Phobias
Phobias
A phobia is an irrational, persistent fear of a particular object or place, class of objects or places, etc. Used as a noun or combining form, phobia denotes fear or dread, and in medicine and psychiatry it is joined either with names of objects, situations, etc., or with Greek-derived forms of such names; thus, street phobia, or agoraphobia (from the Greek agora, or “market place”). As a symptom complex the phobia also includes any avoidances and inhibitions employed to forestall impending attacks of anxiety. Thus, an agoraphobic person may be unable to leave his home without incurring anxiety and may therefore remain in it constantly. A person with rat phobia may stop his ears when rats are mentioned in conversation. The phobic person may elaborate and form compromises to keep the dreaded object, or the idea of it or allusion to it, at a distance (e.g., by restricting his activities, putting general or special taboos on certain localities, etc.).
Whether a state of mind is to be considered rational or irrational eventually depends on commonsense judgment. This judgment is usually that of the phobic person himself, who knows that the feared object is harmless or in any case should not provoke such intense, unmasterable anxiety. Often ashamed or aware of the absurdity, the phobic patient may nevertheless try to rationalize that there is a possibility of “danger.” Accessory circumstances often determine whether a given fear is rational or not, but judging the degree of rationality is still ultimately a matter of common sense.
In early childhood the matter of rationality is irrelevant. The fears of small children are rarely rational according to adult standards. Children’s insecurity and fear of strangers are neither rational nor irrational. Animal phobias of small children resemble in many ways the fears of certain savages, with whom they share a “totemistic” attitude, the differentiation between man and other animals not being well established. Gradual development of the sense of reality through experience and education leads to such differentiation.
History and semantics. Modern interest and ideas about the phobias began with an article by Westphal, “Die Agoraphobie” (1871). The term agoraphobia was invented in this case to denote a morbid fear of open places and is usually extended to mean a fear of streets or the outdoors generally. The German words used were Platzangst and Platzfurcht, which retain the idea of an open square. To one of Westphal’s three patients, a certain square in Berlin looked as if it were miles wide. The patient complained that any attempt to cross the square or to walk on certain streets brought on a severe attack of anxiety accompanied by trembling, head sensations, palpitation, etc. The presence of a companion prevented or assuaged the anxiety and enabled the patient to skirt the square with somewhat lessened fear. He did not fear traffic; indeed, he felt no anxiety if he could stay near a carriage while crossing. To see houses with windows was also reassuring, but to walk along windowless walls, like those of certain barracks, would bring on an anxiety attack, and he could not go into the Tiergarten, where there were no houses. Absence of human beings or signs of life, an empty street or park, was more dangerous than traffic.
Phobeio, the Greek word from which phobia is derived, means “I fear,” but in earliest times it meant both “I am afraid” and “I am put to flight”; for Homeric Greeks, emotion and tendency to action were “close together” (Onians 1951, p. 19). Greek words can be readily used in compounds, and phobo- and -phobia were used as combining forms. Hence, -phobia easily became one of a large class of suffixes (including -mania, -philia, -pathy, etc.) that were adopted by medical and psychological writers. Thus we have hydrophobia, fear of water, at one time also called phobodipsia, fear of drinking; photophobia, fear and avoidance of light, a medical but not necessarily a psychiatric term; xenophobia, fear and avoidance of strangers or foreigners. An obsolete term of this sort is panophobia, the night terror of infants. (See Sauvages 1763.)
Name inventing has periodically flourished and waned in science and medicine. In the late eighteenth and early nineteenth centuries, partly in emulation of Linnaeus, imaginative nomenclature was in vogue. Psychiatrists participated heartily in wordbuilding, particularly after Esquirol’s adventures with the suffix -mania (1838). They made such wide use of the suffix -phobia that Benjamin Rush (1825) jocularly suggested the name rum phobia for what he opined must be “a very rare distemper.” He also facetiously suggested doctor phobia and church phobia (cited in Menninger et al. 1963). Such near-slang usage emphasizes the avoidance aspect and ignores any anxiety. It has been resuscitated in current psychiatric writings in such terms as school phobia, job phobia, and the like, where the anxiety may not be of the conscious phobic type at all.
