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After a short discussion as to the meaning of the term 'anxiety' Carver devotes his attention to the meaning of anxiety in 'anxiety-hysteria', which for no very good reason he prefers to call 'anxiety psychoneurosis'.
Morbid anxiety, he says, is the primary mental disorder upon which the other psychoneuroses are built as superstructures, most of the superimposed symptoms being produced as the result of an effort to defend the 'ego' from the baneful effects of morbid anxiety. Anxiety is therefore the primary mental disturbance, and may be expected to be met with uncomplicated in early cases, and as a corollary of this the removal of superimposed protective symptoms would be expected to set free anxiety again. The symptoms of morbid anxiety are the physical concomitants of the emotion of fear.
The development of symptoms is due to what Freud terms the return of the repressed material, which can only take place when certain conditions are fulfilled. The ideational element of a repressed idea becomes detached from its affect, the affect becomes displaced on to a substitutive idea which is tolerable to consciousness, the intolerable idea to which the affect was originally attached remaining repressed. In this way the irrational phobias are produced, the anxiety mechanism being set going by the substituted idea. No amount of reassurance will free the patient from his phobia, because he really is not aware of what he is afraid of. Psycho-analysis is necessary in order to break down the resistances to the repressed idea coming into consciousness. When this is done the connection between his fear and the repressed idea is made by the patient, and the phobia disappears.
Carver asks the question, Can the repressions of later life come about de novo in an individual whose previous development has proceeded harmoniously? He points out that Freud is emphatic on this point, namely, that these later repressions are only possible as derivatives or connections of the primordi