This slightly revised version of a Pacifica radio talk fits well into our recent discussions about the continuing relevance of Freud, and how liberal mental health professionals thought about anxiety disorders in the early 1990s. I refer the reader to Freud’s Group Psychology and the Analysis of the Ego for a stimulating remark on “neurotic dread.”* I was asked to repeat the KPFK talk, and it was subsequently read by a practicing historian-psychoanalyst Peter Loewenberg. I got no criticisms from listeners who showed it to their therapists. I am not a therapist, but read in the history of medicine and psychiatry.
KPFK program Panic Attacks, hosted by Dr. Etta Enzyme, December 12, 1994. First in a projected series exploring the ways specific historical explanations (especially the causes of World War I, World War II, the Holocaust, the Cold War, ecocide etc.) affect mental and physical health, hence the possibility of constructive social change.
1.What is a panic attack? Panic attacks are not fear responses to immediate threats like earthquakes. Rather, harmless but symbolically laden internal body signals stimulate terror: of isolation, of loss of support, of loss of balance, of descent into madness; it is the state of mind most desired by practitioners of psychological warfare. Persistent anxiety weakens the immune system. Clinicians often see panic attacks as one instance of separation anxiety, itself symptomatic of an underlying narcissistic personality disorder.
2.Comment on Dr. Joycelyn Elders firing: how have journalists explained opposition to masturbation? For instance, see Gina Kolata, “America Keeps Onan in the Closet,” The New York Times, 12/18/94, p. E5 for an ooh-la-la description of masturbation phobia since the 18th century “when sex became medicalized.” Laughable consequences are listed, but none resembles the fear of critical thought (i.e., of separation from abusive authority) in D.H. Lawrence. In a Letter to the Editor 12/20, Frederic C. Thayer writes, “Traditionally, masturbation is condemned because it wastes energy and sperm necessary for procreation, and is for selfish pleasure rather than social duty. Masturbation is described as “self-abuse” that causes mental derangement.”
The hostile conservative response to masturbation is more complex than some timeless resistance to (anarchic) pleasure by ascetic, corporatist thinkers. In Pornography and Obscenity Handbook for Censors, D.H. Lawrence rants on about the “self-abuse” he attributes to mass culture which, while apparently promoting “sex-secrecy,” “stealthily” inflames the flesh: the “mental energy” sometimes released leads solely to the “futility…nothingness…sentimentalities…self-analysis…impotent criticism…suppressed rage” which characterize (solipsistic) “modern literature” and “work[s] of science.” “[Masturbation] is the deepest and most dangerous cancer of our civilization.” Lawrence’s is a class-bound reactionary response to the “the grey ones left over from the nineteenth century,” i.e.,, to Victorian culture; his panicky diagnosis of [narcissism] reminds me of more recent, equally pessimistic criticism. What (other than the family) are the political and institutional sources of this anxiety? How have mental health professionals accounted for panic attacks and related anxiety disorders, and what are some of the debates in the field?
3.Object inconstancy and its discontents. Since the pioneering work of Bowlby, Winnicott, and Mahler, new thinking in clinical psychology and social work stresses the lifelong salutary effects of a strong and reliable maternal bond, experienced as object constancy. Should there be a lack of steady parenting in early childhood, the damage may manifest itself later in panic attacks and related phobias and symptoms, especially during adolescence; appropriate separation is sometimes impeded by parents who ask their growing children to befriend them so as to contain the parents’ anxieties. At all ages related symptoms may include insomnia (there is no internalized representation of the protective parent: only a surrogate close at hand will allow relaxation); hoarding; fears of being poisoned (e.g., by mass culture); school phobia (clinging to mom or exposure to “secular humanism”?); drug use to deaden the pain of loss; self-mutilation and adolescent suicide (only a violent act directed against the self can restore the maternal bond); agoraphobia; compulsive “taking care” of others to control them; clinging to masochistic relationships; the inability to cope with divorce; and in borderline personalities (close to psychotic), oscillations between depression over lost attachments and fears of being swallowed up and disintegrating. One psychologist notes a common wish: the longing for the golden fantasy of a symbiotic [i.e., not draining?!!]) relationship with mother where all needs are met, hallowed by perfection. (None of the dozens of psychology abstracts I consulted specifically alluded to authoritarian ideologies and peasant societies of the Right or Left where individuation would not force young people into agonized choices; cf. D.H. Lawrence, or T.S. Eliot and his hatred of “worm-eaten liberalism” aka “freethinking Jews,” the catalysts or enzymes of social disintegration.)