The modern popularity of the word and suffix began with Westphal’s coining of agoraphobia. The new term was widely accepted, and many analogous terms were invented (see Janet & Raymond 1903). For several decades after Westphal many types of phobias were described and named. Some names are still in use, some are obsolete, and others are met with only occasionally. Claustrophobia still refers to the morbid fear of entering or staying in closed spaces, and ereuthophobia is a word generally understood to mean a fear of blushing. Aelurophobia and gephyrophobia are rather rare and are ordinarily superseded by cat phobia and bridge phobia, respectively. Zoophobia, or animal phobia, is inclusive, applying to dogs, cats, birds, etc. Besides the newly described phobias, others were retrieved from earlier literature and given new names. By 1914, G. Stanley Hall could list 136 words ending in -phobia; many of these were never subjects of clinical description but were apparently purely philological virtuoso inventions. The history of this period and pertinent references are to be found in Krafft-Ebing (1895), Janet (see in Janet & Raymond 1903), and Loewenfeld (1904).
The study of the phobias and other neuroses went well beyond philology. Obsessions and compulsions were described by Westphal (1877), and many studies dealt with nervousness, neurasthenia, and anxiety states other than phobias, such as hysteria and hypochondria. This work culminated in a general conception of the neuroses, or psychoneuroses, a group of conditions with all sorts of nonpsychotic psychological symptoms not attributable to recognizable pathological changes in the body. [SeeObsessive–compulsive disorders.]
Classification. The general tendency was to group phobias along with obsessions and compulsions under one heading, on the grounds that they were “compulsive emotions” (Zwangsaffekte). Even today German textbooks usually put quotation marks around the word phobia or refer to die sogenannten Phobien—the so-called phobias (Bumke 1924; Bleuler 1916). French writers, following Janet (see in Janet & Raymond 1903), group phobias with other anxiety states, compulsions, and obsessions under the general rubric psychasthenia. Such classification has some point, at least superficially, for many adults troubled by obsessions and compulsions also may have one or more phobias. However, there are certain cases, adult and infantile, in which there are phobias but no obsessional symptoms. Moreover, Stekel (1908), psychoanalyzing phobic patients of the “pure” type, found that they resembled the conversion hysterics he had treated, differing only in that where the phobic patient suffered an anxiety attack, the classical hysterical patient would manifest a conversion symptom. For this nearly pure type of case Freud suggested to Stekel the designation anxiety hysteria and justified this term in a paper on a childhood phobia (1909). As psychoanalytic conceptions of anxiety developed, and particularly as analysis of phobias in small children progressed, it became evident that phobias might or might not be found in obsessional persons and that they were to be found in patients of all types. Freud’s final theory of anxiety (1926), which interpreted phobias in a novel and original way, lessened the interest in classification.
Although in a general way earlier authors recognized psychological influences as precipitating and predispositional factors, they did not distinguish the phobia from other neurotic disorders in regard to etiology. From the mid-nineteenth century through the beginning of the twentieth, all neuroses were supposed to arise from constitutional weakness or deficiency (“degeneration” in some authors’ terminology) and essentially from a subtle hereditary or inherent defect of the nervous system. Except for Freud and those who accepted his views phobias were, in short, stigmata of the degénérés supérieurs or of psychasthenia.
Freud and psychoanalysis
Freud’s early papers on anxiety and the neuroses contained incidental discussion of certain phobias (1894; 1895a; 1895b), but he first clearly expressed his thoughts on this matter in the case history of “little Hans” (1909; see also Strachey 1962). There he recognized a class of phobias of psychic origin, resembling in many ways the agoraphobia previously described; he gave them the name anxiety hysteria. Phobias were conceived not as illnesses, nor yet precisely as signs of an illness, but as a set of findings: anxiety plus certain special avoidances and inhibitions. In such cases, as time goes on, overt anxiety decreases pari passu as restrictive measures increase. An anxiety state becomes more and more of a phobia.
Infantile zoophobias
Freud characteristically looked to the phobias of children for a situation that would furnish a clue, uncomplicated by later elaborations, to their essential meaning, much as he had found simple, direct wish fulfillments in children’s dreams that threw light on the complicated and distorted wish-fulfilling dreams of adults. The childhood zoophobias did indeed provide a relatively simple picture of the elements in the formation of phobias and ultimately of psychogenic symptoms in general. The two cases best studied and most cited are the horse phobia of “little Hans” (Freud 1909) and the wolf phobia of the young Russian referred to as “the wolf-man” (1918). In later discussions of anxiety, anxiety hysteria, and symptom formation Freud constantly used the material of these cases to illustrate and develop his theories (see 1915a; 1915b; 1926).
