Freud - Complete Works (361 page)

   In the classificatory system of
the neuroses no definite position has hitherto been assigned to
‘phobias’. It seems certain that they should only be
regarded as syndromes which may form part of various neuroses and
that we need not rank them as an independent pathological process.
For phobias of the kind to which little Hans’s belongs, and
which are in fact the most common, the name of
‘anxiety-hysteria’ seems to me not inappropriate; I
suggested the term to Dr. W. Stekel when he was undertaking a
description of neurotic anxiety states,¹ and I hope it will
come into general use. It finds its justification in the similarity
between the psychological structure of these phobias and that of
hysteria - a similarity which is complete except upon a single
point. That point, however, is a decisive one and well adapted for
purposes of differentiation. For in anxiety-hysteria the libido
which has been liberated from the pathogenic material by repression
is not
converted
(that is, diverted from the mental sphere
into a somatic innervation), but is set free In the clinical cases
that we meet with, this ‘anxiety-hysteria’ may be
combined with ‘conversion-hysteria’ in any proportion.
There exist cases of pure conversion-hysteria without any trace of
anxiety, just as there are cases of simple anxiety-hysteria, which
exhibit feelings of anxiety and phobias, but have no admixture of
conversion. The case of little Hans is one of the latter sort.

  
¹
Nervöse Angstzustände und ihre
Behandlung
, 1908.

Analysis Of A Phobia In A Five-Year-Old Boy

2100

   Anxiety-hysterias are the most
common of all psychoneurotic disorders. But, above all, they are
those which make their appearance earliest in life; they are
par
excellence
the neuroses of childhood. When a mother uses such
phrases as that her child’s ‘nerves’ are in a bad
state, we can be certain that in nine cases out of ten the child is
suffering from some kind of anxiety or from many kinds at once.
Unfortunately the finer mechanism of these highly significant
disorders has not yet been sufficiently studied. It has not yet
been established whether anxiety-hysteria is determined, in
contradistinction to conversion-hysteria and other neuroses, solely
by constitutional factors or solely by accidental experiences, or
by what combination of the two.¹ It seems to me that of all
neurotic disorders it is the least dependent upon a special
constitutional predisposition and that it is consequently the most
easily acquired at any time of life.

   One essential characteristic of
anxiety-hysterias is very easily pointed out. An anxiety-hysteria
tends to develop more and more into a ‘phobia’. In the
end the patient may have got rid of all his anxiety, but only at
the price of subjecting himself to all kinds of inhibitions and
restrictions. From the outset in anxiety-hysteria the mind is
constantly at work in the direction of once more psychically
binding the anxiety which has become liberated; but this work can
neither bring about a retransformation of the anxiety into libido,
nor can it establish any contact with the complexes which were the
source of the libido. Nothing is left for it but to cut off access
to every possible occasion that might lead to the development of
anxiety, by erecting mental barriers in the nature of precautions,
inhibitions, or prohibitions; and it is these defensive structures
that appear to us in the form of phobias and that constitute to our
eyes the essence of the disease.

   The treatment of anxiety-hysteria
may be said hitherto to have been a purely negative one. Experience
has shown that it is impossible to effect the cure of a phobia (and
even in certain circumstances dangerous to attempt to do so) by
violent means, that is, by first depriving the patient of his
defences and then putting him in a situation in which he cannot
escape the liberation of his anxiety. Consequently, nothing can be
done but to leave the patient to look for protection wherever he
thinks he may find it; and he is merely regarded with a not very
helpful contempt for his ‘incomprehensible
cowardice’.

   Little Hans’s parents were
determined from the very beginning of his illness that he was
neither to be laughed at nor bullied, but that access must be
obtained to his repressed wishes by means of psycho-analysis. The
extraordinary pains taken by Hans’s father were rewarded by
success, and his reports will give us an opportunity of penetrating
into the fabric of this type of phobia and of following the course
of its analysis.

  
¹
[
Footnote added
1923:] The question
which is raised here has not been pursued further. But there is no
reason to suppose that anxiety-hysteria is an exception to the rule
that both predisposition and experience must co-operate in the
aetiology of a neurosis. Rank’s view of the effects of the
trauma of birth seems to throw special light upon the
predisposition to anxiety-hysteria which is so strong in
childhood.

Analysis Of A Phobia In A Five-Year-Old Boy

2101

   I think it is not unlikely that
the extensive and detailed character of the analysis may have made
it somewhat obscure to the reader. I shall therefore begin by
giving a brief resume of it, in which I shall omit all distracting
side-issues and shall draw attention to the results as they came to
light one after the other.

   The first thing we learn is that
the outbreak of the anxiety state was by no means so sudden as
appeared at first sight. A few days earlier the child had woken
from an anxiety-dream to the effect that his mother had gone away,
and that now he had no mother to coax with. This dream alone points
to the presence of a repressive process of ominous intensity. We
cannot explain it, as we can so many other anxiety-dreams, by
supposing that the child had in his dream felt anxiety arising from
some somatic cause and had made use of the anxiety for the purpose
of fulfilling an unconscious wish which would otherwise have been
deeply repressed.¹ We must regard it rather as a genuine
punishment and repression dream, and, moreover, as a dream which
failed in its function, since the child woke from his sleep in a
state of anxiety. We can easily reconstruct what actually occurred
in the unconscious. The child dreamt of exchanging endearments with
his mother and of sleeping with her; but all the pleasure was
transformed into anxiety, and all the ideational content into its
opposite. Repression had defeated the purpose of the mechanism of
dreaming.

