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Dr. Melitta Sperling, a pioneer in the psychoanalytic study of somatic dysfunctions, raises questions in her presentation that are of great significance. Since a discussion that is only laudatory is not necessarily useful, my comments will deal with questions and issues that may be profitably elaborated in her response.
Dr. Sperling again presents a theoretical thesis with clinical material to demonstrate its validity. Essentially, her study is broadly related to the mind-body problem. Even when we consider the many possible multiple determinants we are still grappling with the “black box” problem—we can discover significant antecedents; we can effect change through psychoanalytic means; we can determine outcome; but we do not as yet know what has gone on in the intermediate stage to produce the clinical result.
Many levels may contribute to the resultant phobia. Dr. Sperling asserts that somatic symptoms may camouflage a severe phobia, but the somatic symptoms may be more than defensive manifestations: they may be expressions of a severely regressed state, they may be manifestations of a fragmented self-organization, or they may be independent though concomitant features of the phobic state.
Dr. Sperling's patients present severe psychopathology. Their fixation points may reflect pathogenic traumatic resultants stemming from early difficulties in the self-system, in
impulse control, and in object relations. In some of her clinical data, there is a suggestion of pathological persistent symbiosis, and this may relate to the severe separation anxiety seen in the cases described.
There are different meanings to phobias, just as phobias may be expressive of intrapsychic pathology stemming from different developmental levels of fixation and arrest of development, e.g., the circumscribed phobia of Little Hans differs from the more massive agoraphobia. Phobia is but a descriptive term applied to the patient's difficulty; in and of itself it is not an indication of a specifi