Empathy and existential anxiety by John Hayes

Existential anxiety, also referred to as death anxiety, has recently become the focus of much attention in the worlds of counselling and psychotherapy.

One of the most high profile psychotherapists, Irvin Yalom, dedicates his most recent publication to the subject. But how relevant is it for hypnotherapists who are using short term, solution focused approaches to treat circumstantial and trauma related anxiety?

As hypnotherapists we all treat some form of anxiety. Indeed, some therapists believe that the majority of psychological disorders have anxiety at their core.

Yet, not much attention has been given to existential anxiety, perhaps because this primordial angst is not something we can really treat, certainly not in the short term. Rather, it is a condition we reflect on, acknowledge and try to embrace as best we can. Is it possible, however, that by incorporating existential anxiety into our therapeutic world view we can better position ourselves in relation to our clients? Can an understanding of it help us to better limit the effects of transference and sabotage? Can it provide us with a "big picture framework" in which to place more personal and treatable anxieties?

Whichever conclusion we arrive at, what exactly is existential anxiety and how do we deal with it?

Existential anxiety, is the natural consequence of our underlying awareness of the precarious, fragile and finite nature of existence. It is the dread of death.

Deeply embedded in our unconscious, it stirs up certainties so dreadful that even were we able to uncover them, we would perhaps not wish to. I have witnessed this core anxiety erupt through to the surface only once. It happened to a terminally ill and immensely courageous friend of mine for whom exhaustion momentarily stripped him of his usually robust line of defences and revealed the dark thoughts and primordial desires of a truly amoral and vicious childlike self. It was a harrowing experience for both of us. Perhaps, then, only by shifting our attention to the fears and desires that enflame the embers of this primitive fear can we glimpse it, just like certain stars can only be glimpsed by diverting our gaze away from them.

What attracts me to the idea that at the core of all anxiety bubbles this universal insecurity is the implication that we are all united in a mutual quest for permanence, meaning and purpose. We all crave to connect and break free, to belong and to feel unique, to control and let go. And to cater for these yearnings we each strive to create an internal safe space that allows us to be moved by our feelings without being overwhelmed by them.

Like other practitioners with a core training in solution focused therapy, hypnotherapists are not expected to tackle the existential dilemma of existence.

This task lies in the realm of long term therapy, philosophy and religion. Most hypnotherapists, however, acknowledge that in order to work effectively with anxiety related conditions, it is essential to be aware of one's own anxieties, limitations and biases, both as a practitioner and as a human being. After all, we have all had our safe spaces jeopardised in some way, whether they be the beliefs we adhere to, the groups we belong to or the homes and bodies we inhabit. And we all finally succumb to death. Likewise, we all exhibit behaviours associated with feeling anxious, such as behaving obsessive-compulsively, being possessive or over-defensive, talking too much or saying nothing at all.

That which separates one person from another is often merely the intensity and duration of the symptoms. It is simply a matter of degree. We all suffer from anxiety, have all suffered trauma and have all reflected on our own mortality. Of course, not all clients seeking help from hypnotherapists for anxiety related problems do so with a conscious desire to heal old wounds, reassess worldviews or ponder the meaning of life. Rather, they seek help for much more prosaic reasons such as fears associated with driving, public speaking, emotional and physical intimacy. In such cases, one of the aims of the hypnotherapist is to uncover the event or set of circumstances to which these apparently harmless triggers are connected and to “unhook” them from one another in order to allow for more positive, life affirming patterns of behaviour to evolve.

However, beyond each personal trauma related anxiety lies the universal anxiety of existence. As with trauma related anxieties, we tolerate existential anxiety by embracing beliefs and identities that empower and protect us. The way in which these beliefs manifest themselves, how constructive or destructive they become and the level of dependency we have on them will depend on our self-awareness, our genetic history and our personal experience. This is not to say that these beliefs are merely the product of a desire to keep safe. They are also necessary and positive components for successful social interaction and personal growth. Although these safe spaces are accessible to all of us, we each acquire or inherit a tendency to use one more than another. The following are, I believe, among the most common. The neurotic tendencies of the individuals I have used as examples are solely to help highlight the implications for therapy. They are not meant to give a negative view of the beliefs.

