Symptoms of Anxiety and Panic Disorders in the Context of the World We Live in

Anxiety and panic disorders are getting increasingly common among young adults. This is a phenomenon observed and mentioned by mental health professionals who work in Europe, Asia and America. There are several hypothesis to this observation. The logic that resonates most with me is the one by a psychiatrist colleague from Italy, Gianni Francesetti.

Francesetti attributes panic disorder to “an acute attack on solitude (loneliness)”. This actually implies that the symptoms of panic and anxiety attacks, while observed to be affecting an individual person, is in fact contributed by this person’s relationship to the world around him/her. Why? Because we cannot be lonely if we are in contact with some other persons in the environment. Hence to be lonely is to be left in the cold with on one for company.

The word panic is descriptive of the state of being left exposed in the wilderness. It is said to have been derived from the name of the Greek god, Pan. Reading the characteristics of Pan one would derive the keywords, all-encompassing, wilderness, solitude, rejection, stomach-churning cry and death. The word panorama describes the wide open field space. A young animal separated suddenly from its mother and exposed to the cold environment would panic. In its panic it would cry out.

Neuroscientist Panksepp’s lecture explains to us how the panic pathway in the brain is wired up. He also tells us in the video below that the baby animal in panic would be quiet again once it is held warmly. If it were not held, it cries would ultimately stop, and the animal would fall into a state of what looks like depression in humans. The panic system generates loneliness and sadness, and it is observed to be the gateway to depression.

The panic system is related in mammals (including humans) to separation distress and over exposure. Human suffers experience the onset of panic disorder usually as young adults, the age when one leaves the parental home.

Most clients who complain of panic attacks are independent and forward-looking people. Feelings of being exposed or separated are not part of their conscious awareness. These experiences belong to the client as toddlers or babies, and are overwhelming. Many clients manage to uncover this hidden past experience after months of psychotherapy.

Psychotherapy for Anxiety or Panic Attacks – A case study

Clarise, 26 years old, a student who holds also a job as a medical receptionist. She had her first panic attack when she was 20 and had just left her family home and moved to another country, Vienna. She explained that the onset of subsequent panic attacks happen when she is about to leave the family home when she is on holiday there. Strangely, this is also related to her leaving her younger brother, Mike.

Proud of being an independent worker, she came to therapy often talking dryly about happenings at work, talking about panic attacks and medication, and avoiding topics about her relationships. I could perceive her avoiding experiencing her emotions, and her intense fear of going there. Sessions in the first 4 months felt slow. I soon had difficulty remembering her among the other clients.

The slow, almost deadening atmosphere in the sessions soon became clear to me. I felt like I was in conversation with someone who was trying to make herself invisible to me. Yet I felt a longing between us for contact. Clarise came every week for therapy faithfully. I decided on several experiments during the sessions. The most useful of which was very simple: to walk around the room as we spoke. Clarise, while walking, became more animated. It seemed as if in order to make herself invisible, she kept her body still. When she had to walk around, her energy flowed. She appeared then more alive and open to being in conversation with me.

Over time, Clarise was able to talk about her childhood. Keywords were: Unwanted child. Emotionally abusive mother who was devaluing, abandoning, de-validating of her feelings, denying, contradicting. Her mother favors her younger half-brothers. As a child she had to look after the boys. She was also competitive with mother with regard to the brothers. She became overtly responsible for Mike.

Her childhood memories were fragmented, indicating a kind of trauma, perhaps from neglect. Only mother’s feelings of those days could be recalled by Clarise. In the therapy room, it felt to me as if her mother always present. Sometimes I would use the mother’s “presence” as an intervention.

Clarise admits to be constantly yearning for attention. This is a paradox, because of the way she unconsciously makes herself invisible. She admits to flattening her voice to control emotions. Clarise has little body awareness, which she became aware of as we walked around the room.

Gestalt Psychotherapeutic intervention for panic attack symptoms

Clarise’s case shed light on the polarities that emerged during our work.

Polarities are:

  • Fear vs. Curiosity,
  • Attention yearning vs. Self-hiding
  • Being forgettable vs. Forgetting

“I must be afraid so that mother can feel good about herself.”

“When my boyfriend is not at home, I am not in danger of having a panic attack.”

“I make my breathing shallow to press against my chest, so that I won’t cry here.”

Clarise also exhibited tendency for Self-ISOLATION, even if it were unconscious to her. One of her strategies was to dissociate. To disappear. To forget. She admitted that as a child, it was “Safer to be unseen.” If her mother was at home, she would not be able to predict if she would be treated with kindness or anger.

Clarise realised that she could use illness and lately the panic symptoms to garner support from people around her. “When I’m in dire straits, people will come to me and they won’t harm me.”

Looking at PSYCHOPATHOLOGY from the perspective of the relationship between client and therapist.

In the therapeutic alliance, suffering is not located only within the client, but is an emergent phenomenon. This means that we as therapist can feel, perceive ourselves as being part of the symptom. We are impacted by the symptom.

When I am able to acknowledge how being with this client impacts me– in this case the feeling of stagnating stillness and forgetting– I am able to adjust my being with her. In so doing, the atmosphere changes. In gestalt therapy we acknowledge this the as the field.

3 levels of observing anxiety disorder symptoms based on this case study
Single person LevelDyadic Interaction Level Aesthetic Field Level
“My client has panic attacks.” “I forget the client. I overlook her. She seems to make herself invisible to me.” “There is stillness and monotony in the air. I can hear the clock tick. The room feels empty. I feel tingly. There is a sense of longing.”

Conclusion

What I attempt to present here is a cutting-edge perspective of treating symptoms of panic disorder in a patient in the clearest way possible in a blog. Medication and quick therapies have not managed to effect lasting relief for most patients of anxiety. This is why we, as gestalt therapists, look to the broader field. We look beyond the person. We have found useful to see the client in context of the socio-cultural environment. We use this field during the session. We move ourselves in the field. We allow ourselves to be impacted. In this way we make small adjustments. These work as tender changes within the psyche of the client.

Remembering the hypothesis that panic is an acute attack of loneliness, the work with Clarise revealed it to be so. Although Clarise never admitted that she was lonely, she revealed her natural tendency for self-isolation. In making herself forgettable, it was I who ended up feeling left alone in the therapy room. Noticing this and sensing our longing for contact, I could affect the field around us. When the field changed, the client eventually changed. Clarise learned to cry. This was a relief to her. It was a relief to feel safe and be vulnerable. It was a relief to her that she did not have to go into a state of panic to afford company.

Bibliography

Francesetti, G. (Ed.). (2007). Panic Attacks and Postmodernity. Gestalt therapy between clinical and social perspectives. FrancoAngeli.

Notes on Field Theory in Gestalt Therapy

The field theory is a gestalt therapy term that warrants interest. Psychotherapy practitioners who consider the field and know how to use this insight in their clinical work can expect better outcome. Lately, there has been “ripples in the field” among gestalt therapy researchers on the topic of field theory and treatment of psychopathological symptoms like anxiety (Francesetti, 2007).

The challenge is in understanding the concept of field in gestalt therapy. The word “field” is associated with different levels of meanings as highlighted by Staemmler (2006). When we consider fields of corn, a football field, a professional field, we may understand the nuances of meaning the word brings. In the scientific arena, we think of magnetic field in physics. In psychology, the field implies mutually interdependent facts or phenomena. The notes below is a summary of the Staemmler article plus my reflections on it.

Field-Staemmler-notes

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In the article there is an attempt at formulating an understanding of “field” in gestalt therapy with the use of lexicon of English words. What ultimately happens is a kind of looping of ideas and argument on the subject.

Another approach to understanding Field

My preference at understanding abstract psychological concept like “field” in gestalt therapy is to use metaphor or what I am calling here “isomorphic universes”. Isomorphism are structurally similar processes that underlie our lived experiences. Observing isomorphic universes, we may be able to understand our human experiences better. This is a way of understanding by feeling as opposed to understanding by explanation with words.

I got this idea to use ants and ant nests as an isomorphic universe to illustrate the field in the world of human experiences after reading Hofstadter’s (1981) charming story, Prelude… Ant Fugue.

Gestalt Therapy Field Theory according to Ants

First is to observe and understand ant colonies:

In this video, the organized nature of an ant colony is compared to human societies except that “this organization does not arise from higher level decisions, but it is part of a biological cycle.” Consider that the field in gestalt therapy is also described as “biological knowledge” (K. Goldstein) and “intra-orgamismic” (Perls and Heferline). This could imply that as humans, we make decisions consciously and are also maneuvered by biological knowledge outside our consciousness.

Ants observed as individuals seem to be autonomous. However when we get a chance to focus on these creatures as a colony, we can appreciate the structure of their “field”. Individual ants as part of the colony react to stimuli from the environment. In contact with a food source or danger signals, the individuals in the colony react somatically. These individuals spontaneously produce pheromones and move their bodies in response to these stimuli. Pheromones and physical contact with each other affect individual ants in the field, which in turn respond and affect the other ants.

Another video about ant colonies.

The understanding of “field” according to the ant colony can be appreciated as mutually interdependent processes that connects the organism and the physical environment. Since it involves mutual interdependence of individuals, we can also see the social aspect of colonies.

When we look at human communities, can appreciate how a person is “of their own field”. Kurt Lewin (1951) used the term “life space (L)” ; the combination of the individual organism (P) with their psychological environment (E) as it exists for this individual.

L=P+E

Consider that for each individual ant (and human) there is a continuous flow of data dynamically being received and presented at the same time from the field and to the field.

Human communities form what Hofstadter (1981) terms “representational systems”, which are “active, selfupdating collection of structures organized to ‘mirror’ the world as it evolves”, like countries, organizations, cultures, families. These systems appear to define themselves through psychological decision making of individuals. Psychological decisions made are in response to environmental and social interactions. The environment and societies return feedback. The environment and societal influences affect the individual (P) physically. Individuals act in a way motivated by own needs in response to their psychological environment (E). The presence of this individual in the field is their life space (L).

5 Principles of Field in Gestalt therapy

Parlett’s (1991) 5 principles deepens our understanding of field in Gestalt therapy. These are the principle of

1. Organization, 2. Contemporaneity, 3. Singularity, 4. Changing process, 5. Possible Relevance.

In our ‘representational systems’ as with ants in ant colonies, we can perceive how the field 1. organizes societies and individuals in their roles. We can see 2. how individuals in the system act in the here-and-now, as consequence to the field. This is not a matter of cause and effect, but rather a consequence of being of or belonging to the field. 3. Each individual’s life space is unique to each situation. 4. the field changes continuously (the time element). 5. Everything that the individual does and feels has possible relevance to the field. Everything in the here-and-now is inherently relevant.

“The five principles laid out above are overlapping and not discrete. Rather they are five windows through which we can regard field theory, exploring its relevance in practice.”

Parlett

The 5 principles are useful in for our work in gestalt therapy. The therapist stays in the here-and-now of the session, and is aware that everything observed is of the field.

Using the Field in Practice

A therapist’s ability to use the field is an asset that contributes positive client outcomes.

Consider again ants. If an ant would decided to abandon colony life, what would its fate look like? The field around this ant changes. It leaves the physical environment of the colony that supports its source of food and protection. This isolated ant is not expected to thrive.

Human beings, unlike ants, have more complex psychological structures. We are able to introspect and reflect on ourselves. We have a sense of self. Often this sense of self or identity leads us to deny the existence of the field. Remember that the field is not the same thing as a community or a system. An individual may be active in a community or a group but be simultaneously in conflict with the needs that emerge from the field. This happens out of awareness.

The field includes the mutually interdependent processes that form or create — the word in German is incidentally, gestalten — the representational system or community.

A person who is not adequately or appropriately supported by the field creatively adjusts to their environment.

Psychopathology in relation to the Field

Like many of my gestalt therapist colleagues, I am no fan of diagnosis. The term psychopathology used here is necessary means of describing symptoms experienced by clients seeking therapy. However, let us consider the following symptoms and their inter-relation between organism and it’s field.

The experience of being separated from the system: The organism finds itself as part of an over-exposed and unprotected field. There is a pervasive feeling of anxiety and panic.

The experience of being abandoned and forgotten by the environment: The organism finds itself part of a lacking, unsupportive, unnourishing field. The experience may feel like depression.

The experience of being in an intrusive environment. The organism finds itself of a field of isolation as a means of protection from being sapped of resource. The experience is of being isolated and schizoid.

The experience of being in a hurtful or dangerous environment. The organism finds itself of a fearful field. There is a need to dissociate the self from the field.

The experience of being squeezed out or non-existent in the environment. The organism finds itself of a field in which the needs of the organism are unworthy of attention, because survival the system is more important. The experience may feel like co-dependency.

Observing the field in gestalt therapy as a way to understand psychopathological states requires the therapist to engage in aesthetics. This is counter-intuitive and often a odds the medical model of psychiatry. Using the field, we do not diagnose the client as a person in isolation. We take the holistic view of the field and the organism as part of it.

Application of Field Theory in Practice

There exists writings on how the field theory in Gestalt therapy is experienced in psychotherapeutic practice, on how the pathos of the field, emerges during the therapeutic encounter.

In my recent papers, I have taken on Francesetti’s illumination on sensing the “aesthetics of the field” in therapy. These papers can be accessed below:

Pain and beauty: from the psychopathology to the aesthetics of contact1
Gianni Francesetti

Bibliography

Francesetti, G. (Ed.). (2007). Panic Attacks and Postmodernity. Gestalt therapy between clinical and social perspectives. FrancoAngeli.

Hofstadter, D. R. (1981). Prelude… Ant Fugue. In The mind’s I: fantasies and reflections on self and soul. Dennett, D. C., & Hofstadter, D. R. (Eds.).Harvester Press. p. 149.

Lewin, K. (1951). Field theory in social science: selected theoretical papers (Edited by Dorwin Cartwright.).

Parlett, M. (1991). Reflections on field theory. The British Gestalt Journal1(1), 69-80. URL: http://itgt.com.br/wp-content/uploads/2014/08/Reflections-on-Field-Theory-Parlett.pdf

Staemmler, F. (2006). A Babylonian Confusion?: On the Uses and Meanings of the TermField’. British Gestalt Journal15(2), 64.