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Introduction
Many intentions to understand human behaviors and the work of the human mind were made in the past and are observed in modern practice. Psychology is one of the crucial fields, the goal of which is to enhance human knowledge through discussing the development of cognitive processes, social behaviors, and different clinical issues. According to Danziger (1997), there is a substantial body of cross-cultural evidence which throws doubt on the universal validity of many of the categories with which the discipline of Psychology has been cooperating (p. 5). Moreover, political achievements cannot be ignored because they determine the quality of social relationships.
In this paper, the main purpose is to investigate the history of psychological efforts to classify and understand anxiety, the cultural-political context will be identified. Anxiety is considered as a normal human reaction to stressful situations. It is also an indicator of serious diseases and a mental health disorder with its signs and types. The history of anxiety as a health problem has been frequently discussed in evidence-based narratives during the last 200 years, and its classification and treatment contribute to a better understanding of related diagnoses.
Research Questions, Goals, and Significance
Today, society recognizes anxiety as one of the most common mental health disorders that can be easily diagnosed, treated, and prevented. Despite the fact that there is no clearly defined term like anxiety disorder , and patients or doctors call similar conditions as phobias, its history, and application in modern psychology deserve attention (American Psychiatric Association, n.d.). The antiquity of psychology directed to the study of anxiety could be traced in the works by Hippocrates and Aristotle.
Then, German scientists and psychiatrists elaborated on a better understanding of the condition. Then, during the period between the end of the 1980s and the beginning of the 1990s, the American Psychiatric Association reshaped the idea of anxiety disorders (Cuncic, 2019a). It was recognized as a health condition that should go separately from such diagnoses as stress, neurosis, or neurasthenia.
The main research question that has to be answered in this paper is as follows: What is a historical significance of anxiety disorder in psychology through the prism of cultural and political contexts? . To give the answer to this complex question, it is recommended to introduce several sub-questions that guide the research strategy and define the critical aspects of the future work. These questions are:
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What is the worth of psychology and psychiatry in understanding mental health disorders?
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What definitions of anxiety formed a current explanation of the condition?
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What are the types of anxiety in modern psychology?
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Does an understanding of anxiety through time influence the choice of treatment?
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What are the current diagnostic and treatment options for anxious people in regards to cultural and political conditions?
Following a list of questions for analysis in this study, several goals must be introduced to explain the chosen direction, methods, and resources. First of all, this paper aims at investigating the relationship between psychology and psychiatry in the intention to understand anxiety as a symptom, condition, and disorder. Secondly, the purpose is to evaluate the historiography of psychology in relation to anxiety. The history of this disorder is ambiguous, but this research is an attempt to learn what was known several centuries ago and what is evident now. Finally, the investigation of cultural and political aspects of psychology and their potential impact of anxiety treatment should be conducted to clarify the internal and external factors of health care.
As soon as the questions are answered, and the goals are achieved, the significance of the study will be evaluated. Anxiety is a disorder that is caused by various stressful conditions under which people have to exist. Cultural background and political decisions influence human behaviors, actions, and thoughts. Therefore, as soon as a practitioner learns the peculiarities of the chosen disease and goes deep into its history and establishment, there is the necessity to understand the reasons for behavioral and emotional changes.
This study is helpful in terms of past and current discoveries of the disorder. Everyday political and social realities provoke anxiety and phobias in human behaviors (Zevnik, 2017). Cultures, in their turn, may encourage or control human emotions, which provoke new anxious stressors and problems. Therefore, cultural sensitivity plays a significant role in diagnosing mental health disorders (Bredström, 2019). In both contexts, anxiety is not an ordinary disorder with clearly defined symptoms but an outcome of external influences.
Methodology
Taking into consideration the goals and significance of the current study, it is extremely important to recognize methods to gather and analyze information. Psychology, as a discipline, has a relatively short history and must be accompanied by historiography when it is possible to unite the achievements of ancient times and modern understandings (Danziger, 2013). Therefore, the creation of research questions and the employment of a comprehensive research strategy enhance the use of a systematic review as the methodology of the scholarly study. This method includes the identification, selection, and evaluation of relevant studies in regard to the chosen criteria.
