The Genesis of Agoraphobia

The observations which I have recorded in this paper have reference to a very definite type of illness, the symptoms of which may be described as follows: There are certain people who, when left to themselves in the street, experience the most intense anxiety. All the different symptoms of anxiety ensue: palpitation, trembling and, above all, the feeling that they are on the point of collapsing, that their end is near and they are helpless to avert it. Their anxiety is a genuine dread of death, and the content of their phobia, if put into words, is this: 'I shall suddenly die'. In this situation the terrifying thought grips them that they are on the verge of a fainting fit, a heart-attack, a stroke or some other catastrophe. Often the anxiety centres in the idea that they will be run over, will meet with a railway or a motor accident, and so forth. It is characteristic of this condition that it either totally disappears or becomes far less acute if the patient has somebody with him. Sometimes he derives a sense of security from being within sight of his home. As a rule the person with him must fulfil certain conditions to be of any use. There must be an affectionate relation between the two of them. Many people suffering from agoraphobia insist on being accompanied by a particular person. Others seem to be less hard to satisfy and will be contented with anyone whom they can associate with the prospect of 'speedy help'. Rich patients want to know that their physician, together with the salvation of his hypodermic syringe, is near at hand.

Since there appeared to be nothing remarkable in such patients' choice of a companion, we have hitherto been satisfied with their assertion that the possibility of rescue was the important point, and we paid no further attention to this 'subordinate figure'. In this paper I propose to discuss three cases which I knew intimately and in which certain circumstances impelled me to examine more closely into the significance