Chapter 5

ANXIETY INTERPRETED BY THE PSYCHOTHERAPISTS

Whereas the life fear is anxiety at going forward, becoming an individual, the death fear is anxiety at going backward, losing individuality. Between these two fear possibilities, the individual is thrown back and forth all his life.

—Otto Rank

FREUD’S EVOLVING THEORIES OF ANXIETY

Sigmund Freud was a giant who, like Marx and Einstein, became a symbol for the new age. Whether we are “Freudians” or not, as I am not, we are surely all post-Freudian. He set the tone for vast changes in our culture: in literature, vide James Joyce and the stream of consciousness; in art, Paul Klee and Picasso in their painting of forms of which people are unaware; in poetry the works of W. H. Auden. The drama on Broadway of the twentieth century, vide Eugene O’Neill’s Mourning Becomes Electra, is not understandable except as we see Freud’s discoveries as its background. His theory of the unconscious was in effect a vast broadening of the minds of all of us, and the source not only of psychoanalysis, but of a new view of medicine, psychology, and ethics. No social science is free from his influence. Hence it is important for all of us, regardless of whether we agree with Freud or not, to have some familiarity with the evolution of his thought.

Freud stands in the line of those explorers of human nature of the nineteenth century—including Kierkegaard, Nietzsche, Schopenhauer—who rediscovered the significance of the irrational, dynamic, “unconscious” elements in personality.1 These aspects of personality had tended to be overlooked—and in many ways suppressed—by the rationalistic preoccupations of most Western thinking since the Renaissance (see Chapter 2). Though Kierkegaard, Nietszche, and Freud attacked the rationalism of the nineteenth century for different reasons, they had in common the conviction that the traditional modes of thought omitted elements vital for the understanding of personality. The irrational springs of human behavior had been left outside the accepted area of scientific investigation or lumped under the so-called instincts. Freud’s reaction against the endeavors of academic medicine of his day to explain anxiety by “describing the nerve-pathways by which the excitations travel” and his conviction that the methods of academic psychology of his day yielded little or no help in the dynamic understanding of human behavior which he sought, can be understood in this light. At the same time, Freud felt himself to be an enthusiastic champion of science in his avowed intention of making the “irrational” elements in behavior explicable in terms of his broader concept of scientific method. That he carried over into his work some of the presuppositions of nineteenth-century traditional (physical) science is illustrated in his libido theory, which we will comment on below.

Though others, like Kierkegaard, had preceded Freud in recognizing the crucial importance of the problem of anxiety in understanding human behavior, Freud was the first in the scientific tradition to see the fundamental significance of the problem. More specifically, Freud directed attention to anxiety as the basic question for the understanding of emotional and psychological disorders. Anxiety, he notes in his later essay devoted to this topic, is the “fundamental phenomenon and the central problem of neurosis.”2

Students of dynamic psychology would no doubt agree that Freud is the pre-eminent explorer of the psychology of anxiety, that he both showed the way and gave many of the most efficacious techniques for the understanding of the problem, and that, therefore, his work is of classic importance. This is despite the fact that it is now widely believed that many of his conclusions must be qualified and reinterpreted. To study Freud on anxiety is to become aware that his thinking on the topic was in process of evolution throughout his life. His theories of anxiety underwent many minor changes as well as one revolutionary change. Since anxiety is so fundamental a question, it cannot be given any simple answers; and Freud significantly confesses in his last writings that he is still presenting hypotheses rather than a “final solution” to the problem.³ Therefore, we shall endeavor in this survey not only to present Freud’s central insights and his innumerable observations into the mechanics of anxiety, but also to plot the directions in which his concept of anxiety was evolving.

To begin with, Freud makes the customary distinction between fear and anxiety which we have already noted in the work of Goldstein and others. Freud holds that in fear the attention is directed to the object, whereas anxiety refers to the condition of the individual and “disregards the object.”⁴ To him the more significant distinction is between objective (what I would term “normal”) and neurotic anxiety. The former, “real” anxiety, is the reaction to an external danger like death. He conceives it as a natural, rational, and useful function. This objective anxiety is an expression of the “instincts of self-preservation.” “On what occasions anxiety is felt—that is to say in the face of what objects and in what situations—will of course depend to a large extent on the state of a person’s knowledge and his sense of power vis-à-vis the external world.”⁵ This “anxious readiness,” as Freud terms objective anxiety, is an expedient function, since it protects the individual from being surprised by sudden threats (frights) for which he is unprepared. Objective anxiety does not in itself constitute a clinical problem.

But any development of anxiety beyond the initial prompting to survey the danger and make the best preparation for flight is inexpedient. It paralyzes action. “The preparation for anxiety seems to me to be the expedient element in what we call anxiety and the generation of anxiety the inexpedient one.”6 It is, of course, this development of anxiety in amounts out of proportion to the actual danger, or even in situations where no ostensible external danger exists, which constitutes the problem of neurotic anxiety.

Anxiety and Repression

How is it possible, Freud asks in his early writing, to bring the phenomenon of neurotic anxiety into logical relationship with objective anxiety? In the endeavor to answer this question he cites his observations in clinical work. He had noticed that patients who exhibit inhibitions or symptoms of various sorts are often remarkably free from overt anxiety, a phenomenon to which we have referred in Chapter 4. In phobias, for example, the patient exhibits an intense concentration of anxiety on one point in his environment—namely, the object of his phobia—but he is free from anxiety at other points in his environment. In obsessional acts, likewise, the patient seems to be free of anxiety so long as he is permitted to carry out his act in unmolested fashion, but as soon as he is prevented from performing the obsessional act, intense anxiety appears. So, Freud reasoned understandably, that some substitutive process must be occurring—i.e., the symptom must in some way be taking the place of the anxiety.

He observed at the same time that his patients who experienced continual sexual excitation which was ungratified—he cites cases of coitus interruptus, for one example—also exhibited a good deal of anxiety. Hence, he concluded, the substitutive process occurring must be the interchange of anxiety, or anxiety-equivalents in the form of symptoms, for unexpressed libido. He writes, “libidinal excitation vanishes and anxiety appears in its place, whether in the form of expectant anxiety or in attacks and anxiety-equivalents.”⁷ Looking back from a later date on the observations which led to this theory, Freud remarks,

I found that certain sexual practices, such as coitus interruptus, frustrated excitement, enforced abstinence, give rise to outbreaks of anxiety and a general predisposition to anxiety—which may be induced whenever, therefore, sexual excitation is inhibited, frustrated, or diverted in the course of its discharge in gratification. Since sexual excitement is the expression of libidinal instinctual impulses, it did not seem rash to suppose that through the influence of such disturbances the libido became converted into anxiety.”8

The first theory, therefore, states that when libido is repressed, it becomes transformed into anxiety, and then reappears as free-floating anxiety or as an anxiety-equivalent (a symptom). “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.”⁹ When an affect is repressed, its fate is “to be transformed into anxiety, whatever quality it may have exhibited apart from this in the normal course of events.”¹⁰ The source of the child’s anxiety at missing his mother, or at the appearance of strange people (which represents the same danger situation as missing the mother, since the presence of the strange people signifies the mother’s absence), lies in the fact that the child cannot then expend his libido toward the mother, and the libido is “discharged as anxiety.”¹¹

Recalling that objective anxiety is a flight-reaction to external danger, Freud asks what the individual is afraid of in neurotic anxiety. The latter, he answers, represents a flight from the demands of one’s own libido. In neurotic anxiety the ego is attempting a flight from the demands of its libido, and is treating this internal danger as if it were an external one.

