CASE STUDIES DEMONSTRATING ANXIETY
Anxiety is the dynamic center of neuroses and thus we shall have to deal with it all the time.
—Karen Horney,
THE NEUROTIC PERSONALITY OF OUR TIME
HOW ARE WE TO STUDY ANXIETY IN HUMAN BEINGS? IN a previous section we discussed the grave problems in inducing anxiety in human beings in the laboratory. We also pointed out that we need to know how the individual, in his fantasy or imagination, symbolically interprets the situation. Indeed, we need to know a good deal both objectively and subjectively about the individual we are studying before we can even tell whether his reaction is anxiety, let alone understand it.
A chief reason the experience of anxiety in human beings is so complex is that its determinants are often unconscious. As illustrated in such cases as those of Brown and Helen in the following pages, the person in severe anxiety may actually be driven to deny the existence of the apprehension—not by caprice or by any uncooperativeness, but simply as a function of the severity of the anxiety itself. The subject can protect himself from the overwhelming effects of anxiety only by persuading himself that he is not afraid. This phenomenon is not at all limited to the consulting room; it is a common human experience, as everyone knows. Vide the whistling-in-the-dark strategy, and the war experience of many soldiers. Small wonder, then, that check-lists on which the subject reports conscious data about his “anxieties” are of such minor value (as I was myself to discover in the study reported later in this book). Some students of anxiety hold that it is in understanding fantasy that we come to the “heart of the anxiety problem.” That is to say, a method is needed which will make accessible the subjective and unconscious forms of motivation as well as motivation in its conscious manifestations. Anxiety has an “inner locus,” as Kierkegaard and Freud insisted, and to the extent that we cannot get at that, the essential meaning of anxiety in human beings will elude us.
There are two phases of this problem. The first is the question of whether the individual-in-a-life-situation is to be taken as the unit of study. I answer this emphatically in the affirmative. Today many sociologists and social psychologists report studies in “life-event crises” such as war, accidents, death.1 The second phase is the more specific one of determining what particular methods within the dynamic field are to be employed. Until the advent of psychoanalysis there was no technique of ascertaining the subjective meanings of an experience like anxiety except the insightful self-observation and intuitive understanding of others by gifted individuals like Pascal and Kierkegaard. But if the term “clinical” is used to refer to method, it must be interpreted broadly to include all those methods which illuminate unconscious motivations.2 The projective technique of the Rorschach, giving what the subject will not or cannot tell, was invaluable in the following studies for yielding keys to the dynamics and underlying patterns in the individual’s behavior, which were later corroborated by a multitude of other data.
The following case studies are presented to illustrate the summary and synthesis of anxiety theory given in the preceding chapter. Obviously no clinical case can be placed on the Procrustean bed of our expectation that it answer certain questions and not others. Each case must be taken on its own merits and should be approached in the open-minded mood typified by the inquiry: What has this particular person to teach us about anxiety? But our keeping certain more specific questions in mind as we investigate each case makes for greater clarity and concreteness. I shall, therefore, list some crucial questions for the theory of anxiety which I was asking myself in the following case studies.
Concerning the nature of anxiety and its relation to fears, I asked: Can we ascertain whether specific fears are the foci of underlying anxiety? If neurotic fears are the expression in specific form of neurotic anxiety and if, as I have indicated, the latter arises from basic conflicts within the individual, it should be true that the neurotic fears will focus now on this object and now on that, but that the underlying pattern of anxiety will remain fairly constant. Hence, can we ascertain whether neurotic fears shift as the issues and problems the individual confronts shift, while the underlying neurotic anxiety remains relatively constant?
In the preceding chapter it was held that neurotic anxiety always has some psychological conflict at its source and that the conflict originally occurs in the child’s relation to its parents. Two questions emerge from this aspect of anxiety theory: (a) Can it be shown in the following cases that subjective, inner conflict is always present as the dynamic source of neurotic anxiety? (b) Can it be shown that individuals who have experienced rejection by their parents (especially by the mother) have a greater predisposition for neurotic anxiety? This is one way of stating the classical hypothesis, propounded in various ways by Freud, Horney, Sullivan, et al., and widely accepted in the field of clinical psychology and psychoanalysis, that the origin of psychological patterns which predispose to neurotic anxiety are in the child’s early relations with its parents, especially with its mother.
