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

It is a Herculean task to integrate psychoanalytic theory and practice with contemporary neuroscience. In their paper, Alexander, Feigelson, & Gorman attempt to advance such an integration by reconciling the psychoanalytic perspective on panic disorder with a proposed model of fear conditioning as it relates to anxiety disorders. The authors succeed in providing a provocative article that makes accessible current scientific knowledge about fear conditioning and extinction processes while also carefully selecting illustrative examples from psychoanalytic doctrine. In the current commentary, we address several issues that we believe are especially germane to this enterprise.

We propose that it is essential to distinguish between psychoanalytic theory as it relates to the etiology or pathogenesis of psychopathology and the theory and practice of psychoanalysis as a treatment. Contemporary psychoanalytic theory regarding development and emergence of panic disorder (or other “neuroses”) hinges on the idea that key archetypal events in childhood leave residua that remain unresolved and that underpin subsequent emergence of psychopathology. The general idea that early social experiences, especially with parents and primary caregivers, represent critical moments in character development or precipitate vulnerability to the development of psychopathology is not controversial. Certainly, as outlined in the authors' article, the emergence of neuroscience data supporting some of the specific mechanisms that mediate these phenomena in animals is one of the most exciting areas in contemporary neuroscience. However, because they lack an evidentiary basis, assertions of psychoanalytic theory regarding specific events in childhood, and how they are perpetuated and played out in adulthood, have failed to gain acceptance among the broader scientific community. Indeed, inferences from data gathered in adulthood—whether