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School Phobias
Melitta Sperling
To cite this article: Melitta Sperling (1967) School Phobias, The Psychoanalytic Study of the Child,
22:1, 375-401, DOI: 10.1080/00797308.1967.11822605
375
376 MELITTA SPERLING
(roughly between age one and one half to three). It is during this
phase that the motor equipment necessary for active separation-
walking away from mother-develops, and when the ambivalence
conflict concerning the anal instincts is at its height. It is the conflict
of whether to hold on or to let go of feces (unconsciously equated
with objects). During the oral phases there is only passive depend-
ence because the child lacks the equipment for initiating any active
separation from mother in reality.
I would suggest classifying the phobias as being midway between
the obsessive-compulsive and the hysterical neuroses, but closer to
the first. The main mechanism of defense in phobias and in obsessive-
compulsive neuroses are similar-namely, displacement, isolation,
and projection. In 1909 Freud described a mechanism characteristic
of the phobias, i.e., the externalization of an instinctual internal
danger, which then can be avoided as an external danger. The high
degree of ambivalence and narcissism, the persistence of the fantasy
of omnipotence, and the exaggerated need for control are character-
istic pregenital (anal-sadistic) features of this neurosis, and provide
the link with other pregenitally fixated disorders (character disorders,
certain perversions such as fetishism) and with psychosomatic dis-
eases, especially with asthma and colitis. In all these conditions, sepa-
ration anxiety is a crucial issue, and its persistence interferes with a
satisfactory resolution of the oedipal conflicts.
From this it follows that school phobia has to be considered a
psychoneurosis in the true sense; that is, that it is based on uncon-
scious conflicts and fantasies and that the reasons a phobic child
gives for his behavior are rationalizations, while the true reasons are
unknown to him. Although this concept is shared by many workers
in the field (Coolidge et al., 1960; A. Freud, 1965; Greenbaum, 1964;
Johnson et al., 1941; Kahn and Nursten, 1962; E. Klein, 1945; Wald-
fogel et al., 1957; Suttenfield, 1954; Talbot, 1957), it is essential to
emphasize this very strongly because there is the temptation to treat
a school phobia with a common-sense approach, such as reassurance,
reasoning, persuasion, reward or punishment. It should be obvious
that none of these can really be effective or have lasting results,
although it may be possible to bring a child back to school by any
of these means. I am aware of the importance of inducing a phobic
patient to return to the phobic situation as soon as possible; the aim
SCHOOL PHOBIAS 377
Acute school phobias can occur at any age, during any time of
the year, not necessarily at the start of school or after school vaca-
tions. There is usually no history of prior school-phobic behavior.
In all cases of acute school phobia, I favor a direct and analytic ap-
proach, regardless of age. I am aware of the fact that this is not
always possible and that such children can be and are brought back
to school by other approaches. In "Analytic First Aid in School
Phobias" (196Ia), I have explained why I consider an analytic ap-
proach in acute cases particularly important, and I shall briefly
recapitulate here some of the salient points:
In the acute school phobia, it is often possible to detect, in one
or in a few interviews, the unconscious significance of the precipitat-
ing event and to interpret it to the child. The traumatic event is
usually one that represents a danger to the child's ability to control
reality; that is, a danger of loss of control over a situation or object
(usually the mother). In the final analysis this extreme need for con-
trol reveals itself as a wish for control over life and death, and the
fear of the phobic patient (child or adult) as a fear of death. The
precipitating event may be real or feared illness or death of a parent
or a person unconsciously representing a parental figure, or illness
or an accident, or surgery performed on the child, which to the
child has the meaning of having barely escaped death. In. other
words, the event represents an acute separation threat and, to the
child predisposed to phobia by its fixations to the anal-sadistic level,
has the meaning of impending death (of the parent or of the child
himself). The fixation to the anal phase has other implications:
object relationships are highly ambivalent, the narcissistic orienta-
tion has persisted, and so has magical thinking '(omnipotence of
thought), which means that the child equates his unconscious death
wishes with actual reality.
I consider an acute school phobia as a "traumatic neurosis with
school phobia as the presenting symptom." The intense anxiety
caused by this trauma leads to an increase in the need for magical
control (control over life and death), which the child is attempting
to achieve by the phobic behavior.
