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Analysts agree that a more basic understanding of anxiety is essential for the solution of the problem of neurosis. From the physiologist they receive important information on the physiology and biochemistry of anxiety. Their own studies reveal the manifold forms of clinical anxiety from the outspoken anxiety neurosis with massive discharges of anxiety, often based on direct sexual frustration, to the subtler manifestations of anxiety as a warning signal in anxiety hysteria, and the marked anxiety which lies hidden under an hysterical conversion symptom or which may be transmuted into spasmodic tic-like compulsions. And all these varied forms of anxiety, as in the present instance, may appear in the same case. Freud refers to anxiety as the common coin into which all other neurotic symptoms can be changed. Furthermore, a characteristic common to all forms of anxiety, as to all neurotic symptoms, is its utilization for pleasurable ends, its "erotization". In searching for the matrix from which these physiological and psychological manifestations emanate, I should like to present the record of an analysis which may possibly throw light on the metabolic changes underlying one form of anxiety and its erotization, with a suggestion as to further investigation of the problem.
A married business man of thirty-three was referred by his physician for a severe neurosis associated with diabetes. He was seen an aggregate of two hundred eighteen hours distributed over a fifteen-month period. The case is of particular interest because of the diabetes which is, I believe, an integral part of the neurosis. In presenting this case it will be our thesis that there is a marked resemblance between the symptoms of hyperinsulinism and the clinical picture of anxiety