Commentary on “Integrating the Psychoanalytic and Neurobiological Views of Panic Disorder”

This is an ambitious and important attempt to bridge psychoanalysis and the clinical neuroscience of anxiety disorders, and although the title emphasizes panic disorder, Alexander, Feigelson, & Gorman review many other clinical anxiety disorders and offer many fine summaries of literatures. I would say that in general I am quite sympathetic with the overall aims of the authors, but I do feel that a couple of issues might get somewhat better underlined.

The centerpiece of some of these more modest differences with the authors might be a larger emphasis on the primacy of separation distress as a prototype emotion. This tendency toward conflation of the two distinct prototype states of fear versus separation distress and the neglect of separation distress is unfortunately widespread within psychiatry, and it is a principled distinction in terms of a nosology for prototype emotion worth emphasizing at the start (Panksepp, 1998; see Panksepp & Watt, 2003, for further elaborations). The authors start out with classical psychoanalytic theory about the nature of anxiety from the standpoint of a basically energic drive theory, but unfortunately they neglect some less visible strands of Freud's thinking that might relate panic disorders more to separation distress. One of Freud's more insightful statements about anxiety was about how human infant had the challenge of “helpless longing.” This formulation for (separation) anxiety as “helpless longing” was generally lost in mechanistic-hydraulic drive-theory metaphors (“what is the poor undeveloped creature to do with his longing”—Freud, 1927). There is rarely, if ever, a principled distinction drawn in much of the psychiatric literature between separation anxiety and fear as truly distinct emotional systems in the brain. This means (among other things) that the potential