Anxiety as Symptom and Signal

193 Pages·1995·3.42 MB·English

by  Steven P. Roose

Anxiety as
Symptom and Signal
Copyrighted Material
Copyrighted Material
Anxiety as
Symptom and Signal
edited by
Steven P. Roose
Robert A. Glick
THE ANALYTIC PRESS
1995 Hillsdale, NJ London
Copyrighted Material
© 1995 by The Analytic Press, Inc.
All rights reserved. No part of this book may be reproduced in
any form, by photostat, microform, retrieval system, or any other
means, without the prior written permission of the publisher.
Published by
The Analytic Press, Inc.
365 Broadway
Hillsdale, New Jersey 07642
Library of Congress Cataloging-in-Publication Data
Anxiety as symptom and signal / edited by Steven P. Roose, Robert A.
Glick
p. cm.
Includes bibliographical references and index.
ISBN 0-88163-118-3
1. Anxiety. 2. Psychotherapy. I. Roose, Steven P., 1948–
II. Glick, Robert A., 1941–
[DNLM: 1. Anxiety. 2. Psychoanalytic Therapy. WM 172 A63769
1995]
RC531.A639 1995
616.85'223—dc20
DNLM/DLC
for Library of Congress 94-44632
CIP
Printed in the United States of America
10 9 8 7 6 5 4 3 21
Copyrighted Material
Contents
Contributors vii
Preface
Steven P. Roose ix
Robert A. Glick
INTRODUCTION
1. Freudian and Post-Freudian Theories of Anxiety 1
Robert A. Glick
ANXIETY AS SYMPTOM: THE MIND AND THE BRAIN
2. An Evolutionary Perspective on Anxiety 17
Myron A. Hofer
3. Neuroanatomy and Neurotransmitter Function
in Panic Disorder 39
Jack M. Gorman
Laszlo A. Papp
Jeremy D. Coplan
4. Genetic and Temperamental Variations in
Individual Predisposition to Anxiety 57
Abby J. Fyer
5. The Ontogeny and Dynamics of Anxiety in Childhood 75
Scott Dowling
V
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vi CONTENTS
ANXIETY AS SIGNAL: THE TREATMENT SETTING
6. Learning to Be Anxious 87
Gerald I. Fogel
7. Anxiety and Resistance to Changes in Self-Concept 105
Gloria J. Stern
8. The Patient's Anxiety, the Therapist's Anxiety,
and the Therapeutic Process 121
OwenRenik
9. A Relational Perspective on Anxiety 131
Charles Spezzano
10. Does Anxiety Obstruct or Motivate Treatment? When
to Talk, When to Prescribe, and When to Do Both 155
Steven P. Roose
11. Epilogue 171
Morton F. Reiser
12 Index 175
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Contributors
Jeremy D. Coplan, M.D., Assistant Professor of Clinical Psychiatry,
College of Physicians and Surgeons, Columbia University
Scott Dowling, M.D., Faculty, Cleveland Psychoanalytic Institute;
Associate Clinical Professor of Psychiatry and Adjunct Associ
ate Professor of Philosophy, Case Western Reserve
Gerald I. Fogel, M.D., Training and Supervising Psychoanalyst,
Columbia University Center for Training and Research, Associ
ate Clinical Professor of Psychiatry, College of Physicians and
Surgeons, Columbia University
Abby J. Fyer, M.D., Associate Professor of Clinical Psychiatry,
College of Physicians and Surgeons, Columbia University
Robert A. Glick, M.D., Admitting Psychoanalyst and Training and
Supervising Psychoanalyst, Columbia University Center for
Psychoanalytic Training and Research, and Clinical Professor of
Psychiatry, College of Physicians and Surgeons, Columbia
University
Jack M. Gorman, M.D., Professor of Clinical Psychiatry, College of
Physicians and Surgeons, Columbia University, and Director,
Department of Clinical Psychobiology, New York State Psychi
atric Institute
Myron A. Hofer, M.D., Professor of Psychiatry, College of Physicians
and Surgeons, Columbia University, and Director, Developmen
tal Psychobiology, New York State Psychiatric Institute
vii
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viii CONTRIBUTORS
Laszlo A. Papp, M.D., Associate Professor of Clinical Psychiatry,
College of Physicians and Surgeons, Columbia University, and
Director of Biological Studies Unit, New York State Psychiatric
Institute
Morton F. Reiser, M.D., Albert E. Kent Professor Emeritus of Psychi
atry, Yale University, and Training and Supervising Analyst,
Western New England Psychoanalytic Institute
Owen Renik, M.D., Training and Supervising Psychoanalyst, San
Francisco Psychoanalytic Institute, Editor-in-Chief, Psychoana
lytic Quarterly, and Secretary of the Board of Professional Stan
dards, American Psychoanalytic Association
Steven P. Roose, M.D., Associate Professor of Clinical Psychiatry,
College of Physicians and Surgeons, Columbia University, and
Faculty, Columbia University Center for Psychoanalytic Train
ing and Research
Charles Spezzano, Ph.D., Training and Supervising Analyst, Psycho
analytic Institute of Northern California
Gloria J. Stern, M.D., Assistant Clinical Professor of Psychiatry,
College of Physicians and Surgeons, Columbia University, and
Training and Supervising Psychoanalyst, Columbia University
Center of Psychoanalytic Training and Research
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Preface
Psychoanalysis is a hybrid discipline that shares questions with the
neurosciences about causes and mechanisms and with the humanities
about meaning. To continue to be both a relevant theory of the mind
and a clinically effective treatment, psychoanalysis must enjoy free
access to knowledge from both of these disciplines. Both the
explanatory and the therapeutic powers of psychoanalysis have
foundered when causation has been attributed to intrapsychic conflict
alone without regard for other knowledge. This has been apparent
with such issues as character development, female psychosocial
development, and male and female homosexuality and in regard to
many major psychiatric disorders, including schizophrenia, panic
attacks, and depression.
By contrast, interdisciplinary approaches have enriched modern
psychoanalytic theory and treatment, leading to greater clinical rele
vance and effectiveness. In recent years psychoanalysis has, perhaps
painfully but profitably, sacrificed some theoretical coherence for this
new relevance. This transition is especially germane to the concept of
anxiety, which has a uniquely central place in psychoanalytic theories
of mind and treatment. We are creatures in pursuit of pleasure and
safety, but forever fearing danger. Consequently we are principally
concerned with threat: we live appraising and reacting to internal and
external dangers, always asking the question, "Danger of what and
from whom?" Data from the neurosciences and from pharmacological
studies have compellingly challenged psychoanalytic models of anxi
ety, creating new ambiguities. Anxiety both organizes and disorgan
izes; it can be both a signal and a symptom. It is this new complexity
that is the focus of this volume.
In his introductory chapter, "Freudian and Post-Freudian Theories
of Anxiety," Robert Glick reviews the development of psychoanalytic
ix
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