Existential Anxiety

A man and a woman walk into a counselor’s office, met by a pair of counselors for conjoint marriage counseling.

The couple says they have done everything they were told to do when growing up: got good grades in school, played sports, got into and graduated from a good college, established a respectable career, fell in love and got married, and had kids.

Now they attend and tithe at church, watch football and drink light beer, volunteer at their children’s school and extracurriculars, contribute the maximum allowed amount to their 401k.

He works longer hours than he would like, does what he feels is more than his share of domestic responsibilities, coaches his kid’s sports, plays video games more than his wife likes, but somehow manages to mow the lawn not once per week but as needed.

She works full-time, takes lead on childcare, manages the family calendar and coordinates all their social events, feels like she does all the domestic work but never to the satisfaction of her real and imagined critics, is class parent for the 2nd grader, and limits her Starbucks trip to what she feels is appropriate: three to eight times per week.

Despite doing everything they should do to be responsible, respectable and “happy” adults, they feel deeply dissatisfied. She is anxious all the time and can hardly sleep. He does not seem to enjoy anything and when forced to engage with the family is often grumpy and hyper-critical.

They want to know how to make her anxiety go away so she can sleep and he can avoid her nagging.

The first counselor says: Let us identify your cognitive distortions to help you (wife) develop a less anxious attachment style and you (husband) develop more effective behavioral choices.

The other counselor says: Anxiety is not the problem; birth is the problem.

Introduction

When seeking counseling, people seek help to address varied problems. However, in run-of-the-mill counseling work, these problems can often be expressed as one or both of the following two widespread problem areas: anxiety and depression. A client will come in to establish services complaining of social limitations, relationship conflicts, unfulfilled goals and objectives, lack of motivation, sadness, excessive worrying about problems, inability to sleep due to excessive worrying about problems, difficulty concentrating, self-destructive personal and relationship patterns, and all manner of variations on these themes. Usually, underneath these behavioral expressions lie deeper emotional turmoil.

As tempting as it is to want to focus on managing behaviors and thoughts, at times it is even more tempting to think of these as the problem. Difficult and painful emotional situations may appear as barriers to accomplishing clinical goals and better lives for clients. This approach is more typically an expression of our own uneasiness. When we back away from uncomfortable truths, we miss vital opportunities to explore the depths of the human condition and potentially work towards enduring lifelong growth. Wincing at discomfort invalidates the essential human experience.

This article will focus on the problem of anxiety. Everyone knows what anxiety is. It is that queasy, shaky, groundless feeling, often accompanied by a tightness in the chest, lightheadedness, edgy fidgetiness, and at times a gripping, crushing panic that feels like death is imminent. Many situations confront us with these feelings. In response, people develop elaborate strategies to avoid them. In their most extreme expressions, one may even avoid ever leaving the house for fear of the anxiety arising. Agoraphobia is a handy label for living in fear of fear.

The currently dominant counseling approach is cognitive behavioral therapy (CBT). Counselors employing CBT often follow the lead of clients by establishing a goal of eliminating anxiety. They believe that if we can vanquish anxiety, or at least significantly lessen it, then their quality of life will improve and they will be better off for it. The exact opposite tends to be more likely. To the extent that we want to silence or block out anxiety, we shove it further out of view and inhibit our ability to work with it. Anxiety is an information feedback system that, if explored thoroughly, can result in a deeper and more profound resolution of the presenting problems.

To think that the presence of even intense anxiety as a problem that should be eliminated betrays a profound misunderstanding of the state and role of anxiety. This is a fundamental oversight of the common application of CBT. The idea that one can simply change thought patterns and behaviors to escape the vicissitudes of a human life ignores the potential for finding dignity in suffering. Anyone who clearly examines their own life, looking at the inescapable situations in which every human being finds themselves, will find that the presence of anxiety is essential to the human condition.

In Irving D. Yalom’s classic 1980 book Existential Psychotherapy, he identifies four fundamental aspects of being human, each of which gives rise to existential anxiety. They are death, freedom, isolation, and meaninglessness. The remainder of this article will explore each of these topics and identify how they lead to fundamental anxiety and how by working with these underlying situations, the source of anxiety can be addressed and dealt with in such a way that the energy behind these anxieties can be transformed from a distracting and inhibiting force into a life-affirming and creative energy.

Death

Every living creature on this planet that succeeds at thriving following birth, expresses an inherent desire to live. Additionally, every one of our ancestors also expressed this inherent desire to live. The moment the infant chooses to take our mother’s milk, one chooses life. This is not a decision made by rational capacities, but instead a decision made by inherited bodies not yet capable of language or discrimination. It is common to think of this as a decision made without consent, but that is misleading. It is only in science fiction that the notion of a human being without a body is possible. A human being is as much a body as a mind. At this point in life, it is the body that makes this decision. Life is chosen, in the least mindful manner, and is clung to until the final breath.

This decision sets up the greatest of our anxieties: fear of death. The fear of death grows from the desire to be, the most basic desire of all living beings. Without this desire, death would have no sting. The difficulty arises from the historicity of humanity. The awareness of the inevitability of death is coupled with the uncertainty of the moment of our deliverance from life. Few want life to end, yet end is out there, at some indeterminate time and location. This sets the stage for a deep uncertainty tied to the impermanence of life.

Freedom

Now that the gift of life has been chosen, something must be done with it. What to do beyond initial instinctual responses is open. Factors like the time and location of our births, physiological configuration, and personal and world historical events constrain and limit our afforded freedom, but within these limits much freedom remains. Family, society, and culture offer ideas as to how to proceed, but each moment a decision must be made. These choices may be as mundane as toppings on a sandwich or as life-defining as pursuing a career or proposing marriage to a lover.

