Vol 4 n° 3 - Anxiety I
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was pleased to be offered the opportunity to contribute a chapter devoted to historical aspects of anxiety. However, my  qualifications  are  clearly  not those of a historian, who is properly concerned with documentation derived from primary data. Primary  data  consist  of  documents,  records,  notes, reports, data, clinical records, hospital charts, church dossiers, tax receipts, artifacts, etc, produced during the historical period in question. Skilled comparative eval- uations yield relatively firm inferences, which never- theless are often controversial and open to “revision- ism.” In psychiatry, much early theorizing derives from anec- dotal case reports that often, as Freud noted, read like novelistic fiction. Unfortunately, that resemblance is more than superficial. Proper historical studies of pri- mary data have shown that many reports were not only literally fiction in terms of clinical description, but also, more  poignantly, in  terms  of  clinical  successes  that apparently validated innovative therapeutic techniques and novel, insightful theories. Of particular note are the hospital  records  of Anna  O., Freud’s  actual  clinical notes on the “Rat Man,” and the Freud–Fliess corre- spondence. These primary sources stand in stark con- tradiction to published reports. Further skepticism is warranted by the problematic evidence for “allegiance effects,” where an investigator’s investments closely parallel their findings. Therefore, critical skepticism is necessary. My understanding of historical developments derives from two sources—personal experiences and studies— amplified by reading papers and summary accounts at some remove from primary data.This requires an infor- mal essay rather than a detailed footnoted and refer- enced thesis. Therefore, these historical notes on anxi- ety  are  quite  personal, emphasizing  influences  that affected my understanding of that important, ambigu- ous term. Hopefully, some inferences are justified. 2 9 5 C l i n i c a l   r e s e a r c h Historical aspects of anxiety Donald F. Klein, MD Keywords: anxiety; panic; fear; history; theory Author  affiliations:  Columbia  University,  Professor  of  Psychiatry,  New  York
State Psychiatric Institute, Director of Research, Department of Therapeutics, New York, NY, USA Address  for  correspondence:  Prof  Donald  F.  Klein,  Columbia  University, New  York  State  Psychiatric  Institute,  Department  of  Therapeutics,  1051 Riverside Drive Unit 22, New York, NY 10032, USA
(e-mail: Donaldk737@aol.com) “Anxiety” is a key term for behavioral, psychoanalytic, neuroendocrine, and psychopharmacological observa- tions and theories. Commenting on its historical aspects is difficult, since history is properly a study of primary data. Unfortunately, much clinical anecdote does not correspond to factual records of a long time ago. Even reports of objective studies may suffer from allegiance effects. This essay therefore primarily reflects the per- sonal impact of others’ work against the background of my experiences, clinical and scientific. These lead me to question the assumption that “anxiety,” as it exists in syndromal  disturbances,  is  simply  the  quantitative extreme of the normal “anxiety” that occurs during the anticipation of danger. An alternative view that empha- sizes dysfunctions of distinct evolved adaptive alarm sys- tems is presented. Dialogues Clin Neurosci. 2002;4:295-304. I