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Angst is not a word often used in conversation, yet it lists very highly on web searches.  I could not find it indexed in the Diagnostic and Statistic Manual IV.  This book lists accepted mental disorders and the codes many insurance companies use for claims.  Two medical dictionaries and a prior DSM (III) did not list angst as well.  It’s an uncommon term for a common condition.

The nearest synonym is anxiety, though it does not capture the full meaning of the word.  There are typically feelings of dread and frustration in a fluctuating balance.  Perhaps many people using “angst” as a search word are trying to capture a state of being they experience.  Perhaps there is a perception of something lacking in their existence, and most English words do not capture the essence of their thoughts adequately.

The existential philosophers address the word “angst,” which is actually a German word for “anxiety” or “dread.”  The philosophical use of the term was coined by Kierkegaard to denote a state of anguish we feel as the responsibility or burden of freedom.  There is dread arising from a lack of purpose, meaning or concern in the universe.  We try to impose our values and meanings on an inherently absurd universe.  Their is a constant dialectical tension between the man searching for meaning, and the universe that is conceived as mute and uncaring.

While a sense of meaning is important, a sense of purpose can truly keep people alive.  In my clinical practice with nursing home patients, a sense of purpose is the single most important factor in turning around many depressive episodes.  Most people do not theorize about the meaning of their lives until something dramatic happens.  A sense of purpose is nearly prerequisite in the average adult, and it has the advantage of being less abstract than the meaning of one’s existence.

The most clinically meaningful use of the term “angst” is anxiety and frustration with an absent or misguided purpose to one’s life.  What makes it clinically relevant is that it captures a broad swath of humanity, and avoids the perception of the universe as absurd.  A sense of meaningless absurdity to one’s existence is often a depressive perception, such that taking it as factual would not be helpful in mitigating a patient’s Major Depression or Adjustment Disorder.  The typical goal of psychotherapy is to adjust someone to their environment, such that a perception of one’s environment as absurd would render the goal absurd as well.

Angst is a handy word to describe something complicated.  A perception that one is on the wrong track in life, that the boat was missed is the precondition of my definition.  The ongoing sense of anxious dread serving out the sentence of one’s life is angst.  The discovering of an ego-syntonic purpose to one’s life is psychotherapy.  Please share your thoughts about this post in the “comments” section below.

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