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The author briefly scans Freud's progressing concepts of anxiety and illustrates how both the earlier, more physiologically oriented ideas and the later ones, stressing the role of anxiety in the functioning of the psychic apparatus, are being confirmed and elaborated in recent analytic, physiological, and sociological studies. The turning point in Freud's thinking about anxiety appears in the final chapter of The Interpretation of Dreams (1900), in which he still explicitly speaks of anxiety as transformed sexual energy but indirectly implies the operation of anxiety in the ego as a signal for defense (in discussing the motive power of dream censorship). In Inhibition, Symptom, and Anxiety (1926), he expresses his final, dual concept of anxiety: the primary anxiety of being overwhelmed by helplessness in massive stimulation, and secondary anxiety as a signal produced by the ego. He changed from thinking of repression as the source of anxiety to thinking of anxiety as the cause of repression.
Zetzel discusses various recent ideas. 1. Aggression can be the source of anxiety, especially in schizophrenics, psychosomatic patients, or depressives. 2. Internal dangers arise from objects inside the self as well as from instincts. 3. Experiencing overstimulation or extreme frustration in the early months of life causes primitive discharge anxiety and impairs development of ego integration. 4. Signal anxiety is an integral feature in psychic development. The capacity to tolerate anxiety is essential for healthy character. 5. 'Anxiety makes for repression, repression causes frustration, frustration may represent an inner danger, and this causes more anxiety' (a concept stated by Schur).