1. Anxiety and existential therapy
Digby Tantam
New School of Psychotherapy
and Counselling
Universities of Sheffield and
Cambridge

2. Anxiety and Depression Association of America http://www.adaa.org/about-adaa/
press-room/facts-statistics
• Anxiety disorders are the most common mental illness in the U.S.,
affecting 40 million adults in the United States age 18 and older
(18% of U.S. population).
• Anxiety disorders cost the U.S. more than $42 billion a year,
almost one-third of the country's $148 billion total mental health
bill, according to "The Economic Burden of Anxiety Disorders," a
study commissioned by ADAA (The Journal of Clinical Psychiatry,
60(7), July 1999).
• More than $22.84 billion of those costs are associated with the
repeated use of health care services; people with anxiety
disorders seek relief for symptoms that mimic physical illnesses.
• People with an anxiety disorder are three to five times more likely
to go to the doctor and six times more likely to be hospitalized for
psychiatric disorders than those who do not suffer from anxiety
disorders.

3. Age-standardized rates for one anxiety disorder (GAD) in Denmark, Finland, Norway and
Sweden from Munk-Jørgensen P, Allgulander C, Dahl AA, Foldager L, Holm M, Rasmussen I,
Virta A, Huuhtanen MT, Wittchen HU.
• The age-standardized rates for generalized anxiety disorder
using general practice sample
• 4.1 to 6.0% men
• 3.7 to 7.1% women
• Anxiety disorders are often defined as qualitatively similar to
anxiety, but more persistent, more prolonged, and more
disabling

4. Bereza, B. G., Machado, M., Ravindran, A. V., & Einarson, T. R.
(2012). Evidence-based review of clinical outcomes of guideline-
recommended pharmacotherapies for generalized anxiety disorder.
Can J Psychiatry, 57(8), 470-478.
al

5. Fig 4 Probabilistic analysis showing percentage probability of each treatment being ranked
first by outcome measure.
Baldwin D et al. BMJ 2011;342:bmj.d1199
©2011 by British Medical Journal Publishing Group

6. Fig 5 Individual rankings for outcomes for response, remission, and withdrawals because of
adverse events for each of treatments considered.
Baldwin D et al. BMJ 2011;342:bmj.d1199
©2011 by British Medical Journal Publishing Group

8. Kjernberg et al

9. Bereza, B. G., Machado, M., Ravindran, A. V., & Einarson, T. R.
(2012). Evidence-based review of clinical outcomes of guideline-
recommended pharmacotherapies for generalized anxiety disorder.
Can J Psychiatry, 57(8), 470-478.

10. ?N
181 completed CBT
Symptom improvement
at end of average of 14
session treatment
(minimum 3)
87
Symptom improvement
at one year
83
Symptom disappearance
at end of average of 14
session treatment
(minimum 3)
26
Symptom disappearance
at one year
22
No. seeking further
therapy
No. seeing a psychiatric
No. also taking meds
50 lost to follow up
Data from
DiMauro, J., Domingues, J.,
Fernandez, G., & Tolin, D. F.
(2013). Long-term
effectiveness of CBT for
anxiety disorders in an adult
outpatient clinic sample: A
follow-up study. Behaviour
Research And Therapy, 51(2),
82-86. doi:
http://dx.doi.org/10.1016/j.brat.
2012.10.003

11. 754
181 completed CBT
Symptom improvement
at end of average of 14
session treatment
(minimum 3)
87
Symptom improvement
at one year
83
Symptom disappearance
at end of average of 14
session treatment
(minimum 3)
26
Symptom disappearance
at one year
22
No. seeking further
therapy
No. seeing a psychiatric
No. also taking meds
50 lost to follow up
DiMauro et al
Extrapolation based on attrition rate in
IAPT project in Doncaster of 76%
(Glenys Parry, personal communication)

12. Total functioning
Household functioning
Work functioning Interpersonal functioning
Figures from:
Iancu, S. C., Batelaan, N. M., Zweekhorst, M. B. M., Bunders, J. F. G., Veltman, D. J.,
Penninx, B. W. J. H., & van Balkom, A. J. L. M. (2014).
Trajectories of functioning after remission from anxiety disorders: 2-year course and outcome
predictors. Psychological Medicine, 44(03), 593-605.

