Phobic Neurosis

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PHOBIC NEUROSIS

Phobic neurosis, referred to by Sigmund Freud as "anxiety hysteria," is characterized by anxiety focusing on certain external objects, be they things, persons, or situations. It is essentially a castration anxiety caused by an oedipal scenario. This distinguishes phobic neurosis from other, less serious situations. Beginning with "The Neuro-Psychoses of Defence" (1894a), Freud gave a fairly clear definition of the phobias, which he connected, in part, to hysteria, and which he distinguished from obsessions. In contrast to the so-called "actual" neuroses, which have a contemporaneous sexual dysfunction in their etiologies, he related obsessions and hysterias to an intrapsychic conflict with roots in childhood sexual history. In the case of an obsession, the sexual idea is later divorced from the corresponding affect; in the case of "hysterophobia," the sexual idea, because of repression, disappears from consciousness only to reappear in the form of anxiety linked to another idea. The sexual idea is maintained with the earlier one by means of surreptitious links, which psychoanalysis can reveal.

This first theory of anxiety, which Freud developed in the context of the first topography between 1895 and 1900, is, as Jean Laplanche pointed out (1980) , an economic theory. In "Analysis of a Phobia in a Five-Year-Old Boy" (1909b), Freud stated that Little Hans's phobia corresponded to a repressed libidinal longing and emphasized the irreversible character of this transformation. Even if the longing could later be satisfied, it "can no longer be completely retransformed into libido; there is something that keeps the libido back under repression" (p. 26). In an attempt to clarify this imprecise understanding, Freud, after elaborating the second topography and returning to his reading of the case of little Hans in "Inhibitions, Symptoms, and Anxiety" (1926d [1925]), reversed his earlier formulation: "The anxiety felt in phobias is an ego anxiety and arises in the ego, and . . . it does not proceed out of repression but, on the contrary, sets repression in motion" (p. 110). As to the origin of this anxiety, Freud concluded with a "Non liquet!" ("It is unclear").

Melanie Klein further developed this line of thinking in light of the death instinct hypothesized by Freud in 1920. As Hanna Segal wrote in 1979, "For her part, Melanie Klein believes that anxiety is a direct response to the internal work of the death instinct." The phobic defenses are erected against unconscious fantasies, which are linked to the death instinct, in an attempt to control the external objects; this attempt is proportional with other attempts to exercise omnipotent obsessive control over internal objects. Even a succinct discussion of the place of these concepts in Klein's metapsychology would require developing other ideas, notably those connected with the hypothesis of the internalization of an early archaic superego. Klein's case study of "Richard" illustrates this problem.

The category of phobic neurosis, under the heading "phobic anxiety disorders," appears in the World Health Organization's Classification of Mental and Behavioural Disorders, in International Classification of Diseases (ICD -10), in a purely descriptive and behavioral formulation. Because of the polymorphism of phobias, this category brings with it a marked risk of imprecise diagnoses. By contrast, the Classification française des troubles mentaux de l'enfant et de l'adolescent (French classification of childhood and adolescent mental disorders, Roger Misès), appears to maintain clear distinctions among the different phobic symptomatologies and the related neurotic structures.

The existence of such a "neurotic phobic structure" has been contested by some authors, notably Jean Bergeret. On another level, Jacques Lacan, in his seminar on object relations (1994) based on the case of Little Hans, introduced the notion of the phobic signifier. This reflection led him to reject the idea of a "phobic structure" in favor of a conception that made phobia a crucial moment that can be turned into hysteria, obsession, or perversion.

René Spitz's work on the "fear of strangers" as the "second organizer" in babies was also carried out from a perspective marginal to the current of thought supporting neurotic structures. In the 1990s there was an inquiry into metapsychologically extending the concept of the phobic to adolescents, as well as an inquiry into whether phobias are a primal structure (Birraux).

Francis Drossart

See also: "Analysis of a Phobia in a Five-year-old Boy" (Little Hans); Anxiety; Castration complex; Inhibition, Symptoms, and Anxiety ; "Neurasthenia and Anxiety Neurosis"; Neuro-psychosis of defense; Neurosis; Phobia of committing impulsive acts; Phobias in children; Prepsychosis; Projection; Symptom-formation.