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I have had only a limited amount of experience with true agoraphobia patients as compared with Dr. Weiss's very extensive experience and considerable success with them. I am thankful to him for emphasizing the often neglected difference between agoraphobia and other common phobias, namely, the emphasis in the former on the experience of inner disorganization as the primary source of the fear, and in
the latter, on some externally perceived threat as the primary source of it.
Since, however, I disagree with the theoretical position taken, and this is primarily a theoretical paper, I will limit my discussion to the elaboration of those questions in the areas of my disagreement.
My first remarks will be addressed to the limitations of the proposition that there are “conscious ego states” and, at least in the patients under discussion, “repressed ego states” which “threaten to replace the adult ego.” No issue is being taken with the disorganizing influence of conflict upon the organization of the ego, including the sense of personal identity. As Dr. Weiss states, this may eventuate in the threat or actuality of identity diffusion, depersonalization and derealization among other things. The “repressed ego state” as an organized entity is too gross an invitation to reify an internal state of affairs rather than to describe it in terms of its dynamics. In addition, in suggesting that this “repressed ego state” takes cathexis away from the “conscious ego state” and thereby “weakens” it, the use of economic postulates is subject to no evident consideration other than the fact that the psychologically ill person is said to have a “weak” ego. Just so, in connection with the achieving of sexual gratification and what Dr. Weiss describes as the “post-climactic efflux of libido” one of the patients described is said to have had a “strengthing of the ego” with a resultant reemergence of repressed ego states and, I would assume, a reduction of his symptomatology.
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