Repression corresponds to an attempt at flight by the ego from libido which is felt as a danger. A phobia may be compared to an entrenchment against an external danger which now represents the dreaded libido.¹² To summarize Freud’s first theory of neurotic anxiety: the individual experiences libidinal impulses which he interprets as dangerous, the libidinal impulses are repressed, they become automatically converted into anxiety, and they find their expression as free-floating anxiety or as symptoms which are anxiety-equivalents.

On later analysis of patients with phobias and other anxiety symptoms, Freud found that a quite different process with respect to anxiety was occurring. A new theory was made necessary, too, by his increasing emphasis on the role of the ego, which had played only an auxiliary part in the first theory. “The division of the mental personality into a super-ego, ego and id,” he writes, “has forced us to take up a new position with regard to the problem of anxiety.”13

He demonstrates the analysis which led to the new theory with the case of Hans, the five-year-old boy who refused to go out into the street (the inhibition) because of his phobia of horses (the symptom). Hans had considerable ambivalence toward his father, which Freud explains in classical Oedipus fashion. That is, the little boy felt strong desires for the love of his mother and consequent jealousy and hatred of his father. But at the same time he was devoted to his father in so far as his mother did not enter the picture as a cause of dissension. Because of the father’s strength, the impulses of jealousy and hatred—or hostility—in Hans would cue off anxiety. The hostility carries with it frightening possibilities of retaliation, and it also involves the boy in continuous ambivalence toward a father to whom he is at the same time devoted; hence the hostility and related anxiety undergo repression. These affects are then displaced upon horses. Without going into detail about the mechanism of phobia formation, we wish only to illustrate Freud’s point that the phobia of horses is a symptomatic representation of Han’s fears of his father. Freud interprets this fear in typical castration terms: the fear of the bite of the horse is fear of having his penis bitten off. Freud writes:

This substitute formation [i.e., the phobia] has two patent advantages: first, that it avoids the conflict due to ambivalence, for the father is an object who is at the same time loved; and secondly, that it allows the ego to prevent any further development of anxiety.14

The crucial point in this analysis is that the ego perceives the danger. This perception arouses anxiety (Freud speaks of the “ego” arousing anxiety), and as an endeavor to avoid the anxiety the ego effects the repression of the impulses and desires which would lead the person into danger. “It was not the repression that created the anxiety,” Freud now remarks against his first theory; “the anxiety was there earlier and created the repression.”¹⁵ The same process holds true for other symptoms and inhibitions: the ego perceives the danger signal, and the symptoms and inhibitions are then created in the endeavor to avoid the anxiety. We may now, writes Freud, take the new view that the “ego is the real locus of anxiety, and reject the earlier conception that the cathectic energy of the repressed impulse automatically becomes converted into anxiety.”¹⁶

A qualification is now also made by Freud in his earlier statement that the danger feared in neurotic anxiety is that simply of inner instinctual impulses. Speaking of Hans, he writes:

Though this interrelationship of external and internal factors was found by Freud in every case he investigated during this later period, he confesses “that we were not prepared to find that internal instinctual danger would turn out to be a situation of determinant and preparation for an external, real situation.”17

Many students of anxiety feel that this second theory, with its emphasis on the ego function is more compatible with other psychological approaches of the problem.¹⁸ Horney, for example, holds that whereas the first theory was essentially “physiochemical,” the second is “more psychological.” In any case, the second hypothesis evidences some clear and significant trends in Freud’s understanding of anxiety, which will be discussed below.

Origins of Anxiety as Seen by Freud

Freud states that the capacity for anxiety is innate in the organism, that it is part of the self-preservation instinct, and that it is phylogenetically inherited. In his words, “we attribute to children a strong inclination to realistic anxiety and we should regard it as quite an expedient arrangement if this apprehensiveness were an innate heritage in them.”¹⁹ Specific anxieties, however, are taught. Of genuine “objective anxieties”—by which Freud means fear of climbing on window sills, fear of fire, etc.—the child seems to bring very little into the world. And “when in the end realistic anxiety is awakened in them, that is wholly the result of education.”20 Thus he takes maturation into account:

A certain predisposition to anxiety on the part of the infant is indubitable. It is not at its maximum immediately after birth, to diminish gradually thereafter, but first makes its appearance later on with the progress of psychic development, and persists over a certain period of childhood.

Beyond the above general statement, Freud finds the origin of anxiety in the birth trauma and fear of castration. These two concepts are interwoven and progressively reinterpreted in his writings. The affect which comes with anxiety, Freud holds in his early lectures, is a reproduction and repetition of some particular very significant previous experience. This he believed to be the birth experience—“an experience which involves just such a concatenation of painful feelings, of discharges and excitation, and of bodily sensations, as to have become a prototype for all occasions on which life is endangered, ever after to be reproduced again in us as the dread of ‘anxiety’ condition.” He adds, foreshadowing his later broadening of the birth concept, “It is very suggestive too that the first anxiety state arose on the occasion of the separation from the mother.”²¹ The child’s having anxiety at the appearance of strange people and its fears of darkness and loneliness (which he terms the first phobias of the child) have their origin in dread lest the child be separated from his mother.