Unfortunately, the information that we need to ensure we are making good decisions is obscured by limited perspective. The outcomes of most endeavors may not be consistently predicted. With great discomfort and a pervading sense of unfairness, the responsibility for the results of each decision falls to the decider. To further complicate matters, humans are social and historical beings, riddled with ideas about the appropriateness of the outcomes we create. Inevitably, opportunities will be missed and unintended consequences will arise. This results in a profound state of existential guilt over misspent efforts. Cultural expectations exacerbate these miscalculations.

The stage is then set for a painful conflict. Each person has the freedom to act as desired. Each decision is accompanied by responsibility for the consequences of the results. Without the ability to read the future, opportunities will be missed and many consequences unintended. It is easy to get stuck in this dilemma. Even if a decision is not made, then one has decided not to act. Responsibility is unavoidable and the results unknown. Many face an overwhelming temptation to freeze and hide from the responsibilities of freedom. In fact, world history is littered with people and societies that have willingly given up freedom for security. The desire to escape from existential anxiety leads to some of life’s most painful situations.

Isolation

The understanding that death is unavoidable and that the responsibility for life is unavoidable leaves quite an uneasy feeling. If only there were someone with whom these pains could be shared, surely, it would be easier to bear. Unfortunately, the moment of exit from the womb confronts one with a foreign and cold world in which one is very much alone. Infants are completely dependent upon their parents. Hopefully, they are caring individuals who feed, clothe, and comfort. However, parents accomplish this with varying degrees of skill and success. Everyone must adapt to and work with the support offered, be that nurturing or terrifying.

No one ever truly knows what anyone else thinks, feels or intends. An unbridgeable gulf between the world and the one behind our eyes creates an underlying sense of estrangement. Most experience a deep desire to connect with others and feel unity, if for no other reason than to ease the terrible responsibility and fear that permeate our inner lives. However, the distance between the inner and outer worlds forever exceeds one’s reach. Much of one’s decisions are efforts to cross this void. They take many forms, from elaborate co-dependencies to quests for fame and riches, compulsive sex to creative expressions, and religious ecstasy to political party affiliation. None fully satisfy the desire to share life’s burden

Meaninglessness

Finally, with all this difficulty, one is left with a bewildering question: what is the point of it all? Humans are the only animals that we know who have a flexible meaning designation system. This is most evident in the use of language. Unlike birds and other animals, humans can assign different significations to sounds, gestures, and markings. To allow for communication, a level of agreement about the meanings of those significations is socially negotiated. Human meaning systems come to be in this way.

This is different from other animals. For example, birds learn to sing their songs socially, but the meanings of their vocalizations are predetermined and intelligible to all members of their species. This is referred to as a call system. Call systems, unlike human language use fixed meaning, as opposed to assigning meaning flexibly in form of language, ideas, and institutions. This places a terrible burden upon humanity in that nothing contains predetermined meaning and assigned meaning is never universal.

One is left searching for a way to interpret life to make it feel more substantial. Accompanying this groundlessness is a nagging conscience, an expression of our existential guilt, demanding some action, but failing to specify the course. What are we left to do?

To address this need, humans have attempted innumerable deeds. Some include raising families, building careers, erecting monuments, writing complex symbolic systems, communing with the gods and conquering Europe. While these efforts have led some to feeling meaningfully situated in their lives, none are universal nor officially sanctioned by the world. Nothing can obviate this responsibility. Meaning creation is personal, and while there are countless ways to do it, it is unique to each person. This is another gift of our freedom and isolation.

Conclusion

That presents a precarious situation: a human life contains no inherent meaning, is closed off by an unbridgeable gap between self and others, bears the full responsibility of all its decisions, decisions whose consequences we cannot consistently predict, with a limited amount of time that is chosen and painfully short. How could one expect to have a consistently positive experience of a life given such conditions? Is it not reasonable then to assume that everyone would have to face a significant level of anxiety if one is remotely aware of the situation?

Failure to understand one’s situation does not improve matters. One must die, bear the responsibility of our decisions, experience fundamental isolation, and find a way to make sense of it. Caught in a double-bind, one must act with the knowledge that it will hurt, regardless of the decision.

Plato, in his Apology, attributed the following words to his teacher Socrates: “the unexamined life is not worth living.” This refers to the difficulty in living a worthwhile life without understanding the fundamental situation in which we find ourselves. To the extent that one can understand what it is that must be contended with in life, one is better prepared to address the specific concerns in a focused and intentional manner. This allows for the anxieties of life to transform into opportunities to explore and resolve humanity more fully.

In the vignette at the opening of this article, many of the problems faced by the couple can be interpreted through this lens. The reliance on “the American dream” as a source of meaning and direction in life offloads the responsibility for a meaningful life onto an external source. Following the script so closely is not an authentic expression of freedom. They do all the right things but still don’t feel close to one another. Life continues to march on, without an adequate approach to handle their finitude. A counselor attuned to existential anxiety could help them explore these issues as a way of resolving the underlying problems challenging their shared lives.

CBT, with its focus on the surface expression of these underlying anxieties, tends to avoid existential issues without addressing their central character. This is akin to putting a Band-Aid on the problem. Such short-sightedness does not result in a sustainable approach to life. The only effective way to attune oneself to this understanding is through direct personal experience. A counselor has a mandate to explore and address these issues within oneself. For if one is unaware of the lay of the land, one becomes a very ineffective guide. It is time for counselors to return to the search for deeper truth instead of settling for symptom management and superficial treatment planning. Let us dig in and understand that anxiety is not the problem, but that birth is the problem.

References

Plato. (1997). Apology (G. M. A. Grube, Trans.). Hackett Publishing Company.

Yalom, I. D. (1980). Existential psychotherapy. Basic Books.

© 2025 Steven H. Smith.