My accountant and my bankers keep singing, don't worry, be happy. They don't understand. I am happy only when I'm worried. And when I'm not worried, it worries me.
When I'm happy, I'm very, very worried that something either is wrong or might go wrong. And of course, the clinical name for this is generalized anxiety disorder.
Today we're going to dissect and bisect and insect worry.
What is worry? What is it made of? What's the difference between worrying and rumination, so and so forth? And does worry really make you unhappy? Is this such a thing as malignant worrying and isn't such a thing as healthy worrying?
It's very worrisome this whole video.
Okay, I'm the worrying professor of psychology, Sam Vaknin, author of Malignant Self-Love, Narcissism Revisited, and I'm at your disposal and I promise you this video is going to make you very, very worried or very, very happy. Stay with me if you dare.
Okay, Shoshanim.
Worry.
Worry is not an emotion. Worry is a state of mind, and it is comprised of three elements, like everything Jewish.
Anxiety, daydreaming, or fantasizing, and compulsion.
When you're worried, you're anxious.
Actually, many scholars suggest that worry is just another name for anxiety.
When you're worried, you're anxious, but I beg to disagree.
I don't think that worry is only anxiety. I think worry starts with an anxiety, and then it is compounded by daydreaming or fantasizing, which often borders on catastrophizing.
And this is done compulsively. When you worry you can't help it, it's compulsive, it takes over you, it's in control, you are at the mercy of your worries, you want to stop, you want to cut it off, but you are having intrusive thoughts.
So every worry has an obsessive, compulsive element to it. And it involves daydreaming because anxiety is not a reaction to any real threat.
If you are responding to a real threat, it's called fear, not anxiety.
What differentiates fear from anxiety is that anxiety is delusional. It is a reaction to an imaginary menace.
So it's an inward reaction. It's a reaction to internal processes, not to anything external.
Take anxiety, add to it catastrophizing, fantasizing about calamities, about disasters, about enemies, about conspiracies, paranoia, paranoid ideation, etc., mix the two, anxiety with paranoid ideation, with catastrophizing, with all this, add to it an inability to stop the process, a compulsive element.
And what you get is worry.
Now, worry exactly like rumination is problem oriented. It revolves around the problem.
You keep rehashing the problem. You keep reconsidering the problem. You keep asking yourself, is there an asset or a facet or an angle I haven't seen? Did I forget anything? Should I take something into account that I haven't? etc.
You doubt yourself. You criticize yourself. You question yourself.
And the more you do this, the stronger your anxiety. The more heightened it is. And the more heightened it is, the more you catastrophize.
And so your daydreaming becomes more compulsive.
And so it's a vicious cycle. It's self-feeding. It's a self-feeding, self-reinforcing mechanism.
Worry. Not necessarily distinguishable from rumination.
Although there is a distinction, clinically speaking, worry can easily devolve into rumination, and rumination involves always an element of worry.
Worry is defined as a state of mental distress or agitation due to concern about an impending or anticipated event, threat, or danger. It is difficult to control, it is persistent, and it is excessive. And it's a symptom of generalized anxiety disorder according to the dictionary.
Now we should distinguish between worry and meta worry.
Meta worry is when you worry about your worrying, when you're worried that you worry all the time.
Many, many anxiety attackspanic attacks are the outcomes of meta-worry.
You anticipate the anxiety, you predict the panic attack, and then it happens because you become anxious, and you are worried about the panic attack or the anxiety attack which are looming.
So this is very ironic.
It's very ironic. The fact that you worry about worrying makes you worry.
And the fact that you anticipate an attack of anxiety or panic brings on the attack of anxiety or panic.
This is a self-fulfilling prophecy.
And the clinical term is meta-worry, a persistent worry about one's own thoughts and cognitive processes, a negative metacognitive process in which one worries about one's own worrying and about its potentially harmful effects on oneself.
There was a British psychologist, Adrian Wells. He coined the word meta-worry in 1994.
