The Letter, Issue 6, Spring 1996, Pages 63 - 73
PSYCHIC STRUCTURE AND MANIFESTATIONS OF ANXIETY WITHIN THE CLINIC
Gerry Sullivan
The aim of this paper is to explore the connection between the context within which anxiety is manifested in the clinic and the psychic structure of the analysand. It is usually held that the difference between the psychiatric and the psychoanalytic clinics is that the former is a clinic of symptoms, while the latter is a clinic of fantasy.[1] This implies that it is symptoms which provide the basis of a judgment of psychic structure in the case of the psychiatric clinic, while it is the nature of the fantasy which is the significant element in the circumstances of the psychoanalytic clinic. However, given the psychoanalytic view of anxiety as the most revealing, the least duplicitous of the affects, it is the hypothesis of this paper that the manifestations of anxiety within the psychoanalytic clinic may also be effective guides to psychic structure.
In order to sustain this argument we will briefly review Freud's later position with respect to anxiety, before considering its symptomatic clinical manifestations. The text we shall draw upon is his New Introductory Lectures on Psychoanalysis, and, in particular, upon the thirty second lecture 'Anxiety and Instinctual Life'. Stratchey, in an editorial note, refers in particular to this lecture, and the previous one, which we shall also touch upon, in terms of a ' ... plunge into metapsychological and theoretical discussions of a difficulty which had been studiously avoided fifteen years earlier'.[2] The lecture referred to above is sandwiched between two others, the preceding on the general structure of the mind and the suceeding on femininity, which proved a continuing theoretical difficulty to Freud, producing ongoing extensive revision and theoretical reformulation. We can consider the concept of
anxiety as belonging to this sequence of crucial yet intractable ideas. In terms of the earlier conception of anxiety as an unpleasurable discharge, its tension with respect to the fundamental notion of homeostatic discharge as the foundation of pleasure was a contributory element in the emergence of a conception of a beyond of the pleasure principle, and an uncoupling of the automatic bond between discharge and pleasure. With respect to the later notion of anxiety as signal, the question of the looming source of the apprehensiveness manifesting itself in anxiety necessitated a structural differentiation of anxiety with respect to triggering sources.