What You Can Change _. And What You Can't - Martin E. Seligman [32]
This psychological theory handles the biological findings well.
Sodium lactate induces panic because it makes your heart race. It creates the initial bodily sensations that you then misinterpret as catastrophe.
Panic is partially heritable because having a particularly noticeable bodily sensation, such as heart palpitations, is heritable, not because panic itself is directly heritable.
Brain areas that prevent the dampening of anxiety are active because this activity is a mere symptom of panic.
Drugs relieve panic because they quiet the bodily sensations that get interpreted as a heart attack.
I was listening closely now as Clark argued that an obvious sign of a disorder, easily dismissed as a mere symptom, is in fact the disorder itself. This kind of argument had been made only twice before in history, and both times the argument had revolutionized psychiatry.
In the early 1950s, Joseph Wolpe, a young South African psychiatrist, astounded the therapeutic world, and infuriated his colleagues, by finding a simple cure for phobias. Established thinking held that phobia—an irrational and intense fear of certain objects, for instance, cats—was just a surface manifestation of a deeper, underlying disorder. The psychoanalysts said a phobia was the buried fear that your father would castrate you in retaliation for lusting after your mother. The biological psychiatrists, on the other hand, claimed that it was some as-yet-undiscovered brain-chemistry problem. What both groups had in common was the belief that some deeper disorder lay underneath the symptoms. Treating only the patient’s fear of cats would do no more good than it would to put rouge over measles.
Wolpe, however, claimed that the irrational fear isn’t just a symptom; it is the whole phobia. If the fear could be removed (and it could be), this would extinguish the phobia. The phobia would not, as the psychoanalytic and biomedical theorists claimed, return in some displaced form. Wolpe and his followers routinely cured phobias in a month or two, and the fears did not reappear in any form. For his impertinence—for implying that there was nothing deep about this psychiatric disorder—Wolpe was ostracized.
The other precedent for David Clark’s assertion involved the founding of cognitive therapy. In 1967, Aaron Beck, a University of Pennsylvania psychiatrist, wrote his first book about depression. Depressives, he noted, think awful things about themselves and about their future. Beck speculated that maybe that is all there is to depression. Maybe what looks like a symptom of depression—gloomy thinking—is the cause. Depression, he argued, is neither bad brain chemistry nor anger turned inward (Freud’s claim) but a disorder of conscious thought. Lightening the gloom of conscious thought should cure depression. This simple theory remade the field of depression and founded a new, effective form of therapy.
David Clark, unassuming of demeanor and only thirty-two years old, was now making the same bold argument for panic. My head was spinning. If he was right, this was a historic occasion. All Clark had done so far, however, was to show that the four lines of evidence for a biological view of panic could be fit equally well with a misinterpretation view. But Clark soon told us about a series of experiments he and his colleague Paul Salkovskis had done at Oxford.
First, they compared panic patients with patients who had other anxiety disorders and with normals. All the subjects read the following sentences aloud, but the last word was presented blurred. For example:
If I had palpitations, I could be dying.
excited.
If I were breathless, I could be choking.
unfit.
When the sentences were about bodily sensations, the panic patients,