The Relation Between Symptom Formation and Fear Development

What now remains is the treatment of the relations between symptom formation and fear development. Two opinions on this point seem widely diffused. The first calls the fear itself a symptom of the neurosis, the other believes in a much more intimate relation between the two. According to this, all symptom formation is undertaken in order to escape fear; the symptoms bind the psychic energy that otherwise would be led off as fear, so that fear is the basic phenomenon and chief problem of the neurosis.

The at least partial justification of this second view is shown by striking examples. When one has accompanied an agoraphobe into the street and then leaves him to himself he produces in him an attack of fear. If one hinder a compulsive neurotic from washing his hands after a contact, he becomes the prey of an almost unbearable fear. It is therefore clear that the conditions of being accompanied and of washing had the intention and also the result of preventing fear.

In this sense every inhibition which the ego lays on itself may be called a symptom. As we have referred the fear development to the danger situation we would prefer to say that the symptoms have been formed to withdraw the ego from the danger situation. If symptom formation is prevented the danger actually appears, that is, a situation results which is analogous to birth, in which the ego finds itself helpless against the constantly growing claim of the impulse---the earliest and most primitive of the fear conditions. For our view the relationship between fear and symptom is less close than has been assumed because we have interpolated between the two elements the danger situation. We might add supplementarily that fear development introduces symptom formation, yes, that it is a necessary presupposition of the same; for if the ego would not arouse the pleasure-pain factor by fear development, then it would not obtain the power of holding back the danger threatening process prepared in the It. Here the tendency is unmistakable of limiting itself to the smallest mass of fear development, to use fear only to give the signal; otherwise one would obtain the pain which is threatened by the impulse process but would feel it only where there would be no result according to the intention of the pleasure principle, which, however, happens often enough in the neuroses.

The symptom formation, then, has the actual result of abolishing the danger situation. It has two sides, one which is hidden from us and prepares in the It that alteration by means of which the ego is withdrawn from danger, while the other, turned toward us, shows what is created at the place of the influenced impulse process---the formation of the substitute.

We should, however, express ourselves more correctly if we ascribed to the defensive process what we have just said of the symptom formation and apply the term symptom formation as a synonym of substitute formation. It now seems clear that the defensive process is analogous to flight, through which the ego withdraws itself from danger which threatens from without, that it represents an attempt at flight from an impulse danger. The criticisms against this comparison will aid us in a further explanation. First let it be objected that loss of the object (loss of love in connection with the object) and the threat of castration are likewise dangers which threaten from without, like a beast of prey, hence not danger from impulses. But the case is not the same. The wolf will probably attack us wherever we may happen to encounter him; but the beloved person will not withdraw love and castration will not menace us if we do not nourish within us definite feelings and intentions. So if these instinct stimuli become conditions of external danger and thereby themselves dangerous we can combat the external danger by measures against internal dangers. In the zoöphobias the danger seems to be felt as a purely external danger and also in the symptom there is experienced a displacement externally. In the compulsive neurosis the danger is far more interiorized, the share of the fear of the super-ego, the social fear, is represented by an internal substitution for an external danger, while the other share, the fear of conscience, is throughout endopsychic.

A second objection is that in attempt at flight from a threatened external danger we do nothing more than increase the space between us and the danger. We do not place ourselves in defense against the danger, do not seek to change anything in the same, as in the other cases, when we charge on the wolf with a cudgel or shoot at him with a gun. The defense process, however, seems to do more than what corresponds to flight. It attacks the threatening course of the process, somehow represses it, diverts its aim and thereby renders it powerless. This objection seems absolute, we must take it into account. We think it would be as if there were defense processes which one could with justice compare to an effort at flight, because the ego defends itself much more actively in others and undertakes energetic counter-efforts. If the comparison of the defense with flight is not disturbed through the circumstance that the ego and the It impulse are parts of the same organization, not detached instances like the wolf and the child, every kind of behavior of the ego must influence the impulse process to change it.

Through the study of fear conditions we must look at the behavior of the ego in defense in a so-to-speak rational clarification. Every danger situation corresponds to a certain period of life or phase of development of the psychic apparatus and seems justified for it. The early child nature is actually not equipped to master psychically the large quantities of excitation which reach it from without. At a certain period of life it is actually of the most importance that the persons on which it depends do not withdraw their tender care. When the boy feels the powerful father as his rival for the mother, becomes aware of his aggressive inclinations against him and his sexual intentions toward the mother, he has the right to fear him and the fear of punishment can through phylogenetic strengthening be expressed as castration fear. With his entry into social relations fear of the super-ego, conscience, necessity, the omission of these factors, become the source of severe conflicts and dangers. But just here a new problem is added. Suppose we attempt to replace for a time the fear affect through another, the pain affect. We hold it as normal throughout that the girl of four years cries painfully when she breaks her doll, at six years when her teacher rebukes her, at sixteen when her sweetheart loses interest in her, at twenty-five when she buries her child. All of these pain conditions have their time relationship and afterwards become void, except the last which persist through life. It would startle us if the girl as wife and mother would weep over damage to some trifle, although the neurotic behaves in just this way. In their psychic apparatus all instances for the mastery of irritation have long been completed within wide limits; they are sufficiently grown up to be able to satisfy most of their needs; they have long known that castration is no longer utilized as a punishment, nevertheless they behave as if the old danger situations still persist, and hold fast to all former fear conditions.

The answer to this will turn out to be somewhat prolix. It will above all have to sift the facts. In a large number of cases the old fear conditions will actually fall out after they have caused neurotic reactions. The phobias of little children---of being alone, darkness and strangers, which may be termed almost normal---mostly pass off in later years and are outgrown, as we say of many other disturbances of childhood. The so numerous animal phobias have the same fate, and many of the conversion hysterias of childhood years find no later continuity. Ceremonial in the latent period is an uncommonly frequent occurrence; only a very slight percentage of these cases develop later into a full compulsion neurosis. The child neuroses---as far as our experience extends among the city children of the white race which is subjected to the high requirements of culture---are regular episodes of development although there is still too little attention granted them. One misses the signs of childhood neurosis not at all in an adult neurotic, while by no means do all of the children who show them become neurotics later. Hence in the course of ripening, fear conditions must be given up and danger situations have lost their significance. Moreover, it happens that some of these danger situations preserve themselves in later times so that their fear condition is modified with time. In this way castration fear is preserved under the mask of syphiliphobia after one has experienced that castration is no longer the punishment for allowing full play to sexual lusts although freedom of impulse threatens severe affections. Other fear conditions are not especially doomed to perish but accompany man through life, as fear of the super-ego. The neurotic is differentiated from the normal by the fact that he immoderately heightens the reaction to these dangers. Again, no sufficient protection is offered even to adulthood that the original traumatic situations may not return; there should be a limit for every man beyond which his psychic apparatus fails to master the disposal of the importunate amounts of excitation.

These small corrections cannot possibly have the determination to shake the fact that is here discussed, the fact that so many individuals remain infantile in their behavior to danger and do not overcome ancient fear conditions. To dispute this would be to deny the fact of neurosis, for such persons are called neurotics. But how is this possible? Why are not all neuroses episodes of development which are concluded with the attainment of the next phase? Whence the element of permanence in these reactions to danger? Whence the advantage which the fear affect seems to enjoy over all other affects that it alone calls forth reactions which separate themselves as abnormal from the others and oppose themselves as unsuitable to the stream of life? In other words we unexpectedly find ourselves once more in the presence of the so often put vexed question, whence comes the neurosis, what it its final, its special motif? After decades of analytical investigation this problem looms before us, as unsolved as in the beginning.