But the wish is savagely thrust from his mind—along with a sudden burst of hostility toward his wife which he
would never have admitted himself capable of experiencing.
Driving home, he suddenly finds that he has difficulty distinguishing the colors of the signal lights, everything in
his field of vision seems to be swimming, and terrible pains appear to be coming from his heart. He feels that he is
going to die of a heart attack. But what he is suffering from—the anxiety that has exploded within him—is a self-
esteem attack.
The collision is: "I must not"—and "I did, and do, and will (wish for my wife's death)."
The clash is between a value-imperative, engaging his sense of personal worth, his self-esteem (or pretense at it)—
and an emotion, a desire which contradicts that imperative. Thus, he experiences a crisis of self-esteem.
In every instance of pathological anxiety, there is a conflict in some such form as: "I must (or should have)"—and
"I cannot (or did not)"; or "I must not"—and "I do (or did or will)." There is always a conflict between some value-
imperative that is tied, in a crucial and profound way, to the person's self-appraisal and inner equilibrium—and
some failure or inadequacy or action or emotion or desire that the person regards as a breach of that imperative, a
breach that the person believes expresses or reflects a basic and unalterable fact of his "nature.''
The mechanics of the anxiety process have been described in a variety of ways by psychologists and psychiatrists
of different theoretical orientations. But if one studies the case histories they themselves report—or any of the case
histories pertaining to anxiety in the many textbooks available today—one can discern very clearly the basic pattern
described above, however the particular cases may differ in details.
One of the commonest errors made by theorists in their interpretations of the anxiety process, is to mistake a
particular instance of pathological anxiety for the abstract prototype of all pathological anxiety —in other words, to
make unwarranted generalizations.
Freud, for instance, in the final version of his theory of anxiety, maintained that anxiety is triggered by forbidden
sexual desires that break through the barrier of repression and cause the ego to feel threatened and overwhelmed.
Karen Horney countered with