It is an important question, in reviewing Freud’s later writings, how far he was considering the birth experience as a literal source of anxiety, to be cued off by later danger situations, and how far he regarded it as a prototype in a symbolic sense—i.e., symbolic for separation from the loved object. Since he places great emphasis on castration as the specific source of anxiety underlying many neuroses, he is at pains to explain how castration and the birth experience are interrelated. We shall, therefore, now investigate how he progressively reinterprets and interrelates castration and the birth experience page by page in his chief essay on anxiety.²²

Speaking of the danger underlying the development of phobias, conversion hysteria, and compulsion neuroses, he notes, “in all these, we assume castration anxiety as the motive force behind the struggles of the ego.”23 Even fear of death is an analogue of castration, since no one has actually experienced death but everyone has experienced a castration-like experience in the loss of the mother’s breast in weaning. He then speaks of the danger of castration “as a reaction to a loss, to a separation,” of which the prototype is the birth experience. But he is critical of Rank’s too specific deduction of anxiety and consequent neurosis from the severity of the birth trauma. In reaction against Rank, he holds that the danger situation in birth is “the loss of the loved (longed for) person,” and the “most basic anxiety of all, the ‘primal anxiety’ of birth, arises in connection with separation from the mother.”²⁴ Castration he now relates to the loss of the mother by Ferenczi’s reasoning: the loss of the genital deprives the individual of the means of later reunion with the mother (or mother substitute). Fear of castration later develops into dread of conscience—i.e., social anxiety; now the ego is afraid of the anger, punishment, loss of love of the superego. The final transformation of this fear of the superego consists of death anxiety.²⁵

Thus we are presented with a hierarchy: fear of loss of the mother at birth, loss of the penis in the phallic period, loss of the approval of the superego (social and moral approval) in the latency period, and finally loss of life, all of which go back to the prototype, the separation from the mother. All later anxiety occasions “signify in some sense a separation from the mother.”²⁶ This must mean that castration stands for the loss of a prized object of value in the same sense as birth stands for the loss of the mother. Another datum which impelled him to interpret castration in a nonliteral fashion was the fact that the female sex, “certainly more predisposed to neurosis,” as he remarks, cannot suffer literal castration because of the absence of a penis to begin with. In the case of women, he states that anxiety arises over fear of the loss of the object (mother, husband) rather than loss of the penis.

Though one cannot be certain as to how far Freud was regarding the birth experience and castration literally and how far symbolically, we submit that the trend in Freud’s reasoning cited above is toward an increasingly symbolic interpretation. I regard this trend as positive. With respect to castration, there may legitimately be considerable question as to whether it is literally a source of anxiety on any wide scale. I suggest that castration is a culturally determined symbol around which neurotic anxiety may cluster.27

With respect to the birth trauma, I regard Freud’s increasingly symbolic interpretation also as a positive trend. It is still an open question in experimental and clinical psychology how far the severity of the birth experience is a literal source of later anxiety.²⁸ But even if the actual birth experience cannot be accepted as the source of anxiety in literal fashion, it would certainly be widely agreed that the infant’s early relations with its mother, which so intimately condition both its biological and psychological development, are of the greatest significance for later anxiety patterns. Hence I emphasize that facet of Freud’s thought which holds that anxiety has its source, as far as a primal source is reactivated in later neurotic anxiety, in the fear of premature loss of or separation from the mother (or mother’s love), and thence fear of the loss of subsequent values. Indeed, in the development and clinical application of Freudian theory, this interpretation is widely made, often in the form of the primal source of anxiety as being rejection by the mother.²⁹

Trends in Freud’s Theories of Anxiety

Since we are concerned with the evolution of Freud’s understanding of anxiety, we shall summarize certain directions in which his thinking was moving from his earlier to his later writings on anxiety.

Our approach—plotting the trends in Freud’s thinking—is fitting in the respect that Freud’s thinking was germinal; it was changing and developing through most of his life. This makes dogmatism about his views of very dubious worth; but the changing nature of his views also makes for ambiguity in his writings. For example, at times Freud writes as though he had completely rejected his first theory, but at other times as though he believed it compatible, in a subsumed position, with the second theory.

The first trend follows from the above; it is a trend toward removing the libido theory from the primary position in his understanding of anxiety to a secondary position. Whereas the earlier theory of anxiety was almost wholly a description of what happened to libido (it was an “exclusively economic interpretation,” Freud remarks), in his later writing he states that he is now not so much interested in the fate of the libido. His second theory still presupposes the libido concept, however: the energy which becomes anxiety is still libido withdrawn from the cathexis of repressed libido. In this second theory, the ego performs its repressive functions by means of “desexualized” libido; and the danger faced (to which anxiety is the reaction) is the “economic disturbance brought about by an increase in stimuli demanding some disposition be made of them.”30 Though Freud retained the libido concept through all his writings, the trend is from a description of anxiety as an automatic conversion of libido to a description of the individual perceiving a danger and utilizing libido (energy) in coping with this danger. This trend accounts partially for the fact that Freud’s second theory presents a more adequate description of the mechanism of anxiety. But I question whether even the secondary emphasis on the libido theory in Freud’s later writings on anxiety does not confuse the problem by its emphasis on the individual as a carrier of instinctual or libidinal needs which must be gratified.³¹ The view I take in the present study (see Chapter 7) involves carrying the above trend in Freud’s thinking further in the respect that libido or energy factors are seen not as given economic quantities which must be expressed, but as functions of the values or goals the individual seeks to attain as he relates himself to his world.

A second trend is seen in Freud’s conception of how anxiety symptoms are formed. This trend is shown most vividly in the reversal of his early view that repression causes anxiety to the later view that anxiety causes repression. What this shift implies is that anxiety and its symptoms are seen not as merely the outcome of a simple intrapsychic process, but as arising out of the individual’s endeavor to avoid danger situations in his world of relationships.

A third trend, with implications similar to that above, is shown in Freud’s endeavor to overcome the dichotomy between “internal” and “external” factors in the occasions of anxiety. Whereas in the earlier theory neurotic anxiety was viewed as arising from fear of one’s own libidinous impulses, Freud later saw that the libidinous impulses are dangerous only because the expression of them would involve an external danger. The external danger was of only minor importance in the first theory when anxiety could be viewed as an automatic intrapsychic transformation of libido. But it became a pressing problem to him in the cases he was analyzing in his later periods when he saw that the internal danger—danger from one’s own impulses—arose from the fact that the individual was struggling against an “external and real danger-situation.”

One might say, then, that symptoms are created in order to avoid the development of anxiety, but such a formulation does not go below the surface. It is more accurate to say that symptoms are created in order to avoid the danger situation of which anxiety sounds the alarm.32

Later in this same essay he notes:

We have become convinced also that instinctual demands often become an (internal) danger only because of the fact that their gratification would bring about an external danger—because, therefore, this internal danger represents an external one.”³³

Therefore, the symptom is not merely a protection against inner impulses: “For our point of view the relationships between anxiety and symptom prove to be less close than was supposed, the result of our having interposed between the two the factor of the danger situation.”34

It may seem at first blush that we are laboring a minor point in emphasizing this shift from “danger” to “danger situation.” But I believe that it is by no means an unimportant issue or a mere question of terminology. It involves the whole difference between seeing anxiety as a more or less exclusively intrapsychic process, on the one hand, and the view that anxiety arises out of the individual’s endeavor to relate himself to his world, on the other. In this second view intrapsychic processes are significant because they are reactions to, and means of coping with, the difficulties in the interpersonal world. The trend in Freud is toward a more organismic view—organismic being here defined as connoting a view of the person in his constellation of relationships. But it is well known that Freud never developed this trend to its logical conclusions in terms of a consistent organismic and cultural viewpoint. I believe he was prevented from doing so by both his libido theory and his topological concept of personality.

