The main theme in the episode was sons. Tony realizes the root cause of his panic attacks and the parallel experiences of Anthony Jr. It's also about Jackie Jr. (The previous boss' son who is going to college and whose father didn't want him involved in the family business.) There are comparisons between the futures of Jackie Jr. and Anthony Jr.
Understanding root cause will help keep panic attacks at bay. Dr. Melfi brought up the point that anytime Tony has these attacks there is meat involved. Later Tony remembers one time where he witnessed his father cut off the pinkie of the meat butcher. Tony's dad tells him that the butcher owed money because he was a gambler and that Tony should NEVER gamble and that a man should honor his debts. Later that same night when his mother received meat from the same butcher she was very happy. His dad and mother were full of joy, laughing and dancing in the kitchen together. Then Tony focused on the meat and passed out. It was his first panic attack but he didn't realize it at the time. Dr. Melfi sees it as a connection to how Tony will have to be the one to deliver the bacon when he grew up. (Tony's mother was apparently always happy when she received her meat delivery. Probably because she knew why they never paid for the meat. It's a similar pattern being played now with Carmella seducing Tony whenever she suspects he has done something violent or illegal. It turns her on just as it did Tony's mother years before.)
Things that seem good at first can actually end up bad.
Even secrets that you think are well kept about yourself can still be known to others.
There are times when the best thing to do is not say anything. Don't add fuel to the verbal fire.
When you are desperate you do desperate things.
Lastly, we are sometimes destined to repeat history. When Anthony Jr. is named Defensive Captain of his football team because he has been shown to be a leader he passes out. Most certainly that is Anthony Jr.'s first panic attack.
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