Phobias in Children
PHOBIAS IN CHILDREN
A phobia (from the Greek phobos : "flight, fear, fright") is an irrational fear aroused by an object, situation, or activity that does not involve real danger. Anxiety, the irrationality of which is generally consciously recognized by the person, results in various defensive strategies: flight, avoidance, or the use of an object or person that enables the subject to face the feared situation.
The term first appeared in the psychiatric literature of the late nineteenth century (Karl Westphal, in 1872, cited agoraphobia); French psychiatrists around the same time (Albert Pitres and Emmanuel Régis) described a very large number of phobias in terms of the triggering object or situation (claustrophobia, erythrophobia, zoophobia, etc.).
Pierre Janet, who linked phobic symptoms to psychasthenia, divided phobias into three categories that remain in use: object phobias, situation phobias, and function phobias. Object phobias involve pointed or cutting objects (scissors, knives, razor blades) associated with auto- or heteroaggressive fantasies that may take the form of phobias of impulsive acts and that are often integrated into obsessional neurosis. Similar to these are phobias of animals, which are very frequent in children but can continue into adulthood (fear of spiders, mice, snakes, birds, etc.).
Situation phobias involve open spaces (agoraphobia), enclosed spaces (claustrophobia), or high places (vertigo). In function phobias, manifest anxiety bears upon the functioning of the organism: fear of falling asleep or of swallowing. Similar to these are the fear of diseases (nosophobia) and social phobias: fear of speaking or blushing in public (erythrophobia), and phobias of touching or contact.
The term pantophobia is sometimes used to describe a diffuse anxiety aroused by several objects or situations, but the absence of specific conditions for the emergence of anxiety makes the inclusion of such cases in the framework of the phobias questionable. Certain phobic behaviors can be likened to the rituals seen with obsessional neurosis (mixed, so-called phobo-obsessional forms).
The clinical study of phobias would be incomplete if it did not consider the behaviors that the person uses to fight against the anxiety associated with the phobogenic object. These behaviors derive from two types of defensive strategy: avoidance and reassurance. Avoidance can be expressed in maneuvers to flee or bypass the phobogenic situation or through varying degrees of restriction in the subject's activities. Reassurance enlists a person or object that makes it possible to face the phobogenic situation.
The understanding of phobias is one of the very earliest topics to engage Sigmund Freud's theoretical reflection, as early as 1894-1895. One of his first articles on this theme, "Obsessions and Phobias: Their Psychical Mechanism and Their Aetiology" (1895c ), originally published in French, discussed Janet's conceptions and clearly separated phobias from obsessions: in particular, the relation to anxiety is specific to phobias. In these early works, Freud considered the phobias as a form of anxiety neurosis, which he classed among the "actual" or defense neuroses and whose etiology he explained in terms of an accumulation of endogenous excitation, "a veritable self-intoxication, by means of a sort of engorgement of the sexual substances."
In his later writings, he linked phobias to hysterical anxiety and thus to the transference neuroses that are accessible to analysis. In hysterical anxiety, the libido is unleashed in the form of anxiety and not converted as would normally happen in hysteria. Repression bears upon an instinctual impulse with projection onto an object; anxiety cannot be totally avoided except at the cost, as Freud noted, of "all sorts of inhibitions and restrictions" to which the person must submit him- or herself.
Freud developed his notion of the formation of phobias in the case of Little Hans, related in "Analysis of a Phobia in a Five-Year-Old Boy" (1909b), and in his return to that case in that of the Wolf Man in "Inhibitions, Symptoms and Anxiety" (1926 ). The symptom results from mental work that aims to "fix once again the anxiety that has become free." Freud showed how Little Hans's phobia of the horse staged the representation of the threat of castration by the father figure. At the same time, through the motor inhibition it entailed in the child, the phobia realized a compromise between the incestuous desires directed toward the maternal object and their repression (pre-vented by his phobia from going out, the boy could remain near his mother). Repression affects the totality of the components of the Oedipus complex.
Returning to this case in 1926, while maintaining the central role of castration anxiety, Freud placed greater emphasis on the repression of parricidal fantasies, as well as on the passive homosexual fantasy of the father figure. The phobia could be understood as an attempt to resolve the conflict of ambivalence: Little Hans's symptom was a compromise between love and hostility for the father. The displacement onto another object of the anxiety that results from a conflict of ambivalence protects the ego from instinctual danger. In this work Freud underscored the reversal that analysis of the formation of phobias had compelled him to make in his theory of anxiety: It is anxiety that is at the origin of repression, and not the reverse.
In the subsequent development of psychoanalysis, phobias in children have incited numerous theoretical debates. Anna Freud and her followers differentiated between phobias and the archaic fears that preexist all earlier experiences (fear of the dark, of storms, etc.). For these authors, these infantile fears, merely an expression of the ego's immaturity, were not phobias in the strict sense, in that they did not bring together condensation, projection, and symbolization. However, they considered such fears to be the precursors to phobias. These authors believed that was is not possible to speak in terms of a neurotic organization before conflicts had been internalized at the end of the Oedipus complex.
