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Isaacs, S. (1943). An Acute Psychotic Anxiety Occurring in a Boy of Four Years. Int. J. Psycho-Anal., 24:13-32.

(1943). International Journal of Psycho-Analysis, 24:13-32

An Acute Psychotic Anxiety Occurring in a Boy of Four Years

Susan Isaacs

I wish to describe and discuss the material which follows because it illustrates clearly the interaction between internal and external situations. During the analysis of this four-year-old boy, certain acute anxieties arose in response to particular external events. These events were reflected in a detailed and dramatic way in the content of the anxieties, and in the various defences to which the patient resorted.

The special anxieties I shall discuss showed themselves about the eighth week of analysis, in response to severe environmental stimuli occurring in the sixth week; they were worked through, in their most acute form, during the following month.

I shall describe the boy's symptoms and the general situation of his life; give a brief outline of the course of his analysis up to the crucial happenings in his external life; describe in some detail the extreme anxiety produced by these events; and then discuss the chief meaning of his symptoms and characteristic defences.


The boy, Jack, was brought for analysis because of periodic and severe attacks of rage when he was frustrated, and also a 'queer' excitement which came on apart from temper, with no immediately obvious stimulus. Apart from these symptoms, his relatives considered him a fairly healthy and happy child, friendly and uninhibited, not specially aggressive or destructive.

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