Medicine: The Anatomy of Angst

The automatic elevator stops with a jolt. The doors slide open, but instead of the accustomed exit, the passenger faces only a blank wall. His fingers stab at buttons: nothing happens. Finally, he presses the alarm signal, and a starter’s gruff voice inquires from below: “What’s the matter?” The passenger explains that he wants to get off on the 25th floor. “There is no 25th floor in this building,” comes the voice over the loudspeaker. The passenger explains that, nonsense, he has worked here for years. He gives his name. “Never heard of you,” says the loudspeaker. “Easy,” the passenger tells himself. “They are just trying to frighten me.”

But time passes and nothing changes. In that endless moment, the variously pleading and angry exchanges over the loudspeaker are the passenger’s only communication with the outside world. Finally, even that ceases; the man below says that he cannot waste any more time. “Wait! Please!” cries the passenger in panic—”Keep on talking to me!” But the loudspeaker clicks into silence. Hours, days or ages go by. The passenger cowers in a corner of his steel box, staring at the shining metal grille through which the voice once spoke. The grille must be worshiped; perhaps the voice will be heard again.

This is not a story by Franz Kafka or by one of his contemporary imitators. It is a recent dream remembered in precise detail by a successful New Yorker (one wife, three children, fair income, no analyst) who works with every outward appearance of contentment in one of Manhattan’s new, midtown office buildings. Whatever Freudian or other analysis might make of it, the dream could serve as a perfect allegory for an era that is almost universally regarded as the Age of Anxiety. It speaks of big city towers in which life is lived in compartments and cubicles. It speaks of the century’s increasingly complex machines that no one man can control. It speaks of the swift ascents and descents not only in a competitive business existence but in an ever-fluid society. It speaks of man’s dreaded loss of identity, of a desperate need to make contact with his fellow man. with the world and with whatever may be beyond the world. Above all, it speaks of God grown silent.

Stage Whines. Anxiety seems to be the dominant fact—and is threatening to become the dominant cliche—of modern life. It shouts in the headlines, laughs nervously at cocktail parties, nags from advertisements, speaks suavely in the board room, whines from the stage, clatters from the Wall Street ticker, jokes with fake youthfulness on the golf course and whispers in privacy each day before the shaving mirror and the dressing table. Not merely the black statistics of murder, suicide, alcoholism and divorce betray anxiety (or that special form of anxiety which is guilt), but almost any innocent, everyday act: the limp or overhearty handshake, the second pack of cigarettes or the third martini, the forgotten appointment, the stammer in midsentence, the wasted hour before the TV set, the spanked child, the new car unpaid for.

Although he died in 1855, the great Dan ish existentialist Soren Kierkegaard de scribed the effects of anxiety in terms that are strikingly apt today. He spoke of his “cowardly age,” in which “one does ev erything possible by way of diversions and the Janizary music of loud-voiced enterprises to keep lonely thoughts away.” Yet all the noise is in vain: “No Grand Inquisitor has in readiness such terrible tortures as has anxiety, and no spy knows how to attack more artfully the man he suspects, choosing the instant when he is weakest, nor knows how to lay traps where he will be caught and ensnared, and no sharp-witted judge knows how to interrogate, to examine the accused, as anxiety does, which never lets him escape, neither by diversion nor by noise, neither at work nor at play, neither by day nor by night.”

War or Peace. When a fact is as uni versal as love, death or anxiety, it becomes difficult to measure and classify. Man would not be human were he not anxious. Is his anxiety today really greater than ever before — different from Job’s? Or is modern man simply a victim of distorted historical vision that always sees the pres ent as bigger and worse than the past?

There is general agreement among psy chiatrists, theologians, sociologists and even poets that in this era, anxiety is indeed different both in quantity and quality.

Other eras were turbulent, insecure and complex — the great migrations after the fall of the Roman Empire; the age of discovery; Copernicus and Galileo’s tink ering with the universe, removing the earth and man from its center; the industrial revolution. But in a sense, the 20th century U.S. is the culmination of all these upheavals—itself the product of a gigantic migration, itself both champion and victim of the industrial revolution, itself faced with the necessity not only of accepting a new universe but of exploring it.

The American today is told without pause that the world is up to him—war or peace, prosperity or famine, the welfare or literacy of the last, remotest Congolese, Tibetan or Laotian. And he is facing his demanding destiny in a state of psychological and religious confusion.

