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    This column originally appeared in the Orange County Register.

    The very unstable economic surround in which we now find ourselves has unleashed an epidemic of anxiety-related complaints.  Stomach upsets, irritability, sleep disturbances, hives and rashes and unpleasantly intrusive thoughts or mental imagery have become increasingly common even among the usually serene and composed.

    What lies beneath

    It is undeniably true that we face very complex concerns that demand acknowledgment and realistic adjustments.  Yet emotional responses, particularly anxiety, speak of feelings rumbling deep beneath the surface of an outer constellation of seemingly unrelated symptoms.

    Simply treating a symptom may bring temporary relief but will do nothing to achieve more permanent emotional stability.  Anxiety can be used as a vehicle for visceral growth only when its dynamics are understood.

    A patient who’d just been pitched into the disequilibrium of a panic attack recently observed that most of the things about which he worries do not actually transpire, yet awareness doesn’t diminish his anxiety.  His worries unfold like choppy waves battering the beach: he’ll be laid off; he’ll crash his car and be unable to buy a new one; he’ll end up on a breadline, barefoot, singing a charmless version of “Buddy can you spare a dime.”  He won’t even be able to do that, because he doesn’t actually know the lyrics to “Buddy can you spare a dime.”  His humor cannot dispel the very real emotional disquiet he faces daily.

    Helplessness and stress

    My patient is flooded with distressing images of himself and helpless feelings about these images.  His body reacts with its own flood of stress hormones, muscle contractions, irregular breathing and heart rhythms.  He identifies this convergence of mind-body dysregulation as anxiety and attributes it to the economy.  While the economy does represent a palpably immediate context, the vulnerabilities of infancy constitute the real source of his anxiety.

    Roots in infancy

    Anxiety is a disturbing fantasy about what we fear might happen in the future.  In order to make dire predictions about the future, we require some point of reference in the past.  Without a past injury, we’d have no reason to predict another in the future.  Anxiety, therefore, is the confluence in the present of a prior injury repackaged as a future inevitability.

    The persistence of memory

    The persistence of memory

    One of my witty patients coined the phrase Terribilities to describe anxiety.  Terrible possibilities.  While somewhat paradoxical, the things we most fear in the future have already happened in the past, usually long before we were sufficiently developed to form concrete memories of our lives.  The “crash” my patient envisions looming in the indeterminate future actually occurred long ago, and he now expects another.

    Infant terror and adult anxiety

    Anxiety, as adults know it, doesn’t mature as an affect until we are toddlers and have begun to acquire an authorial sense of ourselves, a historical context in which to view our lives.  We must first develop the cognitive capacity to observe our contiguous past, present and future, experiencing ourselves as having permanence and constancy over time.

    The child can then recognize herself as the same actor in each of these phrases: I went to the park yesterday.  Today I’m in school.  Tomorrow I’ll go to the park again.

    Prior to developing these cognitive capacities, feelings and memories are not differentiated and are experienced and remembered only as unlabeled body sensations.  These sensations serve as prototypes for what will eventually become cataloged emotional feelings.

    An infant’s pleasant afternoon in the garden is not explicitly recalled as such, but the warm, relaxed state can be activated again and again whenever circumstances recreate a similarly agreeable environment.

    This early memory is implied by subsequent responsiveness to flowers and late afternoon shadows.  If this infant happened to get overheated or nipped by an insect, subsequent warm afternoons might send her scurrying indoors.

    Context generally determines how adults label physiological arousal.  An aroused state experienced before a wedding might be identified as joy; arousal experienced before an exam would more likely be labeled anxiety.

    Learning to regulate emotions

    An infant experiencing heightened physical arousal in response to distress feels only terror and helplessness.  Her body becomes dysregulated, and she is filled with panic and dread.  These sensations are the prototype for the emotion that will eventually be branded anxiety.

    The origins of emotional self-regulation

    An infant cannot regulate her own body-mind and can only return to a calm state when her needs have been met by well-attuned parents or caretakers.  A baby who is soothed learns to self-soothe.  She will manage anxiety-provoking situations later in life much better than the baby who was not; this baby will react to future challenges much as she did as a helpless infant.  She will feel powerless even if she is not.

    Portrait of Joanna Hiffernan

    Portrait of Joanna Hiffernan

    If an infant’s needs for soothing are rarely or never met, this transient state of heightened arousal will become a permanent character trait.  She will become an anxious child and later, a worried adult.

    Like my patient who fears breadlines, she will attribute her anxiety to whatever is transpiring in her immediate surround, but current events simply outline the monstrous shape of terrors experienced originally in infancy.  Anxiety, the inability of a child or adult to self-regulate, signals that the baby’s body-mind wasn’t sufficiently regulated by caretakers.

    Developmental milestones

    As a young child begins to amass explicit memories of her life, her whole world expands.  She can create a narrative about herself.  She can remember what she did yesterday and plan what she will do tomorrow, although her sense of time remains quite immature.

    A young child asked about the expected birth of a new baby is likely to say, “Oh, next week,” and though her timing is inaccurate, it’s clear she has begun to envision herself in an unformed future while remaining in the present and recalling the past.

    Expectations form a template

    If she developed a set of negative expectations during the years before she began to accrue explicit memories, the result of environmental trauma, her emotional template will reflect these deficiencies every time her vulnerabilities are challenged.  She will say, “I don’t know why I react this way.  It always seems to come out of the blue.”

    The wild blue yonder is really the intrusion of pre-labeled, emotional body sensations reemerging in the present.  Psychoanalytic therapy will help her find words for these body feelings, and she will acquire a greater sense of mastery over her emotions.

    Language promotes change

    When anxiety renders the inner world dangerous or overwhelming, people try to compensate by manipulating variables in the external environment in obsessive ways: they check the locks more frequently, or perhaps they become rigidly attached to judgmental opinions.

    Cleaning is often a behavioral metaphor for clearing the mind of painful clutter.  Unbearable anxiety may also be transmitted unwittingly from parent to child, replicating the parent’s original wound.

    Maternity-FULLIt is the parent who must bear the infant’s anxiety, not the other way around.  All these permutations represent desperate attempts to accomplish outside what requires mediation inside.

    It is common to see more rigid reliance on paranormal, religious or superstitious sentiments during stressful periods, as they temporarily explain and contain worrisome feelings.

    We make meaning from random events

    A common parable frequently intoned is that all things happen for a reason.  A more mature interpretation is that we make meaning from the random things that happen to us.  The former philosophy reflects the passivity of infancy, while the latter suggests a greater sense of personal agency.

    Hopeful psychoanalytic solutions

    To understand and regulate anxious feelings, we must work in the present to reconstruct the past.  By being curious about ourselves, we open up creative channels, giving voice to emotions that have ossified in the body.

    We tilt the body-mind configuration toward a more developed mind-body relationship.  Inflexible patterns are replaced by fluid thinking and feeling. This process is called mentalizing; feelings shift from the body into the mind where they can be fully examined and understood.

    Without first grasping the rudimentary origins of all human emotions in the flickering twilight of infancy, it is impossible to make significant changes from the inside out.  We do not shed the baby parts of ourselves like snakeskin, but we can learn to understand and manage them, thereby creating more space in which to develop new competencies and attributes that supersede obsolete patterns.

    As hope begins to replace doom, fresh solutions to life’s challenges avert repetitious spirals mired in the remote past.  Happy and sad memories can be recalled without having to be relived.

    This column originally appeared in the Orange County Register.

    Contact Dr. Heller at www.mlheller.net or 714/662-7975