Anxiety States1

Clinical Case. I should like to begin with a clinical case. A woman in her early thirties comes to consult me. She enters the room, sits down and says that she is frightened, that above all things she cannot stand the idea of her husband going away, even for a single night. She finds it difficult to say more but in reply to my questions I learn that she has just had a baby and that her condition has been worse since. An older and unmarried sister had had a breakdown and the patient regarded this as a reaction to her having had a baby. She tried to persuade the sister to be analyzed but in vain; the mother is against analysis, I believe on moral grounds. I point out that she finds it dangerous to be happy as this is likely to arouse her sister's jealousy. She then starts to speak of her widowed mother, gets up, walks agitatedly up and down, and eventually takes up her position in the furthest corner of the room leaning—or hiding—behind the bookcase. I tell her that she seems to be frightened not only of her mother but also of me and that it looks as if she were afraid of a physical attack, which is why she feels safer at greater distance. She now confesses to having undergone an abortion which she wished to conceal from her mother. I suggest that she had been more afraid of getting hurt through the operation than she realized. She agrees that that is possible and adds that throughout all this her husband had always been her mainstay. It is now clear why she is so alarmed at the thought of his going away; she would have nobody to defend her, especially against her sister and mother. Her fear seems to have been greater at night than in the day, just as it had been in her childhood. I ask her when she wants to come again. She is rather evasive. I point out that she is probably afraid of the analysis, which must feel to her like an abortion on a mental plane, something which might hurt her and of which her mother would equally disapprove. But in so far as she regards ana