13. • Of those entering CBT, 45.9% are improved or have
remitted at one year, 12.2% have remitted
• Of those entering drug treatment, 29.9% are remitted at
end of treatment
• 529 people with anxiety who are referred for specialist help,
16% are improved or recovered at one year, and 3% are
recovered. Many will also have been treated with
antidepressants
• Anxiety disorder is a chronic condition
• Treatments are not particularly effective
• We don’t really understand it

14. Fear syndrome, common to all
anxiety disorders
• Restlessness
• Fatigue
• Muscle tension
• Irritability
• Difficulty concentrating
• Sleep disturbance
• (Other specific disorders of somatic function linked to
autonomic changes)
• (Dysphoria, sometimes reported as depression)

16. Le Doux http://www.scholarpedia.org/article/Amygdala

17. Donatella Marazziti, Marianna Abelli, Stefano Baroni, Barbara Carpita, Carla E.
Ramacciotti and Liliana Dell'Osso Neurobiological correlates of social anxiety
disorder: an update . CNS Spectrums, Available on CJO 2014 doi:10.1017/
S109285291400008X

19. From
Feinstein, J. S., Adolphs, R.,
Damasio, A., & Tranel, D.
(2011). The human
amygdala and the induction
and experience of fear. Curr
Biol, 21(1), 34-38. doi:
10.1016/j.cub.2010.11.042

20. From
Feinstein, J. S., Adolphs, R.,
Damasio, A., & Tranel, D.
(2011). The human
amygdala and the induction
and experience of fear. Curr
Biol, 21(1), 34-38. doi:
10.1016/j.cub.2010.11.042
SM’s lack of reaction to
feared objects: a snake, a
spider and a haunted house

21. • Difference between anxiety and fear is one of persistence,
and absence of overt conditioned or unconditioned stimulus
• Anxiety is described as ‘object-less’ fear
– Fear ‘of’, but anxiety ‘about, ‘to’, or ‘for’
– Object is to change the world to a more satisfactory state (Sartre:
Sketch for a Theory of the Emotions)
– Evaluation of the world
• Disorder is when arousal is discrepant with ‘reality’

22. Jeffrey Gray’s hypothesis
• Septo-hippocampal structures are involved in anxiety and
not fear
• Anxiety is a failure in these structures to resolve conflict
(e.g. approach/ avoidance conflicts) leading to a lack of a
‘map’ of the path to take

24. Figure 1.
Encoding of Contextual Fear Memory in the Dentate Gyrus Granule Cells and Optogentic Dissection of Dorsal and Ventral Hippocampus
(A) Sagittal section of mouse brain showing dorsal and ventral dentate gyrus (DG) (yellow).
(B) Schematic of the activation pattern (in red) of DG-GCs in response to exploring a novel environment during fear conditioning, which activates a discrete
population of granule cells (GCs) that are thought to encode unique aspects of the contextual environment.
(C and D) In dorsal DG, contextual learning is impaired by either optogenetic inhibition (eNpNR3.0) via inhibition of encoding GCs (eNpHR2) or excessive
stimulation (ChR2) of both encoding and non-encoding GCs that causes interference of neurotransmission.
(E) Optical stimulation of the ventral hippocampal DG decreases innate anxiety but does not impair contextual learning.
Neil M. Fournier , Ronald S. Duman Illuminating Hippocampal Control of Fear Memory and Anxiety Neuron, Volume 77, Issue 5, 2013, 803 – 806
Derived from Kheirbek et al

25. Sketch for a theory of the emotions

26. Rejects psychoanalytic idea
• One could thus account for this essential characteristic of emotion -that
it is 'suffered', that it surprises, develops of itself according to its own
laws, and that conscious efforts cannot modify its course to any very
appreciable extent.
• Better still, they will say, in the majority of cases we are struggling, in our
conscious spontaneity, against the development of emotional
manifestations; we are trying to master our fear, to calm our anger, to
restrain our weeping. Thus we have not only no consciousness of any
finality of emotion, we are also rejecting emotion with all our strength
and it invades us in spite of ourselves. A phenomenological description
of emotion ought to resolve these contradictions.
• Emotional consciousness is, at first, consciousness of the world. It is not
even necessary to bring up the whole theory in order clearly to
understand this principle At present, we can conceive of what an
emotion is. It is a transformation of the world. When the paths traced out
become too difficult, or when we see no path, we can no longer live in
so urgent and difficult a world. All the ways are barred. However, we
must act. So we try to change the world, that is, to live as if the
connection between things and their potentialities were not ruled by
deterministic processes, but by magic.

