Fyodor Dostoyevsky’s Crime and Punishment, published in 1866, contains a wonderful passage about psychiatric treatment:
“There have already been some serious experiments relating to the possibility of treating the insane by means of the simple influence of logical reasoning. . . A certain professor. . .believed that insanity is, as it were, a logical error, an error of judgement, a mistaken view of things. He would refute the arguments of his patient step by step and, would you believe it, it’s said he achieved results that way!”
I’ve tried this method—persuading an anxious patient that his worries don’t make logical sense—and I’m sorry to say it doesn’t work. The patient usually feels better during the session and for a short time afterwards, but at his next visit he’s just as anxious, and he reports he’s continued to worry and avoid whatever he’s afraid of. Patients with enough confidence to speak up soon tell me their treatment isn’t helping.
Last week’s post about positive and negative emotions led me to ask what emotions are and how they arise in the brain. The neuroscientiest Joseph LeDoux’s excellent book, Anxious: Using the Brain to Understand and Treat Fear and Anxiety (2015) lays out what we know about anxiety. Two of his points challenged concepts I have relied on for years: the idea of unconscious anxiety, and that it is the brain’s basic response to perceived threats.
LeDoux insists on defining anxiety as a feeling that occurs in consciousness. This is not semantic hair-splitting—it starts from his rigorous insistence on specifying how we know what we know. Limiting the concept of anxiety to what can be put into words turns out to be useful, for it leads to an exploration of the nonconscious brain events which contribute to the feeling of anxiety but are clearly not themselves anxiety. (I will use LeDoux’s “nonconscious” rather than the psychoanalytic term “unconscious” when discussing brain mechanisms.)