Discussion of Edoardo Weiss's Article, The Psychdynamic Formulation of Agoraphobia

Dr. Weiss mentions four types of etiologic explanation of agoraphobia: the classical psychodynamic

formulations; the idea that an ego state from early childhood, poorly repressed and unassimilated into the adult ego, usurps control over the latter; the idea that the agoraphobe is a person who cannot tolerate the absence of intra-ego barriers against instinctual discharge; and the idea that agoraphobia may arise from the need to separate from the mother in the interest of establishing one's own autonomy.

The body of this paper consists of the development of the second theory; the first, third, and fourth are merely noted.

It is evident that in by far the largest number of instances of illness, a predominant, discrete cause cannot be discerned in the sense that one can attribute pneumonia to the pneumococcus or a laceration to a trauma. In this same sense, then, explanation four (maturational need), explanation one (conflict resolution), and explanations two and three (specific kinds of ego weakness) may all be considered etiologic agents which synergistically participate in the pathogenic process. In the paradigmatic case, a striving will originate from inner need; it will engage the ego to find a suitable discharge path for it; the particular discharge pattern selected by the ego will depend upon the constraints and opportunities of reality, the pressures of the superego, the weaknesses and strengths of the ego itself, and the various conflicting dynamic needs. To this point what I have said is conventional wisdom which has by now become textbook cliché.

One may acknowledge that in certain instances one of these several etiologic factors may be so pronounced that minimal cooperation by the others is required. For example, in the case of schizophrenia, there are some individuals who are bom with such weak egos that the normal frustrations and stresses of daily life suffice to precipitate full ego fracture. There are others, though, whose ego weakness is so slight tha