In this project, it will be a mixed systematic review because the studies with qualitative and quantitative data have to be identified. The main benefit of such an approach is the possibility to find unbiased and balanced information. It helps describe the past and present characteristics of psychology and psychiatry and understand anxiety as a disease with more than 200-year-old history. The combination of the works by psychologists and historians contributes to the recognition of cultural, political, and other facts that serve as the foundation of a good history (Benjamin, 2009). To trace the history of the field and the process of formulation of anxiety as a separate mental health disorder, a systematic review will be used with both qualitative and quantitative studies being analyzed.
Results
To meet the goals of this study, it is necessary to gather various sources and compare their ideas in regard to the chosen questions. Peer-reviewed studies and online articles contain interesting facts about the development of an understanding the concept of anxiety during different periods of time. Antiquity, the 17th and 19th centuries, and modern times are the eras for analysis because there was a high concentration of ideas. Along with articles, it is expected to work with diagnostic manuals and books where authors discuss the classification of anxiety and formulate the attitudes towards human behaviors influenced by this disorder. Finally, several articles and websites will be used to identify the peculiarities of the cultural and political contexts in learning anxiety and its progress through centuries.
Definition of Anxiety
Today, people are frequently diagnosed with anxiety and its variety of types. It is easy to find the information about its main symptoms online or address an expert for help and obtain the required diagnosis. According to the World Health Organization (2017), about 300 million modern people suffer from anxiety that is also ranked 6th as a contributor to global disability. Particularly, in the United States, anxiety disorder affects about 18% of the population, which includes about 40 million Americans (Anxiety and Depression Association of America, n.d.). However, the chosen mental health disorder was first introduced and diagnosed in the 19th century.
Digging deeper, one may discover that physicians and philosophers associated the term of anxiety with such concepts as pantophobia and anxiety neurosis , and the former term was investigated in the fifth century. Therefore, it seems reasonable to focus on several critical definitions that contribute to a better understanding of anxiety in psychology and psychiatry.
There are many studies that aim to gather the extracts from credible ancient sources. For example, the evidence from the Oxford English Dictionary proved that pantophibia first appeared in English in 1781 (Crocq, 2017). Pantophonia was originated from the Greek and Latin terminology, meaning À±½Ä¿Æ̲¿Â as all-fearing , the literal sense of which was anxiety about everything (Crocq, 2015, 2017). Caelius Aurelianus was a Roman physician who worked with mad people and elaborated a specific nomenclature that was not always easy to comprehend but influenced the development of psychiatric terms in the future (Gourevitch, 2017).
General meaning of pantophobic patients included people whose behaviors were impossible to control because of fear of everything. Vain fear was also evaluated by Aristotle when he wrote about people who could get scared of a mouses squeak (as cited in Crocq, 2017). All these ancient definitions were brought to the 19th century, where Freud, Kraepelin, and others used these terms in their works.
A transitional phase between ancient and modern definitions of anxiety was made by Bossier de Sauvages in the 1700s. The author developed a nosology, where panophobia was in the same group with antipahia, nostalgia, and satyriasis, along with other independent groups of mental disorders like deliria or hallucinations (Crocq, 2017). In less than a century, the term anxiety was elaborated by Beard (from the United States), Freud (a German founder of psychoanalysis), and Kraepelin (a German psychiatrist). Anxiety was defined as a component of various diagnoses (neurasthenia by Beard or neurosis by Freud) (Crocq, 2015).
In the middle of the 1800s, the conditions known as neurasthenia and anxiety neurosis were separated, and the terms panophobia and anxiety became symptoms (Crocq, 2017). Kraepelin, in his turn, described anxiety as an abnormal distressing effect, a kind of anhedonia that penetrates the body and the mind (Crocq, 2015). In the middle of the 20th century, the first Diagnostic and Statistical Manual of Mental Disorders, also known as DSM, appeared. It was based on the opinions of many psychiatric and psychological experts with the intention to create a specific criterion for mental health problems.