The interrelation of the subject’s anxiety to his or her culture should be demonstrable at almost every turn in the following cases. Out of this complex area, we select one question: Does the individual’s socioeconomic status in the society (e.g., middle-class, proletarian) appear to have significant bearing on the kinds and quantities of his or her anxiety?
Concerning anxiety and hostility, Can it be shown that anxiety is related to hostile feelings, that the more anxious a person is, the greater the tendency to have feelings of hostility? And when the anxiety subsides, do the hostile feelings abate likewise?
In every person there are a number of rule of thumb ways of dealing with anxiety learned over the years. Can we discover whether, when an individual is confronted with an anxiety-creating situation, characteristic behavioral strategies are called into play (defenses, symptoms, etc.), and that these serve to protect the individual from the anxiety-creating situation?
Finally, I shall approach the problem of anxiety and the development of the self from its reverse side in the first two of the following three questions, seeking to determine whether the presence of anxiety tends to retard the development of the self. Can it be shown that the presence of severe neurotic anxiety impoverishes the personality? Does the acceptance of impoverishment on the part of the individual serve as a defense against the anxiety-creating situation? Can we discover whether the more creative and productive the individual, the more he is confronted with anxiety-creating situations?
HAROLD BROWN: CONFLICT UNDERLYING SEVERE ANXIETY
This first case is that of a young man of thirty-two who was diagnosed as suffering from what is called an anxiety neurosis.3 Whatever diagnostic terms one may use to describe his problems, there is no doubt that he experienced a great amount of anxiety which threatened continually to overwhelm him.
Harold Brown was my first patient in the course of my psychoanalytic training. He is presented here on the hypothesis that certain aspects of the problem of anxiety—such as unconscious conflicts—can best be illustrated by the comprehensive subjective data which this method yields. Though the major parts of what transpired have to be omitted, I hope enough is presented here concerning his anxiety to make sense to readers. I saw Brown for more than three hundred hours under the supervision of Erich Fromm, whose help I wish to acknowledge.
It was only after the following material was written up that I realized how well Brown illustrates Kierkegaard’s main points about subjective conflict underlying all anxiety. For me, Harold Brown cast new light on Kierkegaard’s statements, “Anxiety is afraid, yet it maintains a sly intercourse with its object, cannot look away from it, indeed will not. . . .” Anxiety “is a desire for what one dreads, a sympathetic antipathy. Anxiety is an alien power which lays hold of an individual, and yet one cannot tear oneself away, nor has a will to do so; for one fears, but what one fears one desires. Anxiety then makes the individual impotent.”4
THIS YOUNG man had been suffering for the preceding nine years from a severe, recurring anxiety condition. On graduation from college, where he had received high academic honors, he had entered medical school. After two months he had felt increasingly inadequate and helpless in the face of his assignment. The first anxiety state then developed, the symptoms of which were inability to sleep or work, difficulty in making the simplest decisions, and fear that he was “losing his mind.” The anxiety state was relieved by his discontinuing medical school.
During the next years he tried several different vocations, only to have to discontinue each on the recurrence of anxiety attacks. The anxiety states, generally lasting several months (or until he dropped the particular work he was doing), were accompanied by profound depression and suicidal thoughts. In two of the more severe anxiety spells he had committed himself to mental hospitals for periods of one and eleven months. He had finally enrolled in another graduate school, a theological seminary, and when, in his third and final year, another developing anxiety state incapacitated him for work, he applied for psychoanalytic treatment.
During the early sessions of his work with me, Harold Brown’s mood oscillated between lethargy and inertia on one hand and intense anxiety on the other, the one seeming to be a prelude to the other. In the passive states he characterized himself as “like a dog lying in the sun hoping somebody will feed it.” In this stage, he had many “blissful” memories of the care he had received as a child. In the subsequent anxiety states he exhibited great tension and talked very rapidly, as though driven to get out a torrent of words. He described his feelings in anxiety as having a general emotional vagueness and a “blurred” quality. When in anxiety it was difficult or impossible for him to have any clear and distinct feelings, whether of a sexual nature or otherwise. This state of emotional “vacuum” was excruciatingly uncomfortable for him. He would often go to movies or try to become engrossed in a novel, for, as he phrased it, if he could gain “empathy” with other persons, if he could feel something which other people were feeling, he would to that extent find relief from his anxiety. He is apparently here describing the state of diminished awareness of one’s self which characterizes severe anxiety. I think it a significant insight on his part that if he could become aware on a feeling level of the reality of other persons, he would to that extent become aware of himself as a subject differentiated from objects.
