deeper consideration be admitted to need thorough revision. In face of
imminent danger the only expedient behaviour, actually, would be first a
cool appraisement of the forces at disposal as compared with the
magnitude of the danger at hand, and then a decision whether flight or
defence, or possibly attack, offered the best prospect of a successful
outcome. Dread, however, has no place in this scheme; everything to be
done will be accomplished as well and probably better if dread does not
develop. You will see too that when dread is excessive it becomes in the
highest degree inexpedient; it paralyses every action, even that of
flight. The reaction to danger usually consists in a combination of the
two things, the fear-affect and the defensive action; the frightened
animal is afraid _and_ flees, but the expedient element in this is the
‘flight,’ not the ‘being afraid.’
One is tempted therefore to assert that the development of anxiety is
never expedient; perhaps a closer dissection of the situation in dread
will give us a better insight into it. The first thing about it is the
‘readiness’ for danger, which expresses itself in heightened sensorial
perception and in motor tension. This expectant readiness is obviously
advantageous; indeed, absence of it may be responsible for grave
results. It is then followed on the one hand by a motor action, taking
the form primarily of flight and, on a higher level, of defensive
action; and on the other hand by the condition we call a sensation of
‘anxiety’ or dread. The more the development of dread is limited to a
flash, to a mere signal, the less does it hinder the transition from the
state of anxious readiness to that of action, and the more expediently
does the whole course of events proceed. The _anxious readiness_
therefore seems to me the expedient element, and the _development_ of
anxiety the inexpedient element, in what we call anxiety or dread.
I shall not enter upon a discussion whether the words anxiety, fear,
fright, mean the same or different things in common usage. In my
opinion, _anxiety_ relates to the condition and ignores the object,
whereas in the word _fear_ attention is directed to the object; _fright_
does actually seem to possess a special meaning—namely, it relates
specifically to the condition induced when danger is unexpectedly
encountered without previous anxious readiness. It might be said then
that anxiety is a protection against fright.
It will not have escaped you that a certain ambiguity and indefiniteness
exists in the use of the word ‘anxiety.’ It is generally understood to
mean the subjective condition arising upon the perception of what we
have called ‘developed’ anxiety; such a condition is called an affect.
Now what is an affect, in a dynamic sense? It is certainly something
very complex. An affect comprises first of all certain motor
innervations or discharges; and, secondly, certain sensations, which
moreover are of two kinds—namely, the perceptions of the motor actions
which have been performed, and the directly pleasurable or painful
sensations which give the affect what we call its dominant note. But I
do not think that this description penetrates to the essence of an
affect. With certain affects one seems to be able to see deeper, and to
recognize that the core of it, binding the whole complex structure
together, is of the nature of a _repetition_ of some particular very
significant previous experience. This experience could only have been an
exceedingly early impression of a universal type, to be found in the
previous history of the species rather than of the individual. In order
to be better understood I might say that an affective state is
constructed like an hysterical attack, i.e. is the precipitate of a
reminiscence. An hysterical attack is therefore comparable to a
newly-formed individual affect, and the normal affect to a universal
hysteria which has become a heritage.
Do not imagine that what I am telling you now about affects is the
common property of normal psychology. On the contrary, these conceptions
have grown on the soil of psycho-analysis and are only indigenous there.
What psychology has to say about affects—the James-Lange theory, for
instance—is utterly incomprehensible to us psycho-analysts and
impossible for us to discuss. We do not however regard what we know of
affects as at all final; it is a first attempt to take our bearings in
this obscure region. To continue, then: we believe we know what this
early impression is which is reproduced as a repetition in the
anxiety-affect. We think it is the experience of _birth_—an experience
which involves just such a concatenation of painful feelings, of
discharges of excitation, and of bodily sensations, as to have become a
prototype for all occasions on which life is endangered, ever after to
be reproduced again in us as the dread or ‘anxiety’ condition. The
enormous increase in stimulation effected by the interruption of the
renewal of blood (the internal respiration) was the cause of the anxiety
experience at birth—the first anxiety was therefore toxically induced.