Every DSN edition is characterized by clear treatment for patients with anxiety. In DSN-I, anxiety was defined as a symptom of psychoneurotic disorders, a danger signal sent and perceived by the conscious portion of the personality (Crocq, 2015). Compared to the first edition, the second one was improved by enlarged subsets in depressive, personality, and anxiety disorders (Blashfield, Keeley, Flanagan, & Miles, 2014). Anxiety was not only a symptom of neurosis but its synonym, contributing to such disorders like anxiety neurosis (panic and frequent somatic sings), hysterical neurosis, phobic neurosis, and other forms of neurosis (Crocq, 2015). In DSM-III, a separate chapter of anxiety disorders emerged with three main subcategories.
DSM-IV contained a new category in the same chapter to prove the development of the diagnostic system. The latest edition of the source, DSM-V, explains anxiety disorders as those sharing features of fear, anxiety, and related behavioral disturbances (American Psychiatric Association, 2013). Fear is defined as an emotional response to threats, and anxiety is interpreted as an anticipation of future threats (American Psychiatric Association, 2013). In total, being characterized by the presence of Latin and Greek origins, the concept of anxiety has a long way of transformations and improvements. Today, it is defined as a natural response to stress and a mental health disorder with its types and treatment plans determined in specific cultural and political contexts.
Worth of Psychology and Psychiatry in Understanding Anxiety
Peoples understanding of anxiety has to be investigated from the point of view of two perspectives, psychological and psychiatric. Despite the fact that these two fields are associated with common contributions to human mental health, there is a tendency for their overlapping. Both psychologists and psychiatrists work with patients and determine their illnesses in regards to present symptoms, but compared to the former, who focus on understanding, the latter investigate etiology, functioning, and management (Hughes, 2016).
The benefit of this combination lies in the possibility of strengthening psychiatric treatment through the prism of psychological understanding and formulation (Mohtashemi, Stevens, Jackson, & Weatherhead, 2016). Medications and treatment plans offered by psychiatrists can properly work in case a good practitioner is chosen. Psychologists, in their turn, are interested in behavioral changes and communication that may positively influence the condition of a patient.
In case of anxiety, the role of both psychologists and psychiatrists is significant. When the first signs of anxiety are identified by a person or diagnosed by a therapist, it is recommended to visit one of these professionals (Ströhle, Gensichen, & Domschke, 2018). On the one hand, psychologists aim at promoting effective therapies and counseling to support people who suffer from anxiety. The observation and analysis of recent behavioral changes help psychologists understand the nature of problems and stabilize the condition of a patient. However, the prescription of medications is not usually allowed for this group of practitioners (only several states have proved this practice in America).
Therefore, psychotherapy that is offered by psychologists must be based on the conclusions made by psychiatrists. This group of people contains medical doctors who diagnose and develop treatment plans, both drug-based and non-drug. Anxiety is not always easy to control without medications, and a specially qualified person must be involved in the required practice. As it can be seen, psychological and psychiatric help cannot be separated to solve anxiety-related problems in patients.
Classification Attempts
The history of classification of anxiety officially began when the first diagnostic manuals were introduced. According to Ströhle et al. (2018), anxiety disorders are classified in terms of the International Classification of Diseases (ICD-10) and DSM-5. In ICD-10, the codes from F40 to F41 indicate anxiety as the main mental health problem. They contribute to the development of phobic disorders (agoraphobia with/without panic disorder, social phobia, and specific phobia) (Ströhle et al., 2018).
Other anxiety disorders include panic disorder, generalized anxiety disorder (GAD), mixed anxiety disorders, specific anxiety disorders, and unspecified anxiety disorder (Ströhle et al., 2018). There is also separation anxiety that is characterized by emotions associated with the loss of something or someone. Each type has its signs, diagnostic features, and approaches to treatment.
For a certain period of time, obsessive-compulsive disorder (OCD) was a type of anxiety. However, today, the DSM-5 introduces it as a separate disorder with anxiety as its possible but not obligatory symptom. Classification of anxiety depends on behaviors, worriers, and concerns of patients. The American Psychiatric Association (2013) indicates seven main types of anxiety, namely separation anxiety disorder (SAD), selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, and GAD.
SAD occurs when a person experiences fear due to separation from those whom he or she is attached. Additional symptoms are recurrent excessive distress and feeling worried about attachment figures well-being or untoward events (American Psychiatric Association, 2013). Selective mutism is observed in children or adults who do not like social interactions and thus do not want to communicate. Unexpected disturbance results in social anxiety or isolation among patients.
