Anxiety as reaction to psychic pain


Although according to MACHLEIDT and others rage and anxiety are not direct inversely related in the electroencephalogram, their mutual relationship cannot be ignored. The two feelings are either intermingled or they are in competition with each other. 

Similar to the difference between secondary pain and grief, a crucial difference between anger and fear is that anger urges expansive aggressive action, whereas fear (in response to the same stimulus) leads to passivity and restraint even to paralysis. Analogous to secondary anger, we can distinguish secondary fear from corresponding primary feelings.

The meaning of fear

While modern management strategies are concerned with how I can best fight fear and thus disarm it, VERENA KAST, as a student of C. G. JUNG, looks at fear from the final, future-oriented perspective of what for: What does fear want from me? What is there to learn from it? What blind spot is to be observed? The physically perceptible obstruction and constriction of my sense of life by feelings of fear could show me the way to self-knowledge and expansion of consciousness. The constricting results from the fear of possible loss is reinforced by the feeling of not being able to respond.

KAST sees liberation in the courage to hope, in forward-looking perception and realization of the meaning that is inherent in fear. We best redeem everyday fears, which are often perceived as annoying and insignificant, through active doings, by consciously facing a situation that may only be subjectively difficult and daring to walk through it.

Deep psychotherapy makes it possible to get in touch with the meaning of stronger fears and to release the suppressed life energies. 

Everyday fears are often repressed

This awareness-expanding approach does not correspond to the habitual way of dealing with everyday fears. Typically, successfully socialized adults use less confrontational strategies to “face” their fears: they are explained away, positively “ignored” or simply repressed.

Since everything repressed has a tendency to make itself noticed, for example in nocturnal dreams or in the form of unwanted bodily symptoms, it sets in motion the cascade of repression, which in a vicious circle makes the fears or secondary symptoms even worse. Addictions often set in; then a wide variety of drugs and medications shall take care to ensure that the anxiety does not penetrate the consciousness. 

For the existential philosophers, the meaning behind human anxiety becomes the key to their worldview: when, in the experience of total insecurity, all external support disappears, we are thrown back on ourselves.

Anxiety – a fundamental emotion

For the existential philosophers, the meaning behind human anxiety becomes the key to their worldview: when, in the experience of total insecurity, all external support disappears, we are thrown back on ourselves. For the existentialists, anxiety forms the fundamental human emotion.
When man faces nothingness, he also experiences himself as an absolutely individual human being, as a human being who for that moment is not in a relationship, but as a human being who must be anxious about his individuation. By facing this fear, meaning breaks open.

KAST, however, points out the drawback of existential philosophy:
This view is problematic insofar that joy ultimately is supposed to be merely a defense against fear … But that would be a repulsion of the living.” 

For me the existential philosophers’ “way of looking at things” is an indication to where the insistence – that the level of the secondary self is the only human world of experience – can and must take us: To the loveless cold world of imagined reality. The fact that someone has no primal trust because he has not come into contact with it or has “forgotten” it through later traumatizing experiences is no proof that this primal trust does not exist.

If the inner and the bodily experience are considered as secondary phenomena, we are inevitably left with abandonment anxiety as a basic, unbearable feeling which, being repressed, is often only perceptible in bodily tensions. If we understand these bodily symptoms as signals of an existing but blocked life energy, we take courage, we take the old longing seriously, face the fear, and seek a way beyond it to rediscover our buried primary self

By accepting our fear, even if it may be interpreted by our ego as an offending admission of personal failure, we have already gained much: We are able to escape the dictates of performance society by dissolving the repressions. By confronting fear it becomes tangible, allows us to look at it more closely and reveals its hidden meaning. 

forms of anxiety

Similarly, as aggressiveness is more elemental than the psychic feeling of primary rage, we find fear to be a primary anxiety. Fear is a signal necessary for survival; a child who fears nothing is unlikely to grow old, all too many deadly dangers lurk in traffic or at home. 

In addition to learnable and foreseeable situations of threat to which situational fear adjusts itself, there are situations in which the sensory perception passes an object (not yet clearly grasped cognitively) directly to the amygdala without being processed. In this case the human organism reacts immediately in a panic-like manner. This form of the panic reaction seems to be innate and is triggered e.g. by snakes in a flash. Both the triggering and the reinforcement mechanism seem to be different from the panic described later as a secondary emotion and proceed largely reflexively. Panic triggers a flight response. In contrast to aggression – which leaves me as the acting person with some control over my situation – I am now barely able to act.

primary psychic anxiety 

The non-availability of the person of attachment (Bezugsperson) is experienced by the infant as life-threatening and produces elemental feelings of anxiety. This first experience of deprivation of love already is precognitively anchored in the body memory. It is a form of mental processing that begins very early. 

