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It now remains to deal with the relationship between symptom formation and anxiety development. Two opinions about this seem to be prevalent. One of them terms the anxiety itself a symptom of the neurosis, the other conceives of a far more intimate connection between the two. According to this latter view, all symptom formation would be brought about solely in order to avoid anxiety; the symptoms bind the psychic energy which otherwise would be discharged as anxiety, so that anxiety would be the fundamental phenomenon and the central problem of neurosis.
The at least partial justification of this second position can be supplied by means of certain striking examples. If an agoraphobic who has been accompanied whenever he went out on the street is left alone there, he produces an attack of anxiety; if a compulsion neurotic is prevented from washing his hands after touching something, he becomes a prey to almost insupportable anxiety. It is clear, therefore, that the stipulation of being accompanied and the compulsion to wash had as their purpose, and also their result, the averting of an outbreak of anxiety. In this sense, every inhibition also that the ego imposes on itself can be termed a symptom.
Since we have reduced the development of anxiety to a response to situations of danger, we shall prefer to say that the symptoms are created in order to remove or rescue the ego from the situation of danger. If symptom formation is prevented, then the danger actually makes its appearance—that is to say, a situation analogous to birth comes about, a situation in which the ego finds itself helpless against the ever increasing strength of the instinctual demand in question; in other words, we have present the first and earliest of the determinants of anxiety. For our point of view the relationships between anxiety and symptom prove to be less close than was supposed,