Friday, November 22, 2013

"Anxious Personality Disorder"

I’m thinking of nine former clients whose presenting problem was anxiety, whose fear – the original source of anxiety – had good solid reasons in birth or childhood, and who have remained fearfully developmentally immature in various ways.  A*, who could only make fleeting eye contact, had always been afraid of people.  By age thirty-one he’d stumbled his way through an uninspired college major and now followed the path of least resistance by getting cashier jobs.  He lived with an uncle who threatened on whim to cast him out.  B, seventeen years old and raised by an “old school” martinet father and an “always rushed” mother, works a roster of cleanliness obsessions and has the life sophistication of a fifth grader.  He’s never dated, assumes “everyone” finds homework “boring” and “flat-out” refuses to do it.  C, another obsessive-compulsive teen, has convinced himself that school is worth anything only to the extent it is “fun” and social; despite school has a near-reversed sleep cycle; and is faux-blithe and lite-fatalistic about his future.  D, mid-twenties and shaking like a leaf, lives with an unsympathetic relative, always feels he must give elaborate explanations of his behaviors, always feels he did something wrong, remains in thrall to his father who controls his money, and fears being abandoned by him if he were to get in trouble.  Like a surprising number of young lost souls, he is interested in pursuing a career in culinary arts.

E, pressed by her father never to bring attention to herself, has long been unable to stand up to any authority, is afraid to tap on the door of her uncommunicative husband, and by home-schooling her three daughters is cultivating hot-house flowers who don’t date, speak no unkind words and make no waves.  F, sexually abused by a neighbor child and ignored by his parents, now in middle age plays with nostalgic toys, fears people laughing at him, has a contemptuous son who shoplifts and steals from the family, and suffers floor-shaking psychomotor agitation.  G and H, young men, are in abject fear of their elderly fathers, have given up seeking employment owing to extreme psychosomatic reactions, live in the frail ivory tower of their thinking and worrying.  I, age sixty, suffers chronic anxiety, is scared to drive beyond her neighborhood, complains “I hate having to be strong for myself,” and nurses a reversal-of-parenting self-pitying rage about her adult son’s failure to love her.  “Why can’t he be loving?” she asks.  The notion that she, the parent, might be the magnanimous one is shot down.

By its Axis I status, anxiety is tacitly conceived as a “pure” problem – as if it struck an otherwise hale or lucid individual from the outside by traumatic event or environment or bad chemical – and not as if it were character.  But the clients described here show not only a disease incursion but a personality, as each one’s anxious dependency and immaturity are ego-syntonic, a term that means “in harmony with one’s self-view.”  Just as one would be hard pressed to find a Narcissist upset that he feels so good about himself, or a sociopath who wishes he had a conscience, so these frightened people do not hate their passive, or dependent, or non-mature natures.  Hatred might be power that laughs a cruel father into his corner, or a clean loud laugh that says I’m moving out and let the damned chips fall where they may.  Instead of hate, they timidly dislike, or even “love” and roll their eyes.

Fear has through the developmental stages kept them immature, and immaturity then keeps them fearful.  What do we make, then, of The Anxiety & Phobia Workbook and all the techniques that one applies, like lessons or lotion, to someone whose fear is an integral feature of their regressive development?  Are breathing exercises and “positive counterstatements” – “I am confident and calm about boarding the plane”; “I’m lovable and capable” – going to help a scared-to-death lonely child?

Later I’ll write about deep help for anxiety.  This will include the question: Can we “heal” immaturity, the loss of critical times and growth within us?


* Names are eliminated and identifying facts are discombobulated, yet I can picture each person very clearly.

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Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.