A second form of fear in contrast to the one we have just described is psychologically more circumscribed and bound up with certain objects or situations. It is the fear of the manifold and frequently very peculiar phobias. Stanley Hall, the distinguished American psychologist, has recently taken the trouble to present a whole series of these phobias in gorgeous Greek terminology. They sound like the enumeration of the ten Egyptian plagues, except that their number exceeds ten, by far. Just listen to all the things which may become the objects of contents of a phobia: Darkness, open air, open squares, cats, spiders, caterpillars, snakes, mice, thunder-storms, sharp points, blood, enclosed spaces, crowds, solitude, passing over a bridge, travel on land and sea, etc. A first attempt at orientation in this chaos leads readily to a division into three groups. Some of the fearful objects and situations have something gruesome for normal people too, a relation to danger, and so, though they are exaggerated in intensity, they do not seem incomprehensible to us. Most of us, for instance, experience a feeling of repulsion in the presence of a snake. One may say that snakephobia is common to all human beings, and Charles Darwin has described most impressively how he was unable to control his fear of a snake pointing for him, though he knew he was separated from it by a thick pane of glass. The second group consists of cases which still bear a relation to danger, but this is of a kind which we are disposed to belittle rather than to overestimate. Most of the situation-phobia belong here. We know that by taking a railroad journey we entail greater chance of disaster than by staying at home. A collision, for instance, may occur, or a ship sink, when as a rule we must drown; yet we do not think of these dangers, and free from fear we travel on train and boat. We cannot deny that if a bridge should collapse at the moment we are crossing it, we would fall into the river, but that is such a rare occurrence that we do not take the danger into account. Solitude too has its dangers and we avoid it under certain conditions; but it is by no means a matter of being unable to suffer it for a single moment. The same is true for the crowd, the enclosed space, the thunder-storm, etc. It is not at all the content but the intensity of these neurotic phobias that appears strange to us. The fear of the phobia cannot even be described. Sometimes we almost receive the impression that the neurotic is not really afraid of the same things and situations that can arouse fear in us, and which he calls by the same name.
There remains a third group of phobias which is entirely unintelligible to us. When a strong, adult man is afraid to cross a street or a square of his own home town, when a healthy, well-developed woman becomes almost senseless with fear because a cat has brushed the hem of her dress or a mouse has scurried through the room — how are we to establish the relation to danger that obviously exists under the phobia? In these animal phobias it cannot possibly be a question of the heightening of common human antipathies. For, as an illustration of the antithesis, there are numerous persons who cannot pass a cat without calling and petting it. The mouse of which women are so much afraid, is at the same time a first class pet name. Many a girl who has been gratified to have her lover call her so, screams when she sees the cunning little creature itself. The behavior of the man who is afraid to cross the street or the square can only be explained by saying that he acts like a little child. A child is really taught to avoid a situation of this sort as dangerous, and our agoraphobist is actually relieved of his fear if some one goes with him across the square or street.
The two forms of fear that have been described, free-floating fear and the fear which is bound up with phobias, are independent of one another. The one is by no means a higher development of the other; only in exceptional cases, almost by accident, do they occur simultaneously. The strongest condition of general anxiety need not manifest itself in phobias; and persons whose entire life is hemmed in by agoraphobia can be entirely free of pessimistic expectant fear. Some phobias, such as the fear of squares or of trains, are acquired only in later life, while others, the fear of darkness, storms and animals, exist from the very beginning. The former signify serious illness, the latter appear rather as peculiarities, moods. Yet whoever is burdened with fear of this second kind may be expected to harbor other and similar phobias. I must add that we group all these phobias under anxiety hysteria, and therefore regard it as a condition closely related to the well-known conversion hysteria.
The third form of neurotic fear confronts us with an enigma; we loose sight entirely of the connection between fear and threatening danger. This anxiety occurs in hysteria, for instance, as the accompaniment of hysteric symptoms, or under certain conditions of excitement, where we would expect an emotional manifestation, but least of all of fear, or without reference to any known circumstance, unintelligible to us and to the patient. Neither far nor near can we discover a danger or a cause which might have been exaggerated to such significance. Through these spontaneous attacks we learn that the complex which we call the condition of anxiety can be resolved into its components. The whole attack may be represented by a single intensively developed symptom, such as a trembling, dizziness, palpitation of the heart, or tightening of breath; the general undertone by which we usually recognize fear may be utterly lacking or vague. And yet these conditions, which we describe as “anxiety equivalents,” are comparable to anxiety in all its clinical and etiological relations.
Two questions arise. Can we relate neurotic fear, in which danger plays so small a part or none at all, to real fear, which is always a reaction to danger? And what can we understand as the basis of neurotic fear? For the present we want to hold to our expectations: “Wherever there is fear, there must be a cause for it.”
Clinical observation yields several suggestions for the comprehension of neurotic fear, the significance of which I shall discuss with you.
1. It is not difficult to determine that expectant fear or general anxiety is closely connected with certain processes in sexual life, let us say with certain types of libido. Utilization, the simplest and most instructive case of this kind, results when persons expose themselves to frustrated excitation, viz., if their sexual excitation does not meet with sufficient relief and is not brought to a satisfactory conclusion, in men, during the time of their engagement to marry, for instance, or in women whose husbands are not sufficiently potent or who, from caution, execute the sexual act in a shortened or mutilated form. Under these circumstances libidinous excitement disappears and anxiety takes its place, both in the form of expectant fear and in attacks and anxiety equivalents. The cautious interruption of the sexual act, when practiced as the customary sexual regime, so frequently causes the anxiety neurosis in men, and especially in women, that physicians are wise in such cases to examine primarily this etiology. On innumerable occasions we have learned that anxiety neurosis vanishes when the sexual misuse is abandoned.
So far as I know, the connection between sexual restraint and conditions of anxiety is no longer questioned even by physicians who have nothing to do with psychoanalysis. But I can well imagine that they do not desist from reversing the connection and saying that these persons have exhibited a tendency to anxiety from the outset and therefore practice reserve in sexual matters. The behavior of women whose sexual conduct is passive, viz., is determined by the treatment of the husband, contradicts this supposition. The more temperamental, that is, the more disposed toward sexual intercourse and capable of gratification is the woman, the more will she react to the impotence of the man, or to the coitus interruptus, by anxiety manifestations. In anaesthetic or only slightly libidinous women, such misuse will not carry such consequences.
Sexual abstinence, recommended so warmly by the physicians of today, has the same significance in the development of conditions of anxiety only when the libido, to which satisfactory relief is denied, is sufficiently strong and not for the most part accounted for by sublimation. The decision whether illness is to result always depends upon the quantitative factors. Even where character formation and not disease