Carmen, a stylish freelance writer, was 35 and happily married, but she experienced intense panic attacks every day or two. "When they started, five years ago, I thought I was having a heart attack," she said. "Before that, I had strong depressions that lasted weeks at a time. Then the panic attacks replaced the depression."
I asked Carmen to walk me through a recent panic episode. She said she'd been in her dining room the previous evening waiting for her husband to arrive home from work. When he was a few minutes late, she began imagining a terrible car crash and went into escalating panic.
In the old days, when psychoanalytic psychotherapy was dominant, Carmen's panic would have been considered a symptom of repressed conflicts, hidden desires, primal dreads, and guilty secrets. Relief required insight into the underlying psychic dramas stoking such terrors. Today, we tend to regard anxiety almost exclusively as a set of behavioral and physical symptoms, sustained usually by irrational beliefs. Treatment protocols require either that the symptom be quashed, often with medications, and the specific beliefs be "exposed" or "corrected" into nonexistence or that reframes and resources be set up to override and avoid symptom production. To focus on the unconscious psychological roots of an individual's anxiety--the hidden system of personal meaning that might be generating it--has become an anachronism.
But how many of us, with a toolbox full of today's…