Tony Soprano Panic Disorder Case Study

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When a person is faced with a stressful situation, the body’s reaction is to become anxious. In some cases, that reaction is severe, causing individuals to become unable to move beyond the fear and anxiety they feel for long periods of time. Often, this is indicative of an anxiety disorder. There are a number of different types of anxiety disorders. The most common of these disorders includes general anxiety disorder, clinical anxiety disorder, post-traumatic stress disorder, social anxiety disorder, individual phobias, and agoraphobia.

More than 40 million adults over the age of 18 in the United States have an anxiety disorder. While the cause of anxiety disorders is unknown, most researchers and scientists believe that a combination of genetics and traumatic or triggering events is the most likely cause for the development of an anxiety disorder.

With more than 18 percent of the adult population in the nation suffering from an anxiety disorder, everyone is likely to know someone who has one of these conditions. Throughout history, politicians, writers, and artists have suffered from a variety of anxiety disorders. Many celebrities today have started to discuss their own experiences with these conditions, bringing exposure to the disorders and helping others to find ways to deal with the symptoms and causes. Here is a closer look at ten famous people with anxiety disorders and the impact that the disorders have had on their lives.

10. Abraham Lincoln

Abraham Lincoln is famously depicted as somber and serious in photographs and descriptions of him throughout history books and historical accounts. Lincoln endured many traumatic events throughout his life, marked by the repeated loss of those close to him. As a young child, he lost his mother, and when he was only 18, he lost his beloved older sister. Lincoln would also lose ten of his twelve children to death, and he often felt inadequate because of a lack of social upbringing and education. These losses and his own feelings of inadequacy manifested in deep anxiety throughout his life and his presidency. Historians and psychiatric researchers typically agree that Lincoln must have suffered from severe generalized anxiety disorders, based on his letters and journals. Lincoln’s diagnosis would not have existed at the time, and he would have had to have found ways to deal with the stress and anxiety he felt as he managed the challenges of his presidency.

9. Emily Dickinson

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It can be difficult to diagnose a psychological condition after someone’s death, particularly for historical figures that lived prior to the twentieth century. Emily Dickinson, born in 1830, is one of America’s most beloved literary figures, and a world famous poetess. Almost as well known as her poetry, however, is Emily Dickinson’s reclusive nature. Through letters and historical records, experts and researchers have determined that Emily Dickinson began to limit her interaction with other people to her family members after leaving Mount Holyoke Female Seminary. Although Emily Dickinson conversed with journalists, other writers, and editors during the time that she lived, she limited the majority of her interaction to letter writing, refusing to meet most of them in person. As she grew older, her own fear of death also seemed to contribute to her increasing lack of interaction with others. Most experts agree that Dickinson suffered from some type of an anxiety disorder, possibly agoraphobia.

8. Vincent van Gogh

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Vincent van Gogh has been an interesting case study for psychiatric students throughout the world. There are a number of theories about the extent of van Gogh’s mental health disorders, and most expert agree that the famous artist suffered from a combination of a number of physical and psychiatric diseases. In addition to bipolar disorder and epilepsy, experts often agree that van Gogh suffered from anxiety disorders, and his stay in an asylum in the late nineteenth century noted this as one of van Gogh’s conditions. Additionally, historians also note the documentation of his anxiety in his own letters, where he notes that he has “fits of anxiety” and “attacks” of melancholy. Van Gogh also excessively drank liquor, especially absinthe, and this is possibly a cause of an increase in the severity of his anxiety and other disorders. He is also used in genetic studies and research because of the possible suicide of his younger brother and one of his sister’s schizophrenic diagnosis. Van Gogh ultimately committed suicide in his thirties.

7. Kim Basinger

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Kim Basinger’s struggle with anxiety disorders began when she was a child. Basinger suffers from social anxiety, panic disorder, and agoraphobia. The condition was so severe when she was a child that her parents thought it was possible that she had autism. She was tested for autism, along with many other psychiatric disorders, but her condition was not diagnosed. Basinger has been very public about her experiences with anxiety disorders, and she appeared in the documentary “Panic: A Film about Coping” produced HBO, hoping to raise awareness for the spectrum of these disorders. To treat her condition, Basinger turned to psychotherapeutic methods. Although she feels the condition has improved, she still notes that she has some instances of panic.

