Anxiety without Affect1

From a certain standpoint the very title of this communication might be considered as involving a vagueness and even a misconception; for some clinicians, as we know, believe that the very concept of anxiety implies the presence of affect; if the charge of affect (Affektbetrag) happens to be repressed, one naturally assumes that the anxiety too remains unconscious. It was apparently this commonly accepted viewpoint that led Freud to say: "We call it [anxiety] an affective state, even though we do not know what affect is"; yet, regardless of various possible constructions, the clinician is aware of the fact that anxiety, normal or neurotic, once it comes to full expression, is always intimately connected with, or accompanied by, a self-conscious feeling tone which is in some way related to a sense of fear and which apparently represents or is the affect of anxiety. In accordance with Freud's description, we know that anxiety is an unpleasant state of indefinite expectation which is related to no specific object; only when it becomes related to, i. e., when it "acquires" an object, does it become fear. Clinically, however, i. e., as far as the subjective perception of the affective tone is concerned, it is well-night impossible to distinguish anxiety from fear. Patients when under the spell of anxiety, frequently state that they are afraid, or feel frightened, even though they may be unable to tell what they are afraid of or why they are frightened; on such occasions they thus attempt to describe their feelings, rather than the relationships of these to things or events. On the other hand, when both ideational content and the anxiety remain repressed, the modes by means of which the individual defends himself against the breaking through of either, assume protean forms, of which the most successful are certain types of acting out;