The Meaning of Stress, Anxiety and Collective Panic in Clinical Settings

摘要

The physician is often confronted with questions about the meaning of symptoms or diseases. One of the tasks of those practicing psychosomatic medicine is to delve into the answers to these questions. Anxiety is a common phenomenon in everyday practice, and it is evoked in the most different situations. The relationship of this kind of anxiety (i.e. when having to consider painful or life-threatening diseases or medical or surgical procedures) to both neurotic anxiety and normal anxiety (i.e. the one expressed in poetry or artistic creativity or present in the biographies of outstanding men and women who by no means could be considered as psychiatric cases) leads to define anxiety as the psychological equivalent of stress. Anxiety is the unspecific response to a threat induced by too sudden or too extreme variations in the environment (life changes, stressful situations, life events). Such mechanisms, so important for survival, can become self-destructive, paving the way for the appearance of diseases represented by unsuccessful coping mechanisms. The analogy with the diseases of the general adaptation syndrome of Selye (i.e. autoimmune diseases) and with reactions in collective panics in disasters becomes evident under this perspective. The physician has to face anxiety with the same attitude that he faces pain, that is to say, going beyond a consideration of its ‘normality’ (it is quite normal to feel chest pain in acute heart infarct), keeping in mind its role in survival. Most creative men and women are, as many psychohistorical studies have shown, individuals who have been able to find a solution to internal conflicts which were conflicts of the society in which they lived, leading to a solution of this same external conflict. The anxiety which is often expressed in this situation has an element of restlessness, which is lacking in anxiety and related disorders which are dominated by feelings of inability to cope expressed time and again as ‘Dr., I can’t’ (go out in the street, in elevators, live, love, work, a