Some of the following cases, through which it was desired to illustrate or demonstrate only one or two points, are presented only briefly. As frequently as practicable, the subject’s own words are given. In the face of the great mass of data about each person, some selection in presentation was obviously necessary. I hope that enough of each case is presented to make evident the conceptualization of the case and to clarify the points we desire to illustrate. Although the Rorschach numerical scores are given, it is understood that the configuration in each Rorschach is more crucial for its interpretation than the numerical scoring. Unless otherwise stated, the parents in each case were white, American, and Protestant.

Her two years at college had been on a scholarship, where she had done brilliant but erratic academic work. Since leaving college she had held routine jobs such as operating mimeograph machines. Because of boredom she would quit her job every two or three months, “and then is when I would get into difficulty”—i.e., she would live with a man. Her hope was to write radio scripts. The sample scripts she had written which she showed me seemed to be very good technically but artificial in content and lacking in genuine feeling.

The most immediate focus of Helen’s anxiety seemed to be her pregnancy and impending parturition. This, with its related defenses of intellectualizing, laughing-it-off, and evasion, was evidenced not only in our interviews with her but in her behavior with the other young women in the house. She regularly refused to discuss her pregnancy with the social worker, insisting, “It just seems to me I’m not pregnant, and until the baby is born I refuse to give it a thought.” But it was observed that she spent a great deal of time discussing pregnancy in an intellectualized, quasi-scientific manner with the others in the house. She described to them the fetus at various stages in its development as though she were talking from a scientific manual. One day she received a letter from her aunt, telling of the latter’s having gone to the hospital for parturition; Helen reacted with a fit of hysterical weeping. It was evident that she displaced much of her own anxiety about parturition on the aunt, but when the social worker pointed this out, Helen still refused to talk about her own pregnancy.

When I indicated that her Rorschach suggested she felt anxious about going to the hospital for the birth, Helen replied:

The reader will agree, I assume, that this speech, combining emphases on catastrophe and urgency, reveals a very frightened person. It suggests the typical picture of someone whistling in the dark, putting up a front of dramatic bravado toward the prospect she dreads most. This reminds us of the observation of R. R. Grinker and S. P. Spiegel in Men under Stress, that the anxious airman would be the first to get himself into the air and into a situation of danger, the danger itself being less painful than the anticipation of it.

Helen’s bravado and laughing-it-off techniques of allaying anxiety were so well developed that they were carried right up to parturition itself: on departing for the hospital she left a note for me, “I’m off to get myself a new figure.” The obstetrician reported that her last words before going under ether were, “This has got to be adoptable material.”

The chief facts that stood out in Helen’s description of her childhood were the violent quarrels of her parents, the frequent periods of upheaval in the family group (parental divorce, conflict with stepparents, etc.), and Helen’s testimony to her considerable loneliness as a child. There was evidence for much outright rejection of her, as well as of the other children, by her father. She recalled that his regular practice was to deposit the children at the movies all day while he played golf. He would then come home drunk, and a quarrel between the parents would ensue.

It is difficult to determine with any clarity Helen’t attitude toward her mother during early childhood. She speaks of being “excessively devoted” to her mother as a child, but it was my impression that this “devotion” was really a construct from the fact that at that age Helen was considered the favorite child by the mother. Definite indications of hostility and resentment toward both parents, and especially the mother, were present in Helen’s Rorschach and in the interviews. One such response on the Rorschach was “children scaring their parents to death,” and another was “Brownies with round bellies laughing with great pleasure because they have just pulled a hot joke, messing up the housewife’s floor.” This last response suggests that her pregnancy is associated with aggression against her mother. The hostile, aggressive elements in both these responses were omitted in the Rorschach after parturition, the Brownies now specifically described by Helen as “wistful, not malicious.” Likewise the aggression and hostility toward her parents, especially toward her mother, diminished after parturition. Several hypotheses suggest themselves: she was more anxious before parturition and, therefore, felt more hostility and aggression, or she employed the pregnancy as a weapon against the parents and after birth this weapon could be discarded. Finally, she may have held them in some way responsible for her being in this difficult state of pregnancy.

On the Rorschach some of the guilt feeling was connected with sex: on Card VI, which generally elicits a sexual response, there was more nervous laughter than usual, and she paused for long periods after each response saying, “It looks like something else I can’t get.” The final response in this card was a vista of a woman in an idolatrous shrine, which suggests that Helen was not as emancipated from her religious background as she would believe. But most of her guilt feeling and concomitant anxiety seemed to be connected with what people thought of her: after a response “two old maids pointing and gossiping about the pretty widow,” she gave one of her typical anxiety responses related to her pregnancy. On the childhood anxiety check-list, anxiety related to disapproval by her peers was second, and anxiety related to disapproval by her family was third in quantity. The same mechanisms which she employed to allay anxiety were used for allaying guilt feelings: a blasé, laugh-it-off attitude and an endeavor to intellectualize and depersonalize the issue of guilt (e.g., “My mother and I are unmoral not immoral”).

A similar merging of guilt and competitive feelings was evidenced in her numerous remarks of self-depreciation in the interviews. At the outset of the Rorschach she coyly warned that she never did well on tests; then she proceeded to throw herself into the endeavor to produce a superior record. On the whole, the many self-deprecatory remarks of Helen were partly an expression of guilt, and partly a way of disarming others and covering up her competitive striving so that her eventual success would be the more noticeable.

