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Gann, E. (1992). Panic. The Course of a Psychoanalysis: By Thorkil Vanggaard. New York/London: W. W. Norton & Co., Inc., 1989. 144 pp.. Psychoanal Q., 61:495-497.

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(1992). Psychoanalytic Quarterly, 61:495-497

Panic. The Course of a Psychoanalysis: By Thorkil Vanggaard. New York/London: W. W. Norton & Co., Inc., 1989. 144 pp.

Review by:
Erik Gann

Thorkil Vanggaard is not likely to be a name familiar to most American psychoanalysts, even though he is a foremost senior psychiatrist in Copenhagen; he spent part of his long career in this country while doing psychoanalytic training at the New York Psychoanalytic Institute. In this slim volume, he presents the clinical record of an old case and proffers an argument for the psychotherapeutic approach to a clinical entity which is now regarded in this country in general psychiatric circles as an almost purely biological phenomenon, the treatment of which requires primarily pharmacological intervention—so-called "panic disorder."

It is not clear whether Vanggaard intended this report more for a psychoanalytic or for a psychiatric audience. The former group will likely find this effort to be an enjoyable, though not profound, clinical account, which raises indirectly some fascinating questions, albeit without really tackling the theoretical issues involved. They are not trivial matters at all; for instance, Vanggaard's insistence that this five-and-a-half-month, three-times-a-week treatment should be regarded as an "analysis." (Most analytic readers will probably conclude that this case represents a very successful psychoanalytically oriented psychotherapy, and a brief psychotherapy at that.) However, the most enduring value of this case report, one which may, in fact, make it one of the most important psychoanalytic publications in recent years, concerns issues of diagnosis and treatment which Vanggaard addresses to psychiatrists as a whole in a direct, accessible, and convincing manner. Of particular relevance to American psychiatry is the implicit critique of DSM-III and DSM-III-R regarding the politically determined expunging of the term and concept of "neurosis" from the official nosological lexicon.

Even this evaluation of the book does not diminish its potential interest for the psychoanalytic clinician. In spite of the recent trend toward more complete reporting and publishing of clinical process, it is all too rare that we have the opportunity to gain access to the relatively unexpurgated, daily material of a treatment from beginning to end. Add to that the even rarer inclusion of a seventeen-year follow-up on a case, with statements by both patient and therapist,

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