6. Barbra Streisand

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Barbra Streisand is known throughout Hollywood and the music industry for being very reclusive. She is not often seen in public, and, in fact, she would not perform publicly for nearly 30 years out of her career. This 30-year hiatus from public appearances, aside from those for charity, was the result of what happened at a concert that Streisand gave in Central Park in New York City. At the concert, Streisand forgot the lyrics to the song she was singing, and she developed an intense fear of performing in public again and having the same thing happen. Streisand was able to work through the panic attacks and anxiety disorder symptoms to begin to perform again publicly. The actress/singer has reported that medication was a part of the treatment for her symptoms.

5. Brian Wilson

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Brian Wilson of the Beach Boys is often regarded as one of the most creative and prolific musical artists and songwriters of all time. Most experts agree that Wilson’s battles with anxiety and other mental health disorders likely were triggered by his childhood experiences with an abusive father and an alcoholic mother. As a founder of the Beach Boys, he is credited as the creative driving force behind the band’s success, but his time in the group was marred by periods of depression and anxiety, resulting in his refusal to tour or perform with the group. During the highest points of his fame, Wilson self-medicated his conditions with illegal drugs. Since then, Wilson has found a way to deal with his condition, publishing an autobiography and beginning to perform publicly again. It has been reported that his treatment included the controversial 24-hour therapy treatment administered by now unlicensed clinical psychologist Eugene Landy.

4. Donny Osmond

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For many people with an anxiety disorder, the constant presence of anxiousness about stressful triggers is an almost impossible hurdle to get over. In Donny Osmond’s cases, that anxiety resulted in severe panic attacks that would send him to the corner of the room, curled up into the fetal position and unable to handle any situation. For Osmond, that stress was triggered by his own celebrity. Osmond worried constantly that he would not be successful in show business, letting not just himself down but also negatively affecting his family and their individual careers. Osmond sought professional mental health professionals and his treatment includes medication to control and fight the symptoms of the anxiety and panic attacks. After battling anxiety disorder and working to keep it under control, Osmond discussed his struggle in a memoir and on the Dr. Phil television show.

3. Paula Deen

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Some anxiety disorders manifest in a person’s inability to even leave their own homes to go about living day-to-day, seriously impeding everything from personal relationships to careers. This was the case for Paula Deen, the celebrity Southern chef, who developed an anxiety disorder after the loss of her parents. After both of Deen’s parents passed away before she was in her mid-twenties, she developed an intense fear of dying, leading to an acute condition of agoraphobia. Agoraphobia occurs when a person feels that situations are dangerous, or sometimes highly uncomfortable. Deen began to have panic attacks from her own fear of death, and she would often not leave her own home for weeks at a time. To overcome this anxiety, Deen relied on religious prayer and other spiritual methods.

2. Whoopi Goldberg

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Whoopi Goldberg, a famous actress, comedienne, and talk show host, needs to travel. For Goldberg, this was complicated for many years because of her deep fear of flying. This type of fear is a phobia, one specific type of anxiety disorder, often also called aerophobia. Often, individuals who suffer from a phobia undergo cognitive behavior therapy and exposure therapy. Before recent treatment, Goldberg would travel only by bus, train, or car in order to get from one end of the country to the other. Her fear of flying was the result of witnessing a mid-air collision between two planes more than 30 years ago. Goldberg’s own treatment was a type of exposure therapy in which she enrolled in a flying without fear program.


1. Howie Mandel

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In 2009, Howie Mandel revealed to the public that he suffered from obsessive compulsive disorder (OCD), one type of anxiety disorder. Mandel’s condition manifests itself in a deep fear of germs. Because he constantly travels, Mandel keeps a black light and a magnifying glass with him in order to inspect all of his hotel rooms for bedbugs and germs that could be around the room or on the bed. He will also only travel on a private plane because he fears the germs on commercial flights. Individuals with OCD become increasingly obsessed with rituals and are unable to overcome fears of the spread of germs, in spite of acute knowledge of the irrationality of their fears. Mandel manages his own condition with medication and psychotherapy.