A fourth trend in Freud’s thinking on anxiety is shown in his increased emphasis on the topology of the psyche, arising out of his division of the personality into superego, ego, and id. This makes it possible for him to center more of his attention on anxiety as being a function of the way the individual, via the ego, perceives and interprets the danger situation. He remarks that the phrase he employed in his earlier theory, “anxiety of the id,” is infelicitous since neither id nor superego can be said to perceive anxiety.

While this trend, like the others mentioned above, makes Freud’s later concepts of anxiety more adequate and more understandable psychologically, I raise the question as to whether this topology, when employed in any strict sense, does not confuse the problem of anxiety. For example, Freud speaks in his later writing of the ego “creating” repression after it perceives the danger situation. Does not repression involve unconscious (“id,” in topological terms) functions as well? Indeed, any symptom formation which is effective must involve elements which are excluded from awareness, as Freud himself, despite his topology, would be the first to admit.

I suggest that repressions and symptoms can best be viewed as the organism’s means of adjusting to a danger situation. While it is helpful and necessary to see in given cases that certain elements are in awareness and others are excluded from awareness, the strict application of the topology makes not only for inconsistencies in the theory but also shifts the attention away from the real locus of the problem, namely the organism and its danger situation.35

An application of his topology made by Freud which reveals this problem is seen in his discussion of helplessness in anxiety. He holds that in neurotic anxiety the ego is made helpless by its conflict with the id and superego. In all neurotic anxiety the individual is engaged in intrapsychic conflict. But is not this conflict, rather than being a lack of accord among ego, superego, and id, really a conflict between contradictory values and goals the individual seeks to attain in relating himself to his interpersonal world? It is to be granted that certain poles of these conflicts will be in awareness and others will be repressed, and it is also to be granted that in neurotic anxiety previous conflicts in the individual’s life-history are reactivated. But to my mind both the present and the previous conflicts are to be seen not as between different “parts” of the personality but as between mutually exclusive goals made necessary by the individual’s endeavor to adapt to a danger situation.

It is unnecessary to labor the point of Freud’s far-reaching contributions to the understanding of anxiety. For our purposes here, these contributions consist chiefly in the many-sided illumination he shed upon symptom formation, in his many insights into the primal source of anxiety in the separation of the child from its mother, and in his emphasis on the subjective and intrapsychic aspect of neurotic anixety.

Freud will go down in history as the great figure in modern psychology, the one who correctly sensed the significance of psychology—in its form of psychotherapy—for a world in transition and turmoil. Again, whether we agree with him or not is irrelevant. His contributions to the theory of anxiety, “the nodal problem,” remain in the center around which other theories congregate.

RANK: ANXIETY AND INDIVIDUATION

Otto Rank’s view of anxiety stems logically from his belief that the central problem in human development is individuation. He conceived of the life history of a human being as an endless series of experiences of separation, each such experience presenting the possibility of greater autonomy for the individual. Birth is the first and most dramatic event in this continuum of separations, but the same psychological experience occurs, in greater or lesser degree, when the child is weaned, when it goes off to school, when the adult separates from his or her single state in favor of marriage, and at all steps in personality development until ultimate separation in death. Now, for Rank, anxiety is the apprehension involved in these separations. Anxiety is experienced in the breaking of previous situations of relative unity with, and dependence upon, the personal environment: this is anxiety in the face of the need to live as an autonomous individual. But anxiety is also experienced if the individual refuses to separate from his immediate position of security: this is anxiety lest one lose one’s individual autonomy.³⁶

Rank’s understanding of anxiety was influenced by his celebrated studies of the birth trauma.³⁷ The symbol of birth has basic significance in Rank’s interpretation of psychological events all through the life career of an individual, even though his belief that the infant feels anxiety at the time of parturition is debatable. He held that the “child experiences his first feeling of fear in the act of birth,” an apprehension which Rank termed “fear in the face of life.”³⁸ This primal anxiety is anxiety at being separated from the previous situation of wholeness with the mother and being projected into the radically different state of individual existence in the world.

Now, I would agree that our adult minds can imagine the birth experience to be filled with portentous possibilities, certainly enough to engender profound anxiety. But what the infant being born experiences, or whether it experiences anything which can be called a “feeling” is a different question, and in my judgment an open question. It seems more accurate to speak of “potential” anxiety at birth rather than actual, and to treat birth as a symbol. Indeed, it is clear from Rank’s later writings (with the exception of such sentences as that quoted above) that he does employ the birth experience symbolically. For example, Rank rightly held that the patient goes through a birth experience at separation from the analyst in the end phases of psychotherapy.39

What Rank insists upon is that anxiety exists in the infant before any specific content attaches to it. “The individual comes to the world with fear,” he remarks, “and this inner fear exists independently of outside threats, whether of a sexual or other nature.” Later in the development of the child the “inner fear” becomes attached to outer experiences of threat, a process which serves to “objectify and make partial the general inner fear.” This attaching of primal anxiety to specific experiences in the form of fears he describes as “therapeutic,” implying that the individual can deal more effectively with specific threats.⁴⁰ Thus Rank distinguishes between the primal undifferentiated apprehension, which in this study we term “anxiety,” and the later specific, objectified forms of apprehension, which we term “fears.”

A confusion is presented by the fact that Rank uses the term fear to stand for both fear and anxiety. But it seems clear in the contexts of his writing as well as in the phrases themselves that what he refers to as “fear of life,” “inner fear,” and the “primal fear” of newborn infants is what other authors such as Freud, Horney, and Goldstein call anxiety. For example, he describes primal fear as the “undifferentiated feeling of insecurity,” a phrase which is certainly a sound definition of early anxiety. Indeed, it seems to me clear that such general phrases as “life fear” and “death fear” have no meaning unless they refer to anxiety. One can be afraid his neighbor will shoot him, but persistent “death fear” is a different matter. The reader will make better sense of Rank’s discussion in this connection if he reads “anxiety” in most cases where Rank writes “fear.”