The name _Angst_ (anxiety)—_angustiæ_, _Enge_, a narrow place, a
strait—accentuates the characteristic tightening in the breathing which
was then the consequence of a real situation and is subsequently
repeated almost invariably with an affect. It is very suggestive too
that the first anxiety state arose on the occasion of the separation
from the mother. We naturally believe that the disposition to reproduce
this first anxiety condition has become so deeply ingrained in the
organism, through countless generations, that no single individual can
escape the anxiety affect; even though, like the legendary Macduff, he
‘was from his mother’s womb untimely ripped’ and so did not himself
experience the act of birth. What the prototype of the anxiety condition
may be for other animals than mammals we cannot say; neither do we know
what the complex of sensations in them is which is equivalent to fear in
us.
It may perhaps interest you to know how it was possible to arrive at
such an idea as this—that birth is the source and prototype of the
anxiety _affect_. Speculation had least of all to do with it; on the
contrary, I borrowed a thought from the naïve intuitive mind of the
people. Many years ago a number of young house-physicians, including
myself, were sitting round a dinner-table, and one of the assistants at
the obstetrical clinic was telling us all the funny stories of the last
midwives’ examination. One of the candidates was asked what it meant
when the meconium (child’s excreta) was present in the waters at birth,
and promptly replied: “That the child is frightened.” She was ridiculed
and failed. But I silently took her part and began to suspect that the
poor unsophisticated woman’s unerring perception had revealed a very
important connection.
Now let us turn to neurotic anxiety; what are the special manifestations
and conditions found in the anxiety of nervous persons? There is a great
deal to be described here. First of all, we find a general
apprehensiveness in them, a ‘free-floating’ anxiety, as we call it,
ready to attach itself to any thought which is at all appropriate,
affecting judgements, inducing expectations, lying in wait for any
opportunity to find a justification for itself. We call this condition
‘_expectant dread_’ or ‘anxious expectation.’ People who are tormented
with this kind of anxiety always anticipate the worst of all possible
outcomes, interpret every chance happening as an evil omen, and exploit
every uncertainty to mean the worst. The tendency to this kind of
expectation of evil is found as a character-trait in many people who
cannot be described as ill in any other way, and we call them
‘overanxious’ or pessimistic; but a marked degree of expectant dread is
an invariable accompaniment of the nervous disorder which I have called
anxiety-neurosis and include among the actual neuroses.
In contrast to this type of anxiety, a second form of it is found to be
much more circumscribed in the mind, and attached to definite objects
and situations. This is the anxiety of the extraordinarily various and
often very peculiar phobias. Stanley Hall, the distinguished American
psychologist, has recently taken the trouble to designate a whole series
of these phobias by gorgeous Greek titles; they sound like the ten
plagues of Egypt, except that there are far more than ten of them. Just
listen to the things that can become the object or content of a phobia:
darkness, open air, open spaces, cats, spiders, caterpillars, snakes,
mice, thunder, sharp points, blood, enclosed places, crowds, loneliness,
crossing bridges, travelling by land or sea, and so on. As a first
attempt to take one’s bearings in this chaos we may divide them into
three groups. Many of the objects and situations feared are rather
sinister, even to us normal people, they have some connection with
danger; and these phobias are not entirely incomprehensible to us,
although their intensity seems very much exaggerated. Most of us, for
instance, have a feeling of repulsion upon encountering a snake. It may
be said that the snake-phobia is universal in mankind. Charles Darwin
has described most vividly how he could not control his dread of a snake
that darted at him, although he knew that he was protected from it by a
thick plate of glass. The second group consists of situations that still
have some relation to danger, but to one that is usually belittled or
not emphasized by us; most situation-phobias belong to this group. We
know that there is more chance of meeting with a disaster in a railway
train than at home—namely, a collision; we also know that a ship may
sink, whereupon it is usual to be drowned; but we do not brood upon
these dangers and we travel without anxiety by train and boat. Nor can
it be denied that if a bridge were to break at the moment we were
crossing it we should be hurled into the torrent, but that only happens
so very occasionally that it is not a danger worth considering. Solitude
too has its dangers, which in certain circumstances we avoid, but there
is no question of never being able to endure it for a moment under any
conditions. The same thing applies to crowds, enclosed spaces,
thunderstorms, and so on. What is foreign to us in these phobias is not
so much their content as their intensity. The anxiety accompanying a
phobia is positively indescribable! And we sometimes get the impression
that neurotics are not really at all fearful of those things which can,
under certain conditions, arouse anxiety in us and which they call by
the same names.
