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

What frightens us? Alexander, Feigelson, & Gorman have summarized the neurobiology of fear and cogently argued for the homology of these fear mechanisms with those of anxiety generally and panic disorder specifically. Their central thesis explicates a phenomenology of learned behavior in the pathogen-esis of panic, which has been advanced in the service of the ambitious and laudable goal of integrating neurobiological and psychoanalytic theory, at least as pertains to this condition. In some aspects finely woven tapestry, in other aspects patchwork quilt, their thesis offers a trove of ideas and questions to contemplate in regard to the potential integration of these ostensibly different domains. The hard science that stands in support of at least some of their thesis presents a useful challenge to psychoanalytic theorists to integrate its discrete findings, if not its speculations, which are far more plentiful. Indeed, psychoanalytic theorists cannot ignore the findings of neuroscience, and the field should welcome opportunities, however tentative, for integration. To be sure and to be clear, we are still at the level of comparing theoretical models, not reconciling and integrating data.

As presented in the paper, evidence from both animal and human models compellingly argues for a biology of fear and anxiety expressed as a learned and thereby enduring response. The anxiety response is potentially evoked by a universe of triggers increasingly populated by life experience—a response that can also be, must also be, unlearned to secure any remedy. It bears emphasis that this model posits an actual experience of danger, inextricably coupled with an adaptive fear response occurring in the earliest eras of precognitive development, as a predicate to the later experience of panic. When later occurring apart from objective danger, panic is considered archaic and maladaptive, a response insufficiently mediated (inhibited) by reason—that is, the prefron