Freud - Complete Works (571 page)

  
¹
[These Latin and German words, meaning
‘narrow place’, ’straits’, are from the
same root as ‘angst’ (and
‘anxiety’).]

Introductory Lectures On Psycho-Analysis

3446

   If we now pass over to consider
neurotic anxiety, what fresh forms and situations are manifested by
anxiety? There is much to be described here. In the first place we
find a general apprehensiveness, a kind of freely floating anxiety
which is ready to attach itself to any idea that is in any way
suitable, which influences judgement, selects what is to be
expected, and lies in wait for any opportunity that will allow it
to justify itself. We call this state ‘expectant
anxiety’ or ‘anxious expectation’. People who are
tormented by this kind of anxiety always foresee the most frightful
of all possibilities, interpret every chance event as a premonition
of evil and exploit every uncertainty in a bad sense. A tendency to
an expectation of evil of this sort is to be found as a character
trait in many people whom one cannot otherwise regard as sick; one
calls them over-anxious or pessimistic. A striking amount of
expectant anxiety, however, forms a regular feature of a nervous
disorder to which I have given the name of ‘anxiety
neurosis’ and which I include among the ‘actual’
neuroses.

   A second form of anxiety, in
contrast to the ones I have just described, is bound psychically
and attached particular objects or situations. This is the anxiety
of the extremely multifarious and often very strange
‘phobias’. Stanley Hall, the respected American
psychologist, has recently taken the trouble to present us with a
whole series of these phobias in all the magnificence of Greek
names. This sounds like a list of the ten Plagues of Egypt, though
their number goes far beyond ten. Listen to all the things that can
become the object or content of a phobia: darkness, open air, open
spaces, cats, spiders, caterpillars, snakes, mice, thunderstorms,
sharp points, blood, enclosed spaces, crowds, solitude, crossing
bridges, sea voyages and railway journeys, etc., etc. A first
attempt at finding one’s way about in this confusion suggests
a division into three groups. Some of the dreaded objects and
situations have something uncanny about them for normal people as
well, some relation to danger; and such phobias, therefore, do not
strike us as unintelligible, though their strength is greatly
exaggerated. Thus most of us have a sense of repulsion if we meet
with a snake. Snake phobia, we might say, is a universal human
characteristic; and Darwin has described most impressively how he
could not avoid feeling fear of a snake that struck at him, even
though he knew that he was protected from it by a thick sheet of
glass. We may refer to a second group the cases in which a relation
to a danger is still present, though we are accustomed to minimize
the danger and not to anticipate it. The majority of situation
phobias belong to this group. We know that there is more chance of
an accident when we are on a railway-journey than when we stay at
home - the chance of a collision; we know, too, that a ship may go
down, in which case there is a probability of being drowned; but we
do not think about these dangers, and travel by rail and ship
without anxiety. It cannot be disputed that we should fall into the
river if the bridge collapsed at the moment we were crossing it;
but that happens so exceedingly seldom that it does not arise as a
danger. Solitude, too, has its dangers and in certain circumstances
we avoid it; but there is no question of our not being able to
tolerate it under any condition even for a moment. Much the same is
true of crowds, of enclosed spaces, of thunderstorms and so on.
What in general appears to us strange in these phobias of neurotics
is not so much their content as their intensity. The anxiety of
phobias is positively overwhelming. And sometimes we get an
impression that what neurotics are afraid of are not at all the
same things and situations which may in certain circumstances cause
anxiety in us too and which they describe by the same names.

Introductory Lectures On Psycho-Analysis

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   We are left with a third group of
phobias, which is quite beyond our comprehension. When a strong,
grown-up man is unable owing to anxiety to walk along a street or
cross a square in his own familiar home-town, when a healthy,
well-developed woman is thrown into insensate anxiety because a cat
has brushed against the edge of her dress or because a mouse has
run across the room, how are we to relate these things to the
danger which they obviously constitute for the phobic subject? In
the case of such animal phobias there can be no question of an
exaggeration of universal human antipathies, since, as though to
demonstrate the contrary, there are numerous people who cannot pass
by a cat without coaxing it and stroking it. The mouse that these
women are so much afraid of is also [in German] one of the chief
terms of affection; a girl who is delighted when her lover calls
her one will often scream with terror when she sees the pretty
creature which bears that name. In the case of the man with
agoraphobia the only explanation that we can reach is that he is
behaving like a small child. A child is actually taught as part of
his education to avoid such situations as dangerous; and our
agoraphobic will in fact be saved from his anxiety if we accompany
him across the square.

   The two forms of anxiety that I
have just described - the freely floating expectant anxiety and the
sort which is bound to phobias - are independent of each other. One
is not a higher stage, as it were, of the other; and they only
appear simultaneously in exceptional cases and, so to speak,
accidentally. The most powerful general apprehensiveness need not
be expressed in phobias; people whose whole existence is restricted
by agoraphobia may be entirely free from pessimistic expectant
anxiety. Some phobias - for instance, agoraphobia and railway
phobia - are demonstrably acquired at a fairly mature age, while
others - such as fear of darkness, thunderstorms and animals - seem
to have been present from the first. Those of the former kind have
the significance of severe illnesses; the latter make their
appearance rather as eccentricities or whims. If a person exhibits
one of these latter, one may suspect as a rule that he will have
other similar ones. I must add that we class all these phobias as
anxiety hysteria
; that is to say, we regard them as a
disorder closely related to the familiar conversion hysteria.