Even greater is the early childhood fear of being killed by one’s own mother; it is also an existential primal fear of the human being. According to in-depth research by lawyer and psychologist ANNEGRET WIESE in the context of mothers who have killed, this fear still affects an overwhelming part of adults in an unconsciously deep way.

Apart from the fact that infanticide was legitimate in many cultures and is still more or less silently tolerated in some – and even more so practiced in a myriad of voluntary abortions every day – sufficient grounds for such fears arise from the complete dependence on maternal care on the one hand and from the fact of unconscious rejection of the child by the mother on the other. 

As indicated for their reaction to pain autistic infants also seem to exemplify a model situation in connection with the mode of their action towards fear: BRUNO BETTELHEIM points out the paradoxical situation “that autistic children do not seem to feel pain, but that their fear of pain releases almost superhuman energies in them.” This loss of pain perception in the context of feelings I describe as a “package deal” .

The relation of primary anxiety to psychic pain

The enormous energies of psychic pain can take the form of an exorbitant, all-destroying rage. However, if a certain resignation or “insight” has already set in regarding the life-threatening effects of one’s own actions, the result is an elaborately ritualized apathy (athymia) that withdraws more or less active from all living activity.

Autistic children do everything not to hear, not to smell, not to see, respectively not to be forced by any external stimuli to act in a self-defeating way. Perhaps here, too, severely autistically disturbed children show behavior that represents a relatively pure, original form of emotional development: In addition to the extreme behavior of “powerless, all-destroying rage” these children soon develop an overpowering fear that permanently determines their entire existence, which eventually leads to the avoidance of all contact with people – an absolute must. 

The underlying extreme aggressiveness seems to be wiped away, BETTELHEIM writes:
The way the autistic child totally avoids relationship with others is characterized by the non-existence of visible hatred. Also such hate can not be inferred from such open behavior, since this behavior makes only one thing visible: the autistic child’s deep disappointment in relation to his fellow human beings …

Why am I so sure of myself when, in contrast to other authors who assume that communication is non-existent, I claim that the autistic child does know the relational systems of love and hate?

The reason for this is to be found in the fact that in every case in which we have penetrated deeper, we have encountered extreme and explosive hatred. Behind this hatred however, there was always hidden the constantly disappointed desire, which was admittedly not abandoned – a desire that was now encapsulated in repression with the aim of preventing its becoming conscious and the unbearable pain associated with it.

The reversal of the emotional state in the course of a successfully conducted therapy seems to me significant: “In fact, the autistic child initially releases blind hatred and senseless rage when he comes to believe that change is possible and when his feelings begin to defrost.

It may be presumed that it directs these feelings against the only available object – the self, which becomes the victim of its suicide attempts. Thus autism is an even more extreme position than suicide and suicidal tendencies are the first step toward a new activation.

The repression of all feelings

In this – according to BRUNO BETTELHEIM legitimate course – I see a confirmation of my model of the development of feelings: the intense pain of the absolutely dependent infant over early deprivation of love ultimately leads to the repression of all feelings (athymia). This deficit of feelings is a feature of early disorders. The process is as follows:

In the beginning there is a deep disappointment at the loss or complete lack of the possibility to relate in a loving manner. As long as there is still a hope the child tries to “get his right way” via his rage outburst. 

In the resulting resignation, under the pressure of a situation experienced as existentially threatening, there is extreme anxiety and consequently repression of all feelings (athymia). 

When in the course of years of patiently enduring therapy overcoming absolute distrust – when the all-determining fear gives way to trust towards the empathic reference person, i.e. the therapist – the feelings gradually defrost. The first reappearing is the senseless rage that has lost none of its explosive power over all these years. 

secondary PSYCHIC fears

If we do not react reflexively when a situation that frightens us occurs – if we “keep it cool” – we wait for the neocortex to process the sensory impressions and perhaps realize in retrospect that our first, still diffuse assessment was wrong. On the other hand with this delay we risk losing valuable seconds. 

However with increasing cultural development the conditions have become more and more “neutralized”, less threatening. The risk of losing life-saving time by deliberate waiting became less likely; correspondingly the purposeful use of mind has become more reasonable.

However, this also has a downside. The more we evaluate in our imagination in a threatening situation all the pros and cons, the greater is the risk that processes will take on of their own that no longer have anything to do with the immediate occurring situation.