We now consider competitive ambition as such, the final and in many respects the most pronounced area of Helen’s anxiety. In contrast to her denial of apprehension in the areas of parturition and feeling, Helen consciously admitted that competitive ambition was a source of pronounced anxiety for her. The highest score on her childhood anxiety check-list was for anxiety in the area of success and failure in school and work. She was unwilling merely to check “often” for her anxiety about “failing a test in school” or not being a success,’ but added several exclamation points for special emphasis. Competitive ambition in intellectualized form was shown in the Rorschach not only in the “whole compulsion” but also in her straining herself to the limit, which she rationalized by misinterpreting my directions (“You told me to give all I could”). Other evidence of this competitive ambition, in the social worker’s judgment is that Helen sought to impress her with the high intellectual talent of the groups in which she moved in the city.

It is not difficult to see why Helen chose an intellectual sphere as the chief area for the exercise of her competitive ambition. As a child she was precocious in school; her family had rewarded her with considerable prestige for her academic successes. In periods of emotional insecurity in the family—caused chiefly by violent quarrels between the parents—Helen was able, even as a child, to assume leadership and exercise control over her parents because they recognized her as the “bright one” in the family. Apparently from her early childhood onward her intellectual capacities had been rewarded not only as a method of gaining competitive prestige but also specifically as a means of controlling and ameliorating anxiety-creating situations.

OUR OVER-ALL ranking for Helen’s degree of anxiety was moderately high. Her ranking for rejection by her parents was likewise moderately high.

The methods of avoiding anxiety illustrated in the case of Helen deserve further discussion. We have seen that these methods included laughing-it-off behavior, evasion and outright denial, which might be termed an “ostrich” pattern of behavior toward anxiety, and intellectualizing. If these are Helen’s chief methods of avoiding anxiety, two conditions should be demonstrable. First, it should be true that when her anxiety is relatively greater, these avoidance forms of behavior should be more in evidence; and second, when the anxiety subsides, the avoidance behavior mechanisms should abate. In other words, the more the subject experiences anxiety, the more the mechanisms for avoiding are called into play, and vice versa.

It became clear in Nancy’s behavior and in my interviews with her that her security, and consequently her ability to keep anxiety at bay, depended almost entirely on whether she could convince herself that other people accepted her. She was intensely worried about whether her fiancé’s parents would continue to like her, and tried constantly to reassure herself by the fact that they seemed to like her now. Her continual reference to them, as to most people she admired, was, “They are such nice people, and they like me.” She searched the letters from her fiancé for assurances that he still loved her. It was only by the security she found in him, she emphasized, that she could go through her present difficulties: “If anything went wrong with his love for me, I’d break down completely.” The criterion of whether the fiancé, or anyone else for that matter, loved her was whether he could be depended upon, as her mother and her first boy friend could not be, but as she believed her fiancé could be.

Though Nancy had amicable relations with everyone, she stated that she was very cautious in choosing real girl friends, for “most girls can’t be depended upon to help you.” She never brought up any references to her own feelings which would indicate affective, outgoing responses to these other people who were so important to her. Her own emotional response, even to her fiancé, seemed not to enter the picture, her only reference being the general statement that she loved him. The important point for her was not how she felt toward the other but whether the other person “loved” her—by which she meant a condition in which the other would not reject her. Thus “love” for Nancy was essentially a security device by which she could keep anxiety at bay.

Her repeated statements that loneliness was her motivation for making love and having sexual relations with the first boy friend now make sense in the respect that sexual activity was a way of placating him and thereby holding him. She was upset by the need to deceive anyone. She stated several times that she hoped she could some day tell her prospective mother-in-law about the pregnancy—though this was certainly not an objective problem at the moment—because she hated to have that deceit between them. As an adolescent she had often been given money by her stepfather for her personal needs; she could never keep this fact from her mother despite the fact that she knew her mother would then take the money from her to spend on liquor. All of the above indications give us a picture of Nancy as a person to whom any rejection is a profound threat, and who must, therefore, placate other people at all costs. Her interpersonal security was so tenuous that the slightest ill will, aggression, discord, or deceit, however justified, would destroy it, and unmanageable anxiety would ensue.

Her conscientiousness in her work, as we shall see, on her Rorschach, was a method of buying acceptance. Though Nancy had never had any problems in getting and retaining jobs in the workaday world, she had always been anxious about her work, feeling she would be discharged if she did not keep constantly alert. “There’s always some one to take your place if you don’t keep on your toes.” This repeated phase “keeping on your toes” is a very apt expression for this type of anxiety, in which the individual feels that disaster can be avoided only by remaining perpetually in a state of tense balance.

Apparently this rejection of the child continued, though on a somewhat diminished scale, after the mother remarried. The subsequent period, when “we had a good home in the suburbs,” is emphasized by Nancy as a kind of Garden of Eden period of happy childhood. In her interpretation of her background, she dates her real misfortunes from the time of their losing this house when she was twelve.

After that my mother became unsteady, and she and my stepfather began to go out to bars all the time. They’d take me sometimes, but I didn’t like that. Sometimes they wouldn’t come home all night. They’d leave a girl with me, of course, but I’d wake up in the morning and not find them there. That’s not right. . . . I’d worry for fear something had happened to them. Then, when I got to be sixteen, my mother really did go bad.

Nancy intensely disliked talking about her childhood, a discomfort which was shown in inordinate smoking and in her stating that such conversation made her “nervous,” which embarrassed her. She remarked that she could remember the events but not the feelings and added, “That’s strange—the way I seemed to want my mother as a child, you’d think I would remember the feelings about her.” She exhibited a need not only to block off the affect connected with these childhood rejections themselves but also to block off the immediate affect in telling about the events. The fact that she had shown emotional involvement, “nervousness,” in telling of these childhood rejections very much upset her. During the subsequent two interviews she remained carefully poised and exhibited an unspoken determination not to display any emotional involvement again.

