[Panic disorder and theories of neurosis].

In early 1960's, psychopharmacologist DF Klein cut out from anxiety neurosis a drug-responsive acute anxiety syndrome, later named panic disorder in the Research Diagnostic Criteria (RL Spitzer et al. 1978). Nowadays, many authors tend to consider panic disorder a clinical entity with biologically determined causes distinct from psychodynamic aetiology. The author keeps a reserved distance from this trend. Japanese psychiatrist M. Morita, described in 1928 paroxysmal anxiety neurosis, symptomatically identical to panic disorder. This anxiety neurosis is related to the mental life of individuals who have a particular temperament, i.e., nervous, introverted, and easily trapped in a vicious circle of mental activities. Spontaneous panic consists of an evoked dreadful feeling connected with some dreadful life event buried in the mind and its crescendo is vivid escalation due to a vicious circle of mental activities. Many psychoanalysts have proven that neurotic symptoms, including spontaneous panic and phobic avoidance, derive from inner conflict and unconscious process. American psychoanalyst JC Nemiah, reported in a meeting a spontaneous panic case. During his psychoanalytically-oriented interview, the patient revealed violently aggressive impulses related to the panic. Nemiah explained the nature of the causes of panic anxiety in this case in terms of psychodynamic concepts. The attendants, biologically-oriented researchers of panic disorder, criticized Nemiah: there was no scientific evidence in his method of proof and explanation. Discussion in the meeting revealed that the epistemology of the attendants and that of Nemiah were totally different, the former tending to see a panic attack as a biological phenomenon in the world of matter and energy, and the latter tending to see panic anxiety as a phenomenon of mental life in the world of meaning and information. In the treatment of panic disorder cases, especially chronic cases frequently seen in daily practice, we psychiatrists can not help regarding neurotic symptoms as closely related to the mental life of the patient and resorting to psychodynamic considerations.