27. • One could thus account for this essential characteristic of emotion -that it is 'suffered', that it surprises, develops of itself according
to its own laws, and that conscious efforts cannot modify its course to any very appreciable extent. This dissociation between the
organized character of emotion -the organizing theme being relegated to the unconscious- and its ineluctable character, which it
would not have for the consciousness of the subject, would render something like the same service in the psychological domain as
the Kantian distinction between the empirical and the noumenal does in the domain of metaphysic.
• Better still, they will say, in the majority of cases we are struggling, in our conscious spontaneity, against the development of
emotional manifestations; we are trying to master our fear, to calm our anger, to restrain our weeping. Thus we have not only no
consciousness of any finality of emotion, we are also rejecting emotion with all our strength and it invades us in spite of ourselves. A
phenomenological description of emotion ought to resolve these contradictions.
• Emotional consciousness is, at first, consciousness of the world. It is not even necessary to bring up the whole theory in order
clearly to understand this principle. A few simple observations may suffice, and it is remarkable that the psychologists of emotion
have never thought of making them. It is evident, in effect, that the man who is afraid is afraid of something. Even if it is a matter of
one of those indefinite anxieties which one experiences in the dark, in a sinister and deserted passageway, etc., one is afraid of
certain aspects of the night, of the world. And doubtless, all psychologists have noted that emotion is set in motion by a perception,
a representation-signal, etc. But it seems that for them the emotion then withdraws from the object in order to be absorbed into
itself. Not much reflection is needed to understand that, on the contrary, the emotion returns to the object at every moment and is
fed there. For example, flight in a state of fear is described as if the object were not, before anything else, a flight from a certain
object, as if the object fled did not remain present in the flight itself, as its theme, its reason for being, that from which one flees. And
how can one talk about anger, in which one strikes, injures, and threatens, without mentioning the person who represents the
objective unity of these insults, threats, and blows? In short, the affected subject and the affective object are bound in an
indissoluble synthesis. Emotion is a certain way of apprehending the world.... The subject who seeks the solution of a practical
problem is outside in the world; he perceives the world every moment through his acts. If he fails in his attempts, if he gets irritated,
his very irritation is still a way in which the world appears to him. And, between the action which miscarries and the anger, it is not
necessary for the subject to reflect back upon his behavior, to intercalate [[= insert]] a reflexive consciousness. There can be a
continuous passage from the unreflective consciousness "world-acted" (action) to the unreflective consciousness "world-
hateful" (anger). The second is a transformation of the other.
• At present, we can conceive of what an emotion is. It is a transformation of the world. When the paths traced out become too
difficult, or when we see no path, we can no longer live in so urgent and difficult a world. All the ways are barred. However, we must
act. So we try to change the world, that is, to live as if the connection between things and their potentialities were not ruled by
deterministic processes, but by magic.

28. 6/12/2011 28NSPC teaching
Kurt Lewin’s hodology from which Sartre may have borrowed

29. Downloaded from http://www.ediblegeography.com/sensory-maps/ 2 May 2014

31. • Scent maps
• Emotional flavour maps
• The ‘hodology’ of emotions

32. Independent route of emotional processing
summarized in LeDoux’ Emotional Brain, and also by
Damasio in several books
• Claparede effect
10-11 April
2008,
Pre-conference
workshop

33. • Emotional flavour
• Preoccupying concern
• Value congruity

34. • Emotional flavour
– Respectful but not fearful attitude to anxiety
• Preoccupying concern
– Experience of anxiety (‘phenomenology’)
• Value congruity
– Emotions might be right: I should listen (‘existential’ approach)

35. Conroy, S. A. (2003). A pathway for interpretive
phenomenology. International Journal of Qualitative Methods,
2(3). Article 4. Retrieved 2 May 2014 from http://
www.ualberta.ca/~iiqm/backissues/2_3final/html/conroy.html

