Thursday, July 26, 2012

Fear of the Unknown

A theme that has been coming up among my clients this week is fear of the unknown. Specifically, several of them who are "stuck," immobilized by their ambivalence about recovery, have identified the fact that they don't know and can't imagine what recovery might be like as the strongest force pulling them away from recovery efforts.

While everyone may experience different versions of it, I think we all share this kind of fear of the unknown. The whole fortune telling industry banks on this anxiety, and our willingness to spend money to make life more predictable. The thing is, life is inherently unpredictable, and seems to delight in proving that to us.

And here is the other thing: even when we have every reason to expect a positive outcome, we still experience the fear. For example, one of the ways I have tried to assuage my clients' fear of recovery is to remind them of other people's stories of what recovery is like - both the stories of people they may know, and stories that have been published in popular recovery books. However, while such stories may temporarily raise overall sense of hope that recovery might be possible and positive, they don't erase the fear.

The fact that fear continues regardless of efforts to cognitively talk oneself out of it suggests that this kind of anxiety is not cognitive at all. In fact, although I rarely subscribe to Freudian theory, I think he may have been onto something when it comes to anxiety. Freud identifies five types of anxiety, associated with stages of development:
  1. The first kind of anxiety which infants experience Freud called automatic anxiety. It is a reaction to stimuli that are perceived as threats beyond the infant's control - things that cannot be escaped or regulated. Ego psychologists have renamed this kind of anxiety annihilation anxiety. They argue that "infants experience these terrifying moments at the level of excruciating organic distress, accompanied by inchoate fears that overwhelm them" (Berzoff et al., p. 81), in large part because they have not yet developed a structure of defense mechanisms to assuage their anxiety.
  2. The next form of anxiety that develops, in early childhood, is separation anxiety, or fear of abandonment. It is less intense than annihilation anxiety, but still quite intense, since young children depend upon adults for their very survival.
  3. The next level of anxiety involves fear of loss of a caregiver's love and esteem (fear of rejection). It shapes children's behavior by motivating them to adhere to rules and limits set by caregivers.
  4. The fourth level of anxiety Freud termed "castration anxiety," but modern theorists have renamed fear of bodily harm, or loss of valued physical or mental capacities. It is understood as "projected fear of retribution for hostile wishes against a parent" (p. 82).
  5. Finally, the fifth stage recaps the four earlier stages, this time triggered not by interactions with the caregiver, but by internal interactions between the superego and ego.
While I have some skepticism about the latter two stages, I have observed the first three to be common ongoing concerns for people at various ages and stages of development; therefore, I can easily believe that they might be universal.

I also suspect that they have something to do with our fear of the unknown. My theory is that the unknown becomes a projective test of our deep-seated anxieties. In the absence of evidence or data about the nature of what will come (which is, after all, the definition of the unknown), our psyche runs through its repertoire of worst fears. Thus, when clients are able to explore their fear of the unknown, common themes that come up include abandonment, rejection, loss of capacity, and even annihilation.

So, where does that leave us - clients and therapists alike? Recognizing these core fears and their developmental basis does not necessarily make the fear go away. And when it comes to fear of the unknown, the only true antidote is to turn the unknown into the known. That means "feeling the fear and doing it anyway" - accepting the experience of fear, exposing oneself to fear without avoidance, and guiding our choices and actions by our values and goals rather than our emotions or worry thoughts (sounds a lot like ACT, right?).

How do you think about the fear of the unknown? How do you respond to clients' fear of the unknown?

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