According to Melanie Klein, the primitive Ego is subjected to experiences of intense anxiety. Phobia corresponds to the projection of the death instinct onto external objects; it comes about in relation to the forming of object relations and the emergence of a terrifying, archaic superego that is identified with the paternal penis. This destructiveness, projected onto the introjected parents, constitutes the internal threat that is the source of phobias. Archaic anxiety produces fantasies of being devoured; phobias of animals, especially, represent the fear of being devoured by the superego. However, the phobia also expresses a sadistic destructiveness that is linked to aggression directed toward the paternal imago; the violence of this destructive impulse is the source for massive anxiety that, in turn, becomes a source of persecution.
In 1956-1957 Jacques Lacan introduced the notion of the phobic signifier, the equivalent of the paternal metaphor that makes it possible to symbolize the Real of phallic jouissance. The phobogenic object masks the subject's fundamental anxiety and comes to occupy an intermediate position between the phallic signifier and an appeal to the Name-of-the-Father. Whereas the fetish object, in perversion, is the absolute condition for jouissance, the function of the phobic signifier is to protect the subject from the disappearance of desire.
Although castration anxiety does indeed appear to be central in phobias, the affect that characterizes it seems to originate in the experience of separation. The absence of the mother, in the preverbal infant's situation of helplessness and distress (Hilflosigkeit ), creates the traumatic conditions for terror (Schreck ). The defensive mechanisms put into place to cope with this can be seen as the precursors to the organizing mechanisms of phobia. According to Annie Birraux in Éloge de la phobie (In praise of phobia, 1994), phobia is "a primitive structure of thought": Projection, one of its fundamental mechanisms, is to be linked to the primitive movement of expulsion that Freud, in "Negation" (1925h), placed at the origins of the coming into being of the subject and the activity of thought.
From a clinical viewpoint, Jean Mallet, in "Contributionà l'étude des phobies" (Contribution to the study of phobias, 1956), described the development of phobias in children as a function of age. He showed the continuity between the child's archaic fears and the phobias proper of the oedipal period. The prototype of phobia can be seen at around eight months in the child's negative reaction to the approach of a stranger; according to René Spitz, this reaction expresses the child's accession to a total object relation and thus to the experience of separation. This issue becomes the basis for the organization of the fears and phobias (or prephobias, according to some authors) of the pregenital period.
Anxieties often manifest during sleep or at bedtime: fear and refusal to go to bed (the transitional object can be considered as a precursor to the counterphobic object), or nightmares, which Mallet linked to night terrors. Around the age of two, dream imagery takes the form of large animals that can bite or devour, and which translate fantasies related to orality—the source, according to Mallet, of the phobias of large animals that often occur around this age. Later, the shift toward phobias of small animals—a source of repulsion rather than fear, and with which the child avoids visual or tactile contact—coincides with entrance into the genital stage. These phobias can be understood as an expression of the prohibition against the voyeuristic impulses and touching, and more generally against sexual curiosity.
School is one of the main places where phobic manifestations occur. While some intellectual inhibitions can be related to castration anxiety and oedipal issues, most anxiety disorders centering on school are connected to difficulties of separation, whether in the form of transitory—although sometimes extremely intense—reactions against the early experience of being in school, or more serious and persistent phobias relating to school. Serge Lebovici has emphasized that serious school phobias appearing later in life (in preadolescence or adolescence) are often congruent with a prepsychotic organization. This underscores the heterogenous nature of phobic manifestations in children and the need for a psychopathological evaluation of the developmental and structural context in which these manifestations emerge.
See also: Phobic neurosis.
Birraux, Annie. (1994).Éloge de la phobie. Paris: Presses Universitaires de France.
Cyssau, Catherine. (1997). La peur et les phobies: des név-roses d'angoisseà l'hystérie d'angoisse. In Peurs et phobies (A. Fine, A. Le Guen, and A. Oppenheimer, Eds.). Paris: Presses Universitaires de France.
Freud, Anna. (1977). Fears, anxieties, and phobic phenomena. Psychoanalytic Study of the Child, 32, 85-90.
Freud, Sigmund. (1895c ). Obsessions and phobias: their psychical mechanism and their aetiology. SE, 3: 69-82.
——. (1909b). Analysis of a phobia in a five-year-old boy. SE, 10: 1-149.
——. (1925h). Negation. SE, 19: 233-239.
——. (1926d ). Inhibitions, symptoms and anxiety. SE, 20: 75-172.
Mallet, Jean. (1956). Contributionà l'étude des phobies. Rapportà la XVIIIe Conférence des psychanalystes de langues romanes, Paris, 1955. Revue Française de Psychanalyse, 20, 1-2, 237-282.
Valentin,Éric. Les phobies chez l'enfant. Perspectives Psychiatriques, 4, 265-319.