It will already be evident to the reader that there was a patent contradiction in Nancy’s description of her childhood. This contradiction, consisting of conflicting attitudes toward her mother, was of fundamental importance. On one hand there was the actual fact that Nancy felt, with considerable basis in reality, that she was rejected as a child, and that this rejection was exceedingly painful to her. But on the other hand there was her tendency to idealize her mother and parts of her background. In her recounting these memories, there emerged time and again the refrain about the “good home in the suburbs, with a little brown road leading up to it,” and the accompanying assertion, “My mother was such a good mother then.” I take the romanticized references to the “good home in the suburbs” as one symbol of her idealization of her relationship with her mother. When Nancy would approach some aspect of her childhood which was repugnant to her, she would interpolate as a vague but intense hope, “But my mother could have been such a good mother.” This phrase sounded like the talisman of a primitive, an incantation with magical properties, an amulet to ward off evil.

Much ambition was shown in the record, taking the form of compulsions to produce in quantity, to get everything in (as though she must cover all of experience by including every tiny detail), to produce perfectly, and to show originality. The perfectionism was partly a way of gaining security by sticking to details in which she could be meticulously accurate, but it was also an endeavor to gain acceptance and reassurance from the tester. Her ambition was not to gain power over others (like Helen’s) but rather served as a way of getting acceptance—e.g., “If I do well, if I am ‘interesting,’ I will not be rejected.” Her rating for anxiety on the Rorschach was: depth 3, width 5, handling, 1, which placed her highest among all the young women in this study.

Nancy filled out the anxiety check-lists with the same meticulous care for accuracy, pondering each item (“I don’t like to check them unless I’m sure”), and returning to reconsider items and revise her checking. In quantity, she ranked in the high category on the childhood list, moderately high on the present list, and low on the future list. All three lists showed the chief areas of anxiety to be success and failure in work and what her peers thought of her.

AS AN over-all rating, we found in Nancy a high degree of anxiety. She illustrates one type of anxiety neurosis, characterized by the adoption of the “anxious attitude” toward life, so that practically everything she thought or did was motivated by anxiety. The goal of her behavior was not to avoid anxiety; rather, it was to keep anxiety at bay. She was characterized by continual foreboding and a constant endeavor to keep herself precariously balanced in her relations with people lest catastrophe (in Nancy’s sense, rejection) should occur. We can say that this is not a case of the person having anxiety, but of “anxiety having the person.”

It may seem confusing to make this distinction between avoiding anxiety and keeping anxiety at bay. But a real distinction is referred to—namely, the fact that in this type of anxiety neurosis the anxious attitude is so intimately a part of the individual’s method of evaluating stimuli, of orienting herself or himself to every experience, that he or she cannot separate him- or herself enough from anxiety to comprehend the goal of avoidance of, or freedom from, anxiety. What Nancy sought was to be able to step cautiously from rock to rock without falling; the idea or possibility of not being on a precipice at all did not occur to her.

The conflict underlying Nancy’s neurotic anxiety may be described as arising from a hiatus between expectations and reality. The conflict was perpetuated in the form of an excessive need on one hand to depend on others (specifically, on their accepting, liking her) as her security device; but an underlying conviction on the other hand that other people were not dependable and would reject her. We have observed this conflict in its original form in her attitudes toward her mother, and in its present form in her attitudes toward her fiancé as well as toward other contemporaries.

A more specific formulation of Nancy’s conflict would require psychoanalytic knowledge of her unconscious pattern—data which the above methods do not yield. It is certainly a justified hypothesis, however, that a great deal of hostility would be present in a pattern in which the individual is so dependent on other people but believes these others to be undependable; and it is entirely understandable that such hostility, in a person as anxious as Nancy, would be radically repressed.

It appeared in these first interviews that Agnes was expecting, consciously or unconsciously, some attack. This same expectation or aggression against her appeared in forms of phobic anxiety in her behavior at Walnut House; whenever she was given an aspirin by the nurse, she would look at it carefully with the expectation that she was being poisoned. Later, in telling me about this and other phobic feelings, Agnes realized their irrationality. She stated that she often had “claustrophobia” in her room at Walnut House and on the subways, which she associated with a traumatic experience as a child when her stepmother, who after “she got tired slapping me, locked me in a closet.”

Agnes’ real mother had died when she was one year old. She had lived with her father and stepmother, both Catholic, until the latter died when she was thirteen. After keeping house for her father for a year, she left him because of his excessive drinking and his attitude, as she expressed it, of “complete lack of concern for me.” There was some doubt in her mind as to whether her father and mother had been her real parents; this doubt was also shared by the social workers at Walnut House on the basis of the scanty legal birth data available. She had no siblings. Her father and stepmother had adopted a boy when Agnes was eight, but she had objected so strongly that they had returned the boy to the orphanage. Her Wassermann test at entrance to Walnut House was +4, considered by the physician as congenital syphilis.

It is difficult to place Agnes accurately with respect to socioeconomic class; her father had frequently changed his occupation, at this time being a cook in a restaurant. Her vocational aims at the time of her stay at Walnut House were to leave show business, attend art school, and then become a commercial artist. On the basis of her aims, as well as the socioeconomic status of her friends, we think of her as in the middle class.