The chief features of Harold Brown’s first Rorschach, which was given to him at the beginning of his analysis when he was in a relatively severe anxiety state, were the great predominance of vague, unelaborated whole responses, the low degree of the responsiveness and productivity, the general banality, and the complete absence of any originality.5 The “blurred” relation to reality which characterized this first Rorschach corresponds to Brown’s testimony that in severe anxiety he could not experience “distinct feelings.” It is as though the inner, subjective vagueness involved in the anxiety carried over into a general vagueness in his manner of evaluating outside, objective stimuli as well. This is an illustration of the thesis advanced earlier that severe anxiety breaks down the capacity to experience the self in relation to objects and is, correspondingly, an experience of “dissolution” of the self. Brown’s endeavor to overcome his anxiety by becoming aware of other people’s feelings is insightful in the respect that he could then become aware of himself in relation to other people and to this extent overcome the state which we term the “dissolution” of self.
He had been born in India, the son of American missionaries. While his mother was pregnant with him, the only two other children in the family died in a plague. In his childhood he felt he had been “coddled,” not only by his mother but by the native women servants, who insisted on dressing him until he was seven. Three girl siblings were born later, with one of whom he engaged in very severe and violent competition for the favor of his parents. “I wanted to be the baby,” he phrased it; and when his parents would adjudicate a dispute in the sister’s favor, he would feel deeply incensed and threatened. When the patient was in his teens, his father broke down in what was diagnosed as manic-depressive psychosis and the family returned to this country, where his father was hospitalized. Several years later his father committed suicide.6
The pattern that seemed crucial to Brown’s anxiety was his very dependent, symbiotic relationship with his mother. Two significant memories illuminate the early relationship. First, when he was five, his mother, while nursing one of the babies, had offered him her breast with the remark, “Do you want a drink too?” The intense humiliation he had felt at this implication that he was still a baby came up repeatedly in the therapy in many different contexts of his relations with his mother. Second, when he had engaged in a prank at the age of eight, his mother had punished him by making him whip her. The traumatic experience of his being forced to punish his mother, became the focus for his later feeling that he could never hold any opinion or exercise any judgment independently of his mother, for she would then assume a martyr role and “my hands would be tied.” He was dominated by the mother under the formula, “If you go against my authority, you do not love me.”
At the time of this therapy he was being supported by his mother, as he had been during his previous periods of incapacitation. Both he and his mother were worried about how he would be supported when she died. Even at his present age his mother’s letters addressed him as “my darling boy,” after receiving which he often had anxiety dreams of “some one trying to kill me” or, in one illuminating example, of “Russia trying to converge on a small country.” In one of the letters he received from his mother during the analysis, she stated that if she had sufficient faith in God, he would be cured of his illnesses through her faith. He was understandably resentful at her implication that he could do nothing whatever, religiously or psychologically, to help himself apart from her. The origins of Brown’s anxiety pattern can be understood in the context of his having to deal from the time of birth onward with a dominating, sado-masochistic mother, who exercised her tyranny at one moment by an assumption of strength but at other times by the more effective—and, for Harold, more confusing—strategy of cloaking the tyranny under a pretense of her weakness.
This conflict underlying his anxiety was shown in two dreams during the first months of therapy:
I was in bed enjoying a close physical embrace with a woman. It became apparent that it was my mother. My penis was erect, and I was embarrassed. As I tried to pull away, she said, “You’ve got to grant me some satisfaction.” So I fondled her breasts. Then an emission of semen came from her breasts, as from a male genital.