In The Problem of Anxiety (1926) Freud explained Hans’s phobia as originating in oedipal wishes. Hans was in love with his mother and was jealous of his father, toward whom he harbored hostile wishes; these wishes came into conflict with his love for his father. The aggression led to a fear of castration, the possibility of which he believed to be a reality. Repressing his love for his mother and his hostility toward his father from consciousness, he displaced his aggression and consequent fear from his father to horses, which he feared would bite off his penis. Thus, to form his phobic symptom, after his repression of the original impulses, Hans used three defense mechanisms: displacement, reversal, for actually his feelings were dangerous to his father rather than the other way round, and regression from the genital idea of castration to the oral idea of being bitten.
The wolf-man’s phobia arose from a different component of the Oedipus complex, from an inverted oedipal wish. Having observed parental coitus, he identified himself with his apparently castrated mother and feared castration if he permitted himself feminine longings for his father. His fear of castration was displaced to the picture of a wolf in a storybook. The fear that came to consciousness when he ran the risk of seeing the picture was of being devoured—an oral equivalent of the desired passive genital satisfaction. Memories recovered during his analysis established the connection between the wolf and the idea of castration. Avoidance here took the convenient form of not looking at the wolfs picture.
From these and other cases of childhood zoophobia Freud asserted that the motive for repression was castration anxiety and that the repressed wishes were the erotic or aggressive components of the Oedipus complex, whether normal or inverted. Repression was then followed by an appropriate displacement, determined by individual experience. Other infantile phobias are based on other types of anxiety, particularly on a fear of losing love, which serve as motives for repression.
Because of a child’s limited experience, the choice of animals is not large. The Angsttier (“dreaded animal”) is apt to be a horse, cow, dog, cat, bird, chicken, beetle, or wasp.
Totemism and zoophobia
The study of the zoophobias showed that a child could displace his feelings about his father to an animal and that this displacement reflected ambivalence. Hans not only feared horses but admired them, and at one point in his therapy he began to jump around like a horse and even bit his father (Freud 1909). His ambivalent attitude and his identification with the animal gave Freud one argument for interpreting the totem animals of primitive peoples as substitutes for the father, and he spoke of the “return of totemism in childhood” (1913, chapter 4).
Mechanisms in the phobia
The defense mechanism of displacement, by which the repressed wishes return to consciousness in disguise, is basic for all phobias, including those of adults. Avoidance behavior or restriction of function follows upon this. In adult phobias, too, the wishes are aggressive or erotic—largely the latter; they are the revived wishes of childhood, usually in new garb. Freud compared the content of the phobia to the manifest façade of the dream (1916–1917), implying that many defense mechanisms may alter the original content and give a conscious picture different from the unconscious latent fantasy. Thus regression modified the wolf-man’s fantasy of being castrated into a conscious fear of being devoured. This further altered the picture, in which the father had already been changed to a wolf by displacement. The displacement mechanism is fundamental, since it is the first and invariable means used by the ego in distorting material that comes back from repression. Other defense mechanisms, such as regression, reversal, and identification, are accessory or secondary in altering the content of the manifest phobic picture. Additional defense mechanisms are described by Sigmund Freud (1926) and some relevant to children by Anna Freud (1936). In the more complicated adult phobias several instinctual wishes may gain expression at the same time through the same content, as a dream may fulfill several wishes at the same time through what is called overdetermination (see Deutsch 1929; Weiss 1935; Fenichel 1944; Lewin 1952).
From the study of the simple phobias Freud constructed a paradigm for the formation of neurotic symptoms in general: threatened eruption of an instinct from repression (or from the id); anxiety or threatened anxiety as the signal of such impending danger; subsequent alterations in the ego by means of defense mechanisms that produce symptoms, each type of which (conversion, phobia, obsession, etc.) appears because of the predominance of one (or a few) defense mechanisms. Thus, the meaning of the word symptom is completely altered. No longer an indication of some underlying illness, it is considered a “structure” composed of alterations in ego functioning due to the mutual interaction of id, ego, and superego.
