You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In over 50 years of psychoanalytic practice I have had the opportunity to study very many cases of agoraphobia. Some were not very accessible to treatment, but in several cases I obtained a good and lasting therapeutic result. However, I have gained a deeper insight into the psychodynamics of this neurosis only in recent years.
As I mentioned in my book, there is a voluminous pre-Freudian literature on this particular neurosis. French, German, Swedish, and Italian neurologists and psychiatrists described its various clinical aspects and the physiological manifestations of agoraphobic anxiety. However, none suspected the psychological nature of this phobia. Only in the light of psychoanalysis were unconscious conflicts recognized as the determining factors.
In the psychoanalytical literature there is no accurate description of this neurosis. Furthermore, some of the concepts of agoraphobia are confusing. Phobias which in their manifestations and psychodynamic aspects are quite different from agoraphobia are often considered agoraphobias by some psychoanalysts. In the classical—but not the most frequent type of—agoraphobia, the patient is afraid to cross a wide open space, a square, or a broad street. (In 1872 the German neurologist, Westphal, (8) introduced the term “agoraphobia” for this fear. He considered it to be a neurological disease.) Why is the patient afraid to cross such a wide open space? He will tell us that he is afraid to fall or that he feels dizzy. A more accurate investigation of his conscious experience is that he does not trust his ability to walk into a wide open space.
One of my patients said that he lost the sensation of his own body when he had to cross a wide open space, and that he could do so only when he shielded his eyes, thereby excluding from his sight the expanse of space which lay before him. So it would seem that the classical type of agoraphobia is due to some physiological sensory disturbance. In fact, in this type the patient becomes