Plus … Tony Soprano

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In the television show The Sopranos, Tony Soprano suffers from several different types of anxiety disorders that manifest in debilitating panic attacks. The character undergoes psychiatric care for 8 ½ years, taking medication as part of the treatment, but is unable to control the attacks and other effects of PTSD and stress anxiety disorder. He ends up ending his treatment with his psychiatrist, and he begins to treat his condition through self-help programs. It is a trend that many people are following for treatment of anxiety disorders.

Tony Soprano’s treatment on the television show is one of the latest trends in treatment for anxiety disorders. Other types of treatment often include medication, prescribed by a qualified physician or psychiatrist, psychotherapy, homeopathic care, and cognitive behavior therapies.

Panic attacks are caused by something else than too much stress, too many working hours or an unhealthy diet.

If you’re suffering from panic attacks and you’re not aware of the reasons for these intense emotions, you can learn to disclose them.

I believe that, learning about your inner triggers is the way out of the panic world. Studying my anxiety (and panic attacks) for many years in a row with the help of psychodynamic therapy and journal writing, helped me calm down.

For basic information about panic attacks, please read here.

Panic attacks and The Sopranos

‘The Sopranos’ is an American TV-show created by David Chase and starring James Gandolfini and Eddie Falco, among others. It tells about the life of a New Jersey mobster who finds himself trapped in the middle of a mental crisis, while raising two children and dealing with his ‘waste management consultant’ job.

The show had a huge influence on my emotional state when I started to watch it. I can even say that it helped me grow emotionally by inspiring me to take responsibility for my emotions, for the troubles in my life, for the relationship with my family.

Therefore, I’d like to use few of the ideas thrown in the series to get a clearer image on how panic attacks function.

I have been in Tony’s place and I assume many people have been, too: a person with no sense of awareness over his emotional state, with a shady family past, ruled by the need to protect himself from danger over and over.

This place is no fun and, if you had been challenged by intense anxiety, too, you’ll know what I mean.

The trigger for panic attacks

Tony Soprano finds himself losing his consciousness one day after grilling meat for his son’s birthday party. He faints several times in the show but, not all moments involve a steak.

In one particular scene, Tony faints at the sight of an Uncle Beans advertising photo on a rice package.

In therapy, he learns that, it wasn’t the ‘Uncle Beans’ image that made him vulnerable, but what he was doing before reaching for the rice in the cupboard-eating cappicola from the fridge.

During his therapy session with a therapist recommended by the family doctor, he discovers that, his panic attacks are an important vulnerability in his subconscious. Moreover, the anxiety he deals with is a warning sign that something in his life was not quite right.

Apparently, for Tony, meat was a trigger that would immediately bring the symptoms of panic attacks.

Helped by the therapist, the mobster starts recounting his childhood which wasn’t one that any child would like to remember.

We see how little Tony catches a glimpse of his mobster father chopping the family butcher’s fingers with a knife. We understand from this scene that, the butcher was indebted to his father and was unable to pay his dues.

This horrific moment witnessed by a 11-year-old Tony was followed by another one. Upon returning home, he sees his mother praising the steak that she cooked that attracts her husband’s attention.

While looking at the knife cutting though the juicy meat, Tony loses consciousness for the first time.

Upon confronting these feelings with Dr. Melfi, the mobster finds out why his attacks started in the first place: his parents’ sexuality, his father’s violence and the shed of blood were closely connected to the food he was eating. Instead of feeling comfort and protection through the food that his parents were providing, he felt fear.

Much like in Proust’s novel,  ‘Remembrance of things past’, he, too associated the visual sight of food and its texture with intense memories from his childhood.

One of the triggers for my panic back in the past was the inability to be assertive in situations that required assertiveness. For example, if someone offended me, I wouldn’t know how to stand up for myself. Or if someone would cross my boundaries, I didn’t know that it matters a lot and this can even be a deal-breaker in a relationship.

Also, not having an autonomous personality and depending on other people’s opinion about me, kept me in a constant state of anxiousness.

The fear of the feeling

Not being able to recognize our own emotions  and even being frightened when they shake us inside, is another problem when dealing with panic disorder.