We note in this dream that the mother commands him to devote himself to her satisfactions, and that he imputes to her the sexual functions of the male. Several weeks later he received word that his mother had hurt her arm, which news so perturbed him that he had immediately phoned her in the distant city where she lived. That night he had the following dream:
A rotting, putrid arm had reached out from a hole in a rock and grabbed my penis, pulling it away from me. I was mad, and I reached in the hole to grab the hand, pull it out, and make it let go of my penis. Then I felt some one punch me in the back with a knife or pistol, to force me to let go. It seemed to be another person, an accomplice of the hand, who was going to kill me if I didn’t let go. I awoke in great fright.
His associations with penis—“strength,” “power,” “my own penis is small”—indicated that the word for him, as for many persons in our culture, stood for his own individual power. Since the arm obviously is his mother’s, the dream seems to say in the easiest way possible that his mother has taken his individual power away from him, and if he tries to regain it he will be killed. In both dreams he sees his mother as possessing great power, including masculine power, and himself as the victim of her demands.
His conflict may be stated: If he tries to use his own power, to produce and achieve independently of his mother, he will be killed. But the opposite path, namely remaining dependent upon her, can be pursued only at the price of continued feelings of inadequacy and helplessness. The latter way out of the conflict requires a renunciation of his individual autonomy and strength, but, in symbolic language, it is better to be castrated than to be dead.
These dreams might be interpreted in the classical mode of Oedipus, incest and castration. But in my judgment, the meaning of the symbols is significant rather than the sexual content per se. From this viewpoint the essential point about the first dream is not simply that the subject has sexual contact with the mother, but that the mother commands it. In the second dream it is his mother who castrates Brown, not his father.
There are, of course, bound to be many incest references in a case of this sort. The significant point is illustrated in the following dream: “I was secretly married to an older woman. I didn’t want to be, so I had myself committed to an institution.” This is an eloquent statement of his struggle to get away from his mother—even to the point of having himself committed to a mental hospital (which suggests, also, that his psychological illness has some function of protection against his mother). One might hypothesize that his not wanting to be married to her and his having himself incarcerated are the result of guilt feelings arising from the incest desires; but it does not seem necessary to make that interpretation. The dream can be understood more simply and directly as saying that he knows what marriage to his mother really means—i.e., to be enslaved by a tyrant—and being incarcerated is preferable if that is the only way one can avoid such a relationship. In the present study I treat incest phenomena as indicative of excessively dependent relations of the person upon the parent, beyond which the person has been unable to “grow up.”
The above dreams indicate how severe the conflict underlying neurotic anxiety may be. It is scarcely surprising that such a conflict should have such thoroughly paralyzing and incapacitating effects upon Harold Brown. Much of the superficial material in this case could be interpreted in Adlerian fashion—e.g., as anxiety used as strategy for remaining under the care of the mother and mother substitutes. But if such an interpretation is made, we must not overlook the crippling conflict which underlies the anxiety. It is comprehensible why this person should describe his feelings during anxiety as “like fighting something in the dark, when you don’t know what it is.” When he received letters of moralistic advice from his friends, he reacted with a surprisingly insightful analogy: “They [the friends] are like people calling to a drowning man to swim, when they don’t know that under the water his hands and feet are tied.”