36. Conroy, S. A. (2003). A pathway for interpretive
phenomenology. International Journal of Qualitative
Methods, 2(3). Article 4. Retrieved 2 May 2014 from
http://www.ualberta.ca/~iiqm/backissues/2_3final/
html/conroy.html

37. Quotes from Kierkegaard, S.
Concept of anxiety
• og da ængstes jeg for det Mulige og det
Tilkommende. Saaledes ere vi atter komne
hen, hvor vi vare i Cap. I. Angest er den
psychologiske Tilstan, der gaaer forud for
Synden, kommer den saa nær som mulig, saa
ængstende som mulig, uden dog at forklare
Synden, der først i det qualitative Spring bryder
frem.
• The history of the individual life proceeds in a
movement from state to state. Every state is
posited by a leap. As sin entered into the world,
so it continues to enter into the world if it is not
halted. Nevertheless, every such repetition is
not a simple consequence but a new leap.
Every such leap is preceded by a state as the
closest psychological approximation. This state
is the object of psychology. To the extent that
in every state possibility is present, anxiety is
also present. Such is the case after sin is
posited, for only in the good is there a unity of
state and transition. P. 113

38. Two ways to approach psychotherapy:
What does it feel like to be you?
How are you trying to make the best of
your life?
• Emotions are not merely symptoms
• They are qualia, like flavours or colours: feelings
• They have directedness

39. Phenomenology of anxiety
disorders
• Using the writings and the lives of some key philosophers in
the existential tradition
• Imagine the fear syndrome, but persistent, and according to
Jeffrey Grey leaving people irresolute, planless, and
therefore stewing plus…

41. • Lost father when young
• Long period in hospital with TB, and could not play semi-
pro football thereafter
• Moved to France
• Married but many relationships
• Died in car accident going home from holiday in a sport’s
car, while his family were travelling by train

42. Separation anxiety
• Newly added to DSM-5
• Fear of being alone or unsupported
• Meursault murders the Arab in L’Etranger: “I waited. The
heat was beginning to scorch my cheeks; beads of sweat
were gathering in my eyebrows. It was just the same sort of
heat as at my mother’s funeral, and I had the same
disagreeable sensations—especially in my forehead, where
all the veins seemed to be bursting through the skin”

43. • Lost father when young
• Long period in hospital with TB, and could not play semi-
pro football thereafter
• Moved to France
• Married but many relationships
• Died in car accident going home from holiday in a sport’s
car, while his family were travelling by train
Key theme: absurdity
What clients say:
“I disappear when I am alone, I
feel nothing”
“What if something goes wrong when you are here”
“Can’t settle”
“insecure”

44. “A world that can be explained (. . .) is a familiar world. But, on
the other hand, in a universe suddenly divested of illusions
and lights, man feels an alien, a stranger. His exile is without
remedy since he is deprived of the memory of a lost home or
the hope of a promised land. This divorce between man and
his life, the actor and his setting, is properly the feeling of
absurdity.” Camus, A. (2000). The Myth of Sisyphus London:
Penguin Classics. . p. 13)

45. Maps of separation anxiety
• Anxiety reducing
– Clinging
– Checking up on another person
– Jealousy
• Anxiety denying
– ‘Foot loose and fancy free’
• ‘Magical transformations’ (Brain-based behavioural
repertoire)
– Depersonalization: a consequence of ‘disorganized attachment’–
although this may be attention deficit hyperactivity disorder/
hyperkinetic syndrome (ADHD)

46. Depersonalization, absurdity, and
knowing oneself
Mantovani A1, Simeon D, Urban N, Bulow P, Allart A, Lisanby S.
(2011) Temporo-parietal junction stimulation in the treatment of
depersonalization disorder. Psychiatry Res. 2011 Mar 30;186(1):
138-40. doi: 10.1016/j.psychres.2010.08.022. Epub 2010 Sep 15
Abstract
This is the first clinical trial of repetitive Transcranial Magnetic
Stimulation (rTMS) in depersonalization disorder (DPD). After
3weeks of right temporo-parietal junction (TPJ) rTMS, 6/12 patients
responded. Five responders received 3 more weeks of right TPJ
rTMS showing 68% DPD symptoms improvement. Right TPJ rTMS
was safe and effective.