Specific phobia is a reaction of people to specific events, situations, or objects. The most common examples are fears of flying, animals, injections/blood, or heights. Their presence makes a person nervous and anxious, and the solution that is made is avoidance. People who have social phobia do not like the idea of being exposed to society because of potential scrutiny. Anxiety symptoms occur when it is necessary to meet with new people, do unusual stuff, or be observed by someone. Panic disorders are diagnosed when people experience sudden panic attacks and start sweating, choking, fainting, etc. It is important to gain control over a situation and relax.
The cases of agoraphobia include fears of crowded or enclosed spaces, and anxious people do not feel comfortable in shops, automobiles, crowds, or even home (alone). Finally, GAD may challenge a person for more than six months when uncontrollable worry about something occurs. This condition is associated with sleeplessness, restlessness, fatigue, or irritability (American Psychiatric Association, 2013). This particular type is frequently discussed in the cultural or political context because people depend on their traditions, beliefs, and public events.
Before the publications offered by the American Psychiatric Association or the World Health Organization, the classification of anxiety was not properly developed. It was considered as a part of other mental health disorders like neurosis or pantophobia (Crocq, 2015). With time, Kogan et al. (2016) underlined that the development of classifications could provide a more direct understanding of underlying disorder etiology to reduce disagreements and define psychopathology of disease (p. 1142).
Consistent and categorical classifications are usually based on evidence to clarify which intervention is more appropriate for a particular person. Besides, one should know that anxiety disorders remain the most commonly comorbid and misdiagnosed disorders (Abbott, Shirali, Haws, & Lack, 2017). A further treatment plan and outcomes depend on how well a clinician understands the disease, how thorough a report of a patient is, and how subjective a nurse assessment is. Many complex situations are observed in anxiety treatment, and the identification of cultural and political norms is important for further treatment and recovery.
Understanding of Anxiety Through Time
In psychology, there is a significant gap between Antiquity and modern medicine, which tells about the progress people were able to achieve through time. An understanding of anxiety was changed because of the possibility to introduce this condition not only as a diagnostic term for other diseases but an independent and treatable disorder with specific signs (Crocq, 2015). Alone with clearly given definitions and explanations of what anxiety meant at different periods, it is also important to recognize the approaches to understanding anxiety in regard to the epoch with its rules and traditions. The term of anxiety can be evaluated in three main periods: Antiquity, transitions between the 17th and 19th centuries, and the modern era.
In Greek medicine, such a term as anxiety did not exist, but its cases were described as a part of behavioral disorder. The texts written by Hippocrates mentioned the name of Nicaron who was afraid of the flute girl, and each time he heard the flute voice, he suffered from terror (Crocq, 2015).
Still, those panic episodes were observed at nighttime only, and during the day, the man was not affected by the same sound. Aristotle, as a representative of the same epoch, understood this behavior as a fear of something or even everything (Crocq, 2017). The relation between anxiety and fear was also observed in the works by Galen, who described this condition as fear with a combination of breath (pneuma) and the blood inward, which caused outward motion. In total, an understanding of anxiety during ancient times was connected with a feeling of fear and the inability to control it under certain irritants.
The next several centuries did not have any contributions or explanations of anxiety. In the 1600s, Robert Burton relied on Galens definitions to explain the causes of fear that did not have clear grounds (according to his understanding). However, in fact, the causes of fear existed, but it was hard for people to identify them at that period. The contribution of Burton was the recognition of sorrow as another element of anxiety (Ingram & Lawlor, 2018). The middle of the 18th century was another remarkable period in discussing the peculiarities of anxiety. Boissier de Sauvages contributed to an understanding of anxiety through his works on medical nosology (Crocq, 2015).
His classification covered more than 2400 diseases, with mental illnesses presenting as the 8th class with four subclasses (hallucinations, morositates, deliria, and folies anomales) with anxiety or panophobia being in the morositates group (Crocq, 2018). In this transition period, anxiety was not coined as a separate term but its preceding synonym, panophobia, was explained as groundless fear. During the chosen centuries, society was close enough to define anxiety as a behavioral disorder with specific symptoms.
