Depression and Claustrophobia1

For many years I have been interested in the relationship between claustrophobia and depression, since I have long been struck by the frequency with which these two symptoms occur in the same patient. It has been a common experience to see depression alternating with claustrophobia, as if there were some kind of reciprocal relationship. In frequent, rather dramatic episodes in treatment, interpretations have succeeded in greatly lessening the phobic anxiety only to find a melancholic state replacing it. At other times a state of depression has been relieved, only to find a claustrophobia making its appearance. In this paper I should like to make note of these observations, and to attempt to establish some conclusions concerning the interrelationship of the clinical entities. These conclusions will follow two major lines: (i) that claustrophobia and depression are closely related phenomenologically, dynamically, structurally, and genetically; (ii) that the claustrophobic-depressive cycle seems to follow the pattern: claustrophobia (maintenance of the object through the projection of the conflict on to the claustrum), increasing intensity and spreading of claustrophobic anxiety leading to panic, acting out (a desperate attempt to deny the loss and maintain the object), increasing guilt, withdrawal of object cathexis, depression, and gradual reformation of the claustrophobia. I make no attempt here to delineate the vicissitudes of claustrophobia or depression in their relationship to other nosological categories, such as other phobias, obsessive compulsive character, or neurosis, drug addictions, alcoholism, paranoia, or others, though much of what will be said may have its application in these other conditions as well.

Freud, in his monograph Inhibitions, Symptoms and Anxiety(1926), attempted to draw some conclusions as to the possible relationship between depressive affects and anxiety. He states in summary, 'Pain is thus the actual reaction to loss of object