And he did this in the framework of his labors, of his studies of generalized anxiety disorder.
Now, let it be clear. Worrying is not the same as planning for adverse circumstances or anticipating contingencies and preparing for them.
Preparedness is not the same as worrying.
Planning, gathering your resources, organizing yourself in anticipation of something bad that's going to happen.
That's not worry because it involves mastery, it involves control over yourself, it involves self-confidence, and it involves actions such as gathering intelligence, or organizing people around you to work together or augmenting your resources.
When you create a plan B or a plan C, when you are planning for contingencies, when you are ready in a state of readiness, this is solution oriented. This is goal oriented.
Remember, worrying is problem oriented. Rumination is about the problem, not about the solution to the problem.
Preparedness and readiness and contingency planning, these are about goals, these are about solutions, they are solution oriented.
So no, when someone comes to you and says listen, I foresee a financial crisis or I anticipate a civil war in the United States or what have you, and I think we need to prepare.
That is not rumination. That is not worry.
You may disagree with the scenario. You may think the person is being paranoid, but this kind of approach, you know, let's get some food, let's store some food, let's get gas masks, I don't know, let's get weapons. This kind of approach is solution-oriented.
Again, you could be a paranoid and solution oriented.
But whenever your focus is on the solution to the problem, you are not a worrier with an O. You're not engaged in worrying, you're engaged in planning.
So if you anticipate a financial crisis, you sell all your stocks, you take your money out of the bank. That is not to worry. That is to prepare. That is to be ready. That is to anticipate contingencies and crises and threats.
Actually, it's a healthy thing in general, unless it is coupled with some kind of paranoid ideation.
So, being paranoid is not the same as worrying.
Remember, the key distinction is, if you're solution oriented, that's not worrying. That's something else.
If you're problem oriented, that's worrying and that's rumination.
Now, generalized anxiety disorder keeps popping up throughout this lively and enchanting lecture. Lively and enchanting, because I'm here and I'm giving it, of course.
Generalized anxiety disorder is an excessive form of anxiety. It is tantamount to worry about a range of concerns.
Anything from world events, finances, your health, your appearance, activities of family members and friends, work, school, your neighborhood, the church, you name it.
And generalized anxiety disorder is anxiety, is worrying in search of a target, in search of a reason.
You worry in principle, you're anxious in principle, you don't even know why, and you are looking for an answer.
Why? You're looking for a reason. You're looking for a cause.
And then you say, I woke up this morning and I'm full of worry and I'm very anxious. Why is that? Why is that?
Wait a minute. Is it my wife? No, it's not my wife. Is it my bank? No, it's not my bank.
Is it? Ah, wait a minute. I know why. The war in Gaza.
Sothis is generalized anxiety disorder. But there's scanning for possible reasons and causes for the anxiety.
And it's accompanied by symptoms, many physical symptoms also, such as restlessness, fatigue, impaired concentration, irritability, muscle tension, and disturbed sleep.
The worry is experienced as difficult to control, as compulsive. And the various symptoms that accompany the worry and the anxiety, they occur on more days than not.
So the worry becomes a determinant, a defining dimension of the personality.
When you try to describe such a person in one word, you would say, this guy is a warrior with an O. He worries all the time. He's anxious all the time.
Now that's not a minor issue.
Let me read to you something written 13 years ago.
At the turn of the millennium, as the nation stood atop an unprecedented summit of peace and prosperity, there was a long time ago, you can tell, anxiety surged, past depression, is the most prominent mental health issue in the United States.
America now ranks as the most anxious nation on the planet with more than 18% of adults suffering from a full-blown anxiety disorder in any given year. This was the figure for 2011.
The figure now is 25 to 33%. Almost double.
And this is according to the National Institute of Mental Health.
On the other hand, in Mexico, a place where one assumes there's plenty to fret about, only 6.6% of adults have ever met the criteria for significant anxiety issues.
