Mental illness is a major source of tension in The Sopranos. Throughout the HBO series Tony (James Gandolfini) undergoes treatment with Dr. Melfi (Lorraine Bracco) for his recurring panic attacks. She helps him uncover an enormous amount of repressed fear and anger that has contributed to his condition, and while Tony improves intermittently, the attacks never entirely subside. He occasionally blames Dr. Melfi for the fact that he isn’t “cured,” but they both know his issues are more complicated than that. As much as crime and violence, anxiety and depression are a Soprano family tradition that will certainly be explored more in the upcoming prequel, The Many Saints of Newark.
Tony’s father Johnny Boy (Joseph Siravo) was a violent criminal whose exploits were widely known, while his mother Livia (Nancy Marchand) was aloof at best and abusive at worst. This explains why Tony’s attacks are most often triggered by family conflict, as was the case in his first on-screen fainting spell at a family barbecue. Through therapy, Tony begins to understand how and why family conflict takes such a strain on his well-being, and a more comprehensive portrait of his dysfunctional background comes to light when his son A.J. (Robert Iler) starts to suffer from similar symptoms.
After witnessing A.J. faint for the first time, Tony tells Dr. Melfi that his son inherited “the putrid, fucking, rotten Soprano gene… I remember hearing about my great great great grandfather, he drove a mule cart off a mountain road… probably was a panic attack.” Dr. Melfi tells Tony that “when you blame your genes you’re really blaming yourself,” which he ignores tellingly. Tony was physically violent with A.J. — as his own father was with him — shortly before his son’s panic attack, but he is unwilling to acknowledge his own part in perpetuating his family’s cycle of misplaced anger and violent outbursts. Rather than some divine birthright or “curse,” as Carmela calls it in season 6, the psychiatric illness suffered by the Soprano men results from several generations of unresolved trauma.
Tony understands on some level that the casual use of violence in his upbringing took an enormous toll on his emotional health. Viewers learned in the season 3 episode “Fortunate Son” that his first ever panic attack occurred in childhood after witnessing his father mutilate a butcher over an unpaid debt. They took home some free meat as partial payment, and Tony fainted upon seeing his mother gleefully slice into the ill-gotten roast. Dr. Melfi explains that “the violence and blood so closely connected to the food” they were about to eat was too much for Tony’s young mind to process, along with the thought that he too might someday “be called upon to bring home the bacon.”
A.J.’s panic attacks also seem to be tied up with expectations his father projects onto him, even though Tony explicitly doesn’t want him involved in the family business. A.J. first faints on-screen during football practice after being commended for his performance. Tony was a successful football player as a teen, and the idea of following in his father’s footsteps in any way was overwhelming for him. A.J.’s suicide attempt in The Sopranos season 6 forces Tony to more seriously confront his role in creating the Soprano family “curse,” something he clearly wishes his own father could have done for him.
In the season 2 episode “Big Girls Don’t Cry,” Hesh Rabkin (Jerry Adler) tells Tony that his father Johnny Boy also had anxiety attacks that caused him to faint, but that “in those days [they] called it a ‘condition.'” Tony seems to take great comfort in the knowledge that his father suffered from the same fainting spells as him, but it doesn’t stop him from recreating elements of their fraught relationship with his own son. Given the overarching significance of the Soprano “curse” throughout the series, and given that we know Johnny Boy suffered from panic attacks, psychiatric illness will undoubtedly figure similarly into the upcoming prequel.