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THE PSYCHOANALYTIC ACCOUNT OF PHOBIAS

PictureFREUD
The psychoanalytic account of phobias was put forward in 1909 by Sigmund
Freud in the famous Little Hans case. To this day, psychodynamic
accounts of phobia rely heavily on the logic of this case (Odier, 1956; Arieti,
1979). Freud's interpretation of a phobia consists of several steps: (1) the
phobic (if he is male) is in love with and wants to seduce his mother; (2) he
jealously hates his father, and wishes to kill him (these first two steps constitute
the Oedipus complex); (3) the phobic fears that, in retaliation, his father
will castrate him; (4) this conflict produces enormous anxiety in the phobic;
because the wishes are unacceptable to the conscious mind, the anxiety is
displaced onto an innocent object (the phobic object), which symbolizes the
conflict and is a more acceptable receptacle for fear; (5) the phobia is cured
when the phobic gains insight into the nature of the underlying conflict.



The Little Hans Case
Hans was a five-year-old boy who developed a fear of horses intense enough
to keep him indoors. When he was four, he saw a horse fall down in the
street and then thrash his legs violently in an apparent attempt to get up.
Hans was very upset by this and thereafter was reluctant to leave the house,
lest he be bitten by a horse who had fallen in the street. After extensive conversation
with his father who had been guided by Freud, Little Hans's phobia
gradually weakened.


Note: Freud weaves an enchanting story, and in the ISO-page case history, marshals
evidence for each of the five premises of phobic origin. 

Here is a sample of the evidence.


HANS'S DESIRE TO SEDUCE HIS MOTHER 
Hans had shown an active interest
in widdlers (penises) from an early age, and was an affectionate and
physical child toward his parents and playmates. When he was four-and-a quarter
years old, a scene of considerable sexual interest occurred. That
morning, Hans was given his usual daily bath by his mother, and afterward,
he was dried and powdered. As his mother was powdering around his penis
and taking care not to touch it, Hans said, "Why don't you put your finger
there?"
MOTHER: Because that'd be piggish.
HANS: What's that? Piggish? Why?
MOTHER: Because it's not proper.
HANS: (laughing) But it's great fun.


HANS'S HATE OF AND DESIRE TO KILL AND TO REPLACE HIS FATHER


Hans had the following conversation with his father:
FATHER: Did you often get into bed with Mummy at Gmiinden?
HANS: Yes.
FATHER: And you used to think to yourself you were Daddy?
HANS: Yes.
FATHER: And then you felt afraid of Daddy?
HANS: You know everything; I didn't know anything.
FATHER: When Fritzl fell down, you thought, "If only Daddy would fall
down like that!" and when the lamb butted you, you thought, "If only it
would butt Daddy!" Can you remember the funeral at Gmunden?
HANS: Yes. What about it?
FATHER: You thought then that, if only Daddy would die, you'd be
Daddy.
HANS: Yes.

RESOLUTION OF THE PHOBIA WITH RECOGNITION OF THE OEDIPUS CONFLICT

At the time the phobia was waning, Hans related the following fantasy
to his father:
HANS: The plumber came; and first he took away my behind with a pair of
pincers, and then gave me another, and then the same with my widdler. He
[the plumber] said, "Let me see your widdler!"
FATHER: He gave you a bigger widdler and a bigger behind.
HANS: Yes.
FATHER: Like Daddy's, because you'd like to be like Daddy.

Freud interpreted all of this by saying the following:

We have all ready considered Hans's two concluding phantasies, with which his recovery was rounded off. One of them, that of the plumber giving him a new and,
as his father guessed, a bigger widdler, was not merely a repetition of the earlier
phantasy concerning the plumber and the bath. The new one was a triumphant,
wishful phantasy, and with it he overcame his fear of castration. (Freud, 1909/1976).

The psychoanalytic account of phobias is not compelling. There are three
grounds for skepticism: (1) the account is based almost entirely on case history
material, and the theoretical inferences from this material are loose; (2)
psychoanalytic therapy for phobias works only infrequently, and then only
with years of therapy; (3) there exists a viable alternative account-the behavioral
analysis-which is based on both experimental evidence and case
histories and which is associated with therapies that treat most phobias successfullywithin
a few months.