Her relations to the other young women at Walnut House were marked by much open hostility and some contempt on her part, with no effort whatever to be friendly. As a consequence, the other girls were hostile toward her and teased her frequently, which Agnes affected to meet with disdain. Her general mood at the house was characterized by brooding on one hand and temper tantrums on the other.

There were many evidences that Agnes was engaged in continual struggles for power—getting the upper hand—over other people. She stated that she greatly admired strength, especially in men. She felt contempt for her father because of what she called his weakness in drinking, and contempt for the men in night clubs who “pulled the line of my-wife-doesn’t-understand-me.” Her attitude toward Bob, the man by whom she was pregnant, was generally aggressive: she would “get a lawyer and ruin him” if he did not support her through her pregnancy. When she had direct contact with him, however, this aggression was usually masked behind a strategy of feminine weakness; with entirely conscious premeditation, she would weep over the telephone to convince him of her “helplessness” and play what she called her “martyr act” (“look how much I am suffering”). But when he did periodically send her a check, she would be temporarily filled with affectionate feelings toward him and say she had misjudged him. She employed her exotic, feminine attractiveness likewise for aggressive purposes: when she was to meet Bob for lunch (or, for that matter, on the days she was to have interviews with me) she would spend hours getting herself made up as attractively as possible. This procedure seemed strangely like preparation for war. After parturition, she enjoyed considerable feelings of triumph from creating a “sensation” in stores by her stunning appearance. These particular evidences of her aggressive struggle to gain power over other people fit the sado-masochistic pattern which will also be seen in her Rorschach.

But a third and less common aspect of the interrelationship of anxiety with hostility and aggression is demonstrated in Agnes’ case—namely, she uses hostility and aggression as a method of avoiding the anxiety-creating situation. This is not the usual behavior: we have seen that other girls try to avoid anxiety by withdrawing or by placating or by being compliant to others. In most cases the periods when they are anxious are precisely the times when they are least aggressive in order not to alienate the persons on whom they are dependent. Agnes, however, operates on the formula that by attacking others she can force them not to reject her, not to make her anxious.

The case of Agnes may throw light on anxiety phenomena in sado-masochistic cases in general—namely, relief from anxiety comes not only from keeping the other persons tied to one’s self in a symbiotic relationship, but also in gaining control, triumphing over, or bending the other person to one’s own will. If one cannot gain relief from anxiety except by bending the other to fit one’s own goals, one’s method of allaying anxiety is bound to be essentially aggressive.

IN AGNES’ case we have seen a high degree of anxiety together with a high degree of rejection by parents. The relation of her present anxiety pattern to her early relations with her parents was shown in a number of ways, one of them being her association of her phobial anxiety with her early relation of reciprocal hostility and aggression with her stepmother. Another was the fact that the anxiety-creating pattern of relationship with the father of her baby followed very closely her relationship with her own father. It is to be emphasized that Agnes, like Nancy and Helen, did not accept rejection by her father as a realistic fact. Through thick and thin she clung to a contradictory position with her father—the contradiction between her subjective expectations and what she knew to be the realistic situation in her relation with her father. This is the hiatus between expectation and reality, discussed later. It was shown most clearly in her journey to see him to force him to show concern for her, despite the fact that she knew realistically that he would not change.

Thus Agnes’ chief defenses against the anxiety-creating situation were hostility and aggression—a striving to triumph over the other person, to become the victor rather than the victimized. In this respect she interpreted others’ rejection of her as their victory over her and her capacity to keep them in a symbiotic relationship as her triumph over them, her bending them to her will. It is clear that such a pattern would generate great quantities of anxiety, for she would always expect that other people were doing to her what she was trying to do to them. This great quantity of anxiety was illustrated in her terror in the first interviews, and in her phobia at Walnut House.

A further question arises: Can any specific causal elements be discovered in Agnes’ case which determine her use of aggression and hostility as methods of avoiding the anxiety-creating situation? Why would a person unconsciously select these weapons? I suggest that such methods in Agnes’ case point toward the presence of a level of overprotection in her early background. Her considerable degree of narcissism would fit such a hypothesis. The hypothesis is likewise supported by her father’s behavior in taking pride in her attractive appearance but rejecting her in all other respects. It is, of course, not at all uncommon that parents overprotect children and at the same time reject them, or direct excessive affect toward them on some levels and reject them on other levels. The overprotection and rejection are sometimes reactions to each other—e.g., if the parent really rejects the child, he may “spoil” it on a different level in order to make up for his rejection.

The official judgment at Walnut House was that Agnes’ personality pattern was so firmly crystallized that very little therapy could at that time be accomplished. Her second Rorschach, taken three weeks after parturition and, therefore, when she was relieved of the particular feelings of helplessness which attended her inability to use her feminine attractiveness as a source of power, shows some relaxing of the feeling that she is the victim of aggression. Hence it also shows some relaxing of the stringency of her pattern. But it was still essentially a sado-masochistic character structure characterized by strong feelings of aggression and hostility.

The last we heard of Agnes (from a letter written a month after her leaving Walnut House), she was being supported by a man much older than herself and bringing up her baby on Bach and Beethoven.

My mother beat me all the time. Even my father would ask her why she did it, and then she would beat me all the more. . . . She beat me with everything she had. She broke my elbow, she broke my back and nose. The neighbors next door used to want to call the police, but they didn’t want to interfere. My mother would say, “Come here, or I’ll kill you.” Sometimes I was so banged up I would feel all right if somebody ran a knife through me. . . . My aunt and uncle wanted to take me, but she wouldn’t let them. I don’t understand why, seeing she hated me, that she didn’t get rid of me.