Some individual phobias
Like the dream, the phobia may show much variation in regard to its manifest façade. However, as certain frequent types of dreams have a nearly standard interpretation, so certain phobias, studied through psychoanalysis, show a relative constancy in unconscious meaning. For example, many wellstudied cases of agoraphobia show that the feared streets are unconsciously conceived as places suitable for sexual adventures (see Deutsch 1929; Katan 1937; Miller 1953; Weiss 1935). The companion chosen as protector by some agoraphobes represents a person to whom they are unconsciously hostile and whom they therefore put in the same jeopardy as themselves. Fear of crossing bridges is a feminine fear of childbirth. A fear of falling, on the street or elsewhere, is also feminine, one of its meanings referring to the figurative sexual fall. Claustrophobic anxiety is connected with unconscious ideas of being buried alive and with prenatal life (Lewin 1935). Generally speaking, these unconscious fantasies are either of temptation or punishment. Fear of being alone often indicates a temptation to masturbate under such circumstances. Fears of insanity may include this temptation, as well as a fear of symbolic castration (head equals penis). Fears of dirt refer to sexuality thus conceived. Animal fears have been discussed above. An interesting phobia is the fear of spiders, representing the devouring and dangerous female genitalia. Butterflies may represent beautiful and tempting women; beetles and crawling insects may represent genitalia of small children. This list could be extended greatly; but many other interpretations depend on the individual prephobic history, which determines the relative importance of the fantasy and the suitability of the object chosen for its representation.
Bertram D. Lewin
[For a conception of phobias that contrasts with the one in this article, seeMental disorders, treatment of, article onbehavior therapy; see alsoAnxietyandEmotion. Other relevant material may be found inDefense mechanisms; Hysteria; Mental disorders, article onChildhood mental disorders; and in the biography ofFreud.]
BIBLIOGRAPHY
Abraham, Karl (1922) 1953 The Spider as a Dream Symbol Pages 326–332 in Karl Abraham, Selected Papers. Volume 1: Selected Papers on Psychoanalysis. New York: Basic Books. ? First published as “Die Spinne als Traumsymbol.”
Benedek, Therese 1925 Notes From the Analysis of a Case of Ereuthophobia. International Journal of Psycho-analysis 6:430–439.
Bleuler, Eugen (1916) 1951 Textbook of Psychiatry. Authorized English edition by A. A. Brill, with a biographical sketch by Jacob Shatsky. New York: Dover. ? First published as Lehrbuch der Psychiatric
Bornstein, Berta (1931) 1935 Phobia in a Two-and-a-half-year-old Child. Psychoanalytic Quarterly 4:93 119. ? First published in German.
Bornstein, Berta 1949 The Analysis of a Phobic Child: Some Problems of Theory and Technique in Child Analysis. Psychoanalytic Study of the Child 3/4:181–226.
Bumke, Oswald (1924) 1948 Lehrbuch der Geisteskrankheiten. 7th ed. Berlin: Springer.
Deutsch, Helene 1929 The Genesis of Agoraphobia. International Journal of Psycho-analysis 10:51–69.
Deutsch, Helene (1930) 1932 Psychoanalysis of the Neuroses. London: Hogarth. ? First published in German. See especially Chapter 6, “Anxiety States”; Chapter 7, “A Case of Hen Phobia”; and Chapter 8, “Agoraphobia.”
Esquirol, Jean E. D. (1838) 1845 Mental Maladies: A Treatise on Insanity. Philadelphia: Lea & Blanchard. ? First published in French.
Fenichel, Otto (1932) 1934 Outline of Clinical Psychoanalysis. New York: Norton. ? First published as Spezielle psychoanalytische Neurosenlehre. See especially Chapter 2.
Fenichel, Otto 1944 Remarks on the Common Phobias. Psychoanalytic Quarterly 13:313–326.
Fenichel, Otto 1945 The Psychoanalytic Theory of Neurosis. New York: Norton. ? See especially “Anxiety as Neurotic Symptom: Anxiety Hysteria,” pages 193–215.
Ferenczi, SÁndor (1913) 1952 A Little Chanticleer. London: Hogarth. ? First published as “Ein kleiner Hahnemann.”
Freud, Anna (1936) 1957 The Ego and the Mechanisms of Defense. New York: International Universities Press. ? First published as Das Ich und die Abwehrmechanismen.
Freud, Sigmund (1894) 1962 The Neuro-psychoses of Defense. Volume 3, pages 43–61 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. ? First published as “Die AbwehrNeuropsychosen.”
Freud, Sigmund (1895a) 1962 On the Grounds for Detaching a Particular Syndrome From Neurasthenia Under the Description “Anxiety Neurosis.” Volume 3, pages 87–139 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. ? First published as “Über die Berechtigung von der Neurasthenie einen bestimmten Symptomen-Komplex als ‘Angstneurose’ abzutrennen.”
Freud, Sigmund (1895b) 1962 Obsessions and Phobias: Their Physical Mechanism and Their Aetiology. Volume 3, pages 71–81 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan. ? First published in French.
