Meeting of the New York Psychoanalytic Society

October 30, 1979. TWO PHOBIC VARIANTS. M. Donald Coleman, M.D.

Dr. Coleman focused on two distinct syndromes which he believes to be phobic variants: "developmental phobias" and "mid-life phobias." He described the developmental phobia as a type of agoraphobia which appears traceable to the separation-individuation phase. Conflicts that arise from the oedipal period, "while evident, do not appear to be decisive in determining pathology… Those cases I am most familiar with clinically seem to have resulted almost entirely from maternal pathology." The mother in such cases has manifested marked hostility toward the child's developing autonomy, and the child has had to deal internally with hostility toward the mother. Since such a mother finds manifestations of hostility from the child to be intolerable indications of autonomy, so eventually will the child. In therapy in adulthood, these patients' "line of development, i.e., the need for symbiosis to respond to the mother's needs, should be seen as a logical, adaptive mode of a child in dealing with the perceived mother." Special tact is necessary if the analyst needs to demonstrate that the patient's current love object has attitudes toward autonomy similar to the mother's. Drawing on his clinical experience with a patient, Dr. Coleman stated that the analyst's lack of tact in relation to this type of current love object may be the rock on which therapy founders. He described a patient's therapy which has been conducted twice weekly for the past four years and has resulted in marked relief of her agoraphobia. Extensive reconstruction of the reality of her relationship with her mother and her adaptive responses to that reality had been of considerable value. Conflicts over oedipal impulses had emerged but at that time "did not appear to have been decisive in the formation of the patient's pathology, although it is clear that conflicts of sexuality and castration anxiety caused the last increment of anxiety