Eighty-six cases of phobias and compulsions constitute the material upon which this study has been carried out, 'primarily to investigate the specific factors producing these conditions'. The problem was approached under two headings: (1) 'The possible existence of the forerunners of the full-blown reactions, especially in the make-up and life situations', and (2) the mechanism of production. In the make-up the author finds consistently a definite social awareness with an acute sense of limitation or inferiority, personal or situational. Only very rarely is there any intellectual inferiority; between one-fourth and one-third reached colleges or professional schools. There is a marked adherence to conventionality. The situational factor is contributed by the cultural and educational contrast between the patient and the environment, also by economic obstacles, as well as by real or fancied sex inferiority. The age of incidence is 16 to 40, most frequently between 21 and 25. Most of the cases had a much earlier beginning, culminating through a series of connected or discrete episodes in the pathological reaction. 'Even when the content of the present obsessive or compulsive activity is unrelated to that of earlier symptoms, the fact still remains that the apparently disconnected outcroppings are evidence of the formation of a mental habit, a growing reaction tendency in meeting conflicting needs and desires'.
The question of the relation of early life rituals and phobias to the adult psychoneurosis the author dismisses by a dialectic gesture: Since childhoodphobias and rituals are very common, and the adult compulsive states comparatively rare … the relation is that merely of a chance
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association; the neurotic hearkening to his past recalls with great ease what the normal forgets. The salient problem as to what determines the psychoneurotic tendency of reverting to childhood is not even raised.
With reference to a possible 'Anlage' as the basis for future compulsive states, the following issues are considered: (1) Frequency of compulsive states in childhood; (2) Do these manifestations in the normal differ from those of the future psychoneurotic; (3) What is the significance of the difference. The material for the comparative study was thirty auto-histories by members of staff and students. Of these only one denied phobias and compulsions—although none was disturbed by these in any measure comparable to the psychoneurotic. The content of these manifestations differs from that of the potential patient. Those compulsive childhood traits which were in keeping with the group, play activities, traditions, superstitions, and religion, caused no intensified sensitivity or disturbance. Among the individual rituals tending to reach the significance of a pathological reaction, those pertaining to eliminative functions of the child are conspicuous.
As regards the mechanism of compulsions and phobias, the author distinguishes three stages of development: First, simple balancing of wishes, with the fear of the consequences of its realization. If neither completely supervenes, then the patient becomes a victim of a constant oscillation between the wish and the fear. Occasionally this mechanism may prevail as a discrete episode even in the normal in an urgent situation. The second type of mechanism arises by way of involving associative material into the wish—fear conflict, with the displacement of the accent upon the associative material. The third type of mechanism is the substitution of a symbolicobject or ritual for the original desire—fear situation.
Since all the mechanisms may occur episodically in the normal and by way of association and symbolism, and may be allocated to a remote material without any deleterious effects, it is obvious that the mechanisms alone could not account for the production of the compulsive states. What determines the persistence of these states in some individuals and the disappearance in others? The answer is to be found in the content of the compulsions and fears. The wish part of the conflict is invariably one which would involve social disapproval. Thus 'It is only a minister who could develop an obsessive desire to be profane'. Obviously, sex impulses par excellence give rise to illicit desires. As an exception to this the author considers the suicidal and homicidal compulsions. The greater the social condemnation for a given wish, the greater the tendency to perpetuate the conflict, and hence the more elaborate compulsive measures to safeguard against the wish asserting itself.
Conflict, involvement of associative material, displacement and symbolization,
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the rôle of sex in the content of the neuroses, the significance of childhood experiences, and childhood compulsive phenomena in relation to the adult affliction, these are the considerations in the light of which this study has been carried on. The vitalizing influence of the Freudian psychology and theory of neuroses is clearly felt in this study, even though it impresses one as a rather dilettante effort.
The author completely dispenses with the unconscious, busies herself with conflicts essentially in terms of surface mental processes, overstresses the precipitating situational factor, sees but a chanceassociation between childhood life and the adult symptoms, and refers to social inhibitions exclusively in terms of an external power, instead of an introjected force which once having become an integral part of the ego exerts its tyranny irrespective of whether the external pressure is actually present or not. There is also a timidity displayed in the consideration of the factor of sex, conceding to it but grudgingly the important rôle it plays, in spite of the fact that even the rather scanty excerpts of the case material in the article are in themselves a most convincing proof of the importance of this factor.
Then again the author has practically entirely disregarded the contributions of psycho-analysis to the subject of compulsion neuroses. To attempt an investigation, these days, of this very interesting ailment, without taking into consideration the descriptive as well as the theoretical material gathered in the light of psycho-analysis is to engage oneself in the naïve undertaking of rediscovering America. It is conceivable how under the prodding of healthy scepticism, established routes may be subjected to criticism and verification as to their efficacy, or that a new and more efficient road may be sought; but that an investigator in his work on a problem should deliberately shut his eyes to all that has been done in that field by other workers represents a curious mental attitude of 'splendid isolation'.
The study would have no doubt proven more fruitful had the author paid attention to the discoveries of Freud and his co-workers in compulsion neuroses, such as, the significance of certain primary impulses, anal erotism, exhibitionism, the phenomenon of ambivalence, homosexuality, and, foremostly, the phenomena of infantile fixation and regression. Obviously the enormous material, eighty-six cases, valuable for whatever statistical data it may render, is much too large for a thorough and penetrating study such as psycho-analysis implies. The question, however, as to whether more productive results may be obtained from intensive study of individual cases as against the statistical data of superficially studied groups of cases still remains an open one in the light of this study.
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Polon, A. (1924). Clinical. Int. J. Psycho-Anal., 5:209-211