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Culture and Panic Disorder

Stanford University Press

Contents

Contributors........................................................................................................................................................................................................................viiForeword David H. Barlow...........................................................................................................................................................................................................xiiiPreface Alan Harwood...............................................................................................................................................................................................................xviiAcknowledgments.....................................................................................................................................................................................................................xxi1. Introduction: Panic Disorder in Cross-Cultural and Historical Perspective Byron J. Good and Devon E. Hinton.....................................................................................................................12. Theoretical Perspectives on the Cross-Cultural Study of Panic Disorder Laurence J. Kirmayer and Caminee Blake...................................................................................................................313. A Medical Anthropology of Panic Sensations: Ten Analytic Perspectives Devon E. Hinton and Byron J. Good.........................................................................................................................574. The Irritable Heart Syndrome in the American Civil War Robert Kugelmann.........................................................................................................................................................855. Twentieth-Century Theories of Panic in the United States: From Cardiac Vulnerability to Catastrophic Cognitions Devon E. Hinton and Susan D. Hinton..............................................................................1136. Comparative Phenomenology of 'Ataques de Nervios,' Panic Attacks, and Panic Disorder Roberto Lewis-Fernndez, Peter J. Guarnaccia, Igda E. Martnez, Ester Salmn, Andrew B. Schmidt, and Michael Liebowitz.....................1357. Dizziness and Panic in China: Organ and Ontological Disequilibrium Lawrence Park and Devon E. Hinton............................................................................................................................1578. Gendered Panic in Southern Thailand: 'Lom' ("Wind") Illness and 'Wuup' ("Upsurge") Illness Pichet Udomratn and Devon E. Hinton..................................................................................................1839. 'Ihahamuka,' a Rwandan Syndrome of Response to the Genocide: Blocked Flow, Spirit Assault, and Shortness of Breath Athanase Hagengimana and Devon E. Hinton.....................................................................20510. Panic Illness in Tibetan Refugees Eric Jacobson.................................................................................................................................................................................230Index...............................................................................................................................................................................................................................263

Chapter One

Panic Disorder in Cross-Cultural and Historical Perspective

Byron J. Good and Devon E. Hinton

PANIC DISORDER (PD), as currently conceived, is a medical condition that may be diagnosed when a person experiences recurrent, unexpected attacks of panic or anxiety, followed by persistent concern about having additional attacks or about losing control, going crazy, or having a heart attack. Panic attacks are intense periods of fear or discomfort, feelings that sometimes seem quite irrational. They are described as "attacks" because they often develop rapidly and include such symptoms as palpitations, sweating, trembling, shortness of breath, a feeling of choking, chest pain, nausea, dizziness, derealization or depersonalization, and numbness or chills or hot flushes, as well as fear of losing control or fear of dying.

PD, according to contemporary psychiatric classification, belongs to a group of neuropsychiatric conditions for which anxiety is the hallmark symptom. Although anxiety disorders are often thought of as relatively mild conditions, researchers estimate that in the United States these disorders account for 32 percent of the total economic costs of psychiatric illness, exceeding the costs associated with schizophrenia (21 percent) and mood disorders, including depression (22 percent) (Taylor 2000:4). Within the costs of panic attacks are emergency room visits and extensive medical tests to determine whether those experiencing the panic are suffering a heart attack or some other life-threatening condition as they fear. PD most commonly begins when the sufferer is between fifteen and thirty years of age. Studies suggest that between 1.5 and 3.5 percent of members of a population will suffer PD sometime during their lifetime.

PD was first recognized-or invented-as a distinctive form of mental illness in the 1970s; codified in 1980 as part of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM-III (APA 1980); and popularized as a treatable clinical entity in the 1980s. Also in the 1980s, many researchers argued that PD had a largely physiological and genetic basis rather than a primarily psychological one. Since Freud, acute anxiety had been interpreted as resulting from unconscious feelings surfacing into partial awareness. PD thus figures prominently in the history of the biological revolution in psychiatry. During the 1990s, PD was, to an important extent, reconceived by cognitive psychologists as spiraling episodes of anxiety arising from catastrophic cognitions that trigger physiological experiences of terror or panic. PD continues to be an important domain of research, clinical care, and pharmaceutical investment within psychiatry, both in the United States and globally. The story of PD is thus an intriguing chapter in the contemporary sociology of psychiatric knowledge and practice.

Acute anxiety and panic, however, quickly escape the confines of current diagnoses of anxiety disorders. They belong, on the one hand, to a long history of changing conceptualizations of neuropsychological distress in North American and European medical writing and practices, sharing complex relationships with categories such as cerebrocardiac neuropathy, irritable heart syndrome, neurasthenia, agoraphobia, anxiety reaction, anxiety neurosis, and neurasthenic neurosis. On the other hand, as Jackie Orr (2006) has recently shown in her book Panic Diaries: A Genealogy of Panic Disorder, acute anxiety and panic belong to a much broader cultural domain of changing experience and understanding in the twentieth-century United States-from the social panic produced by the 1938 radio broadcast of H. G. Wells' War of the Worlds, to concerns about measuring and managing fears and anxieties in American society, to David Sheehan's popular book The Anxiety Disease (1983), to multiple pharmaceutical interventions, clinical trials, and research studies sponsored by the National Institute...