We turn now to the question of the occasions which cued off anxiety in Harold Brown. In spells of acute anxiety, which generally lasted from three days to a week, it was almost impossible to discover at the time what situation in his present experience had cued off the panic. When I would urge him to inquire into the occasion of the present anxiety spell or “what” he was then afraid of, he would insist that the occasion had nothing whatever to do with the anxiety and assert, “I’m afraid of everything, I’m afraid of life.” He was aware only of intense, paralyzing conflict. Despite the fact that the event or experience which cued off that particular anxiety spell could often be recovered in retrospect after the panic was over, there is logic in his feeling that the occasion was of secondary importance. I do not refer simply to the fact that his severe anxiety rendered him incapable of surveying his reality situation objectively. I refer, rather, to the fact that the occasion was not the cause of his anxiety. Whatever had cued the conflict off, it was none the less the conflict which caused his anxiety—i.e., produced his paralysis and helplessness. If we are to interpret his “logic,” it would be that the particular event or experience which activated the conflict might be objectively a relatively minor event, but it had its subjective significance in the fact that it served to cue off the conflict, and it receded in objective importance as the conflict became more severe.7
In less severe anxiety attacks, it was possible to discover the occasions of his anxiety with fair accuracy. These occasions, together with the occasions reconstructed in retrospect after severe panics, fall into three main categories. First, anxiety was obviously occasioned by situations in which he had to assume individual responsibility. For one example, in a period just before our therapeutic work had to be suspended for the summer, he experienced a great deal of tension and spewed out a torrent of words about his dread that he might have cancer. This cancer fear was associated with an anxiety panic in childhood when he feared that he might have leprosy and would have to be separated from his family. It goes without saying that a person with such pronounced feelings of inadequacy would profoundly dread separation and isolation from those upon whom he depended. The fear of cancer vanished on this occasion when the anxiety at separation from me, his therapist, was clarified. Another example of anxiety at having to assume responsibility occurred when, after a year of analysis, he re-enrolled for his final year of study for his graduate degree. Several severe anxiety attacks ensued, during which he was overwhelmed with feelings of helplessness and inadequacy at the prospect of having to produce papers and write examinations. He felt that he “would not measure up,” would “lose out in the race,” would “lose face,” etc. Since he subsequently did accomplish these dreaded academic assignments successfully, with no intervening factor except a reduction in anxiety, it is clear that the anxiety arose not from a realistic appraisal of inadequacy in the face of tasks (i.e., the occasion) but rather from the neurotic conflict which facing these tasks activated.
The second category of occasions of his anxiety was situations of competition. These occasions were not only major events such as academic examinations, but also relatively minor events like bridge games or discussions with his colleagues. This anxiety in competition was generally associated with his severe rivalry with his sister during childhood. The prototype for this anxiety, therefore, seems to be the threat to his excessive needs to be in an approved and favored position with his mother. In such matters as academic examinations, this approval could be gained by his being successful in competition. But on a level quite below his feeling of lack of personal power to achieve, he is faced with the dilemma that if he does achieve—i.e., does use his own power—he will be met with death at the hands of his mother. It is understandable, therefore, that the most minor competitive situation would thus activate a major subjective conflict.
But most significant of all is the third group of occasions of anxiety—namely, anxiety after achieving success. During his final year of graduate study he was invited to preside at a meeting of an important professional society, an event which represented considerable achievement to him. Some undercurrent of tension which he experienced before this event was clarified, and he discharged his responsibility successfully, receiving compliments from persons who had status in his eyes. The next day began one of his most severe attacks of anxiety and depression. This is understandable on the basis of the conflict outlined above, since using his own powers raises the threat of being killed. His general practice was to refuse to admit any achievement, such as wearing his Phi Beta Kappa key, for, as he phrased it, “When I’m succeeding, I’m afraid it will be a barrier between me and others.” If he awoke in the morning feeling rested and strong, he reported apprehension lest he be “separated from other people.” He felt he could overcome anxiety spells by crying in the therapy sessions, by “showing my weakness.” This use of weakness alleviated his conflict in at least two respects: first, by being weak he would be accepted, “loved”—prototypically by his mother—while being strong would mean isolation and separation from his mother; and second, being weak and unsuccessful avoided the threat of being killed.
We have referred to the cause of the anxiety as the neurotic conflict, and the occasions of it as the experiences or events which activated that conflict. It can be noted that the more severe Brown’s anxiety, the more the conflict predominated and the more the occasion receded in importance in his experience. In this respect the significance of the occasion lay in its subjective function of cuing off the conflict. We have also noted that the occasions always bore a logical and consistent relationship to the particular nature of his conflict—e.g., it was not fortuitous that occasions of responsibility, competition, and achieving success cued off this particular patient’s conflict. The occasion always involved some anticipated threat (defeat in competition, “loss of face,” etc.). But what I wish to emphasize is that when the conflict was activated, Harold Brown was faced with threats whichever way he turned. The anxiety was, therefore, due not just to the anticipation of threat inhering in the occasion (e.g., he might fail in an examination), but rather was due to the experience of being in a dilemma in which he was threatened from both sides at once. If he achieved some success, he was threatened with death by his mother; if he failed to achieve the success and remained dependent, he was threatened with continued feelings of helplessness and inadequacy.
