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This paper describes an attempt to improve therapeutic results with phobic patients, and the specific problems arising in a group of such patients. Anthropological and sociological literature on death is considered.
Conscious, preconscious, and unconscious death fears were found in the patients studied and were the focus in the pathogenesis of their phobic anxiety. Death meant something different to each person, according to his stage of development, e.g., suffocation, choking, separation from the mother, hunger, castration, eternal punishment, mutilation, or decay. Data from fourteen patients in individual therapy and fifteen in group therapy elicited the following: children are traumatized by the experience of death just as they are by the primal scene; denial of this experience results in adult phobia when the defense, a fantasy of immortality, breaks down in face of such realities as serious illness, threatened symptoms, or death of someone close; analysis of this initial breakdown indicates that the death fear afterwards becomes displaced to some associated circumstance which becomes phobic; sometimes the fear of death is displaced onto fears for the family, fears of inability to earn, and of pain. Vertiginous and cardiac patients are markedly prone to develop death fears, in contrast to convulsives.
A quantitative relationship between the intensity of childhood fears and the severity of adult symptoms has been noted. Many phobic patients have had initial contact with death at the height of their Oedipal conflict, when aggressive drives toward the parents induce the formation of a punitive superego. The death experience becomes a threat of punishment. The authors found that an active discussion of phobias related to death fears has a rapid and rewarding therapeutic outcome. The support to the ego afforded by the therapeutic situation enables the patient to endure the generalized anxiety connected with his death fears, without the need for defensive displ