plainly implied that we are not distinct from animals. And if we have not been selected by God for special treatment, there is no reason why we cannot be studied scientifically.
The work caused a social and moral storm on publication but it was assimilated by scientists and the public alike within a decade. From there, developments in the many fields of science relevant to anxiety, fear and phobias started to snowball. Psychologists started collecting data. They devised experiments and studied the behaviour of animals and humans. Wilhelm Wundt, who set up the first psychology laboratory in Leipzig, epitomised this new approach. His followers were trained to look for traits that could be measured, and then collect data before they started building their theories.
The foundations were laid for the modern neurosciences. Spanish physiologist Santiago Ramón y Cagal was awarded the Nobel prize for his discovery that the brain is made up of neurones, or nerve cells. Afterwards, scientists went on to establish that the brain consists of a vast interconnected network of these cells. Scientists today are still trying to determine how far communication between these cells determines emotions like fear or anxiety.
Medicine progressed. Psychiatrists like C. Westphal started closely observing and defining phobias. The American Civil War brought tragic opportunities for clinicians to study fear at close quarters. Doctors who might once have moralised about courage or faith started taking measurements and looking more dispassionately at the effect of fear on the heart, lungs and other body systems. They wrote up their observations and developed theories, some of which are explored in chapter 4, on neurophysiology.
All of this work set the scene for probably the single most influential figure in the history of thought on phobias.
Freud on Fear
Five-year-old Hans was walking along the street with his mother. It was in the early years of the twentieth century and there were horses trotting by, pulling carriages, vans and buses. Wheels and hooves clattered on the cobbled road, people walked across and between them and it was an ordinary, busy day.
Hans’ mother stopped to greet an acquaintance and he looked idly down the street. A bus came towards them, pulled by two black horses. Just as it reached them, one of the horses stumbled and fell heavily on to its belly, jolting the bus. The other horse swished its tail in distress, shook its head and stamped its feet. The driver jumped down to help, and people peered out of the bus to see what was going on.
The horse looked enormous as it lay on the ground, covered in dust, in front of Hans. It snorted and tried unsuccessfully to get up. Its harness was twisted, making it difficult for the horse to move. A crowd started to gather and the noise grew. Hans stared in fright and his mother led him away from the scene.
Hans was agitated and could think and speak of nothing else for the rest of the day. Soon afterwards, he developed a phobia of horses. He started crying on his normal walk to the park with his nursemaid, and wanted to be taken home. He was afraid a horse would bite him and later, at home, afraid that a horse would come into the room. He became reluctant to go out at all and was quiet and withdrawn in the evenings.
Hans led an unexceptional, if somewhat closeted, middle-class life. He had a younger sister but few friends of his own age. His parents had, for the previous two years, noticed what they considered to be a precocious interest in sex. He asked questions about his parents’ and his younger sister’s genitalia. Both parents told him that he had the phobia because he often touched his ‘widdler’.
His parents were devotees of Sigmund Freud and Hans’s father wrote to Freud about the horse phobia. The case of Little Hans, as it became known, was the first published account of child analysis, and became celebrated as a key success in psychoanalysis. Freud believed it was proof that sexual urges are an essential part of the development of phobias.
Freud said Hans had an Oedipus complex. He loved his mother and wanted to be taken into her bed. He wanted his father, his rival, dead, and was therefore afraid of him. Hans transferred his fear of his father on to horses and the phobia erupted after some months of longing for sexual contact with his mother. According to Freud, ‘His sexual excitement suddenly changed into anxiety.’ The affection for his mother ‘triumphantly achieved its aim’, by making Hans afraid of going out into the street and allowing him to stay at home with his mother.
These were tendencies in Hans which had already been suppressed [wrote Freud] and which, so far as we can tell, had never been able to find uninhibited expression: hostile and jealous feelings against his father, and sadistic impulses (premonitions, as it were, of copulation) towards his mother. These early suppressions may perhaps have gone to form the predisposition for his subsequent illness. These aggressive propensities of Hans found no outlet, and as soon as there came a time of privation and of intensified sexual excitement, they tried to break their way out with reinforced strength. It was then that the battle which we call his phobia burst out.
Hans’s father received Freud’s letters over a period of months and Hans recovered gradually.
The case of Little Hans, which has been argued about ever since, was a fascinating example of Freud’s theory of mind. Freud said the ‘id’ stands for untamed passion, and the ‘ego’ for reason and good sense. The id generates inappropriate sexual or aggressive impulses, which the ego tries to make socially acceptable. The ego receives the id’s dangerous urges, and represses them if at all possible. Failing that, the ego has to find another outlet and may alter excessive excitement so far that it ceases to be pleasurable and becomes a psychosomatic symptom such as palpitations or fainting.
So, according to Freud, Hans’s sexual desire for his mother and his longing for his father to be dead were unacceptable urges created by the id. They created more excitement than the ego could deal with and were converted into anxiety and a fear of horses.
A single anxiety attack, with palpitations or breathlessness, can be enough to trigger a phobia, said Freud, and many today would agree with this part of the theory, if not with the underlying explanation. The ego feels helpless during the attack, Freud says, and deals with this by projecting the anxiety on to the external situation. The anxiety attack then becomes associated with a bus or train journey, for example, rather than with forbidden excitement. It is easier to control external situations than internal thoughts and the phobia becomes a convenient way of explaining away a terrifying reaction. This process is carried out at a subconscious level; at the conscious level, all we know is that we are afraid of the situation. The ego then prompts us to avoid the situation in future as a defence against the impulse and the feeling of helplessness. So an external, tangible fear replaces an internal, instinctual danger and a phobia develops.
Freud’s theory was at once brilliant – and mistaken. On the positive side, he founded psychoanalysis and highlighted, long before mainstream science, the importance of relationships and childhood experience in shaping adult personalities. Furthermore, his emphasis on the subconscious opened up a whole new way of thinking about mental pain and inner conflicts. But his emphasis on sex was questionable. Other scientists have combed the 140 pages’ worth of his analysis of Little Hans and found no evidence that the boy sexually desired his mother. Nor are there any signs that he feared his father. But the link between sex and phobias, started by Freud, has hampered phobia treatment for decades.
Specialists and theorists today have largely given up the idea but it still lingers and can cause problems. Referral for a phobia from GP to psychiatrist can still lead to a discussion about relationships with parents and possible abuse. It is impossible to completely rule out a link between sex and a phobia; complex phobias can develop from a background of troubled emotions and difficult experiences and there are, of course, phobias of sex itself. But most phobias do not stem from sex or have anything to do with it.
Psychoanalysis itself is largely out of fashion in scientific circles, partly because it has failed to keep up to date and incorporate new findings from cognitive science or physiology. But its legacy in phobia treatment is the enduring idea that phobias are the visible signs of terrible inner conflict. For many years psychiatrists have approached phobias with extreme caution for fear of what might be uncovered.
The whole basis of recent progress