Reviewed by Eric J. Engstrom (Humboldt University - Berlin)
Published on H-German (May, 2010)
Commissioned by Benita Blessing
Genealogies and Anthropologies of Anxiety
Culture and Panic Disorder is a collection of ten articles on panic disorder, addressing different theoretical approaches, historical perspectives, and cultural variations. Approaching the topic from medical anthropology, the editors are interested in exploring the culturally specific idioms of anxiety and fear. They thus intend the book to be a cross-cultural, meaning-centered contribution to the study of panic disorder.
The introduction briefly traces the "biologization" of panic disorder in the 1980s and 1990s and its various transformations through different editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM). By 1980, panic disorder had come to be conceptualized as a discrete disorder with an unprovoked onset and primary symptoms that mapped onto a physiological substrate and in turn produced secondary psychological symptoms. According to Devon Hinton and Byron Good, this understanding of panic disorder has been challenged by a psychological theory of "catastrophic cognition," which maintains that otherwise innocuous bodily sensations are perceived and then interpreted in a catastrophic fashion. The book's contributors marshal evidence in support of this theory and argue that catastrophic cognition plays "a significant role in panic attacks across diverse societies, and that culture is enormously significant in shaping which bodily sensations or internal experiences may be considered threatening or potentially catastrophic by individuals in these societies" (p. 23). The book thus responds to biologically overdetermined assumptions of a "neo-Kraepelinian paradigm" (p. 23) that would understand panic disorders simply as spontaneous eruptions of a natural disease entity.
Of perhaps lesser interest to historians, two initial chapters examine theoretical and analytic perspectives on the study of panic disorders. In the first, Laurence J. Kirmayer and Caminee Blake explain the cognitive origins of panic disorder and show how deeply the illness is embedded in both geography and culturally mediated thoughts of catastrophe. In the second, Devon E. Hinton and Byron J. Good take this argument further, sketching numerous analytic perspectives in the medical anthropology of sensations. They interpret sensations like dizziness, asphyxia, or palpitations not simply as physiological givens, but rather as somatic forms of experience that emerge locally and that are interpreted within networks of meaning and belief in a process they call "sensation semiosis" (p. 74).
The book contains two specifically historical chapters. Robert Kugelmann analyzes irritable heart syndrome in the American Civil War. Kugelmann interprets this debility in terms of "anxious fatigue" amongst soldiers who--confronted with overexertion and death--became aware of their hearts as both mechanical pumps and seats of their courage (p. 107). Irritable heart syndrome provided soldiers with a culturally appropriate metaphor to talk about the radical contingency of their own existence at the limits of courage and endurance.
The second historically framed chapter, by Devon Hinton and Susan Hinton, deals with twentieth-century theories of panic in the United States. It is cast as a "genealogy" of the causes of panic disorder. It therefore seeks to account for different frameworks of meaning in which panic attacks were experienced and interpreted. In recounting the shifting structures of this "panic ontology," the Hintons pursue a course from cardiac fatigue and other heart syndromes in the late nineteenth and early twentieth centuries, to theories of low calcium and spasticity in the 1950s and 1960s, to the biological paradigm of DSM-III, before culminating in the psychological theory of catastrophic cognition--which they themselves advocate. Strikingly, in this genealogy, the authors give essentially no account of mid-twentieth-century psychoanalytic theories of anxiety neurosis (they ignore DSM-II entirely). In other words, they fail to explain significant epistemic shifts in the genealogy. Hence, while the larger claim that panic disorder has become "biologized" since 1980 may be true, in the Hintons' analysis, the claim seems implausible given the absence of a decidedly non-biological predecessor.
The remaining half of the book is comprised of five chapters that treat current anthropological and cross-cultural clinical research on panic disorders. It contains contributions on the ataque de nervios in Puerto Rican and Dominican communities, on dizziness as a characteristic of anxiety states in China, on gender differences and gastrointestinal symptoms of panic disorder in Thailand, on the significance of constipation and shortness of breath in the post-genocide Rwandan syndrome of Ihahamuka, and on the Tibetan life-wind illness. Most of these accounts include individual case studies. Collectively, these chapters point out that, although research on anxiety disorders points to their presence in all human societies, it has also demonstrated that the phenomena and distress of those disorders are constituted and articulated in sociocultural and psychological spaces.
Several of these latter chapters present the results of clinical studies; there is little here for historians who do not work on the history of medicine to really sink their teeth into. Nevertheless, for students interested in the history of emotions, trauma, medicine, and genocide, this book offers valuable orientation. Beyond outlining current theories about panic and anxiety, its sociocultural and anthropological moorings easily lend themselves to application in historical contexts. Readers will have little difficulty finding thematic and analytic ports in which they can dock their historical narratives
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If there is additional discussion of this review, you may access it through the list discussion logs at: http://h-net.msu.edu/cgi-bin/logbrowse.pl.
Eric J. Engstrom. Review of Hinton, Devon E.; Good, Byron, eds., Culture and Panic Disorder.
H-German, H-Net Reviews.
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