The Fear of Getting Well

Freud coined the term ‘negative therapeutic reaction’ to describe the strange behavior of a patient who gets worse in the analysis when we have every reason to expect him to get better because his unconscious sense of guilt cannot allow him any improvement.1

This description is undoubtedly correct but closer study shows that there are several mechanisms at work. To mention a case: after the patient's most acute symptoms had disappeared, the analysis concentrated on diminishing his inhibitions and his relative lack of success in life. Whenever he achieved something he had wanted, he paid for it by developing a depression which sometimes lasted for weeks. When this depression was resolved, he achieved a further measure of success; after that developed another period of depression, etc. For instance, he had badly wanted a car for years; when at last he could afford to buy it, he got a depression. We analysed all the previous occasions in his life when he had wanted a car and could not have it, back to the time when he had wanted a bicycle as a child, and, before that, a tricycle and a toy-train, and the disappointment, depression and resentment he experienced on these occasions.

The depression brought on by achievement was not only due to his sense of guilt in general but had a number of causes. It was a survival of depressions occasioned by frustrations in the past; success underlined the past frustrations. The repressed resentment caused by these frustrations was another reason for his depression. Yet another one was guilt over his triumph at his success. He wanted to show off his car and arouse the envy of his friends. The car was only a beginning; he phantasied of all the other things he wanted to have and do to impress others. These exhibitionistic aggressive impulses roused his fear of people and, to escape it, he got into a state of depression to get people's pity. After having analysed these details, the depression passed and he could risk another achievement.

Ano