Defense Reactions in Anxiety States of Central Origin

The central problem of any neurosis is the problem of anxiety. Symptoms are repressed and distorted vestiges of instincts seeking gratification. They are created to avoid an inner danger whose approach is signaled by the emergence of anxiety.

There is some ambiguity in Freud's (1) use of the terms 'symptom' and 'anxiety' because anxiety may be a symptom as well as the general manifestation of a neurosis. What he says about symptoms is true of neuroses in which anxiety is latent as is the case in the hysterias where the symptoms are a compromise between gratification and punishment. The adaptation of the ego to the symptoms is a secondary process, the primary one being the curbing of the forbidden instinctual impulses which is not always successful. In general, symptoms are formed in order to avoid anxiety. They bind mental energies which would otherwise be discharged as anxiety. Anxiety then is the central problem of the neurosis as well as its commonest outward manifestation.

In those neuroses where a successful repression or other defense measures prevent anxiety, any slight interference with the freedom of expression of symptoms mobilizes the anxiety. An agoraphobic patient left alone on the street immediately becomes anxious. If an obsessional neurotic is prevented from performing his ceremonial rituals, the anxiety becomes unbearable. Symptoms ward off anxiety.

Although Freud was not the first to perceive that anxiety is the chief factor in the neuroses, he was the first to define it clearly (2). His greater contribution was in developing a method of studying and treating anxiety in its relationship to