47. • We may consider these maps self-deceptive even unhelpful
• This morning just focus on what they can tell the
psychotherapist about the lived experience of their emotion,
which includes what Sartre calls their transformation of the
world
• I will come back to what they might be aiming at this pm

48. Generalized anxiety disorder
• Attended seminary as child but had to leave
because of functional heart disorder
• Enthusiastic espousal of Volkisch movement
linked to Nazism
• Regular references to coming death
• Like Kierkegaard believed in importance of
embracing ‘ontological anxiety’
• Lots of stressful events: planned gas attacks
in WWI, wife’s second son was not his,
sacked from Rectorship of Freiberg, banned
from teaching by Denatzification Commission

49. One of the cartoons on the
‘Being and Tim blog’

50. One of the cartoons on the
‘Being and Tim blog’
Ontological anxiety as a mood sweeps away the
Familiarity of the world

51. Heidegger’s autochthonous perception of generalized anxiety disorder
“anxiety in the face of death must not be confused with fear in
the face of one’s demise. This anxiety is not an accidental or
random mood of ‘weakness’ in some individual but a basic
state of mind of Dasein, it amounts to the disclosedness of the
fact the Dasein exists as thrown towards the end” Quoted in
Deurzen, E. van “Everyday Mysteries”
• NB ‘Thrown’ in Heidegger, ‘Leap’ in Kierkegaard

52. Maps of Generalized Anxiety
Disorder
• Anxiety reducing
– Worry and irresolution
– Conflict avoidance
– Risk avoidance
– Reassurance seeking
• Anxiety denying
– Risk-taking
– Aggression
• ‘Magical transformations’ (Brain-based behavioural
repertoire)
– Increasing negative flavour of semantic and perhaps other memory
– Not just ‘divorce’ is a threat, but ‘marriage’ or ‘relationship’, too

53. www.existentiala
cademy.com
53
Tantam,
D. (2003).
The
flavour of
emotions.
" Psychol
Psychoth
er. 76(Pt
1): 23-45.
Sacco, T. and B.
Sacchetti (2010).
"Role of Secondary
Sensory Cortices in
Emotional Memory
Storage and
Retrieval in Rats."
Science 329(5992):
649-656.

54. www.existentiala
cademy.com
54
Sacco, T. and B.
Sacchetti (2010).
"Role of Secondary
Sensory Cortices in
Emotional Memory
Storage and
Retrieval in Rats."
Science 329(5992):
649-656.

55. www.existentiala
cademy.com
55
Sacco, T. and B.
Sacchetti (2010).
"Role of Secondary
Sensory Cortices in
Emotional Memory
Storage and
Retrieval in Rats."
Science 329(5992):
649-656.
Sacco, T. and B. Sacchetti (2010). "Role of Secondary Sensory Cortices in Emotional
Memory Storage and Retrieval in Rats." Science 329(5992): 649-656.

56. Figures from
Reinecke, A., Rinck, M., Becker, E. S., & Hoyer, J. (2013). Cognitive-behavior
therapy resolves implicit fear associations in generalized anxiety disorder. Behaviour
Research And Therapy, 51(1), 15-23.

57. Not all ‘magical transformations’ are
magical
• Predicaments
• Bullying

58. Pupils with AS make fewer steps than neurotypical
pupils and spend less time in the playground
Mean number of steps per hour: AS
group = 902, control group = 1312
(t = -2.645, p = .027)
From
Wainscot, J., Naylor, P., Sutcliffe, P., Tantam, D., & Williams, J.
(2008). Relationships with peers and use of the school
environment of mainstream secondary school pupils with
Asperger Syndrome (High-Functioning Autism): A case-
control study. International Journal of Psychology and
Psychological Therapy, 8, 1-25

59. Where were people with AS in
Sheffield?
• Most living at home, even above 30.
• Most had difficulties coping with changes in everyday
environments
• Difficulties moving between places (for example using
public transport)
• Most common places frequented were libraries and
cinemas
Seeing the light – or ticking the box?

