I have taken enough space and time in discussing anxiety conditions of the mind which may be regarded as more or less normal or in other words, most people, on occasions, get some kind of anxiety or other. I do not believe that there is any man who is free from all anxieties unless he is a corpse. There may be balanced men, but not anxiety-free men. Some may have more anxieties in life, others less. The difference lies in the degree only, not in the quality.
The same difference in degree differentiates the pathological from the normal anxiety. One shades into the other. It is not a new condition with new symptoms. It is a condition of excessive anxiety under normal or everyday conditions.
At the start there may be a difficulty in diagnosing a condition of pathological anxiety from normal anxiety. In fact I believe there are a large number of men who live in this borderline and do not consult a doctor for their condition but try to force themselves to believe that their conditions are normal. But when once the disease has advanced to some extent, there is no difficulty in recognising the condition.
On the contrary it is not often necessary for the physician to investigate it; the patients themselves diagnose their own disease and tell the physician so. The patient complains that he feels excessive anxiety in small things which other persons more or less ignore.
We know of “highly-strung” people, of “nervous” people, people who live always “on edge” so to speak, who feel and worry about things more intensely than others, who are shy and inhibited having an intellectual and a cultured appearance and a silent apologetic bearing. They are as a rule loved by others; but they do not love themselves. In fact, they do not know what to do with themselves.
Their interests may be varied; they know many subjects and keep a great deal of information about things in general, but still there remains a considerable surplus amount of interest which cannot be expended. It is like an amoeba throwing out numerous pseudopodia in all directions and catching only 2 or 3 food particles; the rest of the pseudopodia searching for others, but not finding any. This generates restlessness.
Restlessness–that is one of the cardinal symptoms of pathological anxiety. The patient cannot sit still. He must do something; and even after doing all that he wants to do, he finds no satisfaction. Ask an incipient case of pathological anxiety, “Can you sit still for 15 minutes without doing anything?” He will at once say “no, I cant.”.
That is the beginning of the disease. He starts smoking or chewing something to keep himself engaged. While talking with you he keeps on fidgeting with his tie or a button in his coat or handling something from your table, a pencil or a paper weight.
He uses a large number of adjectives to describe his condition. In fact, he may be a fine talker. I know of cases who can describe their condition so vividly and with such fine expressive language that their narration by itself is an art and you think that if this gift of expression can be applied in describing other things, your patient may become a literary star. They go on describing their symptoms, repeating the different shades of their feelings in different expressions and never seems to be tired of the repetitions.
If left to themselves, they may go on talking for hours, sometimes for 6 or 7 hours at a stretch with- out stopping, a peculiar phenomenon if you compare their communicativeness with normal persons. Evidently they seem to derive a pleasure in telling others their own feelings.
Due to the presence of this pleasure in communicating things to others, they develop a tendency to exaggerate things to make them more interesting. A snake 2ft. long may attain several yards in length to them. A dog becomes a panther. A crowd of 50 men may contain several thousands. This “stretching” is an interesting phenomenon in anxiety conditions and may affect the actual sensory perceptions about which I shall speak later in connection with “time” and “space” impressions.
The anxiety is generated from within the mind and when it comes out, it tries to attach itself to various situations, just as the pseudopodia of an amoeba try to catch food particles. It expends itself in one situation temporarily and then attacks another. It thus flits from one situation to another and is never satisfied.
Clinically we find that the patient complains, as I have said before, that he feels very nervous in situations on which other people do not spend much taught.
This inner anxiety may be projected outside or on his own body.
When it is projected outside, he feels very anxious and apprehensive in outside situations, such as a family litigation, an illness in the family, about his own job, the health of his wife or his child or his mother, his income, his business, in short any outside situation which has got anything to do within. There seems always to be an impending ruin threatening him all the time. At the present moment, during this war situation, I have known some men so much disturbed by the possibility of an air raid in Calcutta that they cannot get up from their beds. People laugh at them, but unfortunately they cannot help them- selves.
When the anxiety is projected on the body, he becomes very apprehensive of some serious disease which may attack him. He magnifies his own ailments and thinks that his minor symptoms are premonitory indications of a mortal disease. It is very interesting to note that practically all the most serious diseases are chosen for the anxiety to attach itself with.
They are (a) Tuberculosis (b) Leprosy (c) Cancer (d) Syphilis (e) Intestinal obstruction (f) Apoplexy (g) Cholera (h) Heart disease (i) Insanity. Of these it appears that the fear of apoplexy or high blood pressure, leprosy and tuberculosis is the commonest. A large number of quacks take advantage of this fear in their patients mind and instead of encouraging them to get rid of this kind of fear, they stimulate it and exact fees. You must have known one or two of your acquaintances very afraid of a particular disease.
He takes all the precautions to avoid it. If it is tuberculosis, he wouldnt go within miles of a tubercular sanatorium. He would get his chest and sputum examined repeatedly by a doctor, would suck a thermometer daily and examine his own sputum daily several times to see whether there is any blood in it or not. An ordinary cough or a slight fever would nearly kill him of fright and confine him to bed for days. Ask him something about tuberculosis and you are amazed to find that he knows many things in detail about it; much more than you know yourself. He has read all the available literature at home.
If it is leprosy-well, he may carry the thing so far that if a fellow called Wellington were known to have leprosy, he will avoid Wellington Street. Please do not laugh. He knows that his fears are very unreasonable, but he cant help it, just as you cannot help feeling miserable when you have got fever.
If you look at a thing through a convex lens, it appears big, which is not true and you know it to be an illusion. The same is true here too. The patient looks at things through the anxiety-lens and they appear big. He knows that the magnification is an illusion but it is there all the same. He has in his mind something which you have not.
It is the pathological anxiety condition of his mind which colours all his vision and estimation of things in general. There is thus a magnification of effects and later an irradiation of them.
As I have said before, the anxiety, in the primal stage of the disease flits from subject to subject. In the later stage of the disease, when the anxiety has increased, it can find no more subjects and becomes a “floating” anxiety in the mind. The anxiety, so to speak, remains in a floating condition in the mind, a cause-less anxiety. This is an interesting phenomenon. If you ask the patient “what is the reason of your excessive anxiety?” his answer will be “I dont know; but I feel restless and anxious.”.
You have known this condition of anxiety in association with certain physical diseases, mostly fevers. There are people who feel very restless during a febrile attack while others stay quiet and do not like to be disturbed. But when there is no fever, in fact, no physical cause whatsoever, this “floating” anxiety appears strange.
It is a very painful condition. The patient cannot concentrate on anything, looses all interest in work and there is such a terrible restlessness in him that he may move his arms and legs aimlessly and may even cry, not knowing what to do with him- self. His mind all the time remains perfectly clear. He does not know what is the matter with him and believes that he is getting insane.
He cannot make others understand what is wrong with him. There is insomnia and loss of appetite to the extent that the patient rapidly loses weight and gets emaciated and may even be altogether bedridden. There is generally a morning aggravation of the symptoms. Towards the evening he feels comparatively quieter.