Believing we are special and invincible

This belief that we are superhuman was clearly illustrated to me by a client called Mark who sought to overcome an anxiety provoked by physical intimacy.Mark formed his safe space by embracing the belief that a unique destiny awaited him which precluded him from the natural laws that applied to everyone else. He was, in his own mind at least, special and invincible. The precise nature of his specialness and invincibility was more intuitive than explicit, but his belief enabled him to temporarily side-step his anxieties about the fragility of his own existence. It also endowed him with a uniqueness and selfassuredness that many woman found attractive.

So well did this gigolo personality deflect away from his fragile existential core that, once he had lived out his limited repertoire of fantasies, there was little to intimately connect him with his lovers. He felt empty, alone and disconnected. And if anyone did threaten to reveal his deep insecurity, he panicked and moved on to the next woman. Time, however, gnaws away at even the most beautiful surfaces, and no matter how obsessively he plucked out his grey hairs, moisturised his sagging skin, avoided mirrors and surrounded himself with youth, it became increasingly difficult for him to collude with the illusion that he was special and invincible. Eventually he would either lose himself in fantasy and denial or something would happen to pierce the surface and touch his mortal self. This something would connect him to every other mortal in a way that would make him common, mundane and the same.

Belonging to something that has the potential to live forever

Embracing this sameness is another way of coping with the dread of death as it provides us with a sense that we are part of something that does not depend on the limited resources of a single individual. This desire to belong was particularly strong in a client called Eddie whose self-esteem was joined at the hip to the fate of the football team he compulsively supported. So strong was his association that he could not bear to watch his team play unless they happened to be winning. Not all of us support a football team, certainly not to the extent that the teams’ fortunes determine how we feel about ourselves. But we all identify with one group or another whether it be our family or country, gang, club, belief or political party.

By identifying ourselves with such groups, we not only get to belong, we gain safety in numbers and a recognized identity. We can bathe in vicarious success, bask in reflected glory and console one another in defeat. However, unlike the solitary, invincible Mark, group members cannot orchestrate their own individual fantasies and outcomes. There is always an element of powerlessness, because no single person can control the destiny of the group, just as Eddie could not determine whether his football team won or lost. His only certainty was that sooner or later the football team would lose, just as all families eventually sub-divide, armies get defeated and trends become outdated. Only when an individual happens to be the leader of the group can they belong and control. Whether this control is total, shared or conditional, whoever takes on the mantle of group leader will invariably be considered by the other members as being different, separate and special, but not invincible.

Investing in an afterlife

Another way of creating a safe space in order to better tolerate the finite nature of existence is to believe that a part of us exists that is not susceptible to the same vicissitudes of time that causes our physical bodies to wither and die. In other words, to believe in heaven or hell, or some other domain or dimension into which our soul or spirit is transported after life. This belief provides specialness, belonging and immortality. Implicit in this belief is that our progression into the afterlife is somehow determined by our actions in this one, whether they are moral ones judged by an omnipotent divinity, natural ones weighed by the indifference of karma or universal ones imposed by the creator of some inter-galactic experiment. Sometimes these “afterlife” conditions lie at the heart of individuals whose sexuality, independence and self-determination are strongly influenced by moral boundaries and a desire to be rescued.

Subscribing to the "game of life"

An alternative to investing in an afterlife is to embrace the world-view that human beings are simply evolving biological entities whose destiny it is to be born, procreate and die in order that natural selection through the survival of the fittest play out the possibly meaningless game of evolution. By adhering to this world-view, we accept that it is our desirability, potency and resourcefulness that determine how well we do. And doing well in the “game of life” means acquiring territory and desirable mates in order to ensure not only our own survival, but the continuation of our line and the survival of the species.

This primordial urge to seek pleasure, mark out territorial boundaries and climb to the top of the pile lurks within all of us. Womanizers are certainly driven by sexual urges, even if socio-economic factors mean that they are usually careful not to actually sire any children. Those who have suffered physical, sexual or emotional abuse are often victims of individuals who are unable to control their own urge to dominate and possess. An unmet need to feel worthy and potent can drive some people to seduce strangers in bars, even if it is emotional intimacy they crave as well its physical counterpart. An inability to reaffirm our desirability and potency can prompt self-esteem to plummet and anxieties about our place in the world to surface.