   But the beginnings of this
psychological situation go back further still. During the preceding
summer Hans had had similar moods of mingled longing and
apprehension, in which he had said similar things; and at that time
they had secured him the advantage of being taken by his mother
into her bed. We may assume that since then Hans had been in a
state of intensified sexual excitement, the object of which was his
mother. The intensity of this excitement was shown by his two
attempts at seducing his mother (the second of which occurred just
before the outbreak of his anxiety); and he found an incidental
channel of discharge for it by masturbating every evening and in
that way obtaining gratification. Whether the sudden change-over of
this excitement into anxiety took place spontaneously, or as a
result of his mother’s rejection of his advances, or owing to
the accidental revival of earlier impressions by the
‘precipitating cause’ of his illness (about which we
shall hear presently) - this we cannot decide; and, indeed, it is a
matter of indifference, for these three alternative possibilities
cannot be regarded as mutually incompatible. The fact remains that
his sexual excitement suddenly changed into anxiety.

  
¹
See my
Interpretation of
Dreams.

Analysis Of A Phobia In A Five-Year-Old Boy

2102

   We have already described the
child’s behaviour at the beginning of his anxiety, as well as
the first content which he assigned to it, namely, that a horse
would bite him. It was at this point that the first piece of
therapy was interposed. His parents represented to him that his
anxiety was the result of masturbation, and encouraged him to break
himself of the habit. I took care that when they spoke to him great
stress was laid upon his affection for his mother, for that was
what he was trying to replace by his fear of horses. This first
intervention brought a slight improvement, but the ground was soon
lost again during a period of physical illness. Hans’s
condition remained unchanged. Soon afterwards he traced back his
fear of being bitten by a horse to an impression he had received at
Gmunden. A father had addressed his child on her departure with
these words of warning: ‘Don’t put your finger to the
horse; if you do, it’ll bite you.’ The words,
‘don’t put your finger to’, which Hans used in
reporting this warning, resembled the form of words in which the
warning against masturbation had been framed. It seemed at first,
therefore, as though Hans’s parents were right in supposing
that what he was frightened of was his own masturbatory indulgence.
But the whole nexus remained loose, and it seemed to be merely by
chance that horses had become his bugbear.

   I had expressed a suspicion that
Hans’s repressed wish might now be that he wanted at all
costs to see his mother’s widdler. As his behaviour to a new
maid fitted in with this hypothesis, his father gave him his first
piece of enlightenment, namely, that women have no widdlers. He
reacted to this first effort at helping him by producing a phantasy
that he had seen his mother showing her widdler.¹ This
phantasy and a remark made by him in conversation, to the effect
that his widdler was ‘fixed in, of course’, allow us
our first glimpse into the patient’s unconscious mental
processes. The fact was that the threat of castration made to him
by his mother some fifteen months earlier was now having a deferred
effect upon him. For his phantasy that his mother was doing the
same as he had done (the familiar
tu quoque
repartee of
inculpated children) was intended to serve as a piece of
self-justification; it was a protective or defensive phantasy. At
the same time we must remark that it was Hans’s parents who
had extracted from the pathogenic material operating in him the
particular theme of his interest in widdlers. Hans followed their
lead in this matter, but he had not yet taken any line of his own
in the analysis. And no therapeutic success was to be observed. The
analysis had passed far away from the subject of horses; and the
information that women have no widdlers was calculated, if
anything, to increase his concern for the preservation of his
own.

  
¹
[
Footnote added
1924:] The context
enables us to add: ‘and touching it’ (
p. 2024
). After all, he himself could
not show his widdler without touching it.

Analysis Of A Phobia In A Five-Year-Old Boy

2103

   Therapeutic success, however, is
not our primary aim; we endeavour rather to enable the patient to
obtain a conscious grasp of his unconscious wishes. And this we can
achieve by working upon the basis of the hints he throws out, and
so, with the help of our interpretative technique, presenting the
unconscious complex to his consciousness
in our own words
.
There will be a certain degree of similarity between that which he
hears from us and that which he is looking for, and which, in spite
of all resistances, is trying to force its way through to
consciousness; and it is this similarity that will enable him to
discover the unconscious material. The physician is a step in front
of him in knowledge; and the patient follows along his own road,
until the two meet at the appointed goal. Beginners in
psycho-analysis are apt to assimilate these two events, and to
suppose that the moment at which one of the patient’s
unconscious complexes has become known to
them
is also the
moment at which the patient himself recognizes it. They are
expecting too much when they think that they will cure the patient
by informing him of this piece of knowledge; for he can do no more
with the information than make use of it to help himself in
discovering the unconscious complex
where it is anchored
in
his unconscious. A first success of this sort had now been achieved
with Hans. Having partly mastered his castration complex, he was
now able to communicate his wishes in regard to his mother. He did
so, in what was still a distorted form, by means of the
phantasy
of the two giraffes
, one of which was calling out in vain
because Hans had taken possession of the other. He represented the
‘taking possession of’ pictorially as ‘sitting
down on’. His father recognized the phantasy as a
reproduction of a bedroom scene which used to take place in the
morning between the boy and his parents; and he quickly stripped
the underlying wish of the disguise which it still wore. The
boy’s father and mother were the two giraffes. The reason for
the choice of a giraffe-phantasy for the purposes of disguise was
fully explained by a visit that the boy had paid to those same
large beasts at Schönbrunn a few days earlier, by the
giraffe-drawing, belonging to an earlier period, which had been
preserved by his father, and also, perhaps, by an unconscious
comparison based upon the giraffe’s long, stiff neck.¹
It may be remarked that the giraffe, as being a large animal and
interesting on account of its widdler, was a possible competitor
with the horse for the role of bugbear; moreover, the fact that
both his father and his mother appeared as giraffes offered a hint
which had not yet been followed up, as regards the interpretation
of the anxiety-horses.