Anguish and depressive crises

A frequent terminological confusion, which can lead to misinterpretations, concerns the definition of anxiety. Being distressed is very different from being anxious; while anxiety becomes pathological by excess, anxiety is in any case a state of discomfort, never of positive activation.

In terms of symptoms, it is a state of negative expectation with respect to future events, and not only a hypothetical pessimism, but the certainty that things will go for the worse without the possibility of intervention.

The distressed person is the one who feels that he has undergone a sentence from which he cannot escape and who lives in a state of oppression waiting for it to be fulfilled. The sense of helplessness makes the expectation even more tragic, rendering the subject helpless and leading to depressive crises. It is no coincidence that the clinical construct of anxiety finds in philosophical existentialism its definition of the inevitable human condition in the face of impotence towards chance and death.

Existential anguish is the clear derivative of the confrontation, however losing, between the individual and his limited existence without the possibility of change. Man has always devised ways to avoid such confrontation: from religious faith to the most refined self-deceptions.

For example, those who are forced to take responsibility for critical decisions often experience the anguish related to their outcomes: when a choice does not appear as the best, but one has been forced to make it, or because a more adequate one has not been found. , or because forced by others or by the situation, the expectation of the results can only be distressing.

Another condition, often a source of anguish, is that of someone who, after having made unsuccessful decisions, is again forced to make important choices and does not feel up to this task due to past experience. In this case, making decisions will be like making a forced suicide. The most frequent symptomatic counterpart of anxiety is a state of depression and a constant sense of oppression, with frequent psychosomatic effects and disturbed sleep.

Also in this case the solution of the discomfort cannot lie in a sedation of the physiological effects, but is represented by the change in the perceptions of condemnation that the subject experiences towards having to decide. Furthermore, in these cases the sedation limits the symptoms and inhibits the resources of the subject, triggering a further vicious pathogenic circle: I feel better, but I feel even more incapable because my reactions are off.

Never underestimate, as the essay says, that "only those who surrender are surely defeated."

George Nardone
(co-founder and director of the Strategic Therapy Center)
based on the book Fear of decisions (2014)