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Eighty-six cases of phobias and compulsions constitute the material upon which this study has been carried out, 'primarily to investigate the specific factors producing these conditions'. The problem was approached under two headings: (1) 'The possible existence of the forerunners of the full-blown reactions, especially in the make-up and life situations', and (2) the mechanism of production. In the make-up the author finds consistently a definite social awareness with an acute sense of limitation or inferiority, personal or situational. Only very rarely is there any intellectual inferiority; between one-fourth and one-third reached colleges or professional schools. There is a marked adherence to conventionality. The situational factor is contributed by the cultural and educational contrast between the patient and the environment, also by economic obstacles, as well as by real or fancied sex inferiority. The age of incidence is 16 to 40, most frequently between 21 and 25. Most of the cases had a much earlier beginning, culminating through a series of connected or discrete episodes in the pathological reaction. 'Even when the content of the present obsessive or compulsive activity is unrelated to that of earlier symptoms, the fact still remains that the apparently disconnected outcroppings are evidence of the formation of a mental habit, a growing reaction tendency in meeting conflicting needs and desires'.
The question of the relation of early life rituals and phobias to the adult psychoneurosis the author dismisses by a dialectic gesture: Since childhood phobias and rituals are very common, and the adult compulsive states comparatively rare … the relation is that merely of a chance