individualized response to outside forces as varied as trauma, family of origin issues, natural disasters, personal genetics or biology, substance use, stress, or a combination of things. The personal impact of anxiety can range from occasional frustration or annoyance to lifelong, crippling fear and self-judgment.

Meaning-making is critical to human survival and if we bracket the symptoms and causes of anxiety it seems to me that anxiety itself is a symptom of a search for certainty. We make sense of the world in any way we can and yet sometimes we are faced with meaninglessness. Anxiety’s emergence is in a sense a rational response adopted in order to survive senselessness. The chaos that characterizes meaninglessness allows us nowhere to focus our emotional response, usually fear, and anxiety emerges, perhaps out of necessity.

Anxiety and Freedom

One philosophical understanding of anxiety emerged in the 19th century with the rise of existential thought. The Danish philosopher Soren Kierkegaard referred to the possibility of taking action, even a potentially dangerous or deadly action, as the “dizziness of freedom.” French philosopher Jean Paul Sartre convincingly used the term nausea to describe this state of human being.

Many of us, myself included, sometimes spend inordinate amounts of time and energy seeking to avoid anxiety and attain certainty. In order to avoid meaninglessness, or the realization that we each have the freedom to make any choice we want, I will experience anxiety and search desperately for some kind of certainty. In this telling, anxiety is a frenzied flailing for some type of life boat. For existentialists, uncertainty is a defining condition of the freedom we all possess to create meaning. Anxiety presupposes the possibility of creation, an act requiring reflection on what has existed, what exists now, and what could exist in the future. Choices are not infinite, they usually are quite limited, but the quest for certainty can send us either ping-ponging back and forth within our freedom or it can freeze us in our tracks. Who wouldn’t want help in this scenario? Thankfully, it is possible and healthy to assume another stance: curiosity. 

A Chaotic Quest for Certainty

Returning to the story I began with, the individual in question had reflected on his situation and chosen to pursue certainty (i.e., the elimination of possibility) via distorted reasoning: I fear X, X appears to be more powerful and convincing than any other option, therefore I will believe X if only to experience the brief tranquility of certainty that my fear is reality, and my assumptions about the world are correct.  This need not have been the case, however. He could have elected to remain free within his anxiety through the creation of a new understanding about himself and his situation. This would have entailed a change in his relationship to another person, to the relationship itself, and to his own self-understanding. The moment was overwhelming for him and he reached out to me, I think, for confirmation of his deepest fears, but without acknowledging the possibility that he could be wrong. He reached towards the choice to believe, which did not yet exclude the choice to not believe, and sought my counsel to confirm and soothe his dizziness, to relieve his anxiety.

In his effort to attain certainty, even if only certainty of his negative interpretation of events, a choice was made by this individual thus, creating a situation in which everyone’s role was predetermined: in choosing to believe, he required confirmation in order to calm his nerves, if only for a moment of satisfaction in being “right,” being certain. Upon reflection I realized there were two choices for me at that moment in time: I could choose to engage and accept his choice – even if I disagreed with his choice, engagement would have validated his belief – or I could choose not to engage and allow this individual, and myself, the opportunity to remain in freedom; that is, in anxiety. My collusion with his version of reality would have granted him certainty, even if only briefly, whereas exiting myself from his predicament would keep him in uncertainty; that is, freedom.  I chose not to participate. 

Anxiety and Psychotherapy

Anxiety is debilitating. There is no doubt about its potential to damage individual lives and relationships. However, choosing to accept the open-endedness and unknowability of life on life’s terms and to examine how one makes sense of this predicament has the potential to create even more possibility, including the possibility of increased anxiety. A primary habit associated with anxious people is the avoidance of anxiety provoking situations, itself a grasping for certainty. Unfortunately, conscious avoidance of anxiety as a style of being ultimately leads to increased and deepened anxiety. (Generalized anxiety disorder, for example, is sometimes the endgame scenario of a lifetime of avoidance, which might be a rational response if one is never allowed the chance to build a collaborative relationship in which to examine and fully experience one’s emotional responses.) The straightforward yet tricky route through anxiety is accepting the sickening reality of it and acting anyway. Avoiding stimuli creates the certainty of avoiding discomfort and also decreases one’s freedom whereas seeking stimuli, an act of curiosity, exercises one’s freedom and increases possibility.

Naming anxiety, exploring its reason for being, and owning one’s primary emotional state when faced with it is difficult. What many of us want is simply to avoid what we perceive as pain. It is today an almost national obsession. We pursue relief through varied means: medication, meditation, exercise, therapy. However, anxiety in my understanding is the human condition. Adverse experiences, individual biology, and working models of self and other prepare the ground for greater or lesser anxiety, but humans are condemned to freedom; that is, no matter how much effort we invest in seeking certainty and security there always exists the option of choosing another path, of experiencing uncertainty. This potentially is debilitating, whether because of panic or guilt, for example, but in the final analysis it opens up the reality of living creatively. We can choose to accept or deny our ability to create, we even can choose both/and. To be fully human is to accept our own responsibility, however limited it is in some instances, and create our own lived meaning. To transcend anxiety is impossible, therefore. To embrace anxiety is difficult, but perhaps the only feasible way to be fully human.

My Role

What does this perspective mean for my clients? Am I asking them to endure suffering because, well, that’s just the way the world is? Emphatically and resoundingly, no! Working from the perspective that relationships or attachments are central to our humanity – they are the both the impediment and the pathway towards meaning and a life well lived – I believe that my role as a psychotherapist is to assist clients as they grapple with the risky proposition that meaning, happiness, fulfillment are not found, they are created in relation with others and with ourselves. Relationships are necessary for physical, emotional, and spiritual or psychological survival. They make life worth living.

As a psychotherapist, I know that attaining some modicum of safety, security, and stability is necessary for clients. After all, people come to therapy for relief. The alleviation of pain can and sometimes must be the focus of my work. The experience of depth psychotherapy requires full participation and only a safe, secure, and stable client can assent to this. However, to stop there is not fully accepting the human capacity for growth and change. Symptom relief is necessary, but not sufficient. Thankfully, because we are social creatures we have an inherent ability to grow within a variety of relationships over time. My role as therapist is to assist my clients in determining how, when, and with whom they wish to engage with life’s anxieties.

In the story above, I chose not to hold another’s anxiety, first, because I am a stranger to him. He was and is not invested in me or us. Perhaps just as significantly, I chose to allow this person the chance to experience his freedom, to actualize the possibility of possibility. This is a scary proposition when so much of our culture, especially masculine culture, embraces a skewed and damaging understanding of strength: act with certainty, deny emotional involvement, and damn the consequences. A more thoughtful approach is to consider the consequences, admit our emotional engagement, and move forward cautiously and humbly. In this way we might just evade the avoidance of anxiety and fully embrace our freedom to create meaning.