Introductory Lectures On Psycho-Analysis

3448

   The third of the forms of
neurotic anxiety faces us with the puzzling fact that here the
connection between anxiety and a threatening danger is completely
lost to view. For instance, anxiety may appear in hysteria as an
accompaniment to hysterical symptoms, or in some chance condition
of excitement in which, it is true, we should expect some
manifestation of affect but least of all one of anxiety; or it may
make its appearance, divorced from any determinants and equally
incomprehensible to us and to the patient, as an unrelated attack
of anxiety. Here there is no sign whatever of any danger or of any
cause that could be exaggerated into one. We next learn from these
spontaneous attacks that the complex which we describe as a state
of anxiety is capable of fragmentation. The total attack can be
represented by a single, intensely developed symptom, by a tremor,
a vertigo, by palpitation of the heart, or by dyspnoea; and the
general feeling by which we recognize anxiety may be absent or have
become indistinct. Yet these conditions, which we describe as
‘anxiety-equivalents’, have to be equated with anxiety
in all clinical and aetiological respects.

   Two questions now arise. Can we
relate neurotic anxiety, in which danger plays little or no part,
to realistic anxiety, which is invariably a reaction to danger? And
how are we to understand neurotic anxiety? We shall certainly be
inclined in the first instance to hold fast to our expectation that
where there is anxiety there must be something that one is afraid
of.

   Clinical observation affords us a
number of hints towards understanding neurotic anxiety, and I will
give you their tenor:-

   (
a
) It is not difficult to
establish the fact that expectant anxiety or general
apprehensiveness is closely dependent on certain happenings in
sexual life, or, let us say, certain employments of the libido. The
simplest and most instructive case of this sort occurs in people
who expose themselves to what is known as unconsummated excitation
- that is, people in whom violent sexual excitations meet with no
sufficient discharge, cannot be brought to a satisfying conclusion
- men for instance, while they are engaged to be married, and women
whose husbands are insufficiently potent or, as a precaution,
perform the sexual act in an incomplete or curtailed fashion. In
such circumstances the libidinal excitation vanishes and anxiety
appears in its place whether in the form of expectant anxiety or in
attacks and anxiety-equivalents. Interruption of the sexual act as
a precaution, if it is practised as a sexual
régime
,
is such a regular cause of anxiety neurosis in men, but more
particularly in women, that in medical practice it is advisable in
such cases to begin by investigating this aetiology. It will then
be found on countless occasions that the anxiety neurosis
disappears when the sexual abuse is discontinued.

Introductory Lectures On Psycho-Analysis

3449

   The fact of there being a
connection between sexual restraint and anxiety states is, so far
as I know, no longer disputed even by physicians who have no
contact with psycho-analysis. But I can well believe that an
attempt is made to reverse the relation and to put forward the view
that the people concerned are such as are already inclined to
apprehensiveness and for that reason practise restraint in sexual
matters as well. This, however, is decisively contradicted by the
behaviour of women, whose sexual activity is essentially of a
passive nature - is determined, that is to say, by their treatment
by the man. The more passionate a woman is - the more inclined,
therefore, to sexual intercourse and the more capable of being
satisfied - the more certain she is to react with manifestations of
anxiety to a man’s impotence or to coitus interruptus,
whereas in the case of anaesthetic women or those without much
libido such ill-treatment plays a far smaller part.

   Of course, the sexual abstinence
now so warmly recommended by doctors only has the same importance
in generating anxiety states when the libido which is prevented
from finding a satisfying discharge is correspondingly strong and
has not been dealt with for the greater part by sublimation.
Indeed, the decision on whether the outcome is to be illness or not
always lies with quantitative factors. Even where what is in
question is not illness but the form assumed by a person’s
character, it is easy to recognize that sexual restriction goes
hand in hand with some kind of anxiousness and hesitancy, while
intrepidity and impudent daring bring along with them a free
indulgence of sexual needs. However much these relations are
altered and complicated by a variety of cultural influences, it
nevertheless remains true of the average of mankind that anxiety
has a close connection with sexual limitation.

Introductory Lectures On Psycho-Analysis

3450

   I am far from having told you of
all the observations that speak in favour of the genetic relation I
have asserted to exist between libido and anxiety. Among them, for
instance, is the influence on anxiety disorders of certain phases
of life to which, as in the case of puberty and the time of the
menopause, a considerable increase in the production of libido may
be attributed. In some states of excitement, too, it is possible to
observe directly a mixture of libido and anxiety and the final
replacement of libido by anxiety. The impression one gains from all
these facts is twofold: first, that what is in question is an
accumulation of libido which is kept away from its normal
employment, and secondly, that here we are entirely in the sphere
of somatic processes. How anxiety arises from libido is not at
first discernible; we can only recognize that libido is absent and
that anxiety is observed in its place.

   (
b
) A second pointer is to
be found in the analysis of the psychoneuroses, and especially of
hysteria. We have seen that in this illness anxiety often appears
in company with the symptoms, but that unbound anxiety appears,
too, manifested as an attack or as a chronic condition. The
patients cannot say what it is they are afraid of, and, by the help
of an unmistakable secondary revision, link it to the first phobias
that come to hand - such as dying, going mad, or having a stroke.
If the situation out of which the anxiety (or the symptoms
accompanied by anxiety) arose is subjected to analysis, we can as a
rule discover what normal course of psychical events has failed to
occur and has been replaced by phenomena of anxiety. To express it
in another way: we construct the unconscious process as it would
have been if it had not experienced any repression and had
proceeded unhindered into consciousness. This process would have
been accompanied by a particular affect, and we now learn to our
surprise that this affect accompanying the normal course of events
is invariably replaced by anxiety after repression has occurred, no
matter what its own quality may be. Thus, when we have a hysterical
anxiety-state before us, its unconscious correlate may be an
impulse of a similar character - anxiety, shame, embarrassment -
or, just as easily, a positive libidinal excitation or a hostile
aggressive one, such as rage or anger. Anxiety is therefore the
universally current coinage for which any affective impulse is or
can be exchanged if the ideational content attached to it is
subjected to repression.