Fear and Anxiety PROBABLY you will term what I told you about ordinary nervousness in my last lecture most fragmentary and unsatisfactory information. I know this, and I think you were probably most surprised that I did not mention fear, which most nervous people complain of and describe as their greatest source of suffering. It can attain a terrible intensity which may result in the wildest enterprises. But I do not wish to fall short of your expectations in this matter. I intend, on the contrary, to treat the problem of the fear of nervous people with great accuracy and to discuss it with you at some length. Fear itself needs no introduction; everyone has at some time or other known this sensation or, more precisely, this effect. It seems to me that we never seriously inquired why the nervous suffered so much more and so much more intensely under this condition. Perhaps it was thought a matter of course; it is usual to confuse the words "nervous" and "anxious" as though they meant the same thing. That is unjustifiable; there are anxious people who are not nervous, and nervous people who suffer from many symptoms, but not from the tendency to anxiety. However that may be, it is certain that the problem of fear is the meeting point of many important questions, an enigma whose complete solution would cast a flood of light upon psychic life. I do not claim that I can furnish you with this complete solution, but you will certainly expect psychoanalysis to deal with this theme in a manner different from that of the schools of medicine. These schools seem to be interested primarily in the anatomical cause of the condition of fear. They say the medulla oblongata is irritated, and the patient learns that he is One can talk about fear for a long time without even touching upon nervousness. You will understand me without more ado, when I term this fear real fear in contrast to neurotic fear. Real fear seems quite rational and comprehensible to us. We may testify that it is a reaction to the perception of external danger, viz., harm that is expected and foreseen. It is related to the flight reflex and may be regarded as an expression of the instinct of self-preservation. And so the occasions, viz., the objects and situations which arouse fear, will depend largely on our knowledge of and our feeling of power over the outer world. We deem it quite a matter of course that the savage fears a cannon or an eclipse of the sun, while the white man, who can handle the instrument and prophesy the phenomenon, does not fear these things. At other times superior knowledge promulgates fear, because it recognizes the danger earlier. The savage, for instance, will recoil before a footprint in the woods, meaningless to the uninstructed, which reveals to him the proximity of an animal of prey; the experienced sailor will notice a little cloud, which tells him of a coming hurricane, with terror, while to the passenger it seems insignificant. After further consideration, we must say to ourselves that the verdict on real fear, whether it be rational or purposeful, must be thoroughly revised. For the only purposeful behavior in the face of imminent danger would be the cool appraisal of one's own strength in comparison with the extent of the threatening danger, and then decide which would presage a happier ending: flight, defense, or possibly even attack. Under such a proceeding fear has absolutely no place; everything that happens would be consummated just as well and better without the development of fear. You know that if fear is too strong, it proves absolutely useless and paralyzes every action, even flight. Generally the reaction against danger consists in a mixture of fear and resistance. The frightened animal is afraid and flees. We are therefore tempted to claim that the development of fear is never purposeful. Perhaps closer examination will give us greater insight into the fear situation. The first factor is the expectancy of danger which expresses itself in heightened sensory attention and in motor tension. This expectancy is undoubtedly advantageous; its absence may be responsible for serious consequences. On the one hand, it gives rise to motor activity, primarily to flight, and on a higher plane to active defense; on the other hand, it gives rise to something which we consider the condition of fear. In so far as the development is still incipient, and is restricted to a mere signal, the more undisturbed the conversion of the readiness to be afraid into action the more purposeful the entire proceeding. The readiness to be afraid seems to be the purposeful aspect; evolution of fear itself, the element that defeats its own object. I avoid entering upon a discussion as to whether our language means the same or distinct things by the words anxiety, fear or fright. I think that anxiety is used in connection with a condition regardless of any objective, while fear is essentially directed toward an object. Fright, on the other hand, seems really to possess a special meaning, which emphasizes the effects of a danger which is precipitated without any expectance or readiness of fear. Thus we might say that anxiety protects man from fright. You have probably noticed the ambiguity and vagueness in the use of the word "anxiety." Generally one means a subjective condition, caused by the perception that an "evolution of fear" has been consummated. Such a condition may be called an emotion. What is an emotion in the dynamic sense? Certainly something very complex. An emotion, in the first place, includes indefinite motor innervations or discharges; secondly, definite sensations which moreover are of two kinds, the perception of motor activities that have already taken place, and the direct sensations of pleasure and pain, which give the effect of