Anxiety was a philosophical concept before it taken up by psychology and psychiatry. The Danish philosopher Kierkegaard (1813-1855) argued that anxiety is part of human nature. Anxiety arises where possibility and actuality come into contact and the present touches the future. Anxiety is a product of having the freedom to make choices and act, and by doing so make a commitment to one’s identity, ways of being in the world, and standing in relation to other people. For Kierkegaard, anxiety can be an avenue to stand in relation to God. This is why he wrote, “Whoever has learned to be anxious in the right way has learned the ultimate.” One can bracket out the God dimensions and still learn something valuable from Kierkegaard, namely that anxiety can cause inaction, which is, in its most basic sense, a loss of freedom. What is possible may never actualize and one may lose the present by tending to an imagined future. One becomes immobilized and unable to meet needs and realize goals and aspirations.

Certainly the neurotic, anxious child is compulsively concerned with security, for example; and certainly the neurotic adult, and we who study him, read our later formulations back in the unsuspecting mind of the child. But is not the normal child just as truly interested in moving out into the world, exploring, following his curiosity and sense of adventure- going out “to learn to shiver and to shake,: as the nursery rhyme puts it? And if you block these needs of the child, you get a traumatic reaction from him just as you do when you take away his security. I, for one, believe we vastly overemphasize the human being’s concern with security and survival satisfaction because they so neatly fit our cause-and-effect way of thinking. I believe Nietzsche and Kierkegaard were more accurate when they described man as the organism makes certain values — prestige, power, tenderness — more important than pleasure and even more important than survival itself. My thesis here is that we can understand repression, for example, only on the deeper level of meaning of the human being’s potentialities. In this respect, “being” is to be defined as the individual’s “pattern of potentialities.” … in my work in psychotherapy there appears more and more evidence that anxiety in our day arises not so much out of fear of lack of libidinal satisfactions or security, but rather out of the patient’s fear of his own powers, and the conflicts that arise from that fear. This may be the particular “neurotic personality of our time” – the neurotic pattern of contemporary “outer directed” organizational man.

When one read’s Kierkegaard’s profound analyses of anxiety and despair or Nietzsche’s amazingly acute insights into the dynamics of resentment and the guilt and hostility which accompany repressed emotional powers, one might pinch oneself to realize that one is reading works written in the last century and not some new contemporary psychological analysis.

Another root of our malady is our loss of the sense of the worth and dignity of the human being. Nietzsche predicted this when he pointed out that the individual was being swallowed up in the herd, and that we were living by a “slave-morality.” Marx also predicted it when he proclaimed that modern man was being “de-humanized,” and Kafka showed in his amazing stories how people literally can lose their identity as persons.

"A person who has not been completely alienated, who has remained sensitive and able to feel, who has not lost the sense of dignity, who is not yet "for sale", who can still suffer over the suffering of others, who has not acquired fully the having mode of existence - briefly, a person who has remained a person and not become a thing - cannot help feeling lonely, powerless, isolated in present-day society. He cannot help doubting himself and his own convictions, if not his sanity. He cannot help suffering, even though he can experience moments of joy and clarity that are absent in the life of his "normal" contemporaries. Not rarely will he suffer from neurosis that results from the situation of a sane man living in an insane society, rather than that of the more conventional neurosis of a sick man trying to adapt himself to a sick society. In the process of going further in his analysis, i.e. of growing to greater independence and productivity,his neurotic symptoms will cure themselves."

"Sigmund Freud was a novelist with a scientific background. He just didn’t know he was a novelist. All those damn psychiatrists after him, they didn’t know he was a novelist either."

(Interview in Writers at Work: The Paris Review Interviews, Eighth Series, ed. George Plimpton, 1988)

Freud’s writings about grief and loss. And he argued that, following the death of a loved one, the loss had to be psychologically accepted and that person relinquished, or else you ran the risk of succumbing to pathological mourning, which he called melancholia—and we call depression.

