With a confidence in Mr Elliot’s regard, more creditable to his feelings than his judgement, Mr Smith had appointed him the executor of his will; but Mr Elliot would not act, and the difficulties and distress which this refusal had heaped on her, in addition to the inevitable sufferings of her situation, had been such as could not be related without anguish of spirit, or listened to without corresponding indignation.
There are no more uses of "anguish" in the book.
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I felt unbearable anguish when my 4-year-old child died from brain cancer.
Her guilt led to anguish until she committed her life to good.