Professionals disagree about the efficacy of antidepressants, or whether or not separation anxiety in infancy and early childhood explains panic attacks in adulthood. To me, the most sensible suggestions for treatment were historical and sociological in approach: psychiatrist Terry Kupers says mental health professionals must be activists to provide public funding for the treatment of anxiety disorders; meanwhile in short-term care the patient should record the circumstances of every parting to detect lifelong patterns of separation anxiety in relationships. Another stressed the need for family therapy to scrutinize the ways in which their interactions impede autonomy. Another writer, in a similar vein, reminded me that the problems in separation cannot be described schematically, that particular families shape the difficult problem of growing up in their own unique and awful ways. [I doubt that there is an infinite variety of histories.] In other words, individuals and their families are being taught to read themselves and the often subtle messages they communicate around issues of maturation and difference, to discover the patterns which contribute to serious mental and physical health problems, and which in turn will affect social action.
4. The larger institutional environment in which anxiety disorders have emerged. Because the transition from pre-modern to capitalist social relations is incomplete, the humanities lag behind the hard sciences. There are some sociologists, political scientists, and cultural anthropologists whose work is avowedly anti-science; Harold Lasswell was part of the moderate conservative movement of academics who explicitly separated the methodologies of the social sciences from the physical sciences in the 1920s. In a related move, the history of science as an academic discipline was contrived by Harvard’s Robert Merton to demonstrate the socially constructed character of scientific knowledge; Merton’s project was candidly counter-Enlightenment.
The legitimacy of the exploring, self-directing individual is advocated by only a minority of liberal and Left intellectuals; scientists are necessary but suspect, like rationalism in general. We give lip service to “cultural freedom,” but few of us are willing to live with its consequences. Yet our official ideology in “the West” asserts numerous civil rights and obligations to participate in democratic processes. What critical tools are required to make popular sovereignty rational and humane? How have threatened élites discouraged the development of critical skills through psychological warfare in popular culture? Have upper-class radicals, in the name of socialism, served reaction, not popular education? What public policy demands should be advanced by liberals to educate citizens for mental and physical health?
5. On narcissism theory and recent prescriptions for its cure. The derogatory term “narcissistic” denotes the selfishness of yuppies; for instance, some social democrats claim that “the culture of narcissism” (Christopher Lasch) has produced Generation X: abandoned, empty, confused and self-destructive. The narcissistic disorder as I see it, is less moralistic in its diagnosis: Perhaps narcissism results from unreliable attachments in early childhood, and the repeated exposure to ambivalent systems of support inside and outside the family, in schools and other socializing institutions, including the media. Because communication is often dishonest but unchallenged (“Be yourself, be original, but don’t make me too angry”), youthful egos are weakened while the source of domination is obscured. Hence narcissists lack a sense of inner balance, competence in defending their interests (who dunnit to me?), and self-worth that would make them self-directed and socially responsible: creative, curious, lovable to others and effective reformers. They may depend on omniscient others who feed their weak egos with flattery/conspiracy theories (we alone are the cognoscenti). To restore the Golden Age, they will fuse with such heroic agitators, or with a glorified racial past, or with fetishized luxury goods. As repressed facts of the material world return, idealizations are shattered. The all-nurturing other (the object) may become a killer who must be destroyed (Otto Kernberg). [My reading:] The switch occurs at the moment of disillusion, as artificially inflated self-esteem (grandiosity) ebbs or rushes away, leaving in its wake emptiness, uncontainable fear and anger. The fear and anger (if suppressed) triggers the adrenalin that begins the panic attack; the ghastly irony lies in the misdirection of our anger toward the self; we may remain politely fastened to an object that was never there for us in the first place. (Or perhaps as children we believed our anger caused the death of domineering or negligent parents and/or sibling rivals or the breakup of a family in divorce: any eruption of anger is unmanageable and world-destroying.)
