Panic Disorder and the Retreat from Meaning

The evolution of psychoanalytic theories of etiology usually spans at least several familiar stages. Phallic—oedipal dynamics are described and then gradually supplemented by preoedipal ones and object relations considerations. A subsequent focus on earlier stages of development and dyadic relations is then accompanied by the postulation of developmental failures and structural deficits and leads to an emphasis on the traumatic, the external, and the interpersonal as opposed to the intrapsychic. Eventually, explanations originally offered as complementing existing theories are presented as supplanting them (the pars pro toto fallacy). Somewhat unique to the evolution of theories about panic and agoraphobia is that, at present, they have come more and more to resemble Freud's prepsychoanalytic formulations of aktuell neurosis, formulations embodied in a theory which lacks the fundamental psychoanalytic concepts of infantile sexuality, dynamic unconscious mentation, and unconscious fantasy. Ironically, biological psychiatrists, cognitive-behaviorists, in addition to significant numbers of psychoanalytic deficit theorists, often quote Freud's pre-1900 remarks about the absence of psychological content in panic attacks and agoraphobia. Such an unlikely alliance among disparate theories is, I believe, due to their sharing of similar nondynamic, nonmental models of pathogenesis, models wherein mechanism obfuscates meaning. Neither psychiatric research nor clinical psychoanalytic data, however, justifies the ignoring of the significant and