William Ellery Leonard
Bizarre Senseless Phobia
This case has special importance as it demonstrates the superiority of PBT upon traditional theories, but also the disadvantage of the psychoanalytic concept of repression. An additional importance of this case is that it illustrates the inadequacy of behavior-cognitive theories in accounting for the development of bizarre phobia, such as panic and agoraphobia. This case is an autobiographical account of Leonard (1927), a poet, writer, and professor at the University of Wisconsin, who suffered from agoraphobia. As described below, Leonard experienced a sudden panic attack, while standing alone on a bluff overlooking a quiet lake, in the absence of any environmental factors that could justify the dramatic shift in his behavior,
"Then on the tracks from behind...comes a freight train, blowing its whistle. Instantaneously diffused premonitions become acute panic. The cabin of that locomotive feels right over my head, as if about to engulf ... My sub-consciousness knows what the torture is; and makes my voice shriek, as I rush back and forth on the bluffs: My God, won’t that train go, my God, won’t that train go away!’" (Leonard, 1927, pp. 304-307).
The panic had such a dramatic impact on Leonard that he stated when he was taken to his parents' home, "Father and mother, this looks like the end. I guess I am dying" (p. 308). As a result of his "illness", Leonard could not go a hundred feet beyond his parents' home.
In the morning, though feeling strangely weak in body, I start out on a little walk down the street. Within a hundred feet of the house I am compelled to rush back, in horror of being so far away... a hundred feet away... from home and security. I have never walked or ridden, alone or with others, as a normal man since that day (p. 308).
Later, when the university authorities threatened to dismiss him due to his long absence, Leonard moved with his parents to an apartment across the street from the university (pp. 328-329). In his self-hypnosis, conducted more than ten years after the onset of his symptoms, Leonard recalled a childhood trauma at the age of two when he was almost run down by a thundering train. Both Leonard, who had extensive knowledge of psychoanalytic theory, and psychoanalysis' advocates (e.g., Allport, 1929; Culler, 1930; Taylor & Culler, 1929, 1931; White & Watt, 1981), attributed Leonard's symptoms to repression of the train trauma.
However, it is difficult to accept this interpretation for the following reasons. First, a large number of studies shows that people remember rather than forget their childhoods and current traumas (e.g., Piper et al, 2008; Rofé, 2008). Second, the train episode was recorded in a diary Leonard's mother started keeping for him three days after the incident. She noted that Leonard was "Talking a great deal about it ever since" (p. 16), which means that he remembered the event, rather than repressed it. The fact that he contemplated the traumatic event is inconsistent with the psychoanalytic assumption that repression is an involuntary, unconscious mechanism causing the immediate removal of the threatening experiences from the individual's conscious (e.g., Alexander, 1932; Cramer, 2001; Fenichel, 1946; Wilson & Dunn, 2004). Third, Leonard continued to travel by trains afterward, so even if a fear originally developed, it should have been extinguished through repeated exposure to locomotives. Leonard himself testified that he "Developed no specialized fear of locomotive... on the contrary, trains became a childish passion" (p. 24). Fourth, even if Leonard was subconsciously affected by the train episode, he should have developed a train phobia not agoraphobia. Fifth, a thorough review of controlled research shows no significant relationships between repressed traumas and specific neurotic symptoms (see review by Rofé, 2008).
Contrary to the psychoanalytic position, PBT claims that Leonard deliberately adopted the panic-agoraphobic symptoms as a coping mechanism, an idea that occurred to him intuitively upon seeing the freight train. The panic attack occurred at the age of 36, soon after his wife, the daughter of a highly respected family, committed suicide. The community regarded Leonard as demanding and self-centered and almost unanimously blamed him for her death. Leonard became extremely miserable, he was extensively preoccupied by the death of his wife, and it seems that the major function of his neurotic disorder was repression. Instead of being engaged with stress-related thoughts, such as self-criticism of his role in his wife's death, he chose to make himself the victim of a serious disease. The intensive preoccupation with his symptoms enabled him to block the accessibility of stress-related thoughts and relieve his intolerable level of depression. Additionally, the symptoms enabled him to distance himself from his ostracizing community, who blamed him for his wife's suicide, and avoid potential rejection by colleagues at the university. Subsequently, when the university authorities threatened to fire him for his absence (p. 328)—when the controllability demands changed—he moved closer to the university to resume his teaching obligations. Leonard also adapted his agoraphobic symptoms in accordance with his unique personal needs; he was able to ride his bicycle and purchase merchandise downtown (pp. 343, 346) and even travel twice to Chicago and once to New York to meet his fiancé. He rationalized this violation of his "illness" by saying he could control his phobia because" the speed of the bicycle magnified my beat"(p. 343).
Leonard's panic disorder was affected by the principle of availability as well. Given the above evidence concerning traumatic events, it seems likely that he consciously remembered the childhood incidence, when he saw the freight train. Thus, considering his strong belief in psychoanalytic theory (see Leonard, 1927, pp. 323-324), he intuitively chose to develop panic and agoraphobic symptoms both because they served his psychological needs and as it enabled him to deceive himself that they were beyond his conscious control, as will be elaborated on later.
Regarding PBT's diagnostic criteria, Leonard's panic disorder fulfills both the five major and the two secondary criteria. The behavior intensively preoccupied his attention and disrupted his daily functioning (criterion 1); the radical change in his behavior cannot be associated with a specific factor that is exclusively linked with his symptom (criterion 2); he was completely unaware of the underlying causes for the dramatic change in his behavior (criterion 3); his disorder is extremely rare (criterion 4); and Leonard himself stigmatized his behavior as reflection of mental illness (criterion 5). Additionally, his symptoms fulfill the secondary criteria, as they developed following a stressful life-event and he was extremely depressed.