For centuries of Christian civilization (and not Christian alone), man assumed that anxiety and guilt were part of his nature and that as a finite and fallen being, he had plenty to be guilty about. The only remedies were grace and faith. When the age of reason repealed the Fall, man was thrust back onto himself and, for a time, reason seemed to be an adequate substitute for the certainties of faith. Spinoza could write confidently: “Fear arises from a weakness of mind and therefore does not appertain to the use of reason/’ But it was soon clear that reason alone could not answer all man’s questions, could not provide what he desperately needs: order and purpose in the universe. And so man invented substitute deities—History, the State, Environment. But in the end all these only led back to the” nearly unbearable message that man is alone in a meaningless cosmos, subject only to the blind forces of evolution and responsible only to himself. As Kirilov puts it in Dostoevsky’s The Possessed: “If there is no God, then I am god.”

The discovery of the unconscious depths of man’s mind by Schopenhauer, Freud and others seemed to offer an escape; here was a dark, mysterious realm, irrational as man knew himself to be irrational, to which he might shift responsibility for his acts. But this worked only partly; ultimately even the cult of the unconscious (psychoanalysis) directed man back to himself and his own resources. Many rejoice that man has been freed from the fear of demons, not realizing that it may be worse to have to fear himself. Many similarly rejoice that, to some extent, he has been freed from the fear of hellfire, not realizing that he has instead been condemned to the fear of nothingness—what Paul Tillich calls the fear of “nonbeing.”

Widespread awareness of all this has itself contributed to the change. Psychologists report that 30 years ago the U.S. was in an “age of covert anxiety.” It is now in an age of “overt anxiety.” People tend to believe that it is wrong and “sick” to feel anxious or guilty; they are beset by guilt about guilt, by anxiety about anxiety.

Bound & Free. Psychiatrists and theologians know, of course, that a certain amount of guilt and anxiety is inevitable and necessary in man. They are like pain: “bad” because they are discomforting, but in normal quantities necessary for survival because they warn of danger and because they make a human being responsible to others. The rare individual who feels neither guilt nor anxiety is a monster—a psychopath with no conscience. What psychologists call Urangst, or original anxiety, the anxiety that is inevitably part of any human being, is well described by Theologian Reinhold Niebuhr, who believes that it springs from man’s dual character: on the one hand, man is involved in the contingencies of nature, like the animals; on the other, he has freedom and understanding of his position. “In short, man, being both bound and free, both limited and limitless, is anxious.”

This basic, or existential, anxiety (which Niebuhr sees as the precondition of sin) is no more disturbing, in normal quantities, than is rational fear of danger. In contrast, neurotic anxiety is irrational fear, a response to a danger that is unknown, internal, intangible or unreal. Anxiety is fear in search of a cause. Authorities differ on the relationship of guilt to anxiety, but Dr. John Donnelly of Hartford’s Institute of Living offers what is for laymen the most sense-making distinction: guilt is apprehension over some transgression in the past, whether actually committed or merely contemplated, whereas anxiety involves only the possible and the future. Because the German equivalent, die Angst, carries a stronger connotation of dread, many psychiatrists prefer this term to the English word. Of itself, anxiety is not a neurosis, but it is an essential ingredient in almost all neuroses, most major mental and psychosomatic illnesses. Its victims fall into three broad categories:

1) The whole men and women, who have such minor emotional disturbances as fear about thunder or a compulsion to twist and untwist paper clips (symbolically twisting the boss’s neck). Their aggressiveness, perfectionism or shyness are not exaggerated.

2) The walking wounded, who can usually control their anxiety and its symptoms well enough to function as breadwinners or housewives, but periodically break down and wind up, in a severe anxiety state, in a psychiatrist’s office or, briefly, in a mental hospital.

3) The ambulance cases, who spend months or years or drag out their lives in mental hospitals, or (in some cases still not recognized often enough) land in the emergency rooms of general hospitals with psychosomatic illnesses often mistaken for heart attacks, asthma or pregnancy complications.

All the neurotic symptoms, major or minor, originate in the same way: they are defenses against anxiety. The most common are the phobias in which—to cover up anxiety and guilt too painful to be acknowledged—people develop an irrational aversion to some act or object seemingly unconnected with their anxiety. Phobias seem to occur in dazzling profusion: Blakiston’s New Gould Medical Dictionary lists 217 of them (see box). More prevalent but less generally recognized as cover-ups for anxiety are com pulsive forms of behavior and addictions to alcohol and narcotics.

