The disciple, in search of meaning, approaches the Zen master. The Zen master tests him: “What is reality?” The disciple responds, “Reality is an internal construction. Reality is the manifestation of mental aggregations. Reality is your mind’s personal creation.” The Zen master then takes a stick and smacks the disciple on the head.
Not to belabor the point, when we speak of fear of physical injury, we are dealing both with reality and fantasy. Sometimes it is difficult to distinguish between the two. Yet, in our everyday lives, we see the operation of the reality principle (Freud, 1920; Schur, 1966). We could not drive on the highway if we did not trust that other people did not want to be physically injured. We rely on the idea that the vast majority of human beings possess a self-preservation function that leads them to try to avoid automobile accidents. We drive “defensively.” On the other hand, there are people who are afraid to drive an automobile, or even get into one, citing the average of about 40,000 deaths per year in auto accidents in the U.S. How realistic are they?
To begin, let’s start with some considerations about how fear of physical injury develops throughout childhood and adolescence, in both boys and girls. Although a vast topic, I will try to touch on some of the nodal points in development that contribute both to reality testing of physical danger and to inhibition and symptom formation (Freud, 1926). Then, after examining some clinical examples, we’ll take a look at how diagnosis and treatment selection are affected. Finally, we can take a brief look at cultural, national, and international implications of this ubiquitous fear.
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