Mental health, Freud says, is the ability to love and work. Inhibitions to mental health should prompt treatment, in that the removal of inhibitions, the work of psychodynamic psychotherapy, frees the ego, the self, and allows the mental expansion into deep feelings of love and fulfillment. “That there is a relationship between inhibition and anxiety is pretty evident.” Freud, said in his paper, referenced above. “Some inhibitions obviously represent a relinquishment of a function because its exercise would produce anxiety,” Freud continued. In other words, to avoid anxiety, we humans, constrict our activities. This avoidance could be conscious or unconscious. We can tell ourselves we love routine, when we really mean that we are too anxious to explore new choices in life. This choice to stay in routine and avoid novelty is not symptomatic of mental illness, but when this rigidity interferes with the ability to “love and work” then Freud would say, there is a mental problem. Often, this rigidity can be seen as “spectrum” disorder, meaning that the person has a limited life because of some brain wiring problem, but many “spectrum” diagnoses are often missing, and hence mislabeling, the anxiety issue. “Inhibition is the expression of a restriction of an ego-function” Freud continues.
Arsi, thirty, comes to mind. I have known him since he was twelve and the previous clinician explained to me that he was on the “spectrum”. After many years of working together, Arsi has described trauma, an issue he had never talked about, which led to such severe anxiety that he restricted his life considerably, and thereby appeared to be on the “spectrum”. His shameful trauma, that he was reluctant to disclose for many years, overwhelmed his ego, such that he could only cope by restricting his life considerably. His only source of soothing was videogames, which to others made him look on the “spectrum” but to me was based in horrible fear of re-traumatizing himself. In a symptom check-list, Arsi does not identify anxiety as an issue, but upon further exploration, this deeply shameful trauma led him to a life of a recluse. Prodded to go out and develop friendships, Arsi, after many years, and after disclosing the trauma, made meaningful friendships which he now treasures dearly. Arsi is a loyal friend, and fortunately, and through our work together, he has found similarly devoted people who share his interests and deeply care about him. Did he leave the “spectrum”? I would say he was never on it. He was traumatized, resulting in unconscious anxiety, resulting in massive social inhibitions. Sometimes, not all the time, I want to bring Freud back. He said some pretty brilliant insights into the workings of the mind. More specifically, I give him credit for my ability to help Arsi. It is nice to stand on his shoulders, sometimes!
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Shirah Vollmer MD 