Louise related these incidents of childhood punishment without much affect or change in expression. I had the impression that she had probably told the story frequently (possibly to the women for whom she worked as a domestic) and that there may be some exaggeration for effect upon the listener (e.g., the details surrounding the “breaking” of the elbow and back did not sound convincing). But granted this possibility of some exaggeration, there still is every indication that she was the victim of physical cruelty and severe rejection as a child. While there was obviously great objective trauma in these childhood experiences, the significant fact is that Louise was able to avoid subjective trauma, both as a child and now as an adult. Her relation to her father, toward whom she felt friendly, was apparently a mitigating influence but on a superficial rather than profound level (e.g., she sees no men in the Rorschach).

It does not seem a tenable hypothesis that Louise was simply repressing all affect connected with this mother relationship; at other points in the interviews, she did express considerable emotion—she cried when she told of her hatred for her mother. But the hatred was stated as a simple fact, without indication of accompanying psychological conflict and without evidence of pervasive underlying resentment of the mother.

When her own baby was stillborn, Louise was inconsolable. She wept profusely the first days in the hospital, and could talk of nothing else during her three weeks of convalescence at Walnut House. She then went to a convalescent home in the country, where she made a good recovery from her depression and grief. The final data concerning Louise were the long, endearment-filled letters which she continued to write to the nurse at Walnut House, with whom she had established a close and affectionate relationship.

OUR OVER-ALL rating for Louise was low in anxiety and high in rejection by her mother. This immediately presents a problem of a person who experienced severe rejection but did not exhibit consequent neurotic anxiety. It goes directly against my hypothesis that maternal rejection is the origin of neurotic anxiety.

Is this lack of anxiety to be explained by her lack of differentiation as a personality or by repression of affect? This question must be answered in its two phases. To some extent it may be said that Louise was a relatively simple, undifferentiated personality in the “normal” sense (i.e., the lack of differentiation was not due to present subjective conflicts). The repression of inner promptings in the Rorschach referred to her sexual promptings toward men and did not in itself explain the lack of neurotic anxiety from her rejection by her mother. To what extent her meagerness in responsiveness to relations with other people was a result of the lack of affection in her relation with her mother it is not possible to state beyond the obvious point that there would be an important relation between these two factors. But her lack of neurotic anxiety could not be explained as a lack or suppression of all affect. This is shown in (a) the fact that she did exhibit affect in talking of her hatred for her mother, (b) she had very great feelings for her hoped-for baby, and (c) she was able to establish an affectionate relationship with the nurse at Walnut House.

It is significant that Louise entertained no pretense about her mother: in radical distinction from the case of Nancy, for example, Louise did not live in expectation that her mother could or would change into a “good” mother. Likewise, Louise’s behavior toward her mother was not influenced by pretension, as witness her refusal to show hypocritical affection for her mother when company was present despite the surety of being beaten for this self-assertion. In contrast to a number of other women in this study (Nancy, Helen, Agnes, etc.), Louise did not have a cleavage between her expectations and the reality situation with respect to the parent. Her case demonstrates that neurotic anxiety is not produced by rejection if the individual is free from subjective contradictions in his attitudes toward her parents.

Some elements in this case, if they should appear in a more extreme form than we have observed in Louise, would suggest psychopathic developments. The psychopathic personality, produced by such complete rejection in the family that the child has no basis for future relatedness, does not exhibit neurotic anxiety (see footnote re Lauretta Bender’s viewpoint, page 409). But I believe it is clear that Louise cannot be classed as psychopathic.

Though it was difficult for Bessie to talk of the particular events leading to her pregnancy, she was responsive and open, albeit somewhat restless and bashful. In the interviews she impressed social workers and myself alike as an outgoing, cooperative, and responsible young woman.

Her mother not only exhibited an attitude of severe rejection toward Bessie, but also she consistently sought to make Bessie’s problems in the pregnancy as difficult as possible. At first the mother insisted that she wanted no responsibility whatever for Bessie, but when Bessie had decided to have the baby adopted, the mother began to insist that Bessie keep it and bring it home. Since it was “Bessie’s fault,” she should be made to take care of the baby; and the mother rationalized her desire to have Bessie and the baby under her control by saying that since her husband was the father, the baby was her own flesh and blood. But it was obvious, as an older sister pointed out to the social worker, that the mother’s real motives were punitive; she wished to have Bessie and the baby home in order that she could forever berate Bessie for the pregnancy. Whenever Bessie had decided on a plan of her own, the mother would aggressively attack her with a contrary plan. She strongly opposed Bessie’s first decision to make her home with an older sister after parturition and also her later plan to live in a foster home. These indications all form a picture of the mother as definitely sadistic.

Bessie experienced a high degree of rejection by both parents. This, again, like the case of Louise, presents us with a distinct problem. Why did severe parental rejection not lead to the development of neurotic anxiety. In Bessie’s case it seems clear that the parental rejection did not engender internal, subjective conflicts. The problems with her parents were not introjected, either as a source of self-condemnation or as a source of persistent resentment. She accepted her parents’ rejection as an objective, realistic fact, an acceptance which was based on her realistic appraisal of her father; and (though her mother still had the power to make decisions difficult for her) her appraisal of her mother was likewise realistic. Thus the rejection was dealt with on the level of conscious awareness; it did not become confused with expectations that the parents might or could be different. The rejection did not basically pervert her own behavior: in the interesting childhood vignette, she continued her plan of playing with the other children despite her father’s flagrant rejection on her approach. She was able to develop affectionate relationships with siblings, peers, and other persons of all ages.

