Meetings of the Psychoanalytic Association of New York

January 31, 1977. A FRESH LOOK AT THE CASE OF LITTLE HANS. Martin A. Silverman, M.D.

Dr. Silverman presented a review of the salient features of Freud's report on the illness and treatment of Little Hans from the recently acquired perspective offered by our knowledge of childhood development and neurosogenesis. Noting that Hans's treatment took place before the advent of either the dual instinct theory or the structural theory, the author attempted an elaboration of the significant understandings related to the preoedipal factors which led to and colored the oedipal phenomena. Hans's early ambivalent and erotized attachment to his seductive mother was marked by strong libidinal and aggressive cathexes of his principal objects. After a period of anal phase difficulties, in his fourth year he began to masturbate and to demonstrate interest in his genitals and in the anatomical differences between the sexes. His conflicts were heightened by his mother's pregnancy and his eviction from her bedroom. After his sister's birth, his jealousy, anger, and castration anxiety were compounded by a tonsillectomy.

Freud's concentration on the oedipal struggles and the castration anxiety behind the phobic neurosis neglected the oral and anal factors related to Hans's jealousy and his wishes to bear children. Dr. Silverman contended that looking at the phobia in connection with difficulties in the practicing and rapprochement subphases of the separation-individuation process showed that anal-sadistic impulses were significantly accompanied by restriction of activity and locomotor anxiety. The preoedipal impairment of certain aspects of Hans's ego development led to regression, phobic withdrawal, externalization, and displacement—measures that emerged to cope with the panicky threat of his helplessness in the face of instinctual tensions. In commenting on the technical handling of the treatment, Dr. Silverman noted the inability of Hans's father to deal with the child's negati