A Clinical Study of a Phobic Illness: The Effects of Traumatic Scars on Symptom Formation and Treatment

Freud (1926) used his investigation of phobias to map the relationship between the generation of anxiety, symptom formation, and the developmental sequence of the danger situation. He concluded that symptomatic and characterological compromises became permanent distortions of the ego to remove the ego from danger of repressed instinctual processes. When the ego is caught off guard and is exposed to a danger that is not mastered through symptom formation, a traumatic neurosis, as opposed to a psychoneurosis, develops. The phobic symptom in particular is distinguished not by its mechanism of formation in response to the unconscious legacies of the infantile neurosis, but by its combination of defenses, which transforms infantile dangers through displacement, regression, externalization, projection, condensation, symbolization, and repression to forms that disguise the wish and the anticipated punishments if the wish were known by the patient and others. The phobic disguise, which Lewin (1952) has likened to the manifest content of the dream, is a deception that retains an unconscious connection to the underlying instinctual