There remains a third group which is entirely unintelligible to us. When
a strong full-grown man is afraid to cross a street or square in his own
so familiar town, or when a healthy well-developed woman becomes almost
senseless with fear because a cat has brushed against her dress or a
mouse has scurried through the room, how can we see the connection with
danger which is obviously present to these people? With this kind of
animal-phobia it is no question of an increased intensity of common
human antipathies; to prove the contrary, there are numbers of people
who, for instance, cannot pass a cat without attracting and petting it.
A mouse is a thing that so many women are afraid of, and yet it is at
the same time a very favourite pet name;[51] many a girl who is
delighted to be called so by her lover will scream with terror at the
sight of the dainty little creature itself. The behaviour of the man who
is afraid to cross streets and squares only suggests one thing to
us—that he behaves like a little child. A child is directly taught that
such situations are dangerous, and the man’s anxiety too is allayed when
he is led by someone across the open space.
The two forms of anxiety described, the ‘free-floating’ expectant dread
and that attached to phobias, are independent of each other. The one is
not the other at a further stage; they are only rarely combined, and
then as if fortuitously. The most intense general apprehensiveness does
not necessarily lead to a phobia; people who have been hampered all
their lives by agoraphobia may be quite free from pessimistic expectant
dread. Many phobias, e.g. fear of open spaces, of railway travelling,
are demonstrably acquired first in later life; others, such as fear of
darkness, thunder, animals, seem to have existed from the beginning. The
former signify serious illness, the latter are more of the nature of
idiosyncrasies, peculiarities; anyone exhibiting one of these latter may
be suspected of harbouring others similar to it. I must add that we
group all these phobias under _anxiety-hysteria_, that is, we regard
them as closely allied to the well-known disorder called
conversion-hysteria.
The third form taken by neurotic anxiety brings us to an enigma; there
is no visible connection at all between the anxiety and the danger
dreaded. This anxiety occurs in hysteria, for instance, accompanying the
hysterical symptoms; or under various conditions of excitement in which,
it is true, we should expect some affect to be displayed, but least of
all an anxiety-affect; or without reference to any conditions,
incomprehensible both to us and to the patient, an unrelated
anxiety-attack. We may look far and wide without discovering a danger or
an occasion which could even be exaggerated to account for it. These
spontaneous attacks show therefore that the complex condition which we
describe as anxiety can be split up into components. The whole attack
can be represented (as a substitute) by a single intensively developed
symptom—shuddering, faintness, palpitation of the heart, inability to
breathe—and the general feeling which we recognize as anxiety may be
absent or may have become unnoticeable. And yet these states which are
termed ‘anxiety-equivalents’ have the same clinical and ætiological
validity as anxiety itself.
Two questions arise now: Is it possible to bring neurotic anxiety, in
which such a small part or none at all is played by danger, into
relation with ‘real anxiety,’ which is essentially a reaction to danger?
And, how is neurotic anxiety to be understood? We will at present hold
fast to the expectation that where there is anxiety there must be
something of which one is afraid.