First, we will consider the looseness ofinference from the case history evidence.

Did Hans really secretly wish to seduce his mother? The only evidence
for this is based on Hans's primitive attempt to get his mother to
touch his penis. It is a large leap ofinference from such a common expression
of sexual interest to a desire to possess the mother and replace the father.
At most, we have evidence of some sexual interest, not very well
disguised at that.

Did Hans really wish to kill and to replace his father? Hans never expressed

fear or hatred of his father. He was told by Freud-who saw Hans
only once-that he hated his father. Later, he was asked by his father about
this, in a series of leading questions. First, Hans denied that it was so, and
eventually he answered with a single "yes."

FATHER: Are you fond of Daddy?

HANS: Oh yes.
FATHER: Or perhaps not. ... You're a little vexed with Daddy because
Mummy's fond of him.
HANS: No.
FATHER: Then why do you always cry whenever Mummy gives me a kiss?
It's because you're jealous.
HANS: Jealous, yes.

Would any evidence "count" as a disconfirmation of the theory? Hans's

denial that he is vexed with his father does not count-in fact, it can be
construed as confirmatory, by showing that Hans is defending himself
against realizing his unacceptable hatred of his father. The theory is built in
such a way that both denying and accepting an interpretation confirm that
theory. This makes the theory difficult to test.

Did Hans really lose his phobia when he resolved his Oedipal conflict?

There is little evidence for such a conflict to begin with, but if we assume it,
should we be convinced that it was resolved? The resolution comes, allegedly,
in the plumber fantasy, which is as much about losing as gaining a
widdler and a bottom. Hans's father seizes on the interpretation of gain, and
Hans then agrees to it. Here, Hans has to be, in Freud's words, "told many
things he could not say himself." Further, Hans's phobic improvement
seems to be smooth and gradual through this period, not a sudden remission
following his "insights." It has since been documented that children between
the ages of two and six suddenly develop strong fears of animals,
which decline gradually on their own with no therapy (Holmes, 1935;Mac Farland, Allen, and Honzik, 1954.) 


Hans is well within the age in which fear spontaneously declines; this speculation is more consistent with the gradual elimination of his phobia than with the interpretation that his Oedipal conflict was suddenly resolved.

The success of a therapy can sometimes be relevant evidence for the

theory from which the therapy is derived. What is the psychoanalytic therapy
for phobias, and how does it fare? The psychoanalytic therapy for phobia
follows from the theory that phobic fear is the displacement of anxiety
generated by unacceptable intra-psychic conflict onto some innocent object.
The therapist must help the patient to bring the unconscious conflict to
light, and to gain insight into the repressed traumatic incident that generated
the phobia. In addition, some analysts recommend that the patient's
attention should be focused away from the phobic object, but that as the patient
comes to recognize the unconscious conflict, he should be encouraged
to re-experience the phobic situation while learning that the fear is not intolerable.
Psychoanalysts recognize that the prognosis for phobics under this
regime is not good (Laughlin, 1967; Arieti, 1979).

One must anticipate that many, many sessions will be required. A great deal of

time and effort is generally required on the part of both doctor and patient alike.
Further, no guarantee as to the results can be given.... It may be a strenuous
job, taking hundreds of therapeutic sessions over some years. The end results can
be worth far more than the considerable investment of time, effort and money required.
(Laughlin, 1967, p. 601)

Note: This frightened child was just saved from a burning building.

The behavioral account of phobia claims that any future and exaggerated fear of fire would be a result of this early trauma.

Overall, then, the Little Hans case history provides unsatisfactory evidence
for the psychoanalytic view of phobias. The interpretations are large,
un-compelling leaps. This alone would not necessarily be fatal to the theory
if there existed experimental evidence to support the interpretation, or if
psychoanalysis cured phobias. 

There is no such evidence, however, and psychoanalytic therapy is of doubtful value for overcoming phobias. Moreover, there exists an alternate account that is consistent with case history material and experimental evidence, and that is of considerable therapeutic value…the behavioral account.


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