Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Theory and Criticism


Joel Faflak


Milrod (2007) identifies persistent emptiness in agoraphobia patients whose symptoms of anxiety and avoidance have remitted. Through an analysis of the available theoretical and clinical literature on agoraphobia, the psychological experience of emptiness, and the development of the ego, I argue that agoraphobia is not an anxiety about “open spaces” but, rather, about the boundaries between spaces. In agoraphobia, there is a pathological persistence of the psychological processes of normal ego development. Recognition of the usefulness of agoraphobic anxieties in the development of ego boundaries may help to identify the point at which they persist beyond usefulness and into pathology, both theoretically and clinically. Following Winnicott (1951, 1969), I argue that the analytic frame – the setting of the analysis – has the potential to become a transitional object for the analysand. The agoraphobic’s opportunity for new experiences with a transitional object – if it can survive her destruction of it – allows the frame to be used in the development of the ego’s boundaries.

Milrod suggests that a deficient Reflective Function (RF) may explain the persistent emptiness she identifies in agoraphobia patients. Though Milrod’s patients may indeed have a weak RF, I argue that assertions of emptiness in the clinical situation cannot be causally attributed to this deficiency. Further, I contend that these patients’ assertions and experiences of emptiness can be better explained by the presence of traumatic and unmourned losses. I propose several explanations for why agoraphobia patients, in particular, defend unconsciously against mourning. I argue that a clinical emphasis on interpreting the transference may lead to an impasse in the relief of this emptiness insofar as it may impede the development of free association. I contend that the agoraphobic requires the freedom to be incoherent, afforded in the psychoanalytic clinic via the distinctive method of free association, in order to define for herself the boundaries of self and other, and to recognize in action – or, more precisely, in words; in the act of putting it all into words – the limits of her affective life. Specifically, these boundaries limit the agoraphobic’s fears of destruction of the object and annihilation of the ego.