The regular pattern of progression assumed by most of his anxiety spells is revealing. First, he would report a fear that he had cancer, or that he had recently experienced a momentary spell of dizziness as “though some one had struck me in the back of the neck.” He spoke of this several times as a “rabbit punch,” a blow at the back of the neck with which you kill a rabbit. This implies that he is the rabbit. This latter symptom, associated with some electric shock treatments he had received several years earlier, was felt by him to indicate that he had some organic brain injury.8 Both the fear of cancer and the dizziness were presented by Brown as entirely rational, with supporting evidence from the daily papers, for example, about the contemporary high incidence of deaths from cancer.9 When I suggested that the psychological meaning of the fears be explored, he would show offense and insist he felt no conscious anxiety whatever.
The second stage would follow a day or so later: the fears associated with cancer and the dizziness would be forgotten, but anxiety dreams would appear, generally about his mother. Still there would be no conscious admission of anxiety. In the third stage he would exhibit increased dependence on me, insisting that authoritative guidance be given, with increasing covert or overt hostility if these demands were not met.
The final, fourth step in the progression, again appearing a day or two later, would be the emergence of a conscious anxiety attack, with concomitant severe tension, discouragement, and eventually depression.
It seems to me that we have in these steps the progressive emergence of anxiety into conscious awareness, the anxiety assumedly occasioned by some experience or event just prior to the reporting of the original dizzy spell or the fear of cancer.
From the dreams and other material so far related it is evident that the patient had much repressed hostility against his mother. Indeed, from the standpoint of almost any form of psychology it would be impossible to conceive of a human being existing in such a dilemma without his experiencing great hostility. During therapy, his hostility was manifested in two opposite forms. First, he exhibited hostility whenever he felt he was not being allowed to remain in a dependent state. This is hostility as a reaction to anxiety at having to assume the independent responsibility for which he felt inadequate. When he felt that being analyzed required too much effort and responsibility on his part, he would demand that the analyst give him specific advice and authoritative directions for his behavior, as he felt a minister would give him “specific moral and religious instruction” or a physician would tell him exactly what was wrong and exactly what he should do without his having to assume any self-direction whatever. The psychosomatic symptom often accompanying this hostility at having to assume independent responsibility was diarrhea. This illustrated in a remark, “I feel all plugged up; if I could just have a big bowel movement—if I could just get mad!”
The other form of hostility emerged whenever he was placed in a dependent, helpless position. Most of the repressed hostility toward the mother falls in this category. We have noted the evidence for this hostility as early as the fifth year, when he was humiliated by his mother’s implication that he was still a baby in proffering him milk from her breast.
His difficulty in admitting overt hostility was present in his relation with me as well as with almost all other persons, and was particularly in evidence when he was anxious. Generally, his hostility took the forms of general resentment, occasional hostile dreams, or displacement on other persons. During his anxious periods, he saw everybody as hostile to him.
It will be noted that these occasions of hostility are really contradictory and that they correspond to the two aspects of Brown’s fundamental conflict. In other words, hostility was a reaction to the exacerbation of either side of his conflict. There was a direct relation between the arousing of the conflict and hostility since the more anxiety he felt, the more hostility (covert or overt) was present. When his anxiety abated his hostility did likewise. It was almost impossible for him to admit overt hostility toward his mother, despite the presence of this hostility in dreams and its evidence as a general undercurrent of resentment toward her and specific annoyance at her letters. The hostility had to be in large measure repressed, lest the great dependence upon his mother be threatened. Two secondary gains of his recurring psychological illness, revealed in his associations, were that since his mother was then required to support him, he could both remain dependent upon her and at the same time get even with her.
A second Rorschach, given to Brown after ten months of analysis when he was relatively free from anxiety, showed a remarkably different picture.10 He now had fifty responses, compared to eighteen on the first record, three original responses compared to none on the first, and a much greater capacity to relate to concrete, specific realities. The banality of the first record was gone; we now see the picture of a productive and effective personality. No matter to what one attributes the change—to the year of psychoanalysis, to the transference situation, etc.—the fact remains that at the time of the first record he was in an anxiety state, and at the time of the second he was not. It seems necessary to conclude that we have in these two records the contrasting picture of the same individual’s behavior and personality when in a state of severe anxiety and when he is relatively free from anxiety. We have in the first Rorschach an individual whose anxiety blocks his capacity to relate to concrete reality, renders reality “blurred” and vague, and undermines both his feeling and thinking capacities. It is the picture of an individual who cannot let himself be aware of other people or respond to them, a “shut-up,” unfree, and thus impoverished personality. In the second, we see a radically freer person able to see and relate to the world around him, to be aware of others and correlatively of himself, a person with his previous banality gone and in its place some genuine originality.