I tentatively suggest this principle: The adjustment to her rejection without internal conflict—i.e., without a rift between subjective expectations and objective reality—is the essential element in Bessie’s relative freedom from neurotic anxiety.

On the mother’s death, Dolores was brought to the United States by an aunt who was childless. The impression given by this aunt in her interviews with the social workers at Walnut House was that she had wanted Dolores in order to fill her own emotional needs. Affectionate toward Dolores for the first few months, the aunt had then abruptly changed to treating the girl with complete coldness, beating her frequently, and ostentatiously rejecting her in favor of the children of a relative who lived nearby.

All we could learn from Dolores was that an unknown man had pushed her into a cellar and had raped her. For over six weeks, during the preliminary interviews for her entrance to Walnut House and in the first weeks in the house, Dolores had clung tenaciously to this explanation of her pregnancy. We knew nothing except that her story was vague and unconvincing. During this period Dolores was very subservient and resigned, answering questions in the manner of one who dutifully obeys authorities but in every other way was markedly withdrawn. It was observed that she seemed alert when she thought she was unnoticed, but as soon as she felt anyone was watching her she assumed a hunched-over position and an “encased” attitude. This case is significant because it reveals the anxiety panic and psychological immobilization of an individual under a strong, persistent threat.

After this conflict was relieved, Dolores’ attitudes and behavior underwent a radical change. She became outgoing and friendly in her relations to the other young women as well as to the personnel at Walnut House, and in contrast to the previous severely subservient behavior she now showed considerable independence in initiating projects in the house and developing her own hobbies. During the latter part of Dolores’ stay at the house, a minor problem began to develop in her defiant and at times aggressive attitude toward some of the girls. I take this behavior to be the opposite side of her compliant, subservient behavior toward authority, which was so predominant in her early attitude toward social workers and myself. It may be assumed that a compliant-defiant pattern, particularly related to her belief in authority, is a prominent part of Dolores’ character structure.

We rate Dolores’ rejection by her father as moderately high. Because of the paucity of data, especially with respect to the mother, we make our over-all rating of moderately high rejection tentative for Dolores, with the realization that she might perhaps as plausibly be placed in the moderately low category.

DOLORES’ CASE demonstrated severe conflict while under threat, resulting in anxiety which approached the intensity of panic, characterized by extreme withdrawal and partial psychological paralysis. She illustrates how a person can literally be scared stiff. The conflict was situational and vanished when Dolores, freed from the power of her aunt’s threats, was able to disclose the truth about her pregnancy. But while she was under the conflict, its power carried over to everything she felt might lead to discovering the secret which she must keep hidden. In this respect, it appears that an irrational, “magical” power to reveal the truth about the origin of her pregnancy was imputed to the gynecological examination.

The great concern of Phyllis and her mother was that she have expert medical care during her pregnancy. She repeatedly emphasized that she was to go to the best women’s hospital in the city, and was now under the care of the head obstetrician at this clinic. The experiences at this clinic which Phyllis related to me illuminate the dynamics underlying her great emphasis on expert medical care. During a visit to this clinic preparatory to parturition, an assistant obstetrician had remarked that a Caesarian section might be necessary. Phyllis reported that the head obstetrician had then taken the assistant aside to caution him “against telling me anything that would make me nervous.” Whenever Phyllis had asked the chief obstetrician about her case, she reported that he always remarked, “You’re all right; we don’t talk to patients.”

Phyllis expressed the desire to go home after parturition and never leave again. Just prior to parturition, the domination of the mother approached the point of cruelty: she made a practice of watching outside Phyllis’ door in the evening at Walnut House until ejected by the nurse and vented her extreme anxiety in the form of outbursts of rage at Phyllis. But all of this behavior by the mother was accepted by Phyllis placidly.

Two weeks after parturition Phyllis and her mother took the baby home, where it shortly died of pneumonia. In her subsequent visits to Walnut House, Phyllis was always dressed in black. She exhibited a large colored painting she and her mother had ordered made of the baby in its coffin; but beyond these ways of dramatizing the death of the baby, she exhibited no particular affect. In the follow-up interviews, Phyllis stated that she had given horseback riding and was refusing dates with men on the pretext that she was married. The social worker reported that Phyllis seemed like a dignified, dependent little girl, operating almost entirely on the theory “mother knows best.”

I speak of irrational faith in science not with reference to the medical care itself (which in other persons may obviously be related to rational methods of coping with anxiety) but rather to the use Phyllis makes of what she terms “science” but I would call “scientism.” With Phyllis, belief in “scientism” is clearly a way of avoiding facing her anxiety, which in the instance of the momentary anxiety about death, might have had any one of many origins quite other than apprehension about death itself. This kind of “faith in science” is a superstition, falling in the same psychological category as a magical incantation or the use of a prayer-wheel, and serves the same psychological function for Phyllis as her submission to her mother’s authority. This case demonstrates that it is possible to avoid anxiety-creating situations by means of impoverishment of personality. But the price for such avoidance is loss of individual autonomy, personal responsibility, and the capacity for meaningful emotional relatedness to other persons.