The primal anxiety present in the infant, says Rank, takes two forms throughout the individual’s life career, namely life fear and death fear. These two terms, unspecific as they seem at first glance, refer in Rank’s thought to the two aspects of individuation which are shown in an infinite variety of forms in every person’s experience. The life fear is the anxiety at every new possibility of autonomous activity. It is the “fear of having to live as an isolated individual.”41 Such anxiety occurs, Rank held, when a person senses creative capacities within himself. The actualization of these capacities would mean creating new constellations, not only in works of art (in the case of artists) but also in new forms of relationship with others and new integration within one’s self. Thus such creative possibilities bring the threat of separation from previous forms of relationship. It is, of course, not coincidental that this concept of anxiety in creative activity is presented by the psychologist, namely Rank, who has done perhaps the most penetrating work in all depth-psychology on the psychology of the artist. It is a concept we have already seen in Kierkegaard and one which is presented in classical form in the Greek myth of Prometheus.⁴²

The death fear in Rank’s thought is the opposite to the above. Whereas the life fear is anxiety at “going forward,” becoming an individual, the death fear is anxiety at “going backward,” losing individuality. It is anxiety at being swallowed up in the whole, or in more psychological language, anxiety lest one stagnate in dependent symbiotic relationships.

Rank believed that each person experiences these two forms of anxiety in polarity:

Between these two fear possibilities, these poles of fear, the individual is thrown back and forth all his life, which accounts for the fact that we have not been able to trace fear back to a single root, or to overcome it therapeutically.⁴³

The neurotic has never been able to keep these two forms of anxiety in balance. His anxiety in the face of individual autonomy keeps him from affirming his own capacities, and his anxiety in the face of dependency on others renders him incapable of giving himself in friendship and love. Hence many neurotics are characterized by a great need to appear independent but at the same time to keep an actual excessive dependence. Because of his exaggerated anxiety, the neurotic engages in widespread constraint of his impulsive and spontaneous activity; and as a consequence of this constraint, Rank held, the neurotic experiences excessive guilt feelings. The healthy, creative individual, on the other hand, can surmount his anxiety sufficiently to affirm his individual capacities, negotiate the crises of psychological separation necessary for growth, and reunite himself with others in progressively new ways.

Though Rank’s chief interest is in individuation, he is well aware that the individual can realize himself only in interaction with his culture, or, as he phrases it, in participation in “collective values.” Indeed, the characteristics of the prevalent neurotic type in our culture—characteristics which he describes as “a feeling of inferiority and inadequacy, fear of responsibility and guilt feeling, in addition to a hyper-selfconsciousness”—are to be understood as products of a culture in which “collective values including religion have been overthrown and the individual has been pushed to the fore.”44 The loss of collective values in our culture (or, as I would say, the chaotic condition of social values) is not only a cause of neurotic anxiety but sets for the individual an especially difficult task in overcoming neurotic anxiety.

Many readers will find Rank’s terminology and his dualistic mode of thought uncongenial. But it would be unfortunate if this kept anyone from reading him. No one has attacked more insightfully two basic aspects of the problem of anxiety—namely the relation between anxiety and individuation, and anxiety and separation.

ADLER: ANXIETY AND INFERIORITY FEELINGS

Alfred Adler does not present a systematic analysis of anxiety, partly because of the unsystematic nature of his thinking as a whole, and partly because the problem of anxiety is contained in his central and inclusive concept of inferiority feelings. When Adler refers to “inferiority feelings” as the basic motivation of neuroses, he is using the term as almost every other psychologist would employ the term “anxiety.” Hence to discover his understanding of anxiety we must examine his concept of inferiority—a concept which is significant but unfortunately elusive.

Every human being, according to Adler, begins life in a state of biological inferiority and insecurity. Indeed, the whole human race was inferior, tooth for tooth and claw for claw, in the animal world. For Adler, civilization—the development of tools, arts, symbols—is a result of man’s endeavor to compensate for his inferiority in nature.45 Each infant begins his existence in a state of helplessness and would not survive except for the social acts of his parents. Normally the child overcomes his helplessness and achieves security through progressively affirming his social relationships—through affirming, as Adler puts it, the “multiplex bonds that bind human being to human being.”⁴⁶ But normal development is jeopardized by both objective and subjective factors. The objective factors are that the infant’s inferiority may be augmented by organic weaknesses (of which even in adulthood he may be unaware). Or by social discrimination (e.g., being born into a minority group, or being a woman in a culture which holds masculinity to be superior—Adler was a women’s liberationist several decades before this was popular). Or by an adverse position in the family constellation (for Adler, being an only child was an example of this). Objective inferiority, however, can be adjusted to realistically despite the fact that it sets up hurdles to be surmounted in the individual’s development.

The crucial factor for the development of the neurotic character is the subjective attitude toward one’s weaknesses—which brings us to the important distinction Adler makes between inferiority as a fact and inferiority “feelings.” It is a characteristic of the human infant, Adler holds, that he apprehends his inferiority long before he can do anything about it. His self-awareness develops in the context of comparison with older siblings and adults who have much more power than he. This may lead to a valuation of the self as inferior (“I am weak” being a different statement about one’s self from “I have weaknesses”). Such inferiority feelings about the self, which focus on the objective inferiorities mentioned above, set the stage for the development of neurotic compensatory endeavors to gain security by achieving superiority.

is a product and instrument of a cautious psyche which strengthens its guiding principle [neurotic goal] for the purpose of ridding itself of a feeling of inferiority, an attempt which is destined to be wrecked as a consequence of inner contradictions, on the barriers of civilization or on the rights of others.47

By “inner contradictions” he refers to the fact that the human being is fundamentally a social creature, biologically and psychologically interdependent upon other people, and that, therefore, inferiority can be constructively overcome only by affirming and increasing social bonds. The essence of the neurotic endeavor to overcome inferiority is the drive to gain superiority and power over other persons, the drive to demote others in prestige and power in order to elevate one’s self. Hence the neurotic endeavors actually undermine the individual’s only lasting basis of security. As Horney and others have pointed out also, striving for power over other persons increases intrasocial hostility and makes the individual’s own position in the long run more isolated.

Turning specifically to anxiety, Adler asks: What purpose does it serve? For the anxious individual himself, anxiety serves the purpose of blocking further activity; it is a cue to retreat to previous states of security. Hence it serves as a motivation for evading decisions and responsibility. But even more frequently emphasized by Adler is the function of anxiety as a weapon of aggression, a means of dominating others. “What appears to us as important,” he holds, “is that a child will make use of anxiety in order to arrive at its goal of superiority—or control over the mother.”48 Adler’s writings are replete with illustrations of patients employing anxiety in order to force the household to accept their regimes, of anxious wives controlling their husbands by means of a convenient attack of apprehension, and so forth.

Now no one would dispute the contention that anxiety is often used for these “secondary gains.” But to imply that these are the chief motivations of anxiety is to oversimplify the problem. It is difficult to see how anyone who has experienced or witnessed genuine attacks of anxiety and comprehended the torment they involve would conclude that such panics are produced chiefly for the benefit of their effects upon others. One has the impression that Adler in these contexts is talking about pseudo, rather than genuine, anxiety. This impression is given support by the fact that he treats anxiety often as a “character trait”⁴⁹ rather than an emotion. All of which indicates again that he subsumes the basic, genuine forms of anxiety under his “inferiority feelings”—which he would certainly not hold to have their genesis in the fact that they may be used for controlling others.

