The subject in an uproar: a Lacanian perspective on panic disorder

From Jacques Lacan's theory of anxiety, principles are deduced for a Lacanian-oriented treatment of panic disorder. This Lacanian approach is related to Freud's theory of the actual neuroses, and is comparable in some ways with the approach taken in Panic-Focused Psychodynamic Psychotherapy (PFPP). The Lacanian conceptualization of panic retains the idea that both repressed material and unsymbolized mental states lie at its basis. People suffering from panic attacks are overwhelmed by signifiers, aspects of corporeal excitation, and/or existential questions that remain too Real. Psychoanalytic therapy aims to create a name for such Real elements. The three registers that Lacan situates at the basis of his psychoanalytic approach (the Symbolic, the Imaginary, and the Real) are discussed, as well as the treatment principles for conducting this clinical work. The case study of a young woman with panic disorder is presented to illustrate how a brief, Lacanian-oriented treatment (forty-eight sessions) progressed, and where the patient managed to both name and find a symbolic place for psychic experiences that were too Real. During this treatment, the patient overcame her avoidant-defensive mode of functioning and her persistent difficulties related to separation.