what we call its feeling tone. But I do not think that the true nature of the emotion has been fathomed by these enumerations. We have gained deeper insight into some emotions and realize that the thread which binds together such a complex as we have described is the repetition of a certain significant experience. Do not assume that what I have said here about emotions is derived from normal psychology. On the contrary, these are conceptions that have grown up with and are at home only in psychoanalysis. What psychology has to say about emotions—the James-Lange theory, for instance—is absolutely incomprehensible for us psychoanalysts, and cannot be discussed. Of course, we do not consider our knowledge about emotions very certain; it is a preliminary attempt to become oriented in this obscure region. To continue: We believe we know the early impression which the emotion of fear repeats. We think it is birth itself which combines that complex of painful feelings, of a discharge of impulses, of physical sensations, which has become the prototype for the effect of danger to life, and is ever after repeated within us as a condition of fear. The tremendous heightening of irritability through the interruption of the circulation (internal respiration) was at the time the cause of the experience of fear; the first fear was therefore toxic. The name anxiety—angustial—narrowness, emphasizes the characteristic tightening of the breath, which was at the time a consequence of an actual situation and is henceforth repeated almost regularly in the emotion. We shall also recognize how significant it is that this first condition of fear appeared during the separation from the mother. Of course, we are convinced that the tendency to repetition of the first condition of fear has been so deeply ingrained in the organism through countless generations, that not a single individual can escape the emotion of fear; not even the mythical Macduff who was "cut out of his mother's womb," and therefore did not experience birth itself. We do not know the prototype of the condition of fear in the case of other mammals, and so we do not know the complex of emotions that in them is the equivalent of our fear. Perhaps it will interest you to hear how the idea that birth Proceeding now to neurotic fear, what are its manifestations and conditions? There is much to be described. In the first place we find a general condition of anxiety, a condition of free-floating fear as it were, which is ready to attach itself to any appropriate idea, to influence judgment, to give rise to expectations, in fact to seize any opportunity to make itself felt. We call this condition "expectant fear" or "anxious expectation." Persons who suffer from this sort of fear always prophesy the most terrible of all possibilities, interpret every coincidence as an evil omen, and ascribe a dreadful meaning to all uncertainty. Many persons who cannot be termed ill show this tendency to anticipate disaster. We blame them for being over-anxious or pessimistic. A striking amount of expectant fear is characteristic of a nervous condition which I have named "anxiety neurosis," and which I group with the true neuroses. A second form of fear in contrast to the one we have just described is psychologically more circumscribed and bound up with certain objects or situations. It is the fear of the manifold and frequently very peculiar phobias. Stanley Hall, the distinguished American psychologist, has recently taken the trouble to present a whole series of these phobias in gorgeous Greek terminology. They sound like the enumeration of the ten Egyptian plagues, except that their number exceeds ten, by far. Just listen to all the things which may become the objects of contents of a phobia: Darkness, open air, open squares, cats, spiders, caterpillars, snakes, mice, thunder-storms, sharp points, blood, enclosed spaces, crowds, solitude, passing over a bridge, travel on land and sea, etc. A first attempt at orientation in There remains a third group of phobias which is entirely unintelligible to us. When a strong, adult man is afraid to cross a street or a square of his own home town, when a healthy, well-developed woman becomes almost senseless with fear because a cat has brushed the hem of her dress or a mouse has scurried through the room—how are we to establish the relation to danger that obviously exists under the phobia? In these animal phobias it cannot possibly be a question of the heightening of common human antipathies. For, as an illustration of the antithesis, there are numerous persons who cannot pass a cat without calling and petting it. The mouse of which women are The two forms of fear that have been described, free-floating fear and the fear which is bound up with phobias, are independent of one another. The one is by no means a higher development of the other; only in exceptional cases, almost by accident, do they occur simultaneously. The strongest condition of general anxiety need not manifest itself in phobias; and persons whose entire life is hemmed in by agoraphobia can be entirely free of pessimistic expectant fear. Some phobias, such as the fear of squares or of trains, are acquired only in later life, while others, the fear of darkness, storms and animals, exist from the very beginning. The former signify serious illness, the latter appear rather as peculiarities, moods. Yet whoever is burdened with fear of this second kind may be expected to harbor other and similar phobias. I must add that we group all these phobias under anxiety hysteria, and therefore regard it as a condition closely related to the well-known conversion hysteria. The third form of neurotic fear confronts us with an enigma; we loose sight entirely of the connection between fear and threatening