Barry Blackwell’s reply to Hector Warnes’ comment
Barry Blackwell: The Anxiety Enigma


       OED:  Enigma: “A mysterious or puzzling person or thing.” From Greek, ainigma, “riddle.”

       I preface my response to Hector Warnes’ comment on “The Anxiety Enigma” with this Oxford English Dictionary definition to highlight the fact that his erudite comments and queries, while pertinent, add to the mystery.

      His opening paragraph raises concerns about the appropriate place of the so called “anxiety disorders” in contemporary nosology, particularly I suspect, with regard to the DSM categorization. As I point out, this problem begins with Aubrey Lewis’ elegant but overlooked dissection of the confusion surrounding the multiple meanings and diverse uses of the term “anxiety.”

      This confusion is contributed to not only by the way “consensus” categories evolved but also by the misleading efforts of Big Pharma to link particular diagnoses and drug response in order to market specific compounds with hypothetical mechanisms of action. Part of the confusion is also driven by the way DSM is used primarily to meet the needs of insurance companies.

      In 2005 I co-authored a book, “Psychiatric Case Formulations,” with three colleagues who had skills to illustrate how succinct case formulations could incorporate biological, psychodynamic, cognitive-behavioral and social features of illness in the multiaxial system by including information about etiology, natural history, treatment options and prognosis (Sperry et al. 2005). The book is now out of print but still available on Amazon, at a price.

      This relates to Hector’s second paragraph about the puzzling response rates of different drug categories in alleviating the multiple psychological and physical manifestation of the so called “stress disorders.” Frank Berger, discoverer of the first “anti-anxiety” drug (meprobamate – Miltown), was firm in his lifelong conviction that these drugs were considerably overused in attempts to deal with existential problems of living; sweeping these under the carpet and failing to address them in ways bound to encourage recurrence. Variable outcomes were inevitably linked to poor compliance, drug dependency, alexithymia, illness behavior or some combination.

      In subsequent paragraphs Hector provides enlightened commentary on the historical evolution of psychosomatic concepts and the need for a “corrective emotional experience” to enhance coping with responses to environmental events that are sometimes fatal.

      With this I fully concur supported by professional and personal experience.  My father, an enigmatic and unemotional man, died prematurely at the age of 71, physically fit and active, but after a painful and bruising family argument he was psychologically ill equipped to handle. Three days later he was found dead by his caretaker, seated facing the TV screen with a half-smoked cigar and half empty glass of Scotch by his side. I had returned to America and his other relatives had dispersed; living alone there was nobody to talk to or comfort him.


Sperry L, Gudeman JE, Blackwell B, Faulkner LR. Psychiatric Case Formulations Washington DC. London England. American Psychiatric Press; 2005.


March 29, 2018