Frances was pregnant by a young man whom she had idealized during the four years of their close friendship because he was a “gentleman and very dependable.” When, at her pregnancy, he did not propose marriage and even refused to contribute to her preparturition support, her attitude toward him abruptly changed to one of hatred. She verbalized this attitude freely, adding that she now “hated all men.” Presumably her idealization of the man had served as a defense against the underlying suspicion of, and her own repressed hostility toward, him; the sudden shift to antagonism suggests that this attitude, in repressed form, was there all the time. What both the idealization and complete antagonism have in common was the pattern to be indicated in the Rorschach, namely that she needed to avoid a realistic appraisal of human relations. After parturition, her attitude toward men (as shown in both the interviews and the second Rorschach) changed from avoiding contact with men to avoiding involvement. She phrased it, “I no longer hate men; I’m afraid of them”; her plan was to renew contacts with men, especially in her church groups, but never to become involved.

In rating Frances’ feeling of rejection, we confront the difficulty in the contradiction between surface statements—in which she would deny experiencing rejection—and the underlying indications. Since Frances’ constrictive pattern and her strategies of avoidance of her problems could not be broken through in the interviews, and since there was ample evidence (e.g., the idealization of her parents and the fairy-tale motif) for assuming that her verbalizations about her relation to her parents were untrustworthy, we based our judgment of her rejection on the underlying indications. From her failure to see people in the Rorschach, her underlying suspicion of and hostility toward other people, and her strong need to avoid contact and involvement with them, we assumed a moderately high degree of rejection.

WE FIND in Frances a moderately high degree of anxiety. She is a demonstration of anxiety emerging in a pattern of unsuccessful constriction. She tried to constrict herself as a means of avoiding anxiety-creating situations, particularly situations of involvement with other people. Two prominent mechanisms for this constriction were her endeavor to keep all her reactions on a very “realistic,” “practical” level and to idealize the other persons. Since she was actually not an impoverished personality, since considerable hostility toward others underlay the idealization, and since, indeed, the “realism” and idealization were contradictory, her constrictive pattern regularly broken down. One cannot hold contradictory beliefs at the same time; such a contradiction is bound, sooner or later, to disintegrate. It was at these points that Frances exhibited anxiety. The suppression of sexual and hostile impulses, as well as the suppression of originality, was part of the constrictive endeavor.

There followed a period of promiscuous sexual activity, during which the pregnancy occurred. The act of intercourse which she assumed accounted for the pregnancy—with an army officer whose last name she did not know—she described as an experience she had not agreed to, but “I couldn’t do anything about it.” Possibly the behavior surrounding her becoming pregnant represents a mildly schizophrenic state (or the onset of the state) at that time.

The family atmosphere in her childhood had been marked by much teasing, some of it of a sadistic intensity, on the part of the father and brothers. The mother had been particularly the butt of this teasing, although Hester herself had received a considerable share. She felt she had had a fairly close relationship with her father as a small child, but some of the stories she related suggested that his teasing had pained her more than she admitted and that his behavior involved some definite rejection of her. For example, she had been out fishing with him as a child; on their way back to the car she had gotten caught on the barbed wire of the fence. He (ostensibly in “teasing”) had gotten in the car and driven around the block, leaving her hanging there. Hester laid her rebellious behavior to the fact that her father died when she was young. “If I had had a father to talk with, all these messes [including the pregnancy] would not have happened.” Her mother, interviewed at Walnut House, appeared to be a passive individual. Beyond the fact that she had always regarded Hester as a problem and had been forced to show some concern about Hester’s predicaments at school and elsewhere, she seemed never to have shown much interest in or understanding of her daughter.

Hester’s defiance and rebelliousness seemed covertly and overtly to be directed against her mother, and there were indications in the interviews (bearing out the Rorschach data) that the sexual impulsiveness fell in this category. Her first sexual experience had occurred when, at the age of thirteen, she had run away from home, hitchhiking to a distant city and back again. There were indications that her pregnancy served both as defiance and as a means of forcing her mother to take an interest in her. Hester’s most frequent method of allaying anxiety was to laugh it off—a form of behavior which, in this context, may also be viewed as defiance (e.g., “I don’t care”).

SARAH RANKED low in degree of anxiety, and at the same time exhibited no discernible experience of rejection. Her problems were objective and realistic, managed without subjective conflict, with the one possible exception of the special sensitivity to racial discrimination and resulting defiance. But this, likewise, may be termed a “normal” rather than neurotic reaction in view of her realistic cultural situation as a black woman. It may be concluded that Sarah’s relative lack of neurotic anxiety was related to the fact that she did not experience psychological rejection within her family circles, either as a child or in the present situation. But a cultural factor emerged in the case of Sarah (as of Ada, the other black woman): extramarital pregnancy is not as much of an anxiety-creating situation in the black communities from which Sarah and Ada came as in the cultural milieux of the white women. It may be, thus, that we did not have Sarah in a genuinely anxiety-creating situation. This factor, though it could account for less presence of anxiety, could not account for the absence of neurotic anxiety in Sarah. The Rorschach would assumedly reveal neurotic anxiety if it were present, whether the subject were in an objective anxiety-creating situation or not.

Ada

The other black in this study is Ada, age nineteen, Catholic, who had lived most of her life in a suburb of New York. Since her father’s death when she was four, she and her brother (two years younger) had been supported by her mother with some help from the department of welfare. Ada had attended a Catholic primary school, but a public high school. After her graduation from high school at seventeen, her mother had had a “nervous breakdown from overwork” and had gone to live with relatives in the South. Ada and her brother moved to New York to live with an aunt.

She was pregnant by a young man her own age with whom she had had a close relationship since the middle of her high-school career. According to her description, he had always been very “possessive” of her and jealous of her other friends, and she had apparently submitted to his dominating tendencies. Though admitting paternity, he had refused to marry her, at which she reported she had “put him out of my mind.” Her medical diagnosis revealed syphilis, contracted from this young man.

