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Wangh, M. (1959). Structural Determinants of Phobia—A Clinical Study. J. Amer. Psychoanal. Assn., 7:675-695.
    

(1959). Journal of the American Psychoanalytic Association, 7:675-695

Structural Determinants of Phobia—A Clinical Study

Martin Wangh, M.D.

SUMMARY

The structural concept of psychic functioning has opened the way to more refined research into the problem of choice of neurosis. The case presented may serve to widen knowledge in this area with respect to phobia. The growth of id, ego, and superego constituents in a phobic patient are examined, the history of disturbance of ego control is pursued, and an attempt is made to glimpse the genesis of the defense of avoidance.

In a case of topophobia it is shown: (i) how the function of drive control was impaired through failure to solve the earliest ambivalence conflict by means of identification; (ii) how the tendency to avoid conflict and tension was reinforced through the mother's separating herself from the infant and child at slight provocation; (iii) how seemingly easy object displacement was fostered by a tenuous primary object relationship and through the availability of a nurse, grandmother, and others; (iv) how the patient was prevented from solid identification with her faithful nurse by the mother's insistence on loyalty to herself.

The case demonstrates further that instinctualization of sphincter control, promoted by the nurse's rigorous toilet training, weakened the function of ego control in general and invited regression. Superego development was impaired by the pregenital and genital seductions of the nurse and/or of the father. The patient's good common sense, by which is meant a well-developed sense of outer reality, and a relatively strong defense against sadomasochistic strivings, served as a counterweight to acting out, a tendency frequently found in the prehistory of phobia.

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