Little Hans. How does a man become anxious to the point of phobia or compulsion? After decades of debate psycholo gists and psychiatrists are at last substantially agreed that anxiety arises from feelings of helplessness.* According to the best modern thinking, Freud never fully understood the essential nature of anxiety. His first theory, propounded in 1894, was that repressed libido (sexual energy) becomes anxiety, which later reappears as free-floating anxiety or a symptom (phobia or compulsion) that is equivalent to it. This, as critics pointed out, was a theory of mechanism and not an explanation of causes. So he tried again, and decided in 1923 that a totally different process was involved: anxiety was the cause of repression.

Freud’s classic example was of little Hans, aged five, who was panic-stricken at the idea of having to go out in the street. Why? Freud explained that little Hans had strong Oedipal feelings toward his mother; therefore he had hostility to ward his father and therefore anxiety. He repressed the anxiety and converted it into hippophobia — he was afraid to go out be cause he was afraid of being castrated by the bite of a horse. To Freud the horse represented little Hans’s father. This elaborate hypothesis neatly fitted Freud’s preoccupation with castration fears, which Psychoanalyst Rollo May now interprets as the fear of losing mother’s love and, hence, selfesteem.

Otto Rank (1884-1939). disciple of Freud, who later split with him, made a cult of birth trauma. To him life was a process of individuation, which meant a series of separations — birth, weaning, going to school, heading a household. To Rank, anxiety was the apprehension involved in these separations. Alfred Adler, apostle of inferiority feelings, never formulated a full-blown theory of anxiety, but showed more insight than his Vienna rivals in seeing the uses that the neurotic makes of anxiety. If it blocks his activity, it permits him to retreat to a previous state of security, to evade decisions and responsibility—and. therefore, dangers. Also, as happens in many families, it can be forged into a weapon for dominating others, who would rather yield to unreasonable demands than be made to feel guilty.

Power Drive. Anxiety won belated recognition as a social phenomenon in the U.S. from Karen Homey. Erich Fromm and Harry Stack Sullivan. To Fromm, the Freudian frustration of sex energy becomes anxiety only when it involves some value or way of life that the individual holds vital to his security—for instance, the prestige of having a pretty wife. Horney believed that Freud put the cart before the horse; anxiety, she held, came before the instinctual drives—the instincts developed into drives only under the whiplash of anxiety. To Sullivan, devotee of the “power motive.” which drives man to pursue security, anxiety arose from the infant’s apprehension of disapproval. And Sullivan had one significant insight: experiences that create anxiety not only limit the victim’s activities, but also actually set limits to his awareness and hence to his learning ability.

University of Illinois’ Psychologist O. Hobart Mowrer agrees with Freud on the mechanism of anxiety’s creation. But Mowrer differs on basic cause. To him the conflicts that cause anxiety are not so much animal and sexual as human and ethical. They involve the repression of moral strivings. Mowrer notes that anxiety arises when the person feared is also loved.

Similarly, Psychoanalyst May sees anxiety in his patients not only when sexual or aggressive urges are revealed but also when the need of desire for constructive new powers is exposed. Thus, it is from the repression of agape, love of one’s fellow men, as well as from the repression of eros, or sexual love, that anxiety springs.

As the earth-moving machines have bulldozed the landscape, so have the technologists -bulldozed the manscape. Human nature, says Dr. May, has been made the object of control measures, just like any other part of nature. “Keeping busy” for its -own sake has become a neurotic anxiety. While it may allay superficial anxiety, Dr. May holds that it exacerbates the deeper and more pervasive existential anxiety, about being and nonbeing. A do-it-yourselfer in a basement workshop may be too busy watching the guard on his bench saw to worry about traditional causes of anxiety, but at heart he eventually begins to wonder what is the meaning of life for him. That existential question, says May, is now the prevailing cause of the anxiety states that send patients to psychoanalysts. They are dealing less with “Sexschmerz” than with Weltschmerz.

Orthodoxy of Change. In the U.S. today, causes for such Weltschmerz are easy to find. Psychologists know that all change is threat and that all threat produces anxiety. The U.S., more than any other society in history, believes in change. Conservative in many ways, the U.S. has never been conservative in the sense of trying to preserve things the way they were yesterday. Its very orthodoxy is based on the idea of change: the most orthodox tenet in the American creed is that the individual can accomplish anything if he tries hard enough. It may be one of the glories of a free society, but it also carries great potential danger and may well be the greatest single cause of anxiety on the American scene. From the noble notion that man is free to do anything that he can do, the U.S. somehow subtly proceeds to the notion that he must do anything he can and, finally, that there is nothing he cannot do.

