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Rhead, C. (1969). The Role of Pregenital Fixations in Agoraphobia. J. Amer. Psychoanal. Assn., 17:848-861.

(1969). Journal of the American Psychoanalytic Association, 17:848-861

The Role of Pregenital Fixations in Agoraphobia

Clifton Rhead, M.D.


We may return to Freud's statement which served as the point of departure for this paper. Certain severe agoraphobics appear to suffer from an ego distortion which is nonspecific in nature but which results from the interplay of several factors:

1. Failure of the individual to achieve a position of psychic separateness, and concomitant fixation to a symbiotic partner.

2. Maternal inadequacy, and failure of the mother to protect the child from overwhelming stimuli.

3. Premature ego crystallization, massive and wholesale identifications, and a prevalence of primitive defensive mechanisms.

The resulting psychic scarring may be compensated for by hypertrophy of other ego functions, e.g., wholesale identifications. The distorted ego is incapable of bringing the oedipal conflict to a successful resolution and is thus vulnerable to a later breakdown when confronted with the stresses imposed by puberty and adolescence. Unsuccessful resolution of the oedipal conflict results in a preponderance of fantasies characteristic of the infantile sexual theories. Those fantasies may appear in the course of the patient's free associations, but their recall and working through fail to result in therapeutic success because of the regressively activated, symbiotic defense: the symbiotic partnership with the mother or mother surrogate. Effective resolution of those fantasies depends upon successful analysis of the symbiotic defense, during the course of which variations in technique or the introduction of parameters (as with all patients suffering from ego distortion) are indicated parts of the treatment, providing they conform to the criteria established by Eissler.

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