The study of Harold Brown demonstrates a number of significant aspects of the dynamics of anxiety, several of which I shall here summarize. In all summaries, the problems seem simpler than they actually are. In the following conclusions, anxiety may sound again like an abnormal condition affecting only unfortunate individuals. I would like to emphasize again that anxiety is a life-long challenge. The tragedy of Brown is that his anxiety, which was severe enough at times to remove almost all possibilities from his existence, is mainly destructive and paralyzing rather than challenging and enlivening. I hope the reader will keep in mind the essential humanness of anxiety.
(1) Relation between Fears and Anxiety
How anxiety relates to fear is illustrated in the phenomenon of the cancer dread. This appeared as a specific, “realistic” fear, clung to by Brown with all sorts of arguments. But it was later demonstrated to be an objectivated manifestation of underlying neurotic anxiety.11
(2) Conflict Underlying Neurotic Anxiety
I have proposed that his anxiety rose out of his symbiotic relation with his mother. This relationship was characterized by a conflict between his own needs to achieve some autonomy and use of his own powers and the conviction that if he did appropriate his own power he would be subject to the dire threat of being killed by his mother. Consequently his behavior was characterized by passivity, a subordination of himself to others (prototypically his mother), and a need to have others take care of him. At the same time he experienced overwhelming feelings of inadequacy and helplessness. Severe anxiety ensued whenever this conflict was activated.
In theory one might assume that there would be no conflict if he simply subordinated himself to his mother’s power and forgot about his own autonomy. Such a prospect only increased his feelings of worthlessness and inadequacy. Whether any human being could permanently surrender his own autonomy to some one else and thus avoid conflict is very much open to doubt.
It might be added that the progress of this patient toward overcoming his anxiety neurosis was characterized by development on three flanks: (1) a gradual clarification of the previously unconscious mother relation; (2) a renunciation of the excessive aspects of his ambition (which had previously shown themselves in perfectionistic academic striving); and (3) a gradual growth in, and experiencing of, his capacity to use his own strength without thereafter feeling threatened. This account of the direction of his development is grossly oversimplified, but at least it may illustrate how the two sides of his conflict were relieved more or less simultaneously.
(3) Relation between Hostility and Anxiety
This relation is illustrated in that the above conflict (and concomitant anxiety) was greatly abetted by his repressed hostility toward his mother. Speaking more specifically, we noted the relation between hostility and anxiety in the fact that when Brown was in relatively greater anxiety, he exhibited increased hostility (covert or overt); and when his anxiety abated, his hostile feelings did likewise.
(4) Symptoms and Anxiety
The symptom of dizziness (a psychosomatic symptom) and the fear of cancer (a psychological symptom) appeared as the first step in the progression of unconscious anxiety into awareness. These symptoms disappeared as the anxiety became conscious. This is in accord with the contention advanced earlier in this study that the presence of symptoms bears an inverse relation to conscious anxiety. The function of these symptoms is to protect the person from the anxiety-creating situation—i.e., any situation which will cue off his conflict. This can be seen when we consider that if this young man really had cancer or an organic injury, his conflict would be relieved in several respects: (a) he could remain in a dependent role (such as being hospitalized) without guilt feeling; (b) he could avoid having to undertake tasks for which he felt inadequate; and (c) he could get even with his mother by requiring her to support him during the illness.
(5) Severe Anxiety and Impoverishment of Personality
This relation is seen in a comparison of the two Rorschachs, which I wish briefly to repeat. The one taken when Harold Brown was in anxiety is characterized by meager productivity, vagueness, no originality, and a blockage both of “inner” activity and the capacity to respond to emotional stimuli from the outside. The Rorschach taken when Brown was relatively free from anxiety shows much greater productivity, radically increased capacity to deal with concrete realities, a fair of originality, and greatly increased “inner” activity as well as increased emotional responsiveness to things and persons in his world.12