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The aim of a phobia is to create a new and less frightening danger than the traumatic state threatened by certain unconscious sexual and aggressive impulses. Each level of psychosexual development has its characteristic fear; and the phobic defense, far from being exclusively linked with hysteria, can be brought into play against any of these phase-specific fears. Phobic patients can be grouped with the obsessional and the schizoid as being remarkably different from neurotic depressive patients. Phobic patients are avoiders, projectors, and distance-seekers; they sacrifice object relations for security, react to objects with hostility, and defend by phobia and inhibition. By contrast, depressive patients seek closeness and employ incorporation, seek objects for their security, and react to them libidinally, although sadomasochistically. The anxious patient fears helplessness and is a pessimist; the depressive fears hopelessness and is an optimist.
Primal anxiety and primal depression are basic ego states which represent different stages of development. In primal anxiety the loss of an external object precipitates a loss of cathexis of the internal object with a resulting loss of ego function. In primal depression, a state occurring somewhat later in development, the loss of the external object does not destroy the internal object and its associated ego function, but rather stimulates a reparative process involving the internal object. It is speculated that all neuroses may be traceable to either primal anxiety or primal depression. If so, a hierarchical series can be constructed for anxiety, from oral fears of being devoured to the relatively benign fear of castration,—and also for depression, from fears of utter abandonment to Oedipal rejection. It is the author's impression that paranoid, schizophrenic, obsessional, and phobic reactions are each derived from primal anxiety; whereas manic-depressive