danger. This anxiety occurs in hysteria, for instance, as the accompaniment of hysteric symptoms, or under certain conditions of excitement, where we would expect an emotional manifestation, but least of all of fear, or without reference to any known circumstance, unintelligible to us and to the patient. Neither far nor near can we discover a danger or a cause which might have been exaggerated to such significance. Through these spontaneous attacks we learn that the complex which we call the condition of anxiety can be resolved into its components. The whole attack may be represented by a single intensively developed symptom, such as a trembling, dizziness, palpitation of the heart, or tightening of breath; the general undertone by which we usually recognize fear may be utterly lacking or vague. And yet these conditions, which we describe Two questions arise. Can we relate neurotic fear, in which danger plays so small a part or none at all, to real fear, which is always a reaction to danger? And what can we understand as the basis of neurotic fear? For the present we want to hold to our expectations: "Wherever there is fear, there must be a cause for it." Clinical observation yields several suggestions for the comprehension of neurotic fear, the significance of which I shall discuss with you. 1. It is not difficult to determine that expectant fear or general anxiety is closely connected with certain processes in sexual life, let us say with certain types of libido. Utilization, the simplest and most instructive case of this kind, results when persons expose themselves to frustrated excitation, viz., if their sexual excitation does not meet with sufficient relief and is not brought to a satisfactory conclusion, in men, during the time of their engagement to marry, for instance, or in women whose husbands are not sufficiently potent or who, from caution, execute the sexual act in a shortened or mutilated form. Under these circumstances libidinous excitement disappears and anxiety takes its place, both in the form of expectant fear and in attacks and anxiety equivalents. The cautious interruption of the sexual act, when practiced as the customary sexual regime, so frequently causes the anxiety neurosis in men, and especially in women, that physicians are wise in such cases to examine primarily this etiology. On innumerable occasions we have learned that anxiety neurosis vanishes when the sexual misuse is abandoned. So far as I know, the connection between sexual restraint and conditions of anxiety is no longer questioned even by physicians who have nothing to do with psychoanalysis. But I can well imagine that they do not desist from reversing the connection and saying that these persons have exhibited a tendency to anxiety from the outset and therefore practice reserve in sexual matters. The behavior of women whose sexual conduct is passive, viz., is determined by the treatment of the husband, contradicts this supposition. The more temperamental, that is, the more disposed toward sexual intercourse and capable of Sexual abstinence, recommended so warmly by the physicians of to-day, has the same significance in the development of conditions of anxiety only when the libido, to which satisfactory relief is denied, is sufficiently strong and not for the most part accounted for by sublimation. The decision whether illness is to result always depends upon the quantitative factors. Even where character formation and not disease is concerned, we easily recognize that sexual constraint goes hand in hand with a certain anxiety, a certain caution, while fearlessness and bold daring arise from free gratification of sexual desires. However much these relations are altered by various influences of civilization, for the average human being it is true that anxiety and sexual constraint belong together. I have by no means mentioned all the observations that speak for the genetic relation of the libido to fear. The influence on the development of neurotic fear of certain phases of life, such as puberty and the period of menopause, when the production of libido is materially heightened, belongs here too. In some conditions of excitement we may observe the mixture of anxiety and libido and the final substitution of anxiety for libido. These facts give us a twofold impression, first that we are concerned with an accumulation of libido, which is diverted from its normal channel, second that we are working with somatic processes. Just how anxiety originates from the libido we do not know; we can only ascertain that the libido is in abeyance, and that we observe anxiety in its place. 2. We glean a second hint from the analysis of the psychoneuroses, especially of hysteria. We have heard that in addition to the symptoms, fear frequently accompanies this condition; this, however, is free floating fear, which is manifested either as an attack or becomes a permanent condition. The patients cannot tell what they are afraid of and connect their fear, through an unmistakable secondary elaboration, with phobias nearest at hand; death, insanity, paralysis. When we analyze the situation which gave rise to the anxiety or to symptoms accompanied by it, we can generally tell which normal psychologic 3. Patients suffering from compulsive acts are remarkably devoid of fear. They yield us the data for our third point. If we try to hinder them in the performance of their compulsive acts, of their washing or their ceremonials, or if they themselves dare to give up one of their compulsions, they are seized with terrible fear that again exacts obedience to the compulsion. We understand that the compulsive act had veiled fear and had been performed only to avoid it. In compulsion neurosis then, fear, which would otherwise be present, is replaced by symptom