60. • Father cursed God, and married the maid
after his wife died, but before she was cold
• "(Merciful God, alas, how my father, in his
melancholia, has wronged me quite
terribly--an old man places the entire
burden of his melancholia on a poor child,
to say nothing of what was even more
dreadful, and yet, for all that, he was the
best of fathers.)"
• Phobia of fire, and rituals lighting matches
(family evacuated because of fire when he
was aged 12; great fires in Kobenhaven in
1728, 1795, abd 1806 (following British
bombardment)
• Collected tea cups and walking sticks
• “all of existence makes me anxious from the
least little fly to the mysteries of the
incarnation”
• 5 out of 7 of his sibs died
• The surviving brother suffered anxiety
disorder, and eventually had to give up his
bishopric because of depression
• Kierkgaard had intense anxiety attacks

61. “All existence makes me anxious,
from the smallest fly to the mysteries
of the Incarnation; the whole thing is
inexplicable, I most of all; to me all
existence is infected, I most of all. My
distress is enormous, boundless; no
one knows it except God in heaven,
and he will not console me….”

62. Map of obsessive –compulsive
disorder
• Nostalgia for what might have been
• Repetition and undoing
• Increased reactivity to threat leading to increased need for
control
• Not being able to let go of objects, or ideas (Kierkegaard
needed many identities to partly deal with this)
• Magical transformation
– Lack of suppression of weaker conflicting stimulus or impulse by
caudate

63. Ambitendency of OCD
• “Anxiety may be compared with dizziness. He whose eye
happens to look down into the yawning abyss becomes
dizzy. But what is the reason for this? It is just as much in
his own eyes as in the abyss . . . Hence, anxiety is the
dizziness of freedom.” (in Concept of Anxiety)
• "Anxiety is neither a category of necessity nor a category of
freedom; it is entangled freedom, where freedom is not free
in itself but entangled, not by necessity, but in itself" (ibid.)

64. • Father a lawyer who wanted to be an actor
gradually lost his money
• She shared a private language with her
younger sister, and played sado-masochistic
games with her, in which she was the tortured
saint
• Her father started to call her ugly in
adolescence when she developed acne
• Her mother disapproved of her giving up her
Catholic faith.
• She had difficulty in making friends, and had no
boyfriends as an adolescent
• In love with but always second to Sartre
• (Most famous book Le Deuxième Sexe)
• Looked after Sartre, but probably no sexual
relations with him after 40
• Many lovers, including Nelson Algren

65. Hélène de
Beauvoir’s home

66. Henriette-Hélène de Beauvoir (6 June 1910, Paris
– 1 July 2001, Goxwiller) was the younger sister of
Simone de Beauvoir. Her art was exhibited in
Europe, Japan, and the US. She married Lionel de
Roulet, a pupil of Sartre when he taught school,
and they were married for 48 years. He became a
representative at the Council of Europe, and they
moved to Goxwiller, a village near Strasbourg,
where she founded a shelter for battered women.
She continued painting until she was 85. Her
paintings were related to feminist philosophy and
women's issues

67. Map of panic disorder
• Suffocating, drowning
• "There was the feeling of panic at being cut off from the world. . . .
I felt I had been put under a curse: I was never going to get away
from here. . . . This continent was a great net from which we were
never going to escape." Flying with Sartre to Amazonia
• on reaching her 50th birthday. She describes waking from a
dream: “ “Sometimes, too, just before I come back to reality, a
giant beast settles on my breast: ‘It’s true. It’s my nightmare of
being more than fifty that’s come true!’. How is it that time, which
has not form or substance, can crush me with so huge a weight
that I can no longer breathe?”
• Magical transformation
– Hyperventilation to hypocapnia leading to chest pain (‘effort syndrome’

68. Poulou as a boy: falling from graceBullied at school, and few
friends
Mother remarried when he
was 12 to an engineer and
the family moved to La
Rochelle where his step
father had been put in
charge of the dockyard.
Untreated squint
when his hair was cut
“ugliness” was disclosed
Poor school results but
then average
Ecole Normale Superieure
(ENS—think of en soi),
aggregé de philosophie,
1929 failed, 1930 (1st.
place, Simone de Beauvoir
second)
12 Mar 11 Titania hotel,
Athens