Our patients are the ones who express and live out the subconscious and unconscious tendencies in the culture. The neurotic, or person suffering from what we now call character disorder, is characterized by the fact that the usual defenses of the culture do not work for him — a generally painful situation of which he is more or less aware...

When we say neurosis represents the truth of life we again mean that life is an overwhelming problem for an animal free of instinct. The individual has to protect himself against the world, and he can do this only as any other animal would: by narrowing down the world, shutting off experience, developing an obliviousness both to the terrors of the world and to his own anxieties. Otherwise he would be crippled for action. We cannot repeat too often the great lesson of Freudian psychology: that repression is normal self-protection and creative self-restriction—in a real sense, man’s natural substitute for instinct. Rank has a perfect, key term for this natural human talent: he calls it “partialization” and very rightly sees that life is impossible without it. What we call the well-adjusted man has just this capacity to partialize the world for comfortable action. I have used the term “fetishization,” which is exactly the same idea: the “normal” man bites off what he can chew and digest of life, and no more. In other words, men aren’t built to be gods, to take in the whole world; they are built like other creatures, to take in the piece of ground in front of their noses. Gods can take in the whole of creation because they alone can make sense of it, know what it is all about and for. But as soon as a man lifts his nose from the ground and starts sniffing at eternal problems like life and death, the meaning of a rose or a star cluster—then he is in trouble. Most men spare themselves this trouble by keeping their minds on the small problems of their lives just as their society maps these problems out for them. These are what Kierkegaard called the “immediate” men and the “Philistines.” They “tranquilize themselves with the trivial”— and so they can lead normal lives.

If man is the more normal, healthy and happy, ... the more successfully he can repress, displace, deny, rationalize, dramatize himself and deceive others, then it follows that the suffering of the neurotic comes ... from painful truth. ... Spiritually the neurotic has been long since where psychoanalysis wants to bring him without being able to, namely at that point of seeing through the deception of the world of sense, the falsity of reality. He suffers, not from all the pathological mechanisms which are psychically necessary for living ... but in the refusal of these mechanisms, which is just what robs him of the illusions important for living.

The upshot is that the values and goals which provided a unifying center for previous centuries in the modern period no longer are cogent. We have not yet found the new center which will enable us to choose our goals constructively, and thus to overcome the painful bewilderment and anxiety of not knowing which way to move. Another root of our malady is our loss of the sense of the worth and dignity of the human being. Nietzsche predicted this when he pointed out that the individual was being swallowed up in the herd, and that we were living by a "slave-morality." Marx also predicted it when he proclaimed that modern man was being "de-humanized," and Kafka showed in his amazing stories how people literally can lose their identify as persons.

The realization that our mental functioning is largely irrational was arrived at by several thinkers at the same time, including Friedrich Nietzsche... Freud, who was much influenced by both Darwin and Nietzsche... was its most profound and articulate exponent. ...Schnitzler, Klimt, Kokoschka, and Schiele also discovered and explored new aspects of our unconscious mental life. They understood women better than Freud... and they saw more clearly than Freud the importance of an infant's bonding to its mother. They even realized the significance of the aggressive instinct earlier than Freud did. ...Plato discussed unconscious knowledge ...pointing out that much of our knowledge is inherent in the psyche in latent form. ...Hermann von Helmholtz... advanced the idea that the unconscious plays a critical role in human visual perception.

Sigmund Freud was a novelist with a scientific background. He just didn’t know he was a novelist. All those damn psychiatrists after him, they didn’t know he was a novelist either.

I'm going to make the obvious point that maybe the word neurotic means the condition of being highly conscious and developed. The essence of neurosis is conflict. But the essence of living now, fully, not blocking off to what goes on, is conflict. In fact I've reached the stage where I look at people and say - he or she, they are whole at all because they've chosen to block off at this stage or that. People stay sane by blocking off, by limiting themselves.