SCHOOL PHOBIAS 379
The inducer, in this case, was the father, who was in analysis
during the time when John developed an acute school phobia. Mr.
J. was very distressed about the situation and blamed himself for his
son's phobia, thinking that he was the cause of it because he had not
devoted enough time to his son. John now was clinging to his father,
and requested that he stay home with him and not go to work. He
could not give a reason why he did not want to go to kindergarten,
which he had previously attended willingly. In fact, he said that he
liked the teacher, and that the children were okay. Attempts to get
him to school failed. Even when his mother could get him into the
car and take him to school, John refused to enter the school. In this
case, my knowledge of the father's personality and of the family dy-
namics made it possible to understand the development and mean-
ing of the child's phobia and helped to resolve it rather quickly
through the help given to Mr. J. in his analysis.
Mr. J. had been a phobic person since childhood, but had man-.
aged to cover up his phobia rather cleverly by manipulating his
environment. His wife, apparently because of her own needs, lent
herself to play in with the patient's phobia. She was always at home
taking care of the house and children. At the time of the acute onset
of John's phobia, Mrs. J. as a result of her husband's analysis had
become much freer and was even considering beginning some activi-
ties which would take her away from the house for brief periods of
SCHOOL PHOBIAS 381
time. John was the youngest of three children and the only boy, and
there had been talk about having a fourth child. Manifestly, this
was a strong wish expressed by Mrs. j., but Mr. J.'s analysis revealed
that it was unconsciously intended by him as a means of tying her to
the house and limiting her newly regained mobility, so that he was
very ambivalent about whether to impregnate her or not. The pa-
tient himself was at a critical phase in his analysis, which at that time
dealt with the core of his phobia, i.e., the early relationship with his
mother displaced onto his wife and, in the transference, onto his
analyst. He seemed to come closer to a resolution. He had begun to
drive alone and to go places by himself, and he had even taken a
plane trip recently. (He had never traveled any place before and had
always managed to have someone go along with him in the car.) He
felt trapped in the analysis; giving up the phobia meant giving up
magical control and resolving the infantile tie with mother (his wife
and his analyst), that is, to finish his analysis. The deepest meaning
of the phobic relationship, as I see it, is to maintain the infantile
tie with mother forever, that is, the avoidance of any change, any
termination. In the final analysis, this equals the avoidance of accept-
ing the reality of death.
My patient had always identified himself with John. He felt that
John looked like him. He also thought that John was rejected by his
mother as Mr. J. had felt rejected by his own mother. He had always
been closer to his father. He looked like his father and felt that his
father preferred John among all the grandchildren. Analysis revealed
that at this critical point in his analysis Mr. .J. had passed on his
phobia to his son. He continued the phobic relationship with John
by playing the part of the solicitous father. This was a piece of clever
acting out. Instead of resolving his phobia, Mr. J. arranged for a
phobic relationship with his son. This could be convincingly and
effectively interpreted to him. He became aware that by his anxiety
and overconcern about John, he had been transmitting to John his
unconscious wish for the phobic dependence. The most startling
thing for Mr. .1. was what he called John's paradoxical reaction.
Without any intervention from the outside, there had been a dra-
matic change in John'S behavior. John, who previously had been
whining and fearful in the morning, reluctant to get dressed and to
leave the house, now was as happy as a lark, more carefree and re-
382 MELITTA SPERLING
laxed than before the onset of the phobia. This change occurred
when Mr. J. was able to disengage himself from his pathological
involvement with John and to treat him more casually. The child
responded with immediate relief, and directed his interest back to
his playmates and outside activities. The extra interest, devotion,
and time given to him by his father had apparently been correctly
interpreted by John as a premium for his compliance with his
father's unconscious wishes.
Certain aspects of Mr. J.'s analysis during this period are of par-
ticular interest for the further understanding of the phenomenon
of induced school phobia. These aspects dealt with Mr. J.'s relation-
ship with his father, which he had conspicuously neglected in his
analysis. He had always considered his father the more independent
and the more considerate parent and had had a manifestly positive
relationship with him. The conscious hatred and hostility he felt
for his mother had occupied a large part of his analysis. He now
remembered that his father would often belittle the mother in his
presence and that he would tell on his mother to his father. His
father used to take him on his business trips and have him sit for
hours in the car waiting for him. The patient had insisted on looking
at this as a proof of love and had never before admitted to himself
that he felt that his father was phobic and inconsiderate and was
using him as a tool in his phobic manipulation. To admit this would
have meant to acknowledge the same concerns in himself. He could
now understand that he had been trying to do the same with John.
