Category: Angst

Psychotherapy Revisited

Perhaps you have read my last post “Psychotherapy 101.”  The post “Psychotherapy 101” is an introduction  into fundamental aspects of psychotherapy.  It also attempts to dispel common myths regarding psychotherapy.  I am satisfied with the post’s information, but a bit unhappy with its tone.  Perhaps in my rush to dispel the “fruit and nut” aspects of psychotherapy, I did not give an accurate description of its softer side.

Even though most people seek psychotherapy to solve particular problems, there are those whose mission is to grow as a person.  It is easy to categorize these people under the “problem” label, since a desire to grow as a person assumes a certain degree of dissatisfaction with one’s life.  Perceived in another way, one may regard these seekers of growth to be satisfied with their lives, yet eager to exceed the boundaries of their current existence.  It is less improving a bad thing than making a good thing even better.

Personal growth through psychotherapy is not problem oriented or solution focused.  There is no mountain of empirical literature to guide the psychologist’s movements.  It is a free style exploration of one’s existence.  Psychodynamic therapists have an interesting perspective on this form of exploration.  They maintain psychotherapy is the construction of a story that both the patient and therapist agree upon.  It is a simple sounding phrase, yet its meaning tends to enlarge as it is turned over in the mind.

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Many growth-oriented therapies eschew goals as an unnecessary stifling of personal exploration.  Perhaps this is based upon the assumption that the goals of an incomplete person will be incomplete as well.  It may be true that one has to reach a certain level of psychological sophistication to formulate reasonable goals.  While this concept rings true for many high functioning people, it is not very applicable to those with more fundamental problems.  Working with victims of head injury, the formulation of any goal may be a great victory for the patient.  Lacking awareness into their deficits, the psychologist must maintain the privilege of  controlling the nature and extent of the treatment.  Growth-oriented psychotherapy assumes good cognitive functioning.

Growth-oriented psychotherapy is likely most beneficial to those whose work and home-life are generally satisfactory.  Personal growth work is easily derailed by current emergencies and old traumas.  Personal growth as a goal is certainly noble and worthwhile.  The time and expense are considerable, and the commitment is extraordinary.  The shared experience of building an autobiography is very powerful.  One cannot help but be altered by the experience.  The person emerging from this process has yet to be revealed.  It is hoped that greater awareness will bring greater clarity, and the clarity will strength our purpose.  Please leave comments regarding this post in the section below.

Angst

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.

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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.