The feared situations are like rehearsing acted out as mere games of thought. As long as this fantasizing relates to possible life-threatening situations, it has proven helpful in the sense of rehearsing emergency situations. What is worrisome is a possible independence of this process when the fantasies are not devoted to fear physical threat but to fear losing your face, the fear that the role in which I want to be seen (as my secondary self, my ego) will not be accepted by my vis-à-vis. 

Fear of abandonment and extinction

Because – we as socialized adults usually identify with our secondary self – secondary anxiety corresponds not only to the anxiety of abandonment (which is existential in primary anxiety) but even more consistently to the anxiety of extinction of the secondary self. This corresponds to an existential threat in the psychic realm, which is experienced as extremely dangerous.

To no longer belong to, to be outlawed, often corresponded to a death sentence in traditional societies, not only psychologically. Thus, this form of psychic secondary fear is also ultimately the fear of existential deprivation of love and thus moves close to the corresponding primary feeling of the infant. 

In people who did not experience such threatening extreme situations in early childhood (as for example autistic children) or who were able to cope with them in a more assimilated way, the elementary emotional reactions are refined over many educational steps and the mechanisms of fear run in a more complex way. Memory and consciousness take on enormous importance in the context of decision-making: evaluating situations within fractions of a second is connected with more or less intensely imprinted reflex-like “emergency programs” that can be helpful but also disruptive, depending on the environment and momentary state of mind. 

basic forms of anxiety

In his classic presentation “Basic Forms of Anxiety” FRITZ RIEMANN describes four basic fears. He relates these to four basic human types, who are characterized by their fear of engaging in any of the four directions of development which he described as fundamental:

  • The fear of giving your self
    experienced as a threat of ego loss and dependence
    (schizoid personality) 
  • The fear of becoming a self
    experienced as a threat of insecurity and isolation
    (depressive personality)  
  • The fear of transformation
    experienced as a threat of impermanence and uncertainty
    (obsessive-compulsive personality). 
  • The fear of the necessity to surrender
    experienced as a threat of ultimacy and lack of freedom
    (hysterical personality).

Depending on the intensity level of their strategies to avoid, harmless shifts in mental balance, neurotic behavior in the sense of mild phobias, compulsions or depressions or even severe neurotic or psychotic disorders occur.  The stronger the emerging pathology of anxiety presents itself to the observer, the less the anxiety itself seems to be visible, either from the outside or more importantly, to the sufferer himself. The symptoms and the externally visible behavior are characterized precisely by the fact that through them the underlying fear is to be concealed, compensated or repressed as effectively as possible.

In my opinion all four of the described forms of anxiety are closely related to a lack of loving affection. From a developmental psychological point of viewthis means:


For schizoid individuals their tendency toward independence primarily serves to avoid the risk of closeness and thus the possibility of being left alone again, of experiencing hurtful rejection again. 


The depressed individuals sacrifice themselves entirely for “the sake of others” in their effort to obtain the love of others that is considered existentially necessary. Thus they hope to escape a looming deprivation of love with its extremely painful consequences. 


The compulsive individuals do everything in their power to prevent changes that might shake their frozen world or perhaps wholesomely shake it up. In doing so they avoid change in their emotional lives, especially in their relationships. Again, this ultimately is about the fear of losing love.

It goes back to early socialization when demands and prohibitions were imposed on the young child, of which refusal was threatened with deprivation of love. Rigid adherence to commandments and prohibitions protects against this. Fear of change becomes the all-determining theme of life. 


In contrast, in hysterical individuals fear of loss of freedom, respectively fear of commitment, of being “forced to love,” is the central theme. In the extreme, this attitude has a paralyzing effect in phobia or an apparently invigorating effect in an overreactive flight forward. The lack of commitment has arisen from parents with whom the child could not identify and whose love he was only able to obtain by manipulation.

The connection between hysteria-conforming behavior and the pursuit of love becomes clear in the following diary excerpt of an adolescent, quoted by RIEMANN:
Be sick and your mother will take care of you, be healthy and ‘normal’ and people will take it for granted. Therefore: be refined, play theater, on the one hand give the people what they want to have – a sunny girl, a child perfect for representation, who radiantly embraces everyone and is called ‘sweet’ – to on the other hand also get you what you need. And if they don’t love you for what you are and you can’t reach your goal for being loved, you force them to worry by your actions.

Further references to secondary anxiety

Anxiety and frustration 

In conflict situations the ego-strong person takes the choice of actively addressing the conflict; he acts because he has learned the ability to assert himself.