69. Sartre the celebrity
Memberships: American
Academy of Arts and
Sciences, Modern
Language Association of
America (honorary fellow).
Lived in hotels or with his
mother for most of adult
life.
Awarded Nobel Prize for
Literature in 1964 but
refused to attend
ceremony.
Also refused to be
Academicien .
12 Mar 11 Titania hotel,
Athens

70. Map of social phobia (shame)
• Internal focus on unacceptability to
others
• Hiding away from other’s gaze
• Fear of contaminating others with
shame (hikikomori)
• Magical transformation
– Self-disgust and nausea
– Blushing
– Tremor

71. “The faces of others have some sense, some direction.
Not mine. I cannot even decide whether it is handsome
or ugly. I think it is ugly because I have been told so. But
it doesn’t strike me. At heart, I am even shocked that
anyone can attribute qualities of this kind to it, as if you
called a clod of earth or a block of stone beautiful or ugly.
People who live in society have learned how to see
themselves in mirrors as they appear to their friends. I
have no friends. Is that why my flesh is so naked? You
might say—yes you might say, nature without humanity.”
La Nausée
Titania hotel,
Athens

72. • ..a gap in the road
• ..what should I do?
• Let God decide, or my family, or the state, or my
neighbours?
• Decide myself…but I want to the right thing…
• …this is what Sartre (and indeed all ‘existential’
philosophers have addressed
Titania hotel,
Athens
12 Mar 11

73. The Look
• Feeling the look on one’s
back
• Caught in a moment of
private excitement
• The look is not returned
• The other is not a person
with a particular reaction
e.g. a facial expression, but
the Other, a totalization
• The name of the father, the
Master, the State, authority,
grandfather Schweitzer
12 Mar 11 Titania hotel,
Athens

74. • “..I persevere in it [in looking through the key-hole], I
shall feel my heart beat fast, at the slightest creaking of
the stairs. Far from disappearing with my first alarm,
the Other is present everywhere, below me, above me,
in the neighbouring rooms, and I continue to feel
profoundly my being- for-others” (B & N p.277).
Titania hotel,
Athens
Etre pour autrui: being for others
12 Mar 11

75. • Sartre’s ‘project’ was to escape from the look of the
other, and to overcome what Kierkegaard, Heidegger,
and he himself all discovered: that without being
anxious to please, we are anxious because we are
potential but not actuality as we look into the future,
and falling short and not perfection if we look into,
project ourselves into, throw ourselves into, or leap into
the past. Whether we call this ‘sin’, or ‘existential guilt’,
or ‘nausea’

76. Heide Klumpp*, David Post, Mike Angstadt, Daniel A Fitzgerald and K Luan Phan (2013) Anterior cingulate
cortex and insula response during indirect and direct processing of emotional faces in generalized social
anxiety disorder. Biology of Mood & Anxiety Disorders 2013, 3:7
A priori region of interest: Anterior insula. A) Voxel-wise main effect of group for the contrast Match Faces >
Match Shapes, along with Match Angry > Match Shapes, Match Fear > Match Shapes, and Match Happy >
Match Shapes, showing bilateral anterior insula (aINS) displayed on statistical F-map at p < 0.05; cluster size
>10 contiguous voxels (family-wise error corrected for multiple comparisons across small volumes of interest).
Color scale reflects F-score. B) Bar graphs depicting extracted parameter estimates of activation from the aINS
ROI within each group showing Generalized Social Anxiety Disorder exhibited greater bilateral anterior insula
activation than Healthy Controls (p < 0.05). fMRI study

77. • Some predetermined, or sensitized biological pathways, but
focus is not on what causes these disorders but on what the
subjective experience is
• Phenomenological approach paramount in this
• Next step: what we do with the emotions
– Win the Nobel prize?
– Kickstart feminism?
– Become a national hero?
– Something more modest: find the path that anxiety is uncovering

