Some theoretical and technical aspects of agoraphobia. Implications derived from its relationship with the "umbilical period"

Abstract

1) The hypothesis maintains that a patient suffering from agoraphobia is like a person only “half born”, an “umbilical being”, in the sense that he lives as if the umbilical cord has not yet been cut.
2) Such a person would be the victim of an anxiety fundamentally confusional —the catastrophic situation— every time he is separated from the accompanying object, and to avoid this anxiety he will regress to a state in which the separation cannot exist, since it is a question of two beings permanently joined by one cord.
3) That period of life between the third month in the womb and the moment when the umbilical cord is cut is called the umbilical period and it is considered that a person suffering from agoraphobia reverts to this state.
4) A person suffering from agoraphobia believes that he can only exist as an umbilical creature —a delusional experience— which implies a profound change of the body-scheme and which determines that vital parts of himself be outside of him.
5) The person suffering from agoraphobia is not only a dissociated being but further and fundamentally an incomplete being, in the sense that he feels the necessity of someone or something other to complete himself. This defines the “umbilical being”.
6) The characteristic of “agoraphobic madness” appears to be a “mania á deux” formed by mixed projective identifications as in the symbiotic relationship, so that the symbiotic link seems to manifest externally an umbilical relationship and to imply a regression to that period of development.
7) This does not mean that between the foetal ego and the mother exist mixed projective identifications but that these mechanisms appear to be an attempt to re-establish in the post-natal life the umbilical link.
8) The traumatic anxiety of birth and particularly that connected with the cutting of the cord is followed through playing activities of children. The game of parachutes and the game of spinning seem to work out the anxiety due to the cutting of the cord and the play of kite-flying and streamer-throwing appear to be an attempt to re-create the umbilical link. 
9) Certain technical consequences of these theoretical concepts are to be considered:
a) The necessity of analyzing the intention of the patient suffering from agoraphobia to transform the analyst into an accompanying object.
b) The analyst in the transfer situation represents the confusional deadalive object (phobigenic object) and to this is due his phobic
avoidance. The possibility of being transformed into a dead-alive object —a confused and desintegrated ego— provokes the
unmanageable anxiety.
e) In giving back to the patient what he has projected —massive projection of parts of his ego together with erotic and
destructive impulses— in a gradual and progressive manner we make it possible for him to strengthen his ego so that he can
establish a new and more successful dissociation and can better support the diminishing confusional anxieties.
d) To analyze the patient’s phantasy that he is “different from everybody else” (a delusional phantasy) and that consequently nothing that the analyst may do will be able to change him. As long as this phantasy is not analyzed it may happen that the patient only continues in analysis because he wants “to go on living”.
e) To try to get under analysis if possible the habitual or main accompanying object.
f) When his ego becomes more integrated we can then “oblige” him to be born, meaning by this to confront him with the situation of the severance of the cord.
10) Finally one must consider the notion of umbilical relationship of the object as a contribution to the theory of objects of Melanie Klein and apply it to the analytical situation itself in so far that it implies the phantasy of an uninterrupted relationship of object. We mean by this that the patient receives from he object in a permanent manner and without being asked anything in
return attention, care, love — experienced as coming not only from a nourishing breast but also from a nourishing cord.
11) The breaks in the analytical situation (week-end, vacations, etc.) are connected to the anxieties related with the cutting of the umbilical cord (as well as with the other anxieties already known of oral and phallic character). 
12) The general phantasy of being “reborn” with the analyst may be in part sustained by the phantasy of reconstruction and cutting of the cord which seems to exist in every analytical situation.