People with a poor frustration tolerance dodge into a behavior of avoidance. The cause of these strategies to avoid conflict is the fear of losing love, which is feared when a conflict is aired openly. 

Fear of living means
Fear of loving

The actual fear of living and the fear of loving result from the sum of many individual experiences of frustration. The social phobics, i.e. people with relationship fears, already make up 15% of the population in our latitudes.

Social avoidance behavior is associated to a high degree (70-80%) with secondary disorders such as depression, agoraphobia, suicide, alcohol and other addictions as well as crime. Those are connected to repressed anger, to which aggression has transformed itself. In an open confrontation, it would have found its outlet, which would also have led to a constructive solution if the “culture of dispute” had been well developed. 

Frequently, only a prolonged psychotherapeutic treatment brings to light the fears underlying the psychological and physical secondary symptoms and finally the repressed anger. At this moment there is an increased risk of autoaggressive acts such as suicidal impulses. 

Fear of losing control

Underneath feelings of anxiety there is often a hidden massive anger, an anger that, because it has been accumulated for a long time, must constantly be kept in check, under control. If the pressure of aggression is so strong that the risk of a spontaneous outburst of anger increases, this generates anxiety about losing control.

The possible effect of a “bursting of the dam” is perceived as so threatening that control has to be reinforced even more. At the same time fear increases. And behind the repressed anger lingers the pain of early deprivation of love, which is much more difficult to bear. That under these circumstances chronic fears may develop does not surprise. 

Secondary fears as consequences of socialization

We “civilized” people live under the spell of secondary fears. Immediate physical threatening situations, which could give rise to direct fear are indeed many. But in most cases they only can be vaguely experienced with our senses. Vaguely, because situations – such as those brought about by the enormous speed in everyday traffic (which in the past would certainly have brought us death – and would have been classified as extremely threatening to our tribal experience) must be continuously repressed for “practical considerations”.

For many truly life-threatening conditions, such as radioactive contamination or for the extent of toxicity of chemicals which we use as daily additions, we do not possess any sensorium at all that would alert us to a threatening danger. 

Secondary fears are expectant fears that relate to a current situation only insofar as it is a medium for projection. They are conscious or even more often unconscious memories of similar situations that we fear might come back to haunt us and then, if possible on an even more terrible scale.

This fear is also experienced as unpleasant on a physical level. However, we rarely give account to the roots of these sensations, which we experience at most indirectly as tenseness, nervousness, a depressed mood or inexplicable irritability. That these bodily symptoms might be expressions of anxiety remains hidden. 

Fear as engine of “progress”

One aspect of secondary anxiety that remains to be pointed out is its function as an engine of progress. The more we have to lose, the more we have to fear for our possessions in our Western world shaped by the “have” philosophy. With great ingenuity we promote economic growth, which is indispensable if our standard of living is to be maintained.

The fear of transience and death that hides behind the youth mania drives even the successful into an ever harder gear, while the “failures” are caught up, overrun and finally drowned in fear. Pharmacological research then provides for a remedy. 

Anxiety as a trigger of panic and depression

The secondary psychic processing of anxiety is a crucial factor in the development of panic. In stressful situations, above all when experienced by imaginative and sensitive individuals who lack a reliable body connection, this may take on a life of its own: a past fearful situation is remembered and imagined as even worse to come.

The reaction loop subsequently leads to a complete breakdown of the nervous system: the contact with reality is lost. We no longer perceive our body while the brain is flooded with imaginations. What is fatal about this is that we no longer relate to our body-related resistance and defenses. In extreme cases panic is the result. 

If this state persists at a less intense level, we sink into crippling passivity: we become depressed.

This derivation of panic and depressive states from life-history causes is questioned by modern bio-psychological research, but by no means invalidated. Even though connections between the deficit of neurotransmitter substances (especially norepinephrine and serotonin) and the excessive production of neuropeptides (especially the corticotropin releasing hormone CRH) have been elucidated in molecular detail, the influence of early traumatizing life experiences is undisputed. The fact that serotonin reuptake inhibitors (SSRIs) are effective in both, depression and panic, points to the close connection of the two phenomena. 

A point of reference is also found between the response patterns of autistic children and the behavior of depressive individuals in therapeutic situations: Both, autistic children, who have repressed the strongest feelings of anger and severely depressed people go through a dangerous phase of suicidal threat when improvement begins to occur. If, seen from the outside, they have already got over the worst, they are increased susceptible to an act of suicide; at the moment when they find their way back to life from depression and thus inevitably also to the vehemence of their repressed anger

Dr. Kurt Eugen Schneider
Dr. Kurt Eugen Schneider