FLIGHT INTO ILLNESS

The Freudian notion of a "flight into illness" should be understood in terms of symptom formation and the primary and secondary gains of illness. The symptom is regarded here as a secondary defense against unconscious conflict, having value as a compromise between a wish and a defense.

Early in his work, Freud discussed this kind of symptom in terms of a psychological conflict, leading to repression and followed by compromise formation: "one portion of the symptom corresponds to the unconscious wish-fulfillment and another portion to the mental structure reacting against the wish" (1900a, p. 569). The concept of gain through illness helps clarify the concept of flight into illness. In a note on the Dora case, added in 1923, Freud mentioned that "The motive for being ill is, of course, invariably the gaining of some advantage" and, further on, "In the first place, falling ill involves a saving of physical effort; it emerges as being economically the most convenient solution where there is a mental conflict" (1905e, p. 43).

Thus, in the case of an hysterical attack, the flight into illness might serve what Freud calls the "primary gain." Aside from the hysterical crisis, Freud noted in 1926 that there are cases in which neurosis is the most harmless solution to a conflict and, from a social point of view, represents the most advantageous solution. For the neurotic, flight into illness is a favorable avoidance of an unsatisfactory reality, a form of self-defense in the struggle to survive. Freud also noted, along the same lines, the desire to remain ill.

Insights associated with flight into illness also operate outside the framework of neurosis and neurotic conflict. As early as 1894 Freud wrote: "One is therefore justified in saying that the ego has fended off the incompatible idea through a flight into psychosis" (1894a, p. 59). In the contemporary context, some authors consider somatic symptoms to be a system of defense and resolution, an avoidance in the face of tension of all kinds.

Alain Fine

See also: "Fragment of an Analysis of a Case of Hysteria" (Dora/Ida Bauer) ; Gain (primary and secondary); Somatic compliance.

Bibliography

Freud, Sigmund. (1900a). The interpretation of dreams. SE, 4-5.

——. (1905e [1901]). Fragment of an analysis of a case of hysteria. SE, 7: 1-122.

——. (1926d). Inhibitions, symptoms and anxiety. SE, 20: 75-172.