Much like Tony, I was unable to accept grief in my life and share it with others. I was afraid to embrace sadness because I saw it as a weakness. However, the sadness that was scooped out of my subconscious during therapy was related to a fear-based education I was given as a child. Back then, I wasn’t allowed to cry or even express my opinion.

It is researched that emotions like sadness, shame or anger are put out of the awareness by those who struggle with anxiety. In the article, ‘Panic attacks and the inability to express emotions: are they related?‘, writer Mike explains why avoiding emotions can makes us more anxious and sensitive to panic attacks.

Tony’s grief was writhing inside his body like a snake, and rather than letting it go, he stuffed it deeper and deeper, hoping it won’t bite him from inside. Even in the aftermath of learning that his own mother attempted to kill him, he still couldn’t accept his feelings.

Sigmund Freud describes this behaviour as the defense mechanism of ‘denial‘.

We prefer to deny reality as a way to regulate our ego’s needs and to not threaten our comfort. I guess this is another way to prevent ourselves from releasing a difficult emotion.

Think about the last time you went through a conflict with someone or you saw something of a violent nature or out of the ordinary. Did you ever think that ‘I’m only imagining’ or ‘This is not as bad as it sounds’? We tell ourselves that because we need to defend our ego from time to time to keep ourselves sane and focused on daily tasks. But we can’t keep emotions inside for too long, otherwise, they will do damage.

Concepts of psychodynamic therapy

Understanding root causes will make you less vulnerable to future episodes

(Dr. Melfi)

While I was in therapy, I wished to speed up the recovery process and find the cause for my anxiety as soon as possible. I wanted to have a clear understanding of my feelings, at least, to be able to have a good night sleep.

Thus, I started reading about the concepts of psychodynamic therapy and how they relate to panic attacks.

The main goal of this type of therapy is to make the patient verbalize his emotions and bring to the surface the conflicts buried under various levels of anxiety.

Psychodynamic therapy that focuses on panic attacks makes use of the following concepts taken from psychoanalysis:

-the existence of the unconscious–what we don’t know about ourselves and the mechanisms we learned to cope with our problems starting with our childhood.

-the connection between conflicted wishes, defense mechanisms and panic symptoms-how panic is related to a conflict inside us and how we keep these conflicts inside from coming to the surface, using defense mechanisms.

-differences between signal and traumatic anxiety-signal anxiety is a stress reaction to the patient’s separation from a person or a certain life event. Traumatic anxiety is often produced when there is a possibility of annihilation or trauma in the person’s life.

-the importance of transference phenomena-the feelings the patient starts to develop for the therapist.

From this therapy we learn that anxiety symptoms develop from unconscious fantasies and conflicts.

As mentioned before, unexpressed emotions feel threatening to the people who often panic. In order to protect ourselves from them, we use three defense mechanisms: reaction formation, undoing, denial.

Normally, we have to handle emotions as they come. We can’t escape them because that’s how we were built. We are psychological creatures with a conscious mind (consciousness) and a concealed mind (the unconscious).

If the childhood provided an outlet for these emotions, it wouldn’t be difficult for the adult to accept the feeling, to recognize it in the body and release it.

However, for those who weren’t given a model to process anger, sadness or grief, it is hard to even recognize them inside.

In order to cope with not being able to process these emotions, we find ourselves in a stateof compromise. Unconsciously, we try to do anything in our power not to let the real emotion surface and ‘damage’ us. Therefore, we make a compromise between the wish to express the difficult emotion and the need to defend ourselves from it. This is called in psychoanalytical terms, a ‘compromise formation’.

For example, let’s assume I am angry with my best friend for not inviting me to her birthday party. She doesn’t know this.

Next time I meet her, I would feel nervous for no clear reason. I would have butterflies in my stomach, negative thinking, a state of restlessness, sweaty palms, difficulty in focusing my attention on what she is saying.

We would talk about our lives without addressing the feeling I have for her: anger. Thus, each time I have to face her, the anxiety takes place of every positive feeling I have for her. I would see her as a threat, so, I’d obviously start avoiding her to get back to my ‘comfort zone’. The compromise here is ‘anxiety’. See how this works?