Stress-related ailments cost the United States an estimated $300 billion per year in medical bills and lost productivity.
And our usage of sedative drugs has shot off the charts.
Between 1997 and 2004, Americans more than doubled their yearly spending on anti-anxiety medications like Xanax and Valium from 900 million to 2.1 billion.
All these figures are antiquated. The figures are double today.
And as a psychologist and anxiety specialist, Robert Leahy, has pointed out, the seeds of modern worry get planted early.
The average high school kid today has the same level of anxiety as the average psychiatric patient in the early 1950s, wrote Leahy.
Security and modernity haven't brought us calm. They've somehow put us out of touch with how to handle our fears.
This is an excerpt from a book titled Nerve: Poise Under Pressure, Serenity Under Stress, and the Brave New Science of Fear and Cool by Taylor Clark, published, the publisher is Little Brown. 2011, and the situation has become doubly as worse since then.
Now of course when I say he, it's a she, she is a he, you know, these gender pronouns are interchangeable.
Anxiety disorders, especially generalized anxiety disorder, GAD, are misdiagnosed very often.
There's a variety of things. They're misdiagnosed as narcissistic personality disorder, as borderline personality disorder, as paranoid personality disorder, as mood disorders. The misdiagnosis with anxiety disorders is pretty huge.
Anxiety is uncontrollable and excessive apprehension.
Anxiety disorders usually come, replete with obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, difficulty to concentrate somatic manifestations, such as an increased heart rate or sweating or in panic attack, chest pains, and genoc pectares.
Let's consider, for example, narcissists.
By definition, narcissists are anxious. They're anxious. They seek social approval. They thrive on attention. They disintegrate when they don't get it.
Narcissistic supply. A state known as collapse. When they don't get narcissistic supply, they collapse.
The narcissists cannot control this need for narcissistic supply, and therefore cannot control the attendant anxiety when he doesn't have supply.
Because the narcissist requires external regulation, external feedback to regulate his labile sense of self-worth.
And this dependency makes most narcissists anxious and irritable. They fly into rages. They have a very low threshold of frustration.
And exactly like patients who suffer from panic attacks and social phobia, another anxiety disorder, narcissists are terrified of being embarrassed or shamed or criticized in public, something known as mortification.
And consequently most narcissists fail to function well in various settings.
So we find failures in social, occupational, romantic environments.
Many narcissists develop obsessions and compulsions, and exactly like people who suffer from generalized anxiety disorder, narcissists are perfectionists. They're preoccupied with the quality of the performance and the level of their competence.
As the Diagnostic and Statistical Manual puts it, GAD patients, especially children, are typically overzealous in seeking approval and require excessive reassurance about their performance and their other worries.
Sounds like a narcissist, doesn't it? And this could apply equally well to analysis, of course.
Both classes of patients, patients with anxiety, well to narcissists, of course. Both classes of patients, patients with anxiety, patients with narcissism are paralyzed by the fear of being judged as imperfect or by fear of being found lacking.
Narcissus, as well as patients with anxiety disorders, constantly fail to measure up to some kind of inner, harsh and sadistic critic and a grandiose inflated self-image.
The narcissistic solution is to avoid comparison and competition altogether and to demand special treatment, entitlement.
The narcissist's sense of entitlement is in commensurate with the narcissist's true accomplishments.
The narcissist withdraws from the rat race. He is a legend in his own mind because he does not deem his opponents, colleagues or peers worthy of his efforts.
As opposed to narcissists, patients with anxiety disorders are invested in their work and in their profession. To be exact, anxious patients are over-invested.
Their preoccupation with perfection is counterproductive. You know, perfect is enemy of the good.
Ironically, this constant anxiety reduces their ability to function, and so they are typically under achievers.
It is easy to mistake the presenting symptoms of certain anxiety disorders. It's easy to confuse them with the signs of pathological narcissism.