Clinical observation yields various clues to the comprehension of
neurotic anxiety, and I will now discuss their significance with you.
(_a_) It is not difficult to see that expectant dread or general
apprehensiveness stands in intimate relation to certain processes in the
sexual life—let us say, to certain modes of Libido-utilization. The
simplest and most instructive case of this kind arises in people who
expose themselves to what is called frustrated excitation, i.e. when a
powerful sexual excitation experiences insufficient discharge and is not
carried on to a satisfying termination. This occurs, for instance, in
men during the time of an engagement to marry, and in women whose
husbands are not sufficiently potent, or who perform the sexual act too
rapidly or incompletely with a view to preventing conception. Under
these conditions the libidinal excitation disappears and anxiety appears
in place of it, both in the form of expectant dread and in that of
attacks and anxiety-equivalents. The precautionary measure of _coitus
interruptus_, when practised as a customary sexual régime, is so
regularly the cause of anxiety-neurosis in men, and even more so in
women, that medical practitioners would be wise to enquire first of all
into the possibility of such an ætiology in all such cases. Innumerable
examples show that the anxiety-neurosis vanishes when the sexual
malpractice is given up.
So far as I know, the fact that a connection exists between sexual
restraint and anxiety conditions is no longer disputed, even by
physicians who hold aloof from psycho-analysis. Nevertheless I can well
imagine that they do not neglect to invert the connection, and to put
forward the view that such persons are predisposed to apprehensiveness
and consequently practise caution in sexual matters. Against this,
however, decisive evidence is found in the reactions in women, in whom
the sexual function is essentially passive, so that its course is
determined by the treatment accorded by the man. The more ‘temperament,’
i.e. the more inclination for sexual intercourse and capacity for
satisfaction, a woman has, the more certainly will she react with
anxiety manifestations to the man’s impotence or to _coitus
interruptus_; whereas such abuse entails far less serious results with
anæsthetic women or those in whom the sexual hunger is less strong.
Sexual abstinence, which is nowadays so warmly recommended by
physicians, of course only has the same significance for anxiety
conditions when the Libido which is denied a satisfactory outlet is
correspondingly insistent, and is not being utilized to a large extent
in sublimation. Whether or not illness will ensue is indeed always a
matter of the quantitative factor. Even apart from illness, it is easy
to see in the sphere of character-formation that sexual restraint goes
hand in hand with a certain anxiousness and cautiousness, whereas
fearlessness and a boldly adventurous spirit bring with them a free
tolerance of sexual needs. However these relations may be altered and
complicated by the manifold influences of civilization, it remains
incontestible that for the average human being anxiety is closely
connected with sexual limitation.
I have by no means told you all the observations which point to this
genetic connection between Libido and anxiety. There is, for instance,
the effect upon anxiety states of certain periods of life, such as
puberty and the menopause, in which the production of Libido is
considerably augmented. In many states of excitement too, the mingling
of sexual excitation with anxiety may be directly observed, as well as
the final replacement of the libidinal excitation by anxiety. The
impression received from all this is a double one; first, that it is a
matter of an accumulation of Libido, debarred from its normal
utilization; and secondly, that the question is one of somatic processes
only. How anxiety develops out of sexual desire is at present obscure;
we can only ascertain that desire is lacking and anxiety is found in its
place.
