Discussion of Melitta Sperling's Article, Somatic Symptomatology in Phobia: A Psychoanalytic Study

Melitta Sperling's paper presents a number of important observations on phobia, which she documents with rich clinical material. For the purpose of my discussion, I would like to summarize what seem to me her most relevant points: (1) the formation of phobia as a protective device against a psychotic development; (2) the role of pregenital and, in particular, anal-sadistic conflicts in the genesis of phobia; (3) the association, alternation, or substitution of phobia with somatic symptoms, especially mucous colitis; (4) the fear of loss of control as a dynamically important feature in phobia.

Before commenting on these, I want to make explicit that from my point of view there are at least two very different kinds of phobias: the true agoraphobias and the phobias to objects or specific situations (including some cases of street phobia). The first group was characterized by E. Weiss (1966) as an anxiety reaction to a danger which is consciously sensed as internal and which appears when the patient leaves a place of support. Other constant features are the need to be taken care of and the inability to tolerate the sensation of being enclosed. As Dr. Sperling puts it, “They must feel free to leave a place whenever they wish.” I think that this distinction is important because there are genetic and dynamic differences between the two groups. I understand that when Sperling is talking about phobias in her paper, she is referring to agoraphobias in the way in which they have been defined here, and I will continue my comments under that assumption.

I fully agree with the idea that the formation of agoraphobia is a protective device against a psychotic development, but I don't think that this is true for other phobias. While Dr. Sperling does not offer an explanation for this fear of ego

disintegration, she implies that pregenital conflicts, especially fixation and regression to the anal-sadistic phase, are prominent. H. Segal (1954) stressed the importance of the paranoid-