We all commonly experience performance anxiety when taking a test, speaking in public, or acting on stage. Patients report all kinds of medical, physical, and psycho-logical symptoms, which range from sweating, nausea, and palpitations to an overwhelming sense of doom to a heightened sense of tension about the potential outcome of their project. This might also happen to accompany an activity which the patient really loves to do (playing her favorite instrument or speaking about the topic which she most enjoys). There often seems to be a history of trauma in these patients.
For example, a child made too much noise when practicing a performance and was terrified by the yelling and beating which ensued, thereby feeling threatened by and afraid of his parents. It may take a while working with any particular patient to get to these memories, but it seems that using medication to control the symptoms more immediately while helping the patient to understand that his or her symptoms are not coming out of the blue (as they first seemed), he or she can achieve a greater sense of control. In the case of the child mentioned earlier, this type of understanding pro-vides the now-adult patient with the realization that he does not have to respond to the performance at hand as if it were a time of stern punishment from childhood, when he really did have no control over the overwhelming fear.
Patients also talk about another kind of memory connected to their anxiety surrounding performance: the fear of loss of love from their families. They fear that love in their particular family depends upon performance; hence, a test or other performance becomes not just about delivering the information that they know or communicating the material of the presentation, but rather an assessment of whether they are lovable. This feeling can leave patients feeling angry and hurt that their self-worth has become tied up in a performance rather than simply in a sense of self. In more complicated cases, parents do more than just become critical; they beat their children if the performance is not perfect or beat their children even when the performance is perfect (ostensibly for some trivial item, like the proverbial spilled milk).
This unfortunate association places the child in a double bind: damned if he does not succeed, and damned if he does. All of these examples combine the hand that feeds the child intermittently with the one that beats it. This kind of rein-forcement—the same principle that keeps people blowing their life savings in Vegas, hoping (in the words of the gambler’s prayer) “Lord, let me break even”—keeps children desperately attached to the pursuit of love from an abusive relationship. Interpretation of success thus becomes complicated.
Is a man who recently became the chair of his department competent, powerful, and able to separate from his parents? Or, has he placed himself at risk for a beating? This man might feel proud on the one hand, but become symptomatically anxious on the other as he experiences new-onset rage or panic attacks. It may feel more socially and psychologically acceptable for this man to avoid treatment, live with symptomatic performance anxiety, and keep himself from acting on more aggressive, violent, disruptive feelings.
Rick’s comments:
Sometimes at work, but more often in my personal life, I tend to put off activities, even potentially pleasurable ones, because of my anxiety. These undone tasks, which might be minor at first, tend to build up and become more urgent as time passes (such as the bill that comes with a past due notice, or a leaky faucet that goes unfixed). They increase my anxiety over whatever I should have done in the first place. Then the task suddenly looms large and threatening.
I’ll bet I’m not the only anxiety sufferer who goes through this! Does it sound familiar to some of you? I think of this pattern as procrastination; it’s deeper than that, however. I tend to be a perfectionist (not, heaven knows, someone who does things perfectly, just someone who thinks I should do things perfectly), and I worry when I begin a task that I won’t do it correctly and then will get down on myself. This happens more often with things that are new to me or when I feel the task does not use one of my strengths. As I wrote earlier, when I overcome this and do the task (finally!), I feel a real sense of achievement.