development. Similar results are yielded by hysteria. Following the process of suppression we find the development, either of anxiety alone or of anxiety and symptom development, or finally a more complete symptom development and no anxiety. In an abstract sense, then, it would be correct to say that symptoms are formed only to evade development of fear, which otherwise could not be escaped. According to this conception, fear is seen to occupy the center of the stage in the problems of neurosis. Our observations on anxiety neuroses led to the conclusion that when the libido was diverted from its normal use and anxiety thus released, it occurred on the basis of somatic processes. The analyses of hysteria and compulsion neuroses furnish the correlative observations that similar diversion with similar results may also be the consequence of a constraint of psychic forces. Such then is our knowledge of the origin of The desired connection is brought about by presupposing the antithesis of the ego to libido that is so frequently claimed. We know that the development of fear is the ego's reaction to danger, the signal for preparation for flight, and from this we are led to believe that in neurotic fear the ego attempts to escape the claims of its libido, and treats this inner danger as though it came from without. Accordingly our expectation that where there is fear there must be something to be afraid of, is fulfilled. But the analogy admits of further application. Just as the attempt to flee external danger is relieved by standing one's ground, and by appropriate steps toward defense, so the development of neurotic fear is arrested as fast as the symptom develops, for by means of it the fear is held in check. Our difficulties in understanding now lie elsewhere. The fear, which represents flight of the ego before the libido, is supposed to have sprung from the libido itself. That is obscure and warns us not to forget that the libido of a person belongs fundamentally to him and cannot confront him as an external force. The localized dynamics of fear development are still unintelligible; we do not know what psychic energies are released or from what psychic systems they are derived. I cannot promise to solve this problem, but we still have two trails to follow which lead us to direct observations and analytic investigation which can aid our speculations. We turn to the origin of fear in the child, and to the source of neurotic fear which attaches itself to phobias. Fear in children is quite common and it is very hard to tell whether it is neurotic or real fear. Indeed, the value of this distinction is rendered questionable by the behavior of children. On the one hand we are not surprised that the child fears all strange persons, new situations and objects, and we explain this reaction very easily by his weakness and ignorance. We ascribe On the other hand, we cannot overlook the fact that not all children are equally afraid, and that those very children who express particular timidity toward all possible objects and situations subsequently prove to be nervous. Thus the neurotic disposition reveals itself by a decided tendency to real fear; anxiety rather than nervousness appears to be primary. We therefore arrive at the conclusion that the child (and later the adult) fears the power of his libido because he is anxious in the face of everything. The derivation of anxiety from the libido is hence put aside. Any investigation of the conditions of real fear consistently leads to the conclusion that consciousness of one's own weakness and helplessness—inferiority, in the terminology of A. Adler—when it is able to persist from childhood to maturity, is the cause underlying the neuroses. This sounds so simple and convincing that it has a claim upon our attention. To be sure, it would result in our shifting the basis of nervousness. The persistence of the feeling of inferiority, and its prerequisite condition of anxiety and its subsequent development of symptoms, is so firmly established that it is rather the exceptional case, when health is the outcome, which requires an explanation. What can be learned from careful observation of the fear of children? The little child is primarily afraid of strange people; situations wax important only because they involve people, and objects become influential much later. But the child does not fear these strange persons because he attributes evil intentions to them, because he compares his weakness with their strength or recognizes them as dangerous to his existence, his safety and freedom from pain. Such a child, suspicious, afraid of the aggressive impulse which dominates the world, would prove a sad theoretic construction. The child is afraid of a stranger because he is adjusted to a dear, beloved The first situation phobias of children are darkness and solitude; the former often persists throughout life; common to both is the absence of the dear nurse, the mother. I once heard a child, who was afraid of the dark, call into an adjoining room, "Auntie, talk to me, I am afraid." "But what good will that do you? You cannot see me!" Whereupon the child answered, "If someone speaks, it is brighter." The yearning felt in darkness is converted into the fear of darkness. Far from saying that neurotic fear is only a secondary, a special case of real fear, we observe in little children something that resembles the behavior of real fear and has in common with neurotic fear, this characteristic feature: origin from unemployed libido. The child seems to bring very little real fear into the world. In all situations which may later become the conditions of phobias, on elevations, narrow bridges across water, on railroad and boat trips, the child exhibits no fear. And the more ignorant he is, the less fear