This leads to a kind of compulsory freedom that encourages people not only to ignore their limitations but to defy them: the dominant myth is that the old can grow young, the indecisive can become leaders of men. the housewives can become glamour girls, the glamour girls can become actresses, the slow-witted can become intellectuals.

Almost every boy in the U.S. has dinned into him the idea that he must excel his father—a guaranteed producer of anxiety, by Freudian theory, if the boy has grown up idolizing his father as a paragon of power and virtues. The process is severest in the sons of outstandingly successful men: their anxiety neuroses are as notorious as the traditional case of the preacher’s son becoming a drunkard. A career girl is shredded by the need to excel father or mother or both, and for her the problem may be complicated by Oedipal feelings toward father.

Many people feel guilty simply about not being talented enough or intelligent enough or well-informed enough. If anybody can be anything he wishes, no wonder the businessman is made to feel guilty if he has neither ear nor taste for modern music (but somehow, the artist never seems to feel guilty about not understanding business). No wonder, too, that the adman thinks he ought to be able to write a novel or to know all about the atom. In an absurd misapplication of the ideal of equality, one man’s opinions become as valid as another’s. Thus, every man competes not only in his own job or his own social setting; he also somehow feels he must compete with the TV newscaster and the editorial writer (not very difficult), with the physics professor and the philosopher (very difficult indeed).

Why Grow Old? Every girl is tight-corseted with the propaganda that she must have a slim, svelte figure, no matter what her natural body build or bone structure. She may react to this either by trimming down mercilessly and suffering near starvation; or she may surrender to the neurotic pleasures of overeating—all the time rationalizing that the trouble is in her glands (which it almost never is). Another deliberate anxiety builder is the slogan, “Why grow old?” It introduces a prescription containing a teaspoonful of wisdom, such as the values of exercise and a balanced diet, diluted in an ocean of nonsense about wrinkle erasers and pep medicines. Actually, the less anxiety is associated with the inevitable aging process, the better are people’s chances of growing old gracefully and with a sense of fulfillment.

The phenomenon of change in the U.S. contributes to anxiety in another way: no one “knows his place,” and even if he does and likes it, there are no easy ways of announcing the fact to others. The worker can indeed still become boss, the immigrant a settled American. But how do they show their newly acquired place in life? No aristocratic titles, no rigid distinctions of dress are available; man’s achievements can be signaled only by the fascinating game of displaying “status symbols.” Hence the endless American preoccupation with what is “in” and what is “out”—clothes, addresses, speech, schools, cars. The phenomenon (well understood by U.S. novelists, most notably John O’Hara) tends to force Americans into infinite patterns of snobbery and reverse snobbery. The first step after success is to display wealth; the second step is to learn that flashy display is wrong; the third step is to learn that, if one is really “secure,” one can afford even to be flashy. This interminable dialectic of snobbery can produce genuine anxiety, as is shown by the innumerable cases of people who frantically seek to hide their families, change their names, tailor their accents — and wind up losing their identities.

This particular form of social anxiety is the most potent of the “hidden persuaders” used by admen. Vance (The Status Seekers} Packard, while superficial in much of his work, is correct in pointing out that a key element in selling is to present a product so that it promises to satisfy some need for security or power.

Abstract & Atonal. Two of the forces that might be counted on to reduce anxiety in U.S. life — the artists and the social scientists — are contributing to it. In abstract painting and atonal music, the modern artist has largely destroyed rec ognizable reality, creating a world in which he is master because it is incom prehensible to others: he is alone, but at least he is boss. In literature and drama, he has just moved through a long period of writing psychiatric case histories, and is now experimenting with improvised works that seek to destroy the barrier between audience and artist. His traditional role is to assume the burdens of guilt and anxiety freely, transforming them in his own soul into works of art that can offer the audience catharsis or clarity. This is the function for which the artist is applauded, adored—and paid. More and more today, he rejects that function and insists on dragging his audiences into his own neurosis, shifting the burden of guilt and anxiety on to them.

The social scientists have helped make the U.S. the most self-analytic civilization ever known. Rome was not conscious of the “fall of the Roman Empire”; the Crusaders scarcely analyzed the infectious new ideas they brought back from the East; the romantics wrote new kinds of poetry, but did not turn out essays on the alarming death wishes in those poems. Americans cannot make a move without having it declared a trend, viewed critically in innumerable books deploring The Lonely Crowd, The Status Seekers, The Organization Man. The exhortations offered to the U.S. public are always contradictory. No sooner had Americans learned that they must not be rugged individualists but must practice “adjustment,” than they were told that they were all turning into conformists. No sooner had they learned that children must be raised progressively and permissively than they were told that children desperately want discipline. No sooner had they accepted the fact that women deserved and needed equal rights than they were informed that women had become too much like men.