John's phobia served many functions in his father's mental life
and in the family's neurotic needs. At this point I want to mention
only the following:
1. In identification with John, Mr. J. could maintain his own
phobia, the maintenance of which was threatened by the analysis.
2. Mr. J. perpetuated with John the relationship he had had with
his own father; that is, he transformed what he had experienced
passively into an active experience; he did with John what had been
done to him by his father.
3. The phobic child also could substitute for the fourth child,
the new baby, by fulfilling the purpose of limiting the freedom of
the parents.
SCHOOL PHOBIAS 383
only with a baby sitter who lived on the same floor. Several weeks
ago, when this girl was not available, the mother hired another baby
sitter. Mrs. A. seemed to have strong feelings about this girl whom
she described to me in great detail. Mrs. A. was shocked when Ann,
who knew this girl, accepted her readily. A week later when this girl
came again, Ann was very upset and did not want her to stay. Al-
though Mrs. A. had no special plans for that evening, she insisted
that the baby sitter stay with Ann. Ann threatened to vomit, but the
mother left her. However, Mrs. A. returned immediately because she
felt that she should not have left and found that Ann had vomited.
The vomiting was then repeated for several nights, Ann getting up
at the same time each night and vomiting.
I then learned that Ann had had a period of nightly vomiting
when she was about eleven months old, and that the pediatrician
had implied to the mother that she must be doing something wrong
with the child. Ann would vomit only during week nights when
the house was quiet and she was alone with her mother. Mr. A. was
working nights at that time. On weekends, when the house was full
of people, the child never vomited. When Ann was about three or
four she was very active and often said, "I want to play on the street.
I want to go there. I want to do this by myself." Yet at night she
always clung to her mother, who had to come into Ann's bedroom
innumerable times. This would end up with the mother becoming
angry, yelling, and spanking Ann.
When I pointed out to Mrs. A. that it appeared to me that she
was overconcerned with Ann and seemed to be holding on to her
tightly, she said, "She's my only child. I am now married fourteen
years, and I had to wait seven years until I could conceive." When
I remarked that she seemed to want an exclusive relationship with
Ann, into which nobody was to intrude, not even her own mother
or husband, she said, "Ann is crazy about her father, but she
wouldn't stay with him alone. In fact, he doesn't want to stay with
her, because he wouldn't know how to handle her." She then related
that Ann was willing to stay with her father or even to go out with
him provided her mother stay at home. Ann had to know where her
mother was and that she would find her in the same place. In her
second interview, Mrs. A. traced the onset of Ann's phobic behavior
back to the time when Ann was ten months old and Mrs. A. had left
SCHOOL PHOBIAS 385
her with a baby sitter for the first time. It was then that the vomit-
ing, which the doctor had diagnosed as purely emotional, began.
The mother felt that the intensification of the phobia occurred
after the last baby sitter had stayed with Ann. Since then, Ann was
getting up nightly and would not stay with her father or grand-
mother in the evening, though she did not mind doing so during
the day when she knew where her mother was. On several occasions
Ann had recently wanted to come into her mother's bed, and al-
though Mrs. A. knew that she should not accede, she gave in to Ann's
demands.
After the second interview I suggested to Mrs. A. that she take
Ann back to school. She reported that Ann refused to go into the
school building, but when Mrs. A. said, "Then let's go home," Ann
became angry at her. Ann did not want to go home and stayed in
school. Then there was a holiday after which Ann refused to go back
to school. Mrs. A. wondered whether she should do homework with
Ann or put her into a private school so that she could stay with her
in school. She talked of the close relationship she had with Ann. She
then began to talk about her marriage and her feelings about her
husband. Her husband has a very bad temper, he gets very upset
when he has to stay with Ann because he has to clean her up after
she vomits. There are frequent scenes between them. At this point
Mrs. A. began to cry and then related that she had been unhappy
when she got pregnant after seven years. She did not like the child.
