THE ANXIETY DISEASE

Having treated patients with an array of severe anxiety/fear/hysteria symptoms, Dr. Sheehan (Mass. General, Harvard Medical School) believes that, in some cases, this ""may be one condition (or a very few) passing through numerous stages as it matures over time."" Here, then, using a few case-histories and one composite-figure patient who goes through everything, he outlines the ""anxiety disease""--which affects, he says, almost 5 percent of the population, mostly women. The stages of the illness: dizzy spells, panic attacks, hypochondria, phobias (""Atone point Maria counted over eighty-five things she was phobia of""), and acute depression. The causes? ""The proposed model suggests that at the center of the disease, feeding it like a spring, is a biological and probably a biochemical disorder""--with conditioning (self-preservation mechanisms) and environmental stress as aggravating factors. The recommended treatment, then, is to try ""medication first, behavior therapy second, and psychotherapy third""; Sheehan goes into non-layman detail on the alternative drugs (MAO inhibitors, tricyclics, etc.), with briefer discussion of behavior-therapy techniques and appropriate psychotherapeutic approaches. And he feels optimistic about the prospects for recovery once the proper combination of treatments has begun. In effect: a simplified, padded-out version of a solid, medical-journal paper, with minimal general-interest appeal--but sufferers of severe anxiety-attacks (and their families) may appreciate this sympathetic, if still-speculative, approach to a debilitating syndrome.