I rather be anxious than having to deal with an intense feeling of anger in my body or worse, having to express this anger to someone I care about.

However, there is another important theme in psychodynamic psychotherapy:

the role of dependency versus independent behavior

Psychoanalysis says that, people prone to panic disorder have to rely on others to get their needs met. They have a fear of taking control over their lives or separate emotionally from their parents (or partners).

This is due to the fact that, the person with anxiety was raised to be rewarded for listening to his parents, being nice and doing what they said and punished for attempting to break himself free from their rules (such as, being criticized for travelling away from home with his friends or spending the night with a school mate).

A lack of autonomy in adult life would mean for example, the inability to break from a husband who supports an anxious wife, the difficulty in getting a job after graduation, the trouble in asking for a higher pay check or in quitting a job for a better one. Even though we ‘want’ to break free from our family’s emotional grab and get a job to be able to support ourselves, we feel we can’t.

This is a conflict between a desired ‘wish’ and the need to protect ourselves from the ‘wish’. We do this because we don’t want to provoke conflicts, we don’t want to put ourselves in risky situations, as we’re not certain we will make it. However, this is not a rigid personality trait. It can be changed with a lot of practice.

Self-help for your panic

If you are interested in your emotional health and want to deal better with your anxiety, psychotherapy will make a huge difference in your life.

During the psychodynamic sessions, we explore our conflicts and learn how to recognize them in our daily lives. What makes this type of therapy great is that, the psychotherapist will provide a relationship that we can feel safe in. A relationship that will allow us to become more independent and assertive.

However, if you want a quicker solution to panic attacks, find some time to be alone, grab a notebook and try to ask yourself a set of questions:

1. What is the emotion I have in my body that feels threatening? Anger, sadness? How does it feel in my body? Do I feel like I can’t breathe or that my chest feels too tight and I’m afraid there’s something wrong with my heart?

Write down the physical sensations in detail and assure yourself that nothing terrible is going to happen to you.

2. Can I express this emotion by using words that describe it? Can I trust someone to practice this emotion with? (a friend, relative)

3. Who is the person that makes me feel anxious for no apparent reason? My parents, one of my friends? Who is the person who crossed one of my boundaries? Write down the things you’d tell them and practice being open to them with a person you trust.

4. What kind of conflicts I might have inside? Do I want to get a better job but feel I don’t have the courage to do it? Why? What do I have to do to get more self-confidence? How does a confident person behave?

Can I practice new skills outside the workplace? How?

Add any other questions you think will benefit you.

In The Sopranos, Tony’s inner conflict was between the wish to see his narcissistic mother the way she really was: a cruel mother who tried to kill his own son, and the need to protect himself from this wish that would have brought terrible heartbreak in his life. He also didn’t want to shatter his image as the ‘good son’ who was respected by his relatives.

‘Family members stick together’, he would often say.

For Tony, family was closely related to loyalty, tradition and respect. He would never go against his family. Therefore, he never really went against his own mother by not grieving the mother he never had. Being upset, angry and even hating our parents for not meeting our needs when we were small, is something we need to feel to move on as adults. In the end, these are just feelings. They won’t last forever.

In psychodynamic therapy, the patient learns to take control over his defense mechanisms and conflicts, and stop using anxiety to react to ego-threatening situations.

I think that, throughout his entire therapy experience, Tony Soprano gained little control over his feelings-he would still have panic attacks even later in the show. The reason for that might be that he was still a mobster-he passed on his father’s legacy and, with it, his lack of awareness over what he was doing to the people he loved, to the society and to his own self.

In the end of the show, Dr. Melfi fired Tony from therapy due to a research she was given to read about long-term therapy’s influence over criminal personalities. Apparently, talk therapy would have opposite effect to someone with an antisocial personality disorder: instead of helping them grow, they gain understanding over other people’s weaknesses and can use this information to proliferate their crimes.

In conclusion, unless we’re psychopaths, being in long-term therapy can help us understand why we panic in certain situations so, we become more independent and learn to verbalize and handle intense emotions.

I now realize how difficult things would have been if anxiety never showed up to teach me about assertiveness and the importance of having an emotional life.

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Thank you!



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