78. Case history of the little monkey
George Williams first presented to his general practitioner complaining of poor sleep. This was of particular concern to him because he was a
window cleaner. When he had a bad night, his coordination was affected and he was afraid that he would fall of his ladder. He had already lost
his job as a computer programmer because he could not concentrate. Mr. Williams lived with Sara who had children by a previous relationship.
Mr. Williams said that he and Sara got on well, but that she had begun to sleep in another room as he kept her awake with his not sleeping. He
was afraid that the relationship was going to breakdown
His general practitioner established that Mr. Williams had difficulty in getting off to sleep, and often woke in a panic in the night; that he was
having trouble with his memory and with his concentration, and that he often felt his heart pounding. The general practitioner prescribed a beta
blocker for the heart pounding, and explained to Mr. Williams that a tablet to help him sleep would only be of short-term value. He would quickly
become tolerant of it, and would therefore be of little help for his long-term sleep problem. There was also a risk of dependence. His GP thought
that Mr. Williams would benefit from anxiety management, gave Mr. Williams some self-help books and referred him to the community psychiatric
nurse. She noted that Mr. Williams had not improved, and attributed this to his disturbed childhood. She thought that he had a post-traumatic
stress disorder and that he would need specialist help. Mr. Williams was therefore referred to the local psychiatrist.
As the local service did not have a community mental health team, Mr. Williams was referred personally to a consultant psychiatrist, and seen by
a trainee who took a history before discussing the case with the consultant. Mr. Williams confirmed the account of his anxiety symptoms that he
had given to the GP He could have attacks up to 8 times in a night, and sometimes had to give up trying to sleep because of them. His shortness
of breath could get so bad that he had once or twice gone to Casualty to get checked out in case he was having a heart attack.
Mr. Williams said that his parents were both alive and well, and that he had three younger sisters. He thought that his parents were closer to his
sisters than to him. His mother had rejected him, he thought, when his younger brother had died of a cot death at the age of four weeks, when
Mr. Williams was only two. After that his mother had not really coped well with the children. The family were frequently seen by psychologists
and psychiatrists, and the children placed in temporary care by social services. Mr. Williams had developed enuresis and encopresis, for which
his mother would punish him physically, sometimes by locking him into his bedroom with a bucket for a toilet. He was sometimes banned from
toilets in other parts of the house. There were two investigations of physical abuse, but no action was taken until he was nine, the year that his
mother did not celebrate his birthday, when he was placed in foster care. He was physically punished in the first foster family, too, but was then
fostered by another, kinder, couple. His encopresis had resolved long before he was fostered, and his enuresis stopped, never to return, shortly
after he joined his second foster family, when he was 12.
From Tantam, D. Brijesh, S. Existential supervision and the NHS, in Existential Perspectives on Supervision (eds. Deurzen, E. van and Young,
S.) Palgrave Macmillan, London, 2009)

79. What anxiety would reach out to if it
were not baffled
(what might we anxious about, or for)

81. • “We must imagine Sisyphus happy”
• i.e. not trying to hold on to death and stasis, but owning both
his life and therefore his death
• Being a member of a football team was his greatest
happiness
• Courage to live with what life brings, and not repine or wait
for respite, or God
Aanxiety points to absurdity

82. Clears the ground
• Resoluteness
• Embracing being finite

83. • Life is never simple: best to long for
it to be more difficult
• Predicaments provoke a leap in
understanding that is emotional and
not rational (contra Hegel)
• Write, think, reflect until the leap is
made
• Sin—falling short—is inevitable. To
imagine it is not is to fall short of
God, who knows

84. • What a suffocating life a woman has?
How smothering Sartre must have
been?
• Do not seek a solution for yourself, but
for those who come after who can go
beyond
• Contain anxiety not to die oneself but to
give birth to other’s freedom
• (Some sinning can sweeten the pill if
one can face up to it)

85. • Anxiety (shame) is a sign that we being
unmade
• Only if we are unmade can we be free
• Each time we think we are free, we
choose a path that will take us forward but
we must be prepared to leave it if we see
it curving away
• And then we will feel anxiety again, which
is good
• (but a bit of alcohol, amphetamines, or
sexual incontinence helps too)
• Anxiety, or at least terror, enables us to be
close to other people if we accept it and
not run away from it

86. 05/05/201
4
86
Final thoughts
• Facing up
• Not crying out for relief
• Digging down to what one
is anxious for, or about
• Choosing to live with this,
or to change
• Revealing the truth
• Accepting that the leap
leads to new ‘sin’ i.e. the
possibility of criticism,
rejection, or shunning