Freud - Complete Works (62 page)

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

344

   This concept of the mechanism of
anxiety neurosis can be made clearer if one accepts the following
view of the sexual process, which applies, in the first instance,
to men. In the sexually mature male organism somatic sexual
excitation is produced probably continuously - and periodically
becomes a stimulus to the psyche. In order to make our ideas on
this point firmer, I will add by way of interpolation that this
somatic excitation is manifested as a pressure on the walls of the
seminal vesicles, which are lined with nerve endings; thus this
visceral excitation will develop continuously, but it will have to
reach a certain height before it is able to overcome the resistance
of the intervening path of conduction to the cerebral cortex and
express itself as a psychical stimulus. When this has happened,
however, the group of sexual ideas which is present in the psyche
becomes supplied with energy and there comes into being the
psychical state of libidinal tension which brings with it an urge
to remove that tension. A psychical unloading of this kind is only
possible by means of what I shall call
specific
or
adequate
action. This adequate action consists, for the male
sexual instinct, in a complicated spinal reflex act which brings
about the unloading of the nerve-endings, and in all the psychical
preparations which have to be made in order to set off that reflex.
Anything other than the adequate action would be fruitless, for
once the somatic sexual excitation has reached threshold value it
is turned continuously into psychical excitation, and something
must positively take place which will free the nerve endings from
the load of pressure on them - which will, accordingly, remove the
whole of the existing somatic excitation and allow the subcortical
path of conduction to re-establish its resistance.

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

345

   I shall refrain from describing
more complicated instances of the sexual process in a similar way.
I will only state that in essentials this formula is applicable to
women as well, in spite of the confusion introduced into the
problem by all the artificial retarding and stunting of the female
sexual instinct. In women too we must postulate a somatic sexual
excitation and a state in which this excitation becomes a psychical
stimulus - libido - and provokes the urge to the specific action to
which voluptuous feeling is attached. Where women are concerned,
however, we are not in a position to say what the process analogous
to the relaxation of tension of the seminal vesicles may be.

   We can include within the
framework of this description of the sexual process not only the
aetiology of anxiety neurosis but that of genuine neurasthenia.
Neurasthenia develops whenever the adequate unloading ( the
adequate action) is replaced by a less adequate one - thus, when
normal coition, carried out in the most favourable conditions, is
replaced by masturbation or spontaneous emission. Anxiety neurosis,
on the other hand, is the product of all those factors which
prevent the somatic sexual excitation from being worked over
psychically. The manifestations of anxiety neurosis appear when the
somatic excitation which has been deflected from the psyche is
expended subcortically in totally inadequate reactions.

   I will now attempt to discover
whether the aetiological conditions for anxiety neurosis which I
set out above exhibit the common character that I have just
attributed to them. The first aetiological factor I postulated for
men was intentional abstinence. Abstinence consists in the
withholding of the specific action which ordinarily follows upon
libido. Such withholding may have two consequences. In the first
place, the somatic excitation accumulates; it is then deflected
into other paths, which hold out greater promise of discharge than
does the path through the psyche. Thus the libido will in the end
sink, and the excitation will manifest itself subcortically as
anxiety. In the second place, if the libido is not diminished, or
if the somatic excitation is expended, by a short cut, in
emissions, or if, in consequence of being forced back, the
excitation really ceases, then all kinds of things other than an
anxiety neurosis will ensue. Abstinence, then, leads to anxiety
neurosis in the manner described above. But it is also the
operative agent in my second aetiological group, that of
unconsummated excitation. My third group, that of coitus reservatus
with consideration for the woman, operates by disturbing the
man’s psychical preparedness for the sexual process, in that
it introduces alongside of the task of mastering the sexual affect
another psychical task, one of a deflecting sort. In consequence of
this psychical deflection, once more, libido gradually disappears,
and the further course of things is then the same as in the case of
abstinence. Anxiety in senescence (the male climacteric) requires
another explanation. Here there is no diminution of libido; but, as
in the female climacteric, so great an increase occurs in the
production of somatic excitation that the psyche proves relatively
insufficient to master it.

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

346

   The aetiological conditions
applying to women can be brought into the framework of my scheme
with no greater difficulties than in the case of men. Virginal
anxiety is a particularly clear example. For here the groups of
ideas to which the somatic sexual excitation should become attached
are not yet enough developed. