Consciousness or Bust

Healing the Soul in the Age of the Brain: Why Medication Isn't Enough NOT Becoming Conscious In An Unconscious World
by Elio Frattaroli, M.D.

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And then one day I found myself standing at a podium, calm and confident as I began to speak, when I was suddenly blindsided by a certified DSM-IV panic attack. My voice began to shake, my heart began to palpitate, my eyesight went dim, my hands went numb, and my face burned with shame as I heard my normally lively, authoritative delivery collapse into a humiliating stammer. I felt sorry for the audience, squirming in their seats as they watched me struggling to maintain a semblance of dignity, trying desperately to continue reading from my prepared text.

Somehow I managed to get through that speech, but I felt physically ill for a week afterward. For several nights I was jolted awake by a furious pounding in my chest, with no recollection of having been dreaming. Fortunately, my work with patients wasn't adversely affected. In fact, I felt a deeper empathy with people who were disabled by their illnesses because I felt suddenly disabled myself. I couldn't imagine ever being able to speak to an audience again. I wasn't even sure I could continue writing, because if people read my articles and then invited me to speak, what was I going to tell them?

When I tried to listen to my anxiety-to recall how the panic began and feel more clearly what I had been panicked about-I didn't get very far. I remembered vividly the physiological affect state, but had no recollection of any preliminary anxiety feeling, a sense of something I was afraid of that might have triggered that visceral upheaval. This was surprising. Before every talk I had ever given I had felt some anticipatory anxiety-which disappeared the moment I began speaking-but this time I hadn't been nervous at all! In fact, I remembered remarking to myself, as I sat waiting my turn to speak, how unusually relaxed and self-assured I felt.

So if symptoms are adaptive, I mused, then perhaps my unconscious had produced this humiliating symptom to warn me that I had grown a little too self-assured, like Icarus flying too close to the sun. This seemed plausible. I knew that I had a penchant for challenging the conventional ideas of received authority, and a talent for finding dramatic, creative ways to do so. I hadn't yet realized that this style was a product of my repetition compulsion but I certainly knew it involved a tendency toward arrogance in my writing and public speaking. Was I too complacent about this tendency, I asked myself? Was the self-assurance I had felt before my talk really arrogance, and the panic attack a way of punishing myself for an overweening desire to show off?

I reviewed the circumstances of the talk. I had been assigned to prepare a formal discussion of a paper presented by a distinguished, nationally respected colleague, Dr. Glen Gabbard. Ordinarily, this would have been a wonderful opportunity to exercise my penchant for challenging authority, but Glen also happened to be a good personal friend of mine. His paper was an excellent discussion of transference projection. This put me in an awkward position. I could find nothing to challenge in Glen's ideas and, as his friend, I didn't even want to challenge him. Yet the impulse to challenge authority was still there, and I had always relied on it to energize my thinking and spur my creativity. So maybe I had been trying to show off, I mused, because I remembered how worried I was about not having any creative ideas, and how excited I felt when I finally came up with one: I would show mock hostility toward Glen, evoking an imaginary competition which I could then use to illustrate what Glen had just said about projection. Well, judging from the panic attack, my unconscious must have taken this imaginary competition as real. In fact, my unconscious did to me exactly what I warned the audience that Glen might want to do (influenced by my projection) in retaliation for my mock hostility. It publicly humiliated me.

Falling Down Is Good

My humiliation turned out in the end to be a blessing. If it hadn't happened, I'm sure that I never could have written this book. In fact, it was only through writing the book that I was eventually able to understand and deal with my symptom. Here's how it happened. Although I never had another full-blown panic attack, I felt seriously hampered by the fear of having another one. Over the next few months, I managed to give a couple of talks to small, friendly audiences who probably couldn't tell how terrified I felt, but the weeks of worrying about those talks beforehand were exhausting. I felt deeply that I had an important contribution to make to psychiatry, but my symptom was stopping me and I needed to learn why. I knew I could treat the symptom with medication, but if my unconscious was trying to send me a message, it would be foolhardy to try to suppress or ignore it. So I decided to go back into analysis.

I explained to my analyst that I was pretty sure my symptom represented a conflict over envy and competitiveness toward Glen, which, in retrospect, I had been somewhat aware of and had tried to defuse (unsuccessfully) by inventing a mock competition. But I couldn't imagine (or feel) how these subtle negative feelings toward a man I respected and admired could have been so powerfully disruptive as to produce a panic attack. It seemed only natural that I would feel a bit of envy and competitiveness over Glen's success. After all, he was the one invited to present a major paper and I was only the discussant. Still, I really didn't begrudge him his preeminence. I knew he had earned it. And he carried it extremely well. I remembered being impressed by his relaxed but commanding presence on stage.

What I didn't know or remember and what took me six years of analysis and four major rewrites of this book to learn-was that, unconsciously, I didn't care whether Glen had earned his preeminence or not. He was alpha male and I wanted to be alpha male and so, like the sons in Freud's primal horde, I had to kill him. Or, more to the point (given the constraints of civilization), I was driven to vanquish and humiliate him with my powerful words. Though it was largely unconscious toward Glen, this was exactly the same arrogantly contemptuous attitude I had been displaying consciously for years in my attacks against Medical Model colleagues. The difference was that I had been thinking of those colleagues as pill-pushing bad guys who (according to the script of my repetition compulsion) deserved to be vanquished, so I had no compunctions about attacking them. Glen, on the other hand, was my friend, my brother. He had even been a kind of father to me, encouraging me in my early efforts at writing, giving me much-needed validation. My envious need to vanquish him put me in a serious Oedipal dilemma. Consciously, I wanted to (and thought I did) have an I-Thou attitude of respect for him as my friend/brother/father who had supported me and whom I admired. But unconsciously I considered this friend an enemy, an alpha-male rival who was in my way, just another I-It straw man for my Oedipal ego trip.

That's when the healing power of nature intervened with the powerful message of my panic attack. "Wait a minute," it was trying to say. "Remember that you aspire to having an I-Thou attitude of respect for all people. That aspiration is central to what you do as a psychotherapist. And yet for years you have been disrespectfully treating your Medical Model colleagues as enemies, I-It straw objects of your alpha-male road rage. If you really believe that your values are better than theirs, then stop being such a hypocrite and start putting your values where your mouth is. Treat your colleagues with the same respect you give to your patients and they might even want to listen to what you have to say."

© 2001 Viking Press, a division of Penguin Putnam, used by permission.

About the Author

Elio Frattaroli, M.D., is a psychiatrist and psychoanalyst in full time private practice. He is on the faculty of the Psychoanalytic Center of Philadelphia and is also an assistant clinical professor of psychiatry at the University of Pennsylvania. He studied Shakespeare at Harvard and trained with Bruno Bettelheim at the University of Chicago before turning to medicine. He has written and lectured on Shakespeare as well as on psychiatry and psychoanalysis. This is his first book.