(_b_) A second clue is obtained from analysis of the psychoneuroses, in
particular, of hysteria. We have heard that anxiety frequently
accompanies the symptoms in this disease, and that unattached anxiety
may also be chronically present or come to expression in attacks. The
patients cannot say what it is they fear; they link it up by
unmistakable secondary elaboration to the most convenient phobias: of
dying, of going mad, of having a stroke, etc. When we subject to
analysis the situation in which the anxiety, or the symptom accompanied
by anxiety, arose, we can as a rule discover what normal mental process
has been checked in its course and replaced by a manifestation of
anxiety. To express it differently: we construe the unconscious process
as though it had not undergone repression and had gone through
unhindered into consciousness. This process would have been accompanied
by a particular affect and now we discover, to our astonishment, that
this affect, which would normally accompany the mental process through
into consciousness, is in every case replaced by anxiety, no matter what
particular type it had previously been. So that when we have a
hysterical anxiety condition before us, its unconscious correlative may
be an excitation of a similar character, such as apprehension, shame,
embarrassment; or quite as possibly a ‘positive’ libidinal excitation;
or an antagonistic, aggressive one, such as rage or anger. Anxiety is
thus general current coin for which all the affects are exchanged, or
can be exchanged, when the corresponding ideational content is under
repression.
(_c_) A third observation is provided by patients whose symptoms take
the form of obsessive acts, and who seem to be remarkably immune from
anxiety. When we restrain them from carrying out their obsessive
performances, their washing, their ceremonies, etc., or when they
themselves venture an attempt to abandon one of their compulsions, they
are forced by an appalling dread to yield to the compulsion and to carry
out the act. We perceive that the anxiety was concealed under the
obsessive act and that this is only performed to escape the feeling of
dread. In the obsessional neurosis, therefore, the anxiety which would
otherwise ensue is replaced by the symptom-formation; and when we turn
to hysteria we find a similar relation existing—as a consequence of the
process of repression either a pure developed anxiety, or anxiety with
symptom-formation, or, symptom-formation without anxiety. In an abstract
sense, therefore, it seems correct to say that symptoms altogether are
formed purely for the purpose of escaping the otherwise inevitable
development of anxiety. Thus anxiety comes to the forefront of our
interest in the problems of the neuroses.
We concluded from our observations on the anxiety-neurosis that the
diversion of the Libido away from its normal form of utilization, a
diversion which releases anxiety, took place on the basis of somatic
processes. The analyses of hysterical and obsessional neuroses furnish
the additional conclusion that a similar diversion with a similar result
can follow from opposition on the part of psychical agents
(_Instanzen_). We know as much as this, therefore, about the origin of
neurotic anxiety; it still sounds rather indefinite. But for the moment
I know of no path which will take us further. The second task we
undertook, that of establishing a connection between neurotic anxiety
(abnormally utilized Libido) and ‘real anxiety’ (which corresponds with
the reaction to danger), seems even more difficult to accomplish. One
would think there could be no comparison between the two things, and yet
there are no means by which the sensations of neurotic anxiety can be
distinguished from those of real anxiety.
The desired connection may be found with the help of the antithesis, so
often put forward, between the Ego and the Libido. As we know, the
development of anxiety is the reaction of the Ego to danger and the
signal preparatory to flight; it is then not a great step to imagine
that in neurotic anxiety also the Ego is attempting a flight, from the
demands of its Libido, and is treating this internal danger as if it
were an external one. Then our expectation, that where anxiety is
present there must be something of which one is afraid, would be
fulfilled. The analogy goes further than this, however. Just as the
tension prompting the attempt to flee from external danger is resolved
into holding one’s ground and taking appropriate defensive measures, so
the development of neurotic anxiety yields to a symptom-formation, which
enables the anxiety to be ‘bound.’
Our difficulty in comprehension now lies elsewhere. The anxiety which
signifies the flight of the Ego from its Libido is nevertheless supposed
to have had its source in that Libido. This is obscure, and we are
warned not to forget that the Libido of a given person is fundamentally
part of that person and cannot be contrasted with him as if it were
something external. It is the question of the topographical dynamics of
anxiety-development that is still obscure to us—what kind of mental
energies are being expended and to what systems do they belong? I cannot
promise you to answer this question also; but we will not neglect to
follow up two other clues, and in so doing will again summon direct
observation and analytic investigation to aid our speculation. We will
turn to the sources of anxiety in children, and to the origin of the
neurotic anxiety which is attached to phobias.