Finally, the era of modern understanding of anxiety occurred when the classifications made by the World Health Organization (ICD) and the American Psychiatric Association (DSM) were officially recognized and applied in medicine. A modern understanding is based on such concepts as anxious arousal (somatic tension) and anxious apprehension (worry about future events). Anxiety is now understood as a physiological response to potential irritants, an emotion that is hard to control, and a disorder with its specific biomarkers.
Treatment for Anxious Patients
The discussion of treatment methods that can be offered to patients with anxiety is closely related to definitions and understanding of the condition. With time, people have got access to a variety of options to identify and diagnose anxiety. Still, according to Crocq (2015), treatment plans in antiquity and modern medicine are usually the same and based on cognitive approaches. As a rule, it is expected to identify the root of the problem and choose some behavioral initiatives to improve health and communicate challenges.
At the same time, treatment of anxiety was an issue for discussion between cultures and times. Thorpe (2017) investigated the most interesting and bizarre cures for anxiety in regards to the cultural and medical preferences. For example, in the oldest medical texts, the idea of luring the organs with perfumes was offered. It was believed that women could have seizures or anxious behaviors because their reproductive organized were accidentally removed to another place (Thorpe, 2017).
It was necessary to choose a pleasant smell and lure the organ to the necessary place. Some Greek communities connected behavioral changes with the influence of God. Therefore, anxiety (not well-known recognized at those times) could be possible healed by means of prays and talks to supreme beings. In Chinese Antiquity, a tea made of the elements of the volcanic rock with some fossil vertebrates was offered to a person (Thorpe, 2017). In Europe, there was a tendency to push patients into holy water to provoke some shock and remove problems. In fact, all these attempts to deal with anxiety remind modern treatment approaches because they include some manipulations with human body and mind.
Today, medical centers and hospitals offer similar diagnostic and treatment methods that have their roots in ancient time. The major division lies in the use of specific medications and drugs to control human emotions and help people deal with unexpected behavioral changes or natural resources and activities with no pharmacology being applied. The most common natural remedies for patients with anxiety include meditation and the use of herbs (Sibley, 2017).
For example, vetiver essential oil was used by Indian tribes to heal people with its soothing properties (Sibley, 2017). Oils with lavender as its component lessen anxiety, remove sleep problems, and predict other disturbances (Arnold, 2018). Valerian roots are frequently used in America and European countries to regulate nerve cells and the work of the brain, which results in calming anxiety (Sibley, 2017). The number of natural products that can stabilize the condition of a patient varies in regions, and it is a persons decision either to use them and believe in their effectiveness or choose additional methods.
Similar natural healing ideas include attention to the quality of food and the style of life. For example, Arnold (2018) uses the investigations of modern psychiatrists and researchers to underline the worth of high-protein diet (fish, greens, and beans) in the morning. Fashion of physical exercises is another way to predict anxiety and control symptoms. Specialized associations proved that regular exercises can alleviate symptoms for hours (Arnold, 2018). The use of vitamins (omega-3, vitamin B-12, and probiotics) may effectively reduce the number of anxiety symptoms and be helpful in clinical diagnoses (Arnold, 2018). Self-care (never confuse it with self-treatment) plays a crucial role in the improvement human health and dealing with anxious-related disorders and changes.
Before Freud, people knew a little about the peculiarities of psychoanalysis and cognitive therapies. Today, modern society (especially in the United States and many European developed countries) cannot imagine their lives without communication with a psychologist or another expert. In the past, such philosophers as Cicero and Seneca used cognitive treatment to help patients with anxiety and get free from the effects of fear (Crocq, 2015). In the middle of the 20th century, the results of the work of such psychologists as Skinner, Wolpe, Eilis, and Beck contributed to the introduction of cognitive therapy (Kaczkurkin & Foa, 2015). They supported the practice during which maladaptive emotional responses are built to change peoples thoughts about something or someone. In other words, ill people use the help of professional practitioners and learn how to improve their symptoms and avoid negative outcomes of anxiety.