Both types of patients are worried about social approbation. Both of them seek it actively. Both present a haughty or impervious facade to the world. Both are dysfunctional. Both are weighed down by a history of personal failure on the job, in the family everywhere.
But the narcissist usually is egosyntonic. Narcissus is proud of who he is and happy.
The anxious, happy-go-lucky guy. I'm not talking about covert narcissists now. I'm not talking about grandiose narcissists.
The anxious patient is more like the covert narcissist. He is distressed and he's looking for help and a way out of his or her predicament.
So let's consider derivatives of anxiety. For example, separation insecurity, colloquially known as abandonment or separation anxiety.
Abandonment anxiety is the outcome of object inconstancy, the infantile belief that the physical absence of a love object is forever and portends an imminent emotional absence.
This is why babies cry when mommy leaves the room. They catastrophize.
So object inconsistency is when you can't trust someone to stay in your life when they're not with you physically present.
The inner narrative of doom is, mommy will never return, she will not love me anymore, and consequently, I'm bound to die because no one is going to feed me. That's a baby's version.
But the adult version is not very far from it.
Normal people sublimate urges, drives, powerful emotions, and consequently, they also sublimate anxieties. They redirect the energy into other activities. I'm sports, writing, gardening, sex, you name it.
Adults with mental health disorders react to anxiety in two major ways.
As an example, abandonment anxiety.
Co-dependence and borderlines, people who suffer from dependent orreact to anxiety in two major ways.
As an example, abandonment anxiety.
Co-dependence and borderlines, people who suffer from dependent or borderline personality disorder, they cling, they become needy, they seek to micromanage and control significant figures in their lives. Control from the bottom with emotional blackmail, labile drama, modulated aggression or outright bribes, sex, money, power, access, contacts, you name it.
I cannot live without you is the manipulative battle cry of such personalities.
Narcissists and psychopaths, on the other hand, dissociate. They mentally delete the source of frustration, anxiety, discomfort and threat. They avoid emotional depth and continuity. Shallow or flat affect is very common.
There's no investment, emotional investment, because they don't believe that emotionally investing in something guarantees happiness or an ongoing relationship. They believe that if they keep their affect shallow or flat, and if they don't have an emotional investment, this guarantees little or no pain when they're abandoned or separated. It ameliorates the anxiety. It's anxiolytic. It reduces anxiety.
This aloofness, this detachment, this indifference, they reduce anxiety.
These people simply move on to the next partner, or they sexualize their anxiety in frustration. They become promiscuous.
The saying, out of sight, out of mind, must have been coined by a borderline or possibly by a psychopath.
So you see, worry and worrying, these are not minor issues. They're at the core of many mental health problems, even at the core of some personality disorders.
Anxiety is the root of many mental illnesses and manifestations of mental illness.
If I had to choose two engines of mental illness, I would choose narcissism and anxiety. You put the two together, you get almost any known mental illness.
And worry is just another name for the type of anxiety that does not dare call its name. The type of anxiety that is sick, that is, that is seeking to find some reason or cause or rhyme. The type of anxiety that is so diffuse that is always there, only present or pervasive, ubiquitous. The type of anxiety that compels people to ruminate, to tackle the problem by focusing on it or by becoming the problem.
So worry is not to be underestimated. And unfortunately in the literature, it is underestimated.
People have transitioned from worry to anxiety, and so now everyone and his mother-in-law is studying anxiety, or narcissism, which is a form of anxiety.
Psychopathy is definitely compensatory to anxiety. The psychopath is anxious, and his psychopathy is a way to allay or to mitigate the anxiety.
I'm such a bad guy, you know, I'm such a bad guy that I'm safe.
And this sense, this lack of a secure base, lack of safety, lack of stability, determinacy, predictability. This leads to compulsive worrying, which is just another phrase, another name for generalized anxiety.
And so I think we need to reassess our priorities, research priorities, and to focus again on basics, worry to start with, to worry about the basics.