Anxious Intellectuals. This kind of ever-contradictory ferment gives the U.S. an exciting intellectual life, but it also makes anxious intellectuals. The intellectuals, in turn, carry their anxiety to the rest of the country through the immensely fast popularization of new ideas. U.S. intellectuals are forever complaining that no one pays attention to their opinions. This is patently untrue: very likely, they complain merely to cover their own guilt at not being as certain about things as they secretly feel they should be—in short, at not being leaders.

This points to what may be the ultimate cause of anxiety in the U.S.: pragmatism. It not only—legitimately—questions every truth, but it also questions whether the concept of truth itself has any meaning. When mixed with logical positivism, it leads to the notion that philosophy, the search for truth beyond mere language or mathematical symbols, is impossible. Few things could produce more anxiety in people who either believe in, or want to believe in, a moral order.

High Places & Dirt. Fantastic and confused though symptoms of anxiety can be, there is often a kind of logic, even a dramatic beauty or poetic justice, about them. They seek to compensate for what is lacking. Thus, according to the Jungian school, the unconscious tries to correct or heal disorganization of the ego—or of society—by doggedly creating images of value, order and meaning. This process can produce fanatics, prophets and saints; it did produce, according to the analytic view of history, Torquemada, Calvin, Knox and Jonathan Edwards. No one can say what prophets or fanatics the U.S. may produce to combat its Age of Anxiety, but its people are certain to react—possibly in futile and less spectacular ways—to the disorder and the threats of their environment.

Logically enough, considering the environment, the phobias most often found in U.S. metropolitan areas have to do with high places, airplanes and dirt. Fear of heights is not a serious matter if it involves only skyscrapers: an occasional high-steel worker or window-washer has to change his job because of this. But many people, as they grow older, become neurotically cautious, get to the stage where they cannot even go near a window above the ground floor. In such severe cases, the anxiety usually extends far beyond this symptom and pervades the whole personality. Airplanes evoke a comparable phobia. In practical terms, such case histories seem relatively simple:

A traveling salesman may be economically crippled and have to change jobs if his company orders him to leave the rails and take to the air. Viewed more philosophically, such cases may suggest a protest against man’s high-flying pride.

Dread of dirt (mysophobia) goes hand in overwashed hand with the cleanliness compulsion. The victim must carry out his cleansing routine even though he knows it is unreasonable. Otherwise, he finds himself the prisoner of intolerable anxiety. The cleanliness compulsion commonly arises from conflict involving a strict and perfectionist parent. The victim begins by being simply overneat and fussy about cleanliness. Then he gets into conflict with all the people around him who do not comply with his compulsive standards. His compulsion may drive him to excessive washing of his body, of clothes, and even doorknobs. (One legendary American tycoon would not shake hands or touch a doorknob unless he had on white cotton gloves.) He gets to the point where he actually washes the skin off his hands and has to go into a hospital.

Most in the Middle. Research in recent years has shown some fairly clear patterns about where anxiety develops. It is greatest where change is swiftest. Children are not very susceptible to it; their problems of adjustment are normal for their age (adolescents show confusing symptoms). Anxiety is most apparent in the 20-to-40 age group. These youngish adults may not suffer from it more than their elders, but they talk more about it. In any case, they are the most active and mobile members of society, constantly making decisions, changing jobs or moving to new locations. From 40 to 70, anxiety is usually better controlled or concealed. Above 70, it breaks out again, now that modern medicine has so greatly prolonged the lives of so many people who are financially and socially insecure, who feel unwanted, useless and rejected.

By social stratification, reports Cornell University’s Dr. Lawrence Hinkle, there is least anxiety at the top and bottom, and most in between. An upsurge of anxiety has begun, and more is predicted, among Negroes, for whom possibilities of social and economic advancement, to a degree undreamed of at war’s end, are now developing. Puerto Rican and Mexican immigrants will have their innings with anxiety later; opportunities for mobility and morbidity go together.