When a response occurred (Card VII) associated with vagina examination at the hospital, a general disturbance was cued off which lasted through all the remaining cards in the test, amounting almost to a confabulatory tendency. This would indicate that if she failed to live up to her standards (the pregnancy being associated with such a failure), she was deeply disoriented in her relation to herself as well as to others, and much anxiety arose. Anxiety rating on the Rorschach was: depth 2 1/2, width 4 1/2, handling 3, which placed her in the high category of anxiety in relation to the other young women.

Ada ranked moderately high in the childhood anxiety check-list and moderately low in both the present and future check-lists. Her chief areas of anxiety were success and failure in work and what her family and parental surrogates thought of her, anxiety about her teacher or mother scolding her being prominent.

In her behavior at Walnut House as well as in the interviews, Ada continually exhibited the above-described combination of compliance and high standards. She answered all questions conscientiously but never volunteered spontaneous expression of thoughts or feelings. She could always be depended upon to run errands at the house and to cooperate in other ways which did not require initiative. Since she had neither the independence nor the defiant tendencies of Sarah, she got along well with the white women. In her school career she had always obtained very high grades. She expressed satisfaction that in her schools “everything was drilled into you—you learn more that way.”

Ada described the aunt as also very strict. In an interview at Walnut House, the aunt explained that she had made a conscious effort to inculcate high standards in Ada, that she had been very proud of her; and although she did not feel punitive toward Ada because of the pregnancy as such, she did not wish to accept Ada back into her apartment after she became pregnant because it would be a sign of the relaxing of the standards she had trained in her own two children. If we may take the aunt’s attitudes as representative of the family constellation in which Ada was brought up, we have a graphic expression of the formula of the adults which presumably underlay Ada’s psychological pattern: (1) these adults sought to inculcate “high standards” in her; (2) they were proud of her to the extent that she complied with these standards; and (3) they threatened her with rejection if she did not comply with these standards.

IN ADA we find a moderately high degree of anxiety. Her degree of rejection varied as it was viewed in different aspects: she was rejected in a moderately high degree by her aunt; she expected a high degree of rejection by her brother; and although the rejection was difficult to assess in her relation with her mother because of her previous complete compliance with her mother’s wishes, there were indications that Ada had considerable fear of rejection by her mother. We could, therefore, assume that rejection was present potentially in the relationship.

But the essential point for the understanding of the dynamics of Ada’s anxiety is the rejection she felt in the face of her “high standards.” These standards were not indigenous, self-chosen values, but were introjections of the formal expectations of her mother and the family environment. Hence the significant form of her present rejection was self-rejection, the self having taken over the authority of the parent. When Ada felt that she had not lived up to these internalized expectations, a profound psychological disorientation occurred (most graphically illustrated in the Rorschach), and subjective conflict and much anxiety ensued.

A COMPARISON of Sarah and Ada highlights the above-described dynamic of neurotic anxiety. For both black women, the fact of illegitimate pregnancy did not present as much of an anxiety-creating situation as it did for the white women. Both showed compliance: in Sarah compliance was a conscious method of adjusting, particularly to the racial issue, but her autonomy and self-feeling were protected by conscious defiance whenever she felt that to comply would threaten her independence. But for Ada compliance was an unconscious pattern as well as conscious, her self-feeling and self-acceptance depending on how well she complied, prototypically with her mother’s expectations. In Sarah, there was very little or no feeling of rejection by her parents; in Ada there was considerable feeling of rejection, in the form of rejection of herself in the face of her introjected standards. In Sarah, there was very little subjective conflict and very little anxiety. In Ada there was strong subjective conflict between her introjected expectations and her reality situation, leading to pronounced psychological disorientation and a moderately high degree of anxiety.

Her parents were very conservative, religiously and morally, not believing in dancing, smoking, or going to the movies. They had, however, overtly granted her freedom in these respects. Irene had joined a more liberal church and participated in the abovementioned recreations without overt conflict with her parents but—as we shall see below—probably with considerable covert conflict. She characterized her mother as having always “worried a good deal.” In an interview at Walnut House the mother referred to Irene as “mother’s little girl,” and it was admitted by both Irene and her that she had always sought to overprotect and “coddle” the daughter. The parents had been hurt and surprised by the pregnancy but had accepted it and cooperated with Irene in her plans. Again, however, their attitude was that of adults taking care of a child.

Her engagement and sexual relations with a boy of whom the parents did not approve seemed to be motivated both by her repressed hostility toward her parents, especially toward her mother, and by her need to compensate for the lack of warmth and understanding in her relationships at home. In her later interviews at Walnut House, Irene expressed considerable hostility and resentment against her mother, focusing chiefly on the facts that her mother had coddled her and had had so little understanding of or faith in her.

Irene was able to use the therapeutic opportunities at Walnut House very constructively. The follow-up data several months later indicated that she was making a very good and enthusiastic adjustment at college.

ALTHOUGH THERE was no physical rejection (e.g., punishment) of Irene, there were sound evidences that she experienced a good deal of emotional rejection and very much loneliness; hence we rated her as moderately high in rejection by her parents. On the basis of her well-defined symptoms of anxiety—overconscientiousness, withdrawal, cautiousness, and shyness—our over-all rating for her anxiety was also moderately high.

It may be observed parenthetically that Irene’s subjective conflict and guilt feeling was all the stronger psychologically because she was never permitted to feel conscious hostility against her parents. In contrast to Louise and Bessie, who suffered outright punishment at the hands of their parents, Irene thus could find no objective focus for her guilt feelings.