Panic Attack – Against Cognitive Therapy

I am reading an older Cognitive Behavioural Therapy text on panic disorder. In it the author quotes a patient at length about her panic attack, only to compare it to the sort of descriptions made by Darwin when observing panic in non-human animals. Allow me to post the patient’s speech here and then comment on it:

“My breathing starts getting very shallow. I feel I’m going to stop breathing. The air feels like it gets thinner. I feel the air is not coming up through my nose. I take short rapid breaths. [italics] Then I see an image of myself gasping for air and remember what happened in the hospital. [end italics] I think that I will start gasping. I get very dizzy and disoriented. I cannot sit or stand still. I start pacing. Then I start shaking and sweating. I feel I’m losing my mind and I will flip out and hurt myself or someone else. My heart starts beating fast and I start getting pains in my chest. My chest tightens up. I become very frightened. I get afraid that these feelings will not go away. Then I get really upset. I feel no one will be able to help me. I get very frightened I will die. I want to run to some place safe but I don’t know where.”

I want to begin by noting that the italics above were placed by the author, not by me. And yet they were not addressed in the text. Had they been addressed they would have been understood to be within the imaginary register, that is, from the ego-ideal, the place from which the subject sees himself from the vantage of the big Other. Here, we can see that the subject becomes victimized not by foreclosing reality but precisely by being too close to it. That is, the subject is inside of the big Other, inside of language, and inside of the symbolic side of imaginary identification. What follows is a description by the subject of his or her symptoms. They are presented as if in medical jargon: short concise and almost objective descriptions as if they were to be written alongside checkboxes. The Other’s discourse thus continues through in its symbolic orientation from the vantage of the ego-ideal. It is only natural, in this discourse, that the subject feels he has lost himself – in a sense, he has lost his subjectivity and attempts rapidly to find it there within language, within the checkboxes, and within the image he has of himself from the perspective of the big Other.

He desires to run some place safe but doesn’t know where to run – in a sense, he has already run to a safe place but found it lacking, it is there in the symbolic and within the repository of the ego-ideal that he outruns himself. The descriptions are perhaps attempts to safely represent the foreign intrusion of the drive and its troubling jouissance. The subject attempts to construct a solution to the problem of the drive and can not find anything there within language to do so. The deadlock is such that the demand to the Other fails because the subject does not ultimately believe in the power of the Other’s representation, and yet nonetheless appeals to it. It is not the panic attack that is the problem for the subject, this much is certain: the subject can come up with all kinds of descriptions of the panic attack. What he or she can not do is describe its cause. And this, precisely, is the enigma of panic – the person suffering from panic is proximate to objet a, and to the biological dimension of the drive itself.

This is why panic attacks are often describe as “spontaneous” by patients, and this explains why their onset is “inexplicable.” It is correct to state that this is a problem of control, but not by the subject. The problem comes from the subject’s position vis-a-vis the displacement of language, S2. The subject turns to all these descriptions for assistance instead of accepting himself as a uniquely situated subject. This is the real trauma, the one which causes the fear: objet petit a as the cause of his or her desire.


One thought on “Panic Attack – Against Cognitive Therapy

  1. Killer. I think another but very simple way of putting it is the panicked subject is oriented upon objects for a solution to the problem. Where as the problem is only located there. Arises as a problem there.

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