Medical Hypotheses 78 (2012) 770–771
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Global panic reaction II – A 7-step repetitive vicious circle W. Sperling, H. Müller ⇑ Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany
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Article history: Received 21 November 2011 Accepted 5 March 2012
a b s t r a c t The GPR-II model describes a ‘‘7-step’’ panic model. In this model, the single panic patient is not only affected as single member. The pressure weighing on him is not only exerted by external factors but also by group members of his network. Therefore, he has to cope with his individual problems and with the expectations of all members. The ‘‘therapeutic’’ model of instant sedation used (rescue screens) and long-lasting steps (behavioural therapy in group models) are not appropriate to treat the patients successfully. Ó 2012 Elsevier Ltd. All rights reserved.
Hypothesis in brief The treatment of the enlarging model of a Global panic reaction (=GPR II) seems to be the main challenge of the 21st century. The specific mechanisms of the current world-wide economic crisis show parallels to the mechanisms of panic in an individual organism, which can be defined in stereotype actions. The interruption of these actions will demand an individual behavioural programme and a ‘‘real motivation’’ to help for all involved participants. Background In our former hypothesis, we defined a new phenomenon of a Global panic reaction [1] in world-wide stock markets. While the stock market crisis seems to have been overcome, the debt crisis mainly in European countries revealed a completely new dimension of a new overflowing international panic, independent of its rational or irrational basis. So, we talked in 2008 about a ‘‘panic patient’’ = stock markets, the situation has now reached a new dimension, where entire countries and fundamental economic systems, mainly the US system and the Euro Zone, are involved. Specifically, the European ‘‘debts crisis’’ of the so-called PIGS countries (Portugal, Italy, Greece, Spain) was made responsible for a loss of affiance credibility and stability in the international markets, which has mainly been defined as a possible decline of the free market economy. Within our first model, we transformed the stock market crisis to a single psychiatric patient with a panic disorder and applied therapeutic approaches of typical psychotherapeutic steps in panic disorders e.g. Psychoeducation, Panic monitoring, ⇑ Corresponding author. Address: Universität Erlangen-Nürnberg, Psychiatrische und Psychotherapeutische Klinik, Schwabachanlage 6, D-91054 Erlangen, Germany. Tel.: +49 9131 8533001; fax: +49 9131 8534510. E-mail address:
[email protected] (H. Müller). 0306-9877/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.mehy.2012.03.001
Autonomic relaxation exercises, cognitive restructuring, Exposure to guarantors of stock markets. Let’s try this way again, now with respect to the new dimension of a supposed international panic reaction in the year 2011. Further evidence Analysing the fundamental contents of a panic model within the new dimension of an international crisis, which we call GPR II, a recurring mechanism can be identified, which we call the ‘‘7steps effect’’. 1. The credit ratings of countries are downgraded (e.g. by international rating agencies). 2. The values for accumulated interest within these countries are increasing (e.g. recently Greece, Italy, Portugal). 3. The values of valuta (EURO, US Dollar) were decreasing. 4. International summit meetings were called. 5. Definition of so-called ‘‘Rescue screens’’. 6. Obligations of debt relief and saving programs of affected countries. 7. Transient reassurance with increase of valutas and decrease of accumulated interest. The 7-steps effect starts start again. The time intervals between the 7-step circles are steadily decreasing. Now it could be interesting to transform this 7-step model back to the beginning of our story, namely to the psychiatric patient with a panic disorder, and to compare the identified mechanisms with his solitary organism. 1. The credit rating (=affective axis: induced panic) From an individual point of view, the ‘‘credit rating’’ could be synonymous for the interpersonal assessment of personal characteristics like personal stability and reliability within the
W. Sperling, H. Müller / Medical Hypotheses 78 (2012) 770–771
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dimension of an interpersonal relationship between two ‘‘equal partners’’. But different questions must be asked: How has one partner failed? What were his mistakes? Which of those two equal partners is the rater and why is one person capable of to rate the other, while the rated person is not allowed to ‘‘rate the rater’’, namely his interpersonal stability and reliability. If we try to get answers to these questions, it seems to be necessary to define changes in the behaviour of one (‘‘the rated’’ partner), namely his instabilities or missing reliabilities toward his partner. We must assert that, in trying to answer these questions, we found incongruence within this partner relationship. Thus, this interpersonal relationship does not seem to be on an equivalent level. Therefore, the two levels must be identified as a ‘‘judge’’ and an ‘‘accused’’, a situation which is steadily repeated in this one-way direction. The additional problem within this apparent unilateral problematical relationship seems to be that the punishment (=downgrading) precludes the possibility of defence of the rated person. Therefore it cannot be excluded that we might define this kind of panic model as a ‘‘unilateral induced-panic model’’ with a clear but not justified distribution of allocated roles. Our patient seems to be always in a helpless position and dependent on his ‘‘partner’’. Induced panic therefore does not seem to be an irrational but