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Dr. Silber has focused on the Max Schur aspect of my presentation. His discussion reflects a deep understanding and appreciation of Schur's contribution to a psychoanalytic formulation of anxiety.
Silber expands Schur's biphasic formulation of the evaluation-of-danger/reaction-to-danger sequence, by making explicit the experiencing of danger prior to its evaluation. Further, Silber appropriately emphasizes the importance for the patient of differentiating between the experiencing and the evaluating functions on the one side, and the reaction/behavior response on the other. Consistent with Schur, Silber underscores the significance of regressive changes in evaluating and reacting to danger.
Silber's case vignette includes some clinical suggestions not found in the literature (except in his own earlier article, [1989]). Silber finds himself using words to provide some familiar structure when the patient has slipped into a regressed state, to help the patient convert the traumatic experience into a tolerable danger, which can be symbolized and conceptualized. This leads to the possibility of evaluating the danger through reality testing and judgment, and allows the subject to exert some choice from the range of possibilities in her response repertory. Silber ends with a caution that the differences among feeling, thinking, telling, and behaving can become blurred to the analyst under the impact of his or her own anxiety in the psychoanalytic situation. This is an important point that merits expansion and careful consideration. It can affect the analyst's participation, role, and interventions in significant ways, and is especially likely to be an issue with patients prone to panic attacks, high aggression, and severe psychopathology more generally.
My thanks to Dr. Silber for his stimulating discussion of Max