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Dunn, P.B. (2007). Emptiness in Agoraphobic Patients: Commentary on Milrod. J. Amer. Psychoanal. Assn., 55(3):1027-1032.

(2007). Journal of the American Psychoanalytic Association, 55(3):1027-1032

Emptiness in Agoraphobic Patients: Commentary on Milrod

Peter B. Dunn

The fundamental problem in agoraphobia, Barbara Milrod argues, is a developmental arrest. Agoraphobics view themselves as weak and incomplete. In order to sustain a feeling of safety they are compelled to live out the fantasy that they are fused with a powerful and loving superperson. They remain anxious nonetheless because this fantasy is always on the verge of being toppled by the reality of the phobic companion's limitations and by their own basic ambivalence. Defenses against aggression are only partly successful, so inevitably agoraphobics make their phobic companion suffer.

Milrod's theory departs from the classical model, but her views express the current clinical consensus. In particular, her emphasis on the agoraphobic's broad-scale character pathology is consistent with the widespread clinical conviction that at this point in history agoraphobic patients from the industrialized Western world suffer invariably from severe character pathology. Milrod's emphasis on the central dynamic role of preoedipal ambivalence is also consistent with the substantial trend in the literature since the mid 1970s. While this may simply reflect the switch away from the once dominant oedipal paradigm, most analysts would agree with Milrod that the shift is consistent with increased clinical sophistication about agoraphobia and greater theoretical clarity about the nature of oedipal/preoedipal condensations.

Scattered through this paper are three complementary explanations as to why agoraphobics feel empty. The first is that agoraphobics complain of feeling empty because they are empty.

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