rational model. Accumulated interest (=personality axis: loss of self confidence) The accused and punished person reacts with panic disorder. Additionally, he is placed on the pillory as a person of diminished reliability, visible to everybody. In this difficult situation, he has to fight for more acceptance by the partners and therefore the tendency to bow to anybody increases. In addition to induced panic, the personality shows reduced self confidence. Valuta decrease (=affective axis: folie au deux panic effect) The effects (see) on one partner, who is only part of a strong connected system (Euro zone), are not limited to him alone. All other partners within this system are now involved in the problems because of this blemished participant. All members of this network are losing their credibility. International summit (=group therapy) All members of the network meet in a so-called summit conference, which deals with the problem of one single member and its consequences on all other members. The ‘‘setting’’ of this group therapy does not show a distribution of equal partners, in fact the role distribution in point 1, judge and accused, is repeated, but the motivation is different. While the judge in 1 (=rating agency) does not have to expect any consequences, the judges in 4 will be completely affected by the attitude of the accused member [1,3,5]. ‘‘Rescue screens’’ (=direct action, pills against panic) The primary aim of the group therapy is to allay all members of the group and the spectators of the scene. For this, so-called ‘‘Rescue screens!’’ are installed to shore up the weak partner or also other potential weak partners. These rescue screens fulfil the function of a fast acting medication against panic, like lorazepam. Obligations of debt relief and saving programs of affected countries (long acting action = behaviour therapy) [1,4,5] All members of the involved ‘‘panic group’’ obligate to debt relief and saving programs to emphasize their expectations for a basic change. Transient reassurance with increase of valutas and decrease of accumulated interests (=period of rapid effectiveness)
Implication of hypothesis The primary GPR model we defined was based upon a ‘‘stock market panic’’. The model we recognize now seems to have a
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new quality of never-before known widespread dynamics with a noticeable ‘‘7-step repeating programme’’. The effect of this model is a generalizing effect of one externally-attacked single member of a defined group (=‘‘currency zone’’) mainly by a foreign aggressor (=rater agency), which is not part of this common zone. On the one hand, this rater could therefore be defined as neutral, on the other hand, the external attack of one member of the apparently ‘‘homogenous’’ group illustrates the liability of the whole group, which then shows classical criteria of a ‘‘Generalized induced panic’’ within this group. The motivation for the whole group to help the single affected and attacked member therefore does not seem to be very altruistic. The other group members’ helping the first attacked member serves to preserve the whole group, its values and its stability. Returning to our panic patient (or the first attacked member), the ‘‘help’’ of the other members seems to have a bitter taste. The ‘‘Rescue screens’’ which is built over him has apparently only short effects, the efficacy of this ‘‘lorazepam’’ decreases, dosages of ‘‘lorazepam’’ (amounts of rescue screens) have to be increased, the phenomenon of tolerance and dependency now grows larger and larger. Our panic patient meanwhile has an additional problem. He shows signs of dependency. He now requires higher and higher rescue screens to obtain the same temporary effect of decreasing panic, and this applies to all other members of the panic group. The promises of long-lasting arrangements (obligations of debt relief) are not – or not yet – efficient, therefore the group challenges its own arrangements. It becomes more apparent that the primary motivation was not explicitly to help the attacked, ill member, but first and foremost preservation of the whole group, circumvention of a diffusion of panic to all members. Does this mean that we have chosen the wrong panic therapy (group therapy) for the panic patient? From a therapeutic point of view: Yes. The treatment of patients with panic disorder cannot be the ‘‘immediate group therapy approach’’. The individual characteristics of the subject must be analysed at once, the specificity of his vulnerability (economic problems of his country), his individual coping strategies (=encouragement of individual economic strength), his general abilities to find a specific way out of irrational towards rational strategies must be recognized and encouraged [1–5]. At this stage of his panic disease, the patient seems absolutely overtaxed with the irrational expectations of group-therapy, which in truth is not honestly interested in his recovery but in the maintenance of the system. So let’s go back to reset and take an individual approach. Acknowledgement None declared. References [1] Sperling W, Bleich S, Reulbach U. Black Monday on stock markets throughout the world – a new phenomenon of collective panic disorder? A psychiatric approach. Med Hypotheses 2008;71(6):972–4. [2] The financial crisis: A light at the end of the tunnel? concerted action is taken around the world to rescue the financial system. The Economist 2008. [3] Marchesi C, Ampollini P, Signifredi R, et al. The treatment of panic disorder in a clinical setting: a 12-month naturalistic study. Neuropsychobiology 1997;36(1):25–31. [4] Clivaz E, Chauvet I, Zullino D. Topiramate and panic attacks in patients with borderline personality disorder. Pharmacopsychiatry 2008;41(2):79. [5] Coupland J, Morrison J, Myrh G. New developments in cognitive-behavioural therapy for mood disorders. Can J Psychiatry 2008;53(6):408.