Wherever there is opportunity, there is anxiety: it is just as severe in the ivied halls of research institutions as it is in the garment district—or in some Government offices. And it is far more severe than it used to be on farms. Big business, on the other hand, is not, as often described, a single pail of anxiously writhing worms. Some giant corporations have become “settled societies” of their own, in which the rungs of the promotion ladder are neatly numbered and everybody knows when he may have his chance to step up. But in advertising, communications and entertainment, anxiety is extensive and vociferously proclaimed; half the name actors on Broadway and in Hollywood have been analyzed, and the others should never be allowed off the couch.

Priests & Prisoners. It is among writers and other editorial workers that Raymond B. Cattell and Ivan H. Sheier of the University of Illinois have found the highest anxiety ratings, based on complex personality tests. That they come just ahead of the Navy’s underwater demolition teams (frogmen) is probably due more to their higher verbal abilities than to on-the-job hazards. Air pilots in training have, naturally, more anxiety than business executives; priests have less—but this may be a reflection of their having found a certainty of faith and of a rigid routine that conceals if it does not catharize anxiety. Convicts have far less than average. This reflects both routine and the high prison population of conscienceless psychopaths. Least anxious of all, on the Cattell-Sheier scale, are university administrators.

Cattell and Sheier give the U.S. a lower anxiety rating than Britain. Explaining this apparent surprise, they suggest that what passes for anxiety in the U.S. is really the stress of effort in a land of ambition, competition and challenge. More convincingly, they note that anxiety is higher in situations where the individual feels unable to save himself. The anxiety of waiting for D-day is worse than the fear of walking through a field of land mines. This principle may help explain the attitude of many U.S. scientists and liberal intellectuals toward The Bomb. The possibility of civilization’s total destruction is usually cited as one of the great factors contributing to anxiety in the U.S. But there is a strong suggestion that The Bomb is merely a handy device, welcomed almost with relief, for the release of anxiety and guilt that have little to do with the subject as such. For many Bomb worriers, it seems to be a true phobia, a kind of secular substitute for the Last Judgment, and a truly effective nuclear ban would undoubtedly deprive them of a highly comforting sense of doom.

Drugs for the Mind. What can psychiatry do to combat anxiety and the various mental illnesses it feeds? The Joint Commission on Mental Illness and Health, set up by Congress in 1955, last week issued an ambitious prescription in a report asking for $3 billion to be spent annually by 1971 (three times the present amount) and for other sweeping reforms to make better psychiatric service more generally available. It also called for a study to find out what is “the public’s image of the psychiatrist,” suggesting that there is guilt and anxiety within the profession itself.

As for treatment of patients, sedatives ranging in potency from aspirin to barbiturates and narcotics have no effect on the underlying emotional state; all they can do is relieve the symptoms temporarily. Only since 1954 have there been tranquilizing drugs specifically designed and directed toward relieving signs of anxiety. For depression, psychiatrists are now prescribing the psychic energizers, of which half a dozen, such as Marplan and Niamid, have won fairly general acceptance. But talking it out in psychotherapy is generally recognized as the only measure that offers the possibility of a true cure. There is still controversy as to the value of different types of treatment, especially between the advocates of the analytic schools and the psychiatrists who favor shorter, more “directive” therapy. There is some question as to whether guilt feelings should be relieved in all cases. Dr. May reports that diluting a patient’s guilt feelings allays superficial anxiety but sometimes obscures the “genuine if confused insights of the patient into himself.”

Order Out of Chaos. Beyond curing the obviously sick, psychologists and psychiatrists evidently must make an effort to teach people not so much to eliminate guilt and anxiety as to understand them and live with them constructively. That is the point made by Hans Hofmann, associate professor of theology at Harvard Divinity School, in a new book called Religion and Mental Health (Harper). Writes Hofmann:

“Our time is one of ferment and potential rebirth. This is so precisely because it is a time full of chaos … It was only natural that Sigmund Freud should at the beginning of his career have thought of the irrational aspects of-the human personality as chaotic and potentially dangerous powers … It did not occur to him that chaos in itself may represent a very positive and fertile current of life. For the people of the Old Testament, especially in the creation story, the question was not: ‘Why is there chaos?’ but rather: ‘Why is there order?’ For them, order was the outgrowth of daily living . . . The unique function of man, in their view, is to live in close, creative touch with chaos, and thereby experience the birth of order . . . Surprisingly enough, modern psychotherapists share this ancient knowledge.”

*Anxiety is not the same as depression. While anxiety is helplessness, depression is hopelessness. But helplessness unendurably prolonged leads inevitably to hopelessness. So anxiety and depression are seen together, as often as not, in many classes of mental patients.