Creating extensions of ourselves that live on after we have gone

An alternative to relying on winning the "game of life" to secure our permanence in this world is to create expressions of ourselves that continue to exist after we do not. For example, we can have babies and write books that carry our name. We can feature in films and, in the eyes of others, remain the same age forever. We can set records that lay testament to our deeds and live on in the memory of others. Anything, in other words, that provides us with lasting status and reputation. Some of our self-creations echo indefinitely in the halls of fame. Most end up in the attic or on a rubbish tip, by which time we no longer require the illusion of permanence.

Believing in cyclical or multi-dimensional lives.

That which one person views as illusion another views as an alternative reality. This shamanic or spiritual world view allows us to embrace the notion that a part of us resides in the realm of the transpersonal where dream logic, vision-logic or dialectical logic coexist with rationality, formal logic, and the evidence based Dawkin reasoning behind evolution. For those who believe in these subtle emotional dimensions in which lives reincarnate or coexist simultaneously outside time, "death" is a less frightening prospect.

Falling in love

Romantic love, as opposed to parental love, sibling love or the love between friends, can prompt us to feel whole or complete so long as our attachment to the object of our affection remains unthreatened. Whether it is fuelled by a desire to return to some symbolic union, to reunite with a lost soul mate, to recreate the early mother-child bond or to recapture a lost memory of life in the womb, being in love enables us to feel an attachment that can seem impenetrable and death defying. For a great many of us, however, this state is not sustainable. Our fear of separation sabotages our special bond, our perfect vision is intruded upon by the rest of the world, and our state of bliss either fragments into one of despair, grows into something far deeper and more durable, or fixes our gaze on a new object of desire.

These, then, are just some of the drug free ways we can more securely live out our lives while being aware of the finite nature of at least a part of our existence.

Which ever of these beliefs and identities we adopt, far from suggesting that they are merely necessary illusions, I present the view that they are essential elements of any relatively anxiety-free individual. I also choose to take the view that they are all real in the sense that personal experience cannot, ultimately, be denied. So long as our beliefs work - they provide stability to us as individuals,
to the group we belong to and to the environment we inhabit - no-one other than the believer is in a position to verify or deny their "truth".

Certainly, in my experience as a practitioner, those individuals with consistently high self-esteem and low anxiety levels manage to embrace aspects of them all. Those who cannot evolve these sustaining beliefs have little or no protection from existential anxiety, which can then manifest as deep depression. The inability to sustain meaning can lead to self destructive behaviours that ironically embrace the very death we originally feared. Most of us avoid this extremity and try to achieve a balance between conflicting physical, emotional and spiritual needs.

We endeavour to fit in to groups and commit to meaningful relationships while at the same time holding on to our individuality and independence. We strive to satisfy our desires without compromising our integrity. That which prompts our clients to seek help may not be a conscious desire to examine life's imponderables, but the way they deal with these bigger questions will inevitably influence how they deal with the personal and circumstantial.

As hypnotherapists, the tools we use to treat personal, trauma related anxiety include internal dialogue, regressions and progressions, direct and indirect suggestion, reframing exercises, analogy or metaphor. For any of these to be effective, it is essential to be able to empathize as best we can with the client in order to gain rapport, inspire trust and engender willingness. By having a broader understanding of existential anxiety we are in a better position to achieve this rapport in a genuine and humble way. It also challenges the traditional power structure in which hypnotherapists are often placed in the role of magical healer, a role which, if not challenged, can disempower the client.

Incorporating the idea of existential anxiety into our professional world view puts us all on a more equal footing and allows us to view personal anxieties simply as alterations of a common primordial insecurity. Our awareness and understanding of our own existential anxiety also reduces the risk of transference and counter-transference sabotaging the therapeutic process as it affords us a broader, more comprehensive perspective. Naturally, we cannot stop transference taking place, we can only be aware of it.

Anything, therefore, that increases empathy and self awareness helps us to monitor and work with transference more effectively.

Bearing this in mind, it is my conclusion that existence anxiety is as relevant to hypnotherapists working with anxiety related issues as it is to anyone interested in human nature and self-determination. Certainly, by acknowledging it we enhance our understanding of the personal and can call upon a shared experience that allows us to empathize with the client more deeply as fellow human beings. After all, we are all at some level searching for meaning and purpose, even if each of our pathways is different. Of course, what we believe is simply a question of choice, as is our decision to believe whether or not existence anxiety is a relevant component of our therapeutic world view.

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