Marlene sat before me describing months of feeling “paralyzing” anxiety and helpless vulnerability to disaster. There were several very real sources of her severe anxiety disorder: Her parents were in medical crises, she and her husband were in a legal battle threatening the family’s home and savings, and some neighbors had become frighteningly aggressive over a squabble between their children. But why had Marlene’s anxiety become an oceanic severe anxiety disorder?
I decided to try a two-step approach that’s often an effective panic attack treatment when dealing with functionless symptoms. I suggested revisiting one of the situations she had told me about. “You’ve opened a piece of mail notifying you of the other party’s new legal maneuver, and you start to feel a whole new wave of vulnerability and fear. Now try to imagine what change or shift of any kind—whether in your attitude, behavior, belief, or perspective—would diminish this fear.”
Marlene’s somewhat hesitant words were a big surprise to me. “I’d have to fight back,” she said.
I now understood what was maintaining her severe anxiety disorder: if you’re under serious assault and don’t protect yourself by fighting back, you feel unbearably open to disaster.
Not fighting back, even though she was under attack, was what I should regard as Marlene’s “real” symptom. I assumed she had some definite, unconscious purpose for not fighting back when under attack. To find that purpose, I guided her into imagining fighting back in various bold ways.
She described a distinct discomfort, and what came into awareness were the rules of being a Good Girl in her strict Roman Catholic childhood. “All my life I’ve worked hard to be a Good Girl. If I got fierce and fought this battle, I’d no longer be a Good Girl—I’d be a crazy troublemaker.”
By getting directly in touch with how her severe anxiety disorder stemmed directly from her own deepest assumptions about the world, Marlene was also now in touch with her own agency in bringing about this symptom.
With the underlying material fully in view, I saw that Marlene’s severe anxiety disorder actually didn’t have a function—it wasn’t the means of carrying out her purpose of being a Good Girl. Rather, the unpresented symptom of not fighting back
carried out this purpose, and her anxiety was its necessary by-product.
Six months after this session, Marlene reported that she’d soon begun to fight back through assertive communications and a demonstrated readiness to follow through with action. She said her anxiety was “hugely eliminated.” By making conscious her symptom-requiring position, she’d been able to revisit and revise that earlier life strategy.
panic attack treatment
severe anxiety disorder