Cultural Context
The cognitive development of every person is unique and depends on a variety of factors. Cultural beliefs may influence the processes directly and indirectly by creating specific threats or providing necessary responses. Recent studies about treatment of anxiety have already shown that cultural preferences determine an understanding of this disorder. Ancient Greeks considered anxiety cases as the ones interfered with the supernatural world (Thorpe, 2017).
It was in Gods powers to control humans, challenge them, and improve their well-being as a part of a healing process after multiple prayers. Chinese traditions are closely related to the natural world and the cooperation of people with flora (teas, herbs, and trees). Each culture has its practices; therefore, in discussing anxiety and its understanding, much attention is paid to the cultural context.
For centuries, nations continue using their past experiences and discoveries to find out the best treatment for the worst diseases. In India, the field of psychiatry is based on the necessity to listen to patients and arrive at the necessary diagnosis (Khambaty & Parikh, 2017). Historical roots of treating mental disorders can be traced in ancient texts like Ramayana (avoidance of events and hyperarousal) or Shrimad Bhagavatam (threats caused worry and sleep disturbance) (Shrimad Bhagavatam, 2017).
Besides, Indian culture is characterized by such values as family unity, intimacy, and respect for older people. Therefore, the recognition of we is higher than I preferences, which influences the expression of anxiety (Shrimad Bhagavatam, 2017). Shame, responsibility, and the necessity to follow social norms and order prevail in Indians, and anxiety may be the result of not following the established standards. Collective healing and communication with several people become the main directions of treatment of anxiety in India.
In China, another approach to dealing with anxiety is offered. Fan and Chang (2015) explain that Chinese society evaluates anxiety as a development outcome of risk genetic factors, inappropriate parenting, poorly explained experiences, and other contextual forces. Compared to India, where common support and cooperation are promoted, Chinese psychology implies obedience and sacrifice of personal interests if they contradict to community demands (Fan & Chang, 2015). Each nation is free to develop its attitudes toward anxiety and the resources that could be spent on its control and prevention.
Cultural differences are also discussed to understand if anxiety could be more inherent to one group of people and diminished in another group. Cuncic (2019b) say that nations have different social rule and expectations, which determines the prevalence of anxiety in countries. For example, in Taiwan, only 0.4% of the population have anxiety, in Japan, about 0.8% of people are anxious, and in the United States, the rate is about 8% (Cuncic, 2019b).
In addition, such factors as ethnicity and gender may influence the risks of this disorder: males over women, Hispanics and Blacks over other races, urban areas over rural regions. Globalization promotes the exchange of experiences and interests within a short period (Yang et al., 2015). Some nations are not able to keep up the achievements, when other communities make use of discoveries and knowledge exchange like the best outcome of acculturation processes (Concha, Sanchez, Rojas, Villar, & De La Rosa 2016). Therefore, even anxiety may be classified as an insignificant behavioral problem for a nation, national preferences, interests, and cultural believes still have a tremendous impact on this disorder.
There are also many individualistic characteristics that may influence the development of anxiety. For example, fear of making other people uncomfortable may contribute to anxiety, as well as serve as a method to treat the disorder (China as an example) (Cuncic, 2019b). In American society, additional help is always promoted, and people find it normal to find an expert and ask for counseling to solve anxiety-related problems. The cultural aspect in understanding anxiety as a mental health disease cannot be ignored because of a number of influential factors and motives individuals use to explain their behaviors, decisions, and concerns.
Political Context
One should admit that many cultural, ethnic, and healthcare categories depend on certain economic, political, and social factors. According to Yang et al. (2015), if the political situation changes, all other categories may change as well and cause new conditions in healthcare or other spheres. At the same time, such mental health problems like anxiety may influence the field of politics and determine human rights and freedoms in different ways. Therefore, the political context discovers additional qualities of the disorder and helps to understand its impact on society through the years. President Franklin Roosevelt was the author of Four Freedoms (speech, worship, want, and fear) to underline American peoples supremacy during the period of the Axis threats.
Fear was one of the elements in the statement, and Crocq (2017) explained that fear was synonymous with anxiety in the 1800s and the main symptom that came from ancient times. The political situation in the middle of the 1900s proved that anxiety was not gone and continued to be a problem that pressed decisions and challenged freedom
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