Freud, Sigmund (1909) 1955 Analysis of a Phobia in a Five-year-old Boy. Volume 10, pages 3–149 in Sigmund Freud, The Standard Edition of the CompletePsychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Freud, Sigmund (1913) 1955 Totem and Taboo. Volume 13, pages ix-162 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Freud, Sigmund (1915a) 1957 Repression. Volume 14, pages 143–158 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Freud, Sigmund (1915b) 1957 The Unconscious. Volume 14, pages 161–204 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Freud, Sigmund (1916–1917) 1952 A General Introduction to Psychoanalysis. Authorized English translation of the rev. ed. by Joan Riviere. Garden City, N.Y.: Doubleday. ? First published as Vorlesungen zur Einfiihrung in die Psychoanalyse.
Freud, Sigmund (1918) 1955 From the History of an Infantile Neurosis. Volume 17, pages 3–122 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Freud, Sigmund (1926) 1936 The Problem of Anxiety. New York: Norton. ? First published as Hemmung, Symptom und Angst. A British edition was published by Hogarth in 1936 under the title Inhibitions, Symptoms and Anxiety.
Friedman, Paul 1952 The Bridge: A Study in Symbolism. Psychoanalytic Quarterly 21:49–80.
Hall, G. Stanley 1914 A Synthetic Genetic Study of Fear American Journal of Psychology 25:149–200, 321–392.
Janet, Pierre; and Raymond, Fulgence (1903) 1919 Les obsessions et la psychasthénie. 3d ed. 2 vols. Paris: Alcan. ? Pierre Janet was the sole author of Volume 1.
Katan, Anny A. (1937) 1951 The Role of “Displacement” in Agoraphobia. International Journal of Psychoanalysis 32:41–50.
Kraepelin, Emil (1883) 1909–1915 Psychiatrie. 8th ed., rev. 4 vols. Leipzig: Barth. ? See especially Volume 4, Part 3.
Krafft-Ebing, Richard Von 1895 Nervosität und neurasthenische Zustande. Volume 12, part 2 in H. Nothnagel (editor), Specielle Pathologie und Therapie. Vienna: Hölder.
Lewin, Bertram D. 1935 Claustrophobia. Psychoanalytic Quarterly 4:227–233.
Lewin, Bertram D. 1952 Phobic Symptoms and Dream Interpretation Psychoanalytic Quarterly 21:295–322.
Loewenfeld, Leopold 1904 Die psychischen Zwangserscheinungen. Wiesbaden (Germany): Bergmann. ? See especially pages 330–355.
Menninger, Karl; Mayman, Martin; and Pruyser, Paul 1963 The Vital Balance: The Life Processes in Mental Health and Illness. New York: Viking. ? See especially page 444.
Miller, Milton L. 1953 On Street Fear. International Journal of Psycho-analysis 34:232–240.
Onians, Richard B. 1951 The Origins of European Thought. Cambridge Univ. Press.
Rush, Benjamin 1825 Medical Inquiries and Observations Upon the Diseases of the Mind. Philadelphia: Grigg.
Sauvages De La Croix, Francois Boissier De (1763) 1768 Nosologia methodica sistens morborum classes juxtd sydenhami mentem & botanicorum ordinem. 2 vols. Amsterdam: Tournes.
Stekel, Wilhelm (1908) 1923 Conditions of Nervous Anxiety and Their Treatment. London: Routledge. ? First published in German. See especially Part 2, pages 163–376.
Sterba, Editha (1933) 1935 Excerpt From the Analysis of a Dog Phobia. Psychoanalytic Quarterly 4:135160. ? First published in German.
Strachey, James 1962 Appendix [to Freud’s “Obsessions and Phobias”]. Volume 3, pages 83–84 in Sigmund Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth; New York: Macmillan.
Weiss, Edoardo 1935 Agoraphobia and Its Relation to Hysterical Attacks. International Journal of Psychoanalysis 16:59–83.
Weiss, Edoardo 1936 Agorafobia: Isterismo d’angoscia. Rome: Cremonese.
Westphal, Carl F. O. 1871 Die Agoraphobie: Eine neuropathische Erscheinung. Archiv fur Psychiatrie 3:138–161.
Westphal, Carl F. O. 1877 Über Zwangsvorstellungen. Berliner klinische Wochenschrift 46:669; 47:687.
Wulff, M. W. 1928 A Phobia in a Child of Eighteen Months International Journal of Psycho-analysis 2: 354–359.