he feels. It would be most desirable to have a greater heritage of such life-preservative instincts; the task of supervision, which is to hinder him from exposing himself to one danger after another, would be lessened. In reality the child at first overestimates his powers and behaves fearlessly because he does not recognize dangers. He will run to the water's edge, mount the window sill, play with fire or with sharp utensils, in short, he will do everything that would harm him and alarm his guardians. The awakening of real fear is the result of education, since we may not permit him to pass through the instructive experience himself. If there are children who meet this education to fear half way, and who discover dangers of which they have not been warned, the explanation suffices that their constitution contains a greater measure of libidinous need or that they have been spoiled early through libidinous gratification. No wonder that those persons who are nervous in later life are recruited from the ranks of these children. We know that the creation of Let us extract the sum of our observations on the anxiety of children: Infantile fear has very little to do with real fear, but is closely related to the neurotic fear of adults. It originates in unemployed libido and replaces the object of love that is lacking by an external object or situation. Now you will be glad to hear that the analysis of phobias cannot teach much more that is new. The same thing occurs in them as in the fear of children; unemployed libido is constantly being converted into real fear and so a tiny external danger takes the place of the demands of the libido. This coincidence is not strange, for infantile phobias are not only the prototypes but the direct prerequisite and prelude to later phobias, which are grouped with the anxiety hysterias. Every hysteria phobia can be traced to childish fear of which it is a continuation, even if it has another content and must therefore receive a different name. The difference between the two conditions lies in their mechanism. In the adult the fact that the libido has momentarily become useless in the form of longing, is not sufficient to effect the transformation of fear into libido. He has long since learned to maintain such libido in a suspended state or to use it differently. But when the libido is part of a psychic impulse which has experienced suppression, similar conditions to those of the child, who cannot distinguish the conscious from the unconscious, are reËstablished. The regression to infantile phobia is the bridge where the transformation of libido into fear is conveniently effected. We have, as you know, spoken a great deal about suppression, but we have always followed the fate of the conception that was to be suppressed, because this was easier to recognize and to present. We have always omitted from our consideration what happened to the emotion that clung to the suppressed idea; and only now we learn that whatever quality this emotion might have manifested under normal conditions, I said that the transformation into fear, rather a discharge in the form of fear, is the immediate fate of suppressed libido. Not the only or final fate, I must add. These neuroses are accompanied by processes that strive to restrain the development of fear, and succeed in various ways. In phobias, for instance, two phases of the neurotic process can be clearly distinguished. The first effects the suppression of libido and its transition to fear, which is joined to an external danger. The second consists in building up all those precautions and safety devices which are to prevent contact with this danger which is dealt with as an external fact. Suppression corresponds to the ego's flight from the libido, which it regards dangerous. The phobia is comparable to a fortification against outer danger, which is represented by the much feared libido. The weakness of the phobias' system of defense lies in the fact that the fort has been strengthened from without and has remained vulnerable within. The projection of peril from the libido into the environment is never very successful. In other neuroses, therefore, other systems of defense are used against the possibility of fear development. That is an interesting aspect of the psychology of neurosis. Unfortunately its study would lead us to digress too far, and presupposes a more thorough and special knowledge of the subject. I shall add only one thing more. I have already spoken to you of the counter siege by which the ego imprisons the suppression and which it must maintain permanently for the suppression to subsist. The task of this counter siege is to carry To return to the phobias, I may now say that you realize how insufficient it would be to explain only their content, to be interested only in knowing that this or that object or situation is made the subject of a phobia. The content of the phobia has about the same importance for it as the manifest dream facade has for the dream. With some necessary restrictions, we admit that among the contents of the phobias are some that are especially qualified to be objects of fear through phylogenetic inheritance, as Stanley Hall has emphasized. In harmony with this is the fact that many of these objects of fear can establish connections with danger only by symbolic relations. And so we are convinced of the central position that the problem of fear assumes in the questions of the neurotic psychology. We are deeply impressed with how closely the development of fear is interwoven with the fate of the libido and the unconscious system. There is only one disconnected point, one inconsistency in our hypothesis: the indisputable fact that real fear must be considered an expression of the ego's instincts of self-preservation. |