She was melancholy. Everything in the house appeared strange to
her. Previously she had never stayed much at home; she did not even
cook at home, they always ate out. She thought that she had finally
become used to having the child. Last winter Ann had had the
whooping cough and Mrs. A. had been with her constantly. During
this and the next interview Mrs. A. became increasingly aware of
her own need for Ann's phobia, which kept Mrs. A. from running
away and leaving her husband. She had suffered from a chronic un-
treated depression since the birth of Ann. Although after the third
interview Mrs. A. was able to convey to Ann that she no longer
needed Ann as a protection and Ann returned to school promptly
and without any fuss, I felt it necessary to refer the mother for psy-
chotherapy, both for her own sake and to make sure that she did not
fall back on Ann for security.
386 MELITTA SPERLING
mother. Peter had never been away from home, even for one night,
until the end of the second year of analysis. He usually became sick
in anticipation of such events and would have sleep disturbances and
nightmares, indicating an acute intensification of separation anxiety.
It was found that the acute exacerbation of Peter's school phobia at
age twelve (Peter had shown milder signs of school phobia from the
start of school, but these had been disregarded until his phobia be-
came so intense that all concessions and manipulations failed to get
Peter to school) had occurred at a time when his father had been
away for several weeks and Peter had been left alone with his mother.
During his treatment I could observe that Peter became very anxious
whenever his wish to stay out of school each time his father left for
short trips was revived. Neither Peter nor his environment had in
any way connected this with his school phobia. This connection was
made at an advanced stage of his treatment when this could be recog-
nized and interpreted as an event that had acutely intensified his
oedipal conflicts and as a consequence led to regression to the anal-
sadistic stage. Peter had at first considered a college where he could
live at home, but he later changed his mind and decided to live on
campus.
The treatment of adolescents suffering from this type of school
phobia can be limited to the adolescent, and no work with the par-
ents is necessary. This is different in induced chronic school phobia,
where the symbiotic tie between child and parent has to be modified
before successful treatment of the child is possible. It is necessary,
however, to insure the parents' willingness to accept long-term treat-
ment because this is the only guarantee for a successful resolution
of the child's neurosis. Peter's parents were genuinely concerned with
helping him and supported my efforts without intruding or inter-
fering with his treatment. In the first few months of Peter's treatment
I spoke to his mother several times, mostly on the telephone, to help
her to disentangle herself from Peter's controlling maneuvers. She
obviously had neurotic, and particularly phobic, problems of her
own, but these were neither interpreted nor dealt with by me. Be-
cause she behaved as though she and not Peter were responsible for
his attending or not attending school she needed support and re-
assurance in order to relax her overcompensations and to let Peter
carry this responsibility himself.
398 MELITTA SPERLING
treated in successful analysis for three and a half years, the mother
was an agoraphobic. It is of interest that Paula behaved as if she were
unaware of this fact, as if she tried to repress this knowledge. Her
mother had been in therapy off and on during Paula's childhood and
had returned to her therapist at the time of Paula's referral to me.
There is a quality of secrecy and denial associated with the way
agoraphobics deal with their handicaps. Paula applied the same
tactics to her own phobia. I would like to repeat again that in the
chronic cases of this type of school phobia one has to be careful with
the interpretation of sexual material. One should first analyze and
devalue the pathological defenses and the inordinate narcissism and
need for omnipotent control. Furthermore, one has to resist the pres-
suresexerted by the parents, the school, or even the patient for a
quick return to school. This technique was applied in Paula's case.
I had an opportunity to see Paula some fifteen years later, when
she consulted me because of problems in her marriage. I learned that
she had gone to college, had finished graduate work, and was pursuing
a career. She had two children, and there seemed to be some conflict
between her career and her children. This conflict was related to her
feelings about her mother. I learned that her mother was still phobic
and manipulating and that her sister (who had always been held up
to Paula as a model) had also developed agoraphobia. Paula was very
critical of both her mother and her sister, but it appeared to me that
her overemphasis on her career had a defensive function and that she
was using it as a protection against her fear that she might repeat
such a pattern with her own children. I am mentioning this here
to indicate that such phobic patterns can be so persistent and per-
vasive that they affect whole families and are perpetuated through
generations.
SUMMARY
BIBLIOGRAPHY