By contrast, some romantic conservatives account for the pervasive “narcissism” and related social problems (including the rise of fascism, a narcissistic disorder) as the result of weakened paternal authority in the family. The newly triumphant figures of modernity have sapped the authority of the paternalistic father: vampirish specters appear as Goldfinger the international Jew (designer and profiteer of mass culture and consumerism) in cahoots with mad scientists, femmes fatales, and perfectionist puritan mothers. Feminized and jewified, modernity has produced, what else? The Masturbator! Similarly, the terror-gothic genre (horror movies and gothic fiction) confronts the viewer with appalling images of the inquisitive, wandering, goal-directed imagination exploring the sensuous material world (D. H.Lawrence’s “nosy Hebrew”). Persistently feeling one’s own unhappiness and the common pain of suffering humanity, asking authority “why” it devises particular damaging social policies, demanding access to state secrets, can lead only to bloody revolution, ripping and shredding of the social fabric, and finally, the Bomb (e.g., the theme of Pandora’s Box in Kiss Me Deadly, a classic of film noir).
One would hope that progressive intellectuals would be alert to such right-wing tactics, but no. As one KPFK listener put it, intellectuals today latch onto traditions which make them comfortable; the idea of the detached, disinterested seeker following the truth wherever it leads is held to be a bourgeois illusion, the Big Lie of objectivity and positivistic science that delivered scientific racism. Some poststructuralists say that (relatively) accurate readings of the world are impossible, that there is only “intertextuality” for ballast, that the goals of “objectivity,” or of universally valid moral standards are (in fact!) a stealthy imposition of a totalitarian ideology. Such irrationalist  ideas should be vigorously opposed in the culture wars raging in our universities, and not just by the libertarian Right. Liberal Freudians are not irrationalists; rather they believe that rational processes (historical memory and the reconstruction of power relations in socializing institutions) can at least diminish the extent to which we are misdirected by self-destructive behavior. (Irrationalists have said that such fantasies are disseminated by Jews, consummate peddlers of false utopias; see the excellent description of the right-wing agitator in Leo Lowenthal and Norbert Guterman, Prophets of Deceit, 1949).
Are panic attacks a health risk of middle-management? Historians revise and reconfigure the past, finding material causes for socially-induced catastrophes; we seek clarity and balance, not chaos, but threaten illegitimate authority. Because democratic pluralists seem to support critical thought (but in practice are unevenly committed to it), institutions are vague and abstract in their demands. Be original, but not too destabilizing, we are advised, echoing the family. But how far to go too far? We don’t know the rules until we break them. So, to keep our jobs, we may betray the real and the good, not daring to hold authority accountable; all relations remain shallow and there is, in fact, little reliable support. In such a deceptive and self-deceptive society, anyone and everyone can turn on us–whenever we demand that our arguments be engaged, calling love and support into question. People too attached to their creative work must be “monomaniacs,” like Melville’s Captain Ahab.
If my analysis is valid, what are the implications for the treatment of anxiety disorders? As long as institutions are unwilling to be tested and challenged, as long as they blunt critical tools, no amount of individual or group therapy or pills will alleviate our distress; perforce we will adjust to a world without many enduring attachments. The fearful may continue to follow false friends and false prophets: screaming, hysterical demagogues and paranoids who will divide us when only species cooperation can protect the planet. Idealizing the father-driven family will not solve the problems conservatives are (often rightly) worried about. Accurate readings of our bodies, our histories, our loves and friendships, the origin and development of all institutions and of the natural world which we are fast destroying, should be the goal of education. Workers in mental health cannot neglect these aspects of their training, lest the good work they do be nullified by the strange world outside the clinic. [12-27-94]
* From Freud (1922): “Dread in an individual is provoked either by the greatness of a danger or by the cessation of emotional ties (libidinal cathexes [Libidobesetzungen]); the latter is the case of neurotic dread. In just the same way panic arises either owing to an increase in the common danger or owing to the disappearance of the emotional ties which hold the group together; and the latter case is analogous to that of neurotic dread.” Group Psychology and the Analysis of the Ego, Chapter V, transl. James Strachey. Apply this suggestion to the assimilating immigrant or upwardly mobile ethnic individual or group. This view eliminates the problem of separation from the mother, but rather extends panic and anxiety to other situations in any society with fluid class boundaries. Imagine the fear of loss of status or the fear of abandoning one’s neighbors and ancestors. (For another blog on this topic, see http://clarespark.com/2012/09/03/eros-and-the-problem-of-solidarity/.)