In genuine anxiety as contrasted with pseudo anxiety, the control exercised over others is a secondary, not a primary, element; and it occurs as a result of the desperation which the patient experiences in his isolation and powerlessness. The distinction between pseudo and genuine anxiety is an important problem which has been very little clarified as yet. It is often difficult to distinguish the two because they may be intermixed in the motivations and behavior of the same person. Many anxiety neurotics, having established their neurotic patterns because of genuine anxiety, powerlessness, and helplessness in the family constellation, learn sooner or later that a strategy (façade) of weakness may be an effective means of gaining power. Hence weakness is used as a way of gaining strength. The case of Harold Brown and others in Part II of this book illustrate this point.50

With regard to the causes of anxiety, Adler does not yield much illumination beyond his general description of the genesis of inferiority feelings. He remarks that anxiety neurosis is always due to the individual’s having been a “pampered” child. This is another example of his tendency toward oversimplification, though perhaps it is no more of an oversimplification than the early Freudian theory that anxiety neurosis was specifically due to coitus interruptus. It is true that anxiety neurotics have learned, generally in early childhood, to depend excessively on others, but this behavior would neither become so firmly entrenched or persist except as the patients are in basic conflict concerning their own capacities.⁵¹

Concerning methods of overcoming anxiety, Adler is very clear, albeit still general. Anxiety

can be dissolved solely by that bond which binds the individual to humanity. Only that individual can go through life without anxiety who is conscious of belonging to the fellowship of man.⁵²

The “bond” is affirmed through love and socially useful work. Behind statements like these lies Adler’s whole positive evaluation of the social nature of man, an emphasis radically different from Freud’s and involving radically different implications for the overcoming of anxiety. Despite his oversimplifications and generalities, Adler has contributed perdurable insights, particularly in the realm of the power struggles between persons and their social implications. These insights are especially valuable because they generally occur in the areas of Freud’s “blind spots.”

JUNG: ANXIETY AND THE THREAT OF THE IRRATIONAL

Only a note concerning C. G. Jung is included in this book, chiefly because Jung has never systematized his views of anxiety. So far as I can determine, the problem of anxiety is not directly and specifically attacked in Jung’s writings, and a comprehensive summary of the implications of his thought for anxiety theory would require a detailed research into all his writings.

One distinctive contribution, however, will be cited here, namely, Jung’s belief that anxiety is the individual’s reaction to the invasion of his conscious mind by irrational forces and images from the collective unconscious. Anxiety is “fear of the dominants of the collective unconscious,” fear of that residue of the functions of our animal ancestry and the archaic human functions which Jung conceives as still existing on subrational levels in the human personality.⁵³ This possible upsurging of irrational material constitutes a threat to the orderly, stable existence of the individual. If the barriers within the individual to irrational tendencies and images in the collective unconscious are thin, there is the threat of psychosis, with its concomitant anxiety. But if, on the opposite extreme, the irrational tendencies are blocked off too completely, there is the experience of futility and lack of creativity. Therefore, as Kierkegaard would say, to avoid futility one must have the courage to confront and work through anxiety.

there is a secret fear of the unknown “perils of the soul.” Of course one is reluctant to admit such a ridiculous fear. But one should realize that this fear is by no means unjustifiable; on the contrary it is only too well founded.54

Primitive peoples are more readily aware of the “unexpected, dangerous tendencies of the unconscious,” Jung holds; and they devise various ceremonies and taboos as protections. Civilized man has likewise devised his defenses against this invasion of irrational forces, which defenses often become systematized and habitual so that the “dominants of the collective unconscious” come into direct control only in such phenomena, for example, as mass panic, or into indirect control in individual psychosis or neurosis.

One of Jung’s central points is that modern Western man places an excessive emphasis on “rational,” intellectual functions, and he holds that in most modern Western individuals this emphasis does not lead to rational integration but rather represents the “misuse of reason and intellect for an egoistical power purpose.”⁵⁵ He cites the case of his patient who was suffering from a cancer phobia. The patient had “forced everything under the inexorable law of reason, but somewhere nature escaped and came back with a vengeance in the form of perfectly unassailable nonsense, the cancer idea.”⁵⁶

In my judgment, the above-mentioned emphases of Jung have a corrective value with respect to characteristics of modern Western culture. They also reveal a common aspect of individual neurosis—namely the misuse of rationalistic functions as a defense against anxiety rather than as a means of understanding and clarifying it. But the problems appear to be that these same emphases in Jung lead to a dichotomy between the “rational” and “irrational” (e.g., his concept of the “autonomy of the unconscious mind”57). This also renders much of his thought difficult to coordinate with other theories of anxiety.

HORNEY: ANXIETY AND HOSTILITY

Important psychoanalytic developments, based on the work of Freud but presenting new elements, are those in which the problem of anxiety is seen in a sociopsychological setting. These views in essence are that anxiety arises out of disturbed interpersonal relationships, an emphasis made, though in somewhat different ways, by Karen Horney, Erich Fromm, and Harry Stack Sullivan. These therapists are often called neo-Freudian or, somewhat derogatorily, revisionists. Since these psychoanalytic developments have large areas of agreement with Freud, we are here concerned with their differences from Freud and with their special contributions to the understanding of anxiety.

This approach involves a new emphasis on culture, both in the broader sense of cultural patterns as determinants in the anxiety prevalent in a given historical period, and culture in the more limited sense of the relationship between the child and the significant persons in his environment. In this last relationship, neurotic anxiety has its source. This approach does not deny, of course, the fact of biological needs in the child or adult. But it holds that the significant psychological question is the role these needs play in interpersonal relations. Fromm, for example, points out that the “particular needs which are relevant to understanding the personality and its difficulties are not instinctual in character but are created out of the entirety of conditions under which we live.”⁵⁸

Anxiety thus is not specifically the reaction to the anticipation of frustration of instinctual or libidinous needs. Considerable frustration of instinctual (such as sexual) need can be borne without anxiety by the normal person. The frustration of instinctual tendencies—again sex is a good example—results in anxiety only when this frustration threatens some value or mode of interpersonal relationship which the individual holds vital to his security. Freud conceived of environmental influences chiefly as a factor in molding instinctual drives; the psychoanalytic developments discussed here, in contrast, make the interpersonal context (the environment, viewed psychologically) central, with instinctual factors as important to the extent that they represent vital values in this interpersonal context.59

To discuss Horney first, it is significant that her viewpoint places anxiety prior to the instinctual drives. What Freud terms instinctual drives, far from being basic, she holds, are themselves a product of anxiety. The concept of “drive” implies some compulsion from within the organism, some stringent and demanding characteristic. (Freud realized that instinctual drives are compulsive in the cases of neurotics; he assumed, however, that the “drive” is biologically determined and that it receives its compulsive strength in neurotics from the fact that they are, for constitutional reasons or because of too much libidinal gratification as infants, unable to tolerate instinctual frustration as much as “normal” persons.) But Horney holds that impulses and desires do not become “drives” except as they are motivated by anxiety.

Compulsive drives are specifically neurotic; they are born of feelings of isolation, helplessness, fear, and hostility, and represent ways of coping with the world despite these feelings; they aim primarily not at satisfaction but at safety; their compulsive character is due to the anxiety lurking behind them.⁶⁰

She equates Freud’s “instinctual drives” with her “neurotic trends.” She believes she thus makes anxiety more basic in personality disturbances than does Freud: “In spite of Freud’s recognition of anxiety as ‘the central problem of neuroses,’ he has nevertheless not seen the all-pervasive role of anxiety as a dynamic factor driving toward certain goals.”⁶¹

Horney agrees with the customary distinction between fears and anxiety. A fear is a reaction to a specific danger, to which the individual can make a specific adjustment. But what characterizes anxiety is the feeling of diffuseness and uncertainty and the experience of helplessness toward the threat. Anxiety is a reaction to a threat to something belonging to the “core or essence” of the personality. She is here in agreement with Goldstein’s concept, described earlier, that anxiety, as inhering in the “catastrophic condition,” is a reaction to a threat to some value which the individual holds essential to his existence as a personality. The question basic for the understanding of anxiety, therefore, is: What is endangered by the threat which provokes anxiety? Her answers to this question can best be understood if we outline first her conception of the origins of anxiety.

Horney takes account of the normal anxiety which is implicit in the human situation of contingency in the face of death, powers of Nature, and so forth. This is the anxiety which has been termed Urangst or Angst der Kreatur in German thought.62 But this is to be differentiated from neurotic anxiety, in that Urangst does not connote hostility on the part of Nature or the conditions which make for human contingency; it does not provoke inner conflict or lead to neurotic defense measures. Neurotic anxiety and helplessness are not the result of a realistic view of inadequacy of power but arise out of an inner conflict between dependency and hostility. What is felt as the source of danger is primarily the anticipated hostility of others.

Basic anxiety is Horney’s term for the anxiety which leads to the formation of neurotic defenses. Such anxiety, itself a neurotic manifestation, is “basic” in two senses: First, it is the basis for neurosis. Second, it is basic in the sense that it develops in early life out of disturbed relationships between the child and the significant individuals in his personal environment, normally his parents. “The typical conflict leading to anxiety in a child is that between dependency on the parents—enhanced by the child’s feeling of being isolated and intimidated—and hostile impulses against the parents.”

The hostility involved in this conflict with the parents has to be repressed because of the child’s dependency on the parents. And since repressed hostility deprives the individual of the capacity to recognize and fight against real dangers, and also since the act of repression itself creates inner unconscious conflict, such repression contributes to the child’s feeling of defenselessness and helplessness. Basic anxiety is “inseparably interwoven with a basic hostility.”63

We have here one example of the reciprocal functioning of anxiety and hostility, each affect accentuating the other. In other language this would be termed the “vicious circle” of anxiety and hostility. Helplessness inheres in the very nature of basic anxiety itself. Horney is well aware that every person—the “normal” adult, for example—has to struggle against opposing forces in the culture, many of which are in fact hostile, but this in itself does not provoke neurotic anxiety. The difference she feels is that the normal adult had the bulk of his unfortunate experiences at a period when he could integrate them, whereas the child in a dependent relationship with essentially hostile parents is in fact helpless and can do nothing about the conflict except develop neurotic defenses. Basic anxiety is anxiety in the face of a potentially hostile world. The multifarious forms of personality disturbances are neurotic defenses created in the effort to cope with this potentially hostile world despite one’s feeling of weakness and helplessness. Neurotic trends, in Horney’s viewpoint, are thus essentially security measures arising out of basic anxiety.

It becomes possible, now, to answer the question: What is endangered by the threat which produces an anxiety attack? Anxiety is the reaction to the threat to any pattern which the individual has developed upon which he feels his safety to depend. The adult in a period of personality disturbance feels the threatening of a neurotic trend which was his only method of coping with earlier basic anxiety, and hence the prospect is one of renewed helplessness and defenselessness. In contradistinction to Freud, Horney holds that it is not the expression of instinctual drives which is threatened, but rather the neurotic trends which operate as safety devices.

Thus neurotic anxiety will be cued off in different persons by different threats; what is important is the particular neurotic trend in the given person upon which he feels his security rests. In a person characterized by masochistic dependence—i.e., a person whose basic anxiety can be allayed only by clinging indiscriminately to another—the threat of desertion by the partner will arouse an anxiety attack. In the case of a narcissistic person—for example one whose basic anxiety as a child could be allayed only by the unqualified admiration of the parents—anxiety will arise at the prospect of being thrust into a situation in which he is unrecognized and unadmired. If a person’s safety depends on being unobtrusive, anxiety will emerge when he is thrust into the limelight.

In the problem of anxiety we must, therefore, always ask the question of what vital value is being threatened; and specifically in neurotic anxiety, what neurotic trend vital to the preservation of the personality against previous helplessness is being threatened. Thus, “anything may provoke anxiety,” Horney writes, “which is likely to jeopardize the individual’s specific protective pursuits, his specific neurotic trends.”64 Of course, the threat may be not only ostensibly external, like desertion by the partner, but it may be any kind of intrapsychic impulse or desire which, if expressed, would threaten the security pattern. Thus certain sexual or hostile inclinations arouse anxiety not because of the anticipation of their frustration per se, but rather because the expression of the inclinations would threaten some pattern of interpersonal relationships which the individual feels vital to his existence as a personality.

The fact that one or the other of the sides of the contradiction will be either continually or at various times repressed only removes the problem to a deeper level.⁶⁵

It will already have been noted that Horney places a great deal of emphasis on the reciprocal relation of hostility and anxiety. This is her forte. She believes that by far the most common intrapsychic factor provoking anxiety is hostility. In fact, “hostile impulses of various kinds form the main source from which neurotic anxiety springs.”⁶⁶ Anxiety generates hostility, and hostile impulses, in the anxious person, generate new anxiety. One is understandably hostile against those experiences and persons which threaten him and which give him the painful experience of helplessness and anxiety. But since neurotic anxiety is caused by weakness and dependence on other powerful persons, any hostile impulses toward these persons would threaten this dependency, which must be maintained at all costs. Likewise, intrapsychic impulses to attack those persons cue off fears of retaliation and counterattack, the prospects of which increase anxiety.

Noting all the reciprocal interactions of hostility and anxiety, Horney concludes that there is a “specific cause” of anxiety in “repressed hostile impulses.”67 Whether such a statement can be made as a generalization without constant reference to our culture we leave an open question. But it probably would be generally agreed that, in our culture, the interrelation of hostility and anxiety is a demonstrated clinical fact.

The contribution of Horney to anxiety theory lies in her elucidation of the conflicting trends in personality as the sources of neurotic anxiety, and in her placing of the problem of anxiety squarely on the psychological level, with its necessary social aspects, in contrast to Freud’s tendencies toward quasi-physiochemical forms of thinking.⁶⁸

SULLIVAN: ANXIETY AS APPREHENSION OF DISAPPROVAL

The concept of anxiety as arising in the locus of interpersonal relations has been most cogently stated by Harry Stack Sullivan. Indeed, he defined psychiatry as the “study of the biology of interpersonal relations.” Though his theory of anxiety was never completely formulated, the salient points presented by him are of considerable importance for any comprehensive understanding of anxiety.

Basic for his theory of anxiety is Sullivan’s concept of personality as essentially an interpersonal phenomenon, developing out of the relations of the infant with the significant persons in his environment. Even in the biological beginnings of life—the fertilized ovum in utero—the cell and environment are unitary, are indissolubly bound. After birth the infant is in intimate relationship with its mother (or mother substitutes), which is both the prototype and the real beginning of those relationships with significant other persons out of which matrix his personality will be formed.

Sullivan divides the activities of the human organism into two classes. First, there are those activities the aim of which is to gain satisfactions, such as eating, drinking, and sleeping. These satisfactions pertain rather closely to the bodily organization of man. The second class is those activities which are in pursuit of security, and these pertain “more closely to man’s cultural equipment than to his bodily organization.”69

A central factor in this pursuit of security is, of course, the organism’s feeling of ability and power. The “power motive”—by which Sullivan means the need and tendency of the organism to expand in ability and achievement—is to some extent inborn.⁷⁰ It is a “given” in the human organism qua organism. This second class of activities—directed toward the pursuit of security—is “ordinarily much more important in the human being than the impulses resulting from a feeling of hunger, or thirst,” or as he goes on to say, of sex as it later emerges in the maturing organism.⁷¹ These needs of the organism which are biological, in the more limited sense of that term, are really to be seen as “manifestations of the organism’s efforts not merely to maintain itself in stable balance with and in its environment, but to expand, to ‘reach out’ to, and interact with, widening circles of the environment.”⁷² The growth and characteristics of personality depend largely on how this power motive, and the pursuit of security it entails, are fulfilled in interpersonal relations.

The infant is first in a state of relative powerlessness. His cry becomes an early tool in his interpersonal relations, and later there develop language and the use of symbols, both of which are powerful cultural instrumentalities in man’s pursuit of security in relations with his fellow-men. But long before language or specific emotional expression or comprehension is possible for the infant, the acculturalization is proceeding apace through empathy, the “emotional contagion and communion” that occurs between the infant and the early significant persons, again chiefly the mother. In this interpersonal matrix, governed chiefly by the needs of the organism for security and self-expression, anxiety is born.

Anxiety, to Sullivan, arises out of the infant’s apprehension of the disapproval of the significant persons in his interpersonal world. Anxiety is felt empathically, in a sensing of the mother’s disapprobation, long before conscious awareness is possible for the infant. It is self-evident that the mother’s disapproval will be very portentous for the infant. Disapproval in the present sense refers to a threatening of the relationship between the infant and its human world. This relationship is all-important to the infant in the respect that he depends upon it not only for the satisfaction of his physical needs but for his more inclusive sense of security as well.73 Hence anxiety is felt as an all-over, a “cosmic,” experience.

With the mother’s approbation come rewards, and with her disapproval come punishment. But more important, there comes the peculiar discomfort of anxiety. This system of approbation and rewards versus disapprobation and discomfort (anxiety) becomes the most powerful fulcrum on which the acculturation and education of the individual proceeds throughout life. Sullivan’s summary of the importance of the mother in this system is as follows: “I have spoken of the functional interaction, in infancy and childhood, of the significant other person, the mother, as a source of satisfaction, as an agency of acculturation, and finally as a source of anxiety and insecurity in the development of social habits which is the basis of development of the self system.”⁷⁴

Anxiety serves to restrain the infant, to restrict his development to those activities of which the significant other persons approve. Sullivan presents the highly significant idea that the self is formed out of the growing infant’s necessity to deal with anxiety-creating experiences. The self is formed out of the need to distinguish between activities which produce approval and those which result in disapprobation. “The self-dynamism is built up out of this experience of approbation and disapproval, reward and punishment.”⁷⁵ The self “comes into being as a dynamism to preserve the feeling of security.”⁷⁶ It is a startling idea—that the self is formed to protect us from anxiety. The self is a dynamic process by which the organism incorporates those experiences which produce approbation and reward, and learns to exclude those activities which have resulted in disapproval and anxiety. The limitations thus set by early experience tend to be maintained year after year “by our experiencing anxiety whenever we tend to overstep the margin.”77

We now need to make explicit what is implied above, namely, that the limitations set by anxiety-creating experiences are not merely prohibitions of action, but are limitations of awareness as well. Whatever tendencies would arouse anxiety tend to be excluded from awareness, or, in Sullivan’s term, dissociated. Sullivan summarizes as follows:

The self comes to control awareness, to restrict one’s consciousness of what is going on in one’s situation very largely by the instrumentality of anxiety with, as a result, a dissociation from personal awareness of those tendencies of the personality which are not included or incorporated in the approved structure of the self.⁷⁸

These concepts throw new light upon some of the common phenomena in anxiety. The restriction of awareness in anxiety states—an occurrence discernible in everyone’s experience as well as a daily observation in clinical work—is Sullivan’s reinterpretation of the classical psychoanalytic idea that anxiety leads to repression. Sullivan sheds new light on why and how this restriction of awareness takes place in his elucidation of the dynamics of interpersonal relations, especially between infant and mother, and the centrally important need of the organism to preserve security. With respect to anxiety and the formation of symptoms, it can readily be seen that, when the dissociation of strong anxiety-creating experience or impulses becomes difficult for the organism to accomplish—as in neurotic states—substitutive and compulsive symptoms develop. These are a rigid means of demarcating awareness. Hence it follows that the dissociated tendencies and experiences will remain dissociated so long as the anxiety connected with them is felt by the person to be too great to be borne.