High Functioning Anxiety

International Institute of Humanology :

Human Conversations

15 April 2024

Jessica Lockhart : Spain

Dr. Ayza Yazdani : Pakistan

Dr. Paul Hokemeyer : United States?

The following are the notes from Dr. Hokemeyer’s talk on high functioning anxiety with Dr. Yazdani of Pakistan and Ms. Lockhart of Spain on 15 April 2024

High Functioning Anxiety

Overview:

Anxiety is a clinical condition that causes emotional and physical discomfort as well as cognitive impairment. It’s typically accompanied by feelings of fear, dread, and a sense of overall uneasiness. Anxiety is different from fear in that anxiety is forward looking and anticipatory. Fear is based on what is present. Anxiety is based on what could become present.

From an evolutionary standpoint, anxiety served humanity well. It alerted us when we or the people we loved could be in harm’s way and motivated us to take actions to reclaim safety in an unsafe and chaotic world.

Over time however, the causes and conditions over which we have little to no control have expanded exponentially. While in primitive times we had to worry just about our immediate surroundings, today, by virtue of our global connections and the Internet, we are wired into the chaos and uncertainty of an unending stream of threats to our individual, collective and environmental wellbeing every hour of every day. We also live in a time when the very political systems and institutions that used to provide solutions to our individual and social ills are being attacked as unreliable by malignant narcissists who intentionally create chaos and disorder.

Central to the negative feelings and intrusive thoughts that accompany anxiety is our need for security, order, and reliability. Human beings hate uncertainty. We like to feel we have a sense of control over, agency and autonomy in the world in which we live. This is why many anxiety disorders manifest through obsessive compulsive disorders, repetitive behaviours and punishing discipline. They rob us of intentionality and cause us to live in a state of hyper-reactivity.

The human being in context:

My research and clinical work place my patients' treatment in three concentric spheres of their existence. These spheres of existence consists of:

1.??????? The Intrapersonal: How do they see themselves? What intergenerational patterns have impacted their physiology, their view of the world and their place in it.

2.??????? The Relational: Who are the significant people in their lives and specifically who has control over their physical, emotional, and financial wellbeing. ?

3.??????? The Sociocultural and Environmental. We live in a multifaceted sociocultural and environmental context that includes religion, economic class, gender, the environmental health of our local communities and planet, and the chances of class and economic advancement.

Taken together these three spheres add up to something known as a person's schema. These schemas the various lenses through which we view the world. In my work, this relates to anxiety in that people fall into two very different personal schemas grounded in the polarity of scarcity and abundance.

The first group are those whose schemas of are focused on a schema of scarcity. There isn’t enough of anything to make them feel safe and give them peace of mind and sense of place. As a result, they live in a heightened state of dread of the future. ?For these people, the acquisition of power, property and prestige is of paramount importance. These people typically come to therapy reluctantly. They know intuitively their anxiety is diminishing the quality of their lives and their physical health, but conceptually cannot grasp who or what they would be without their compulsive drive forward.

The second are people who have a schema of abundance. These are people who feel relatively safe and secure in the world. Surprisingly, these people do come to therapy, but do so to figure out how they can use the abundance of their lives to enrich the world around them.

Treatment protocol for people of wealth and power:

Since anxiety emanates from a mélange of issues which occur in the three spheres of our existence, so too must the treatment protocol. The treatment protocol I use with my patients addresses them in their body, mind, relationships, and world in which they live. It breaks down as follows:

1.??????? Physiology and neurobiology. My patients need immediate and tangible symptom relief. This is especially relevant for people who suffer from anxiety and will seek to self soothe in highly destructive ways. Today, I require all my patient to engage in some sort of alternative and complementary therapy such as acupuncture, massage, yoga, or meditation while we engage in the process of relational therapy.

2.??????? The second comes from the interpersonal aspect of talk therapy. I must model unconditional positive regard for my patients and give them space to come forward with the fullness of their identity. This is of heightened importance if these identities are divergent from the dominant cultural, religious or gender norms. From a psychodynamic perspective this is part of what is known as object relations. Our patients need to internalize me as a safe, reliable and trustworthy other. ?

3.??????? The third comes from an objective assessment of the world and culture in which my patients live. For example, religious, gender and sexual minorities too often live in a persecuted, hostile and life threatening world order. I need to be mindful of the realities of their world and come up with cognitive strategies for enable them to address these harmful forces in productive ways.

Conclusion:

?Anxiety is a complex phenomenon that has biological, emotional, cognitive, relational, environmental, and intergenerational roots. Effective treatment requires interventions that address the fullness of a person’s being to bring immediate symptom relief and rewire their physiology and neurophysiology. Second, effective therapeutic interventions must give them a relational experience where they can calm their limbic system and enhance their cognitive functioning. Finally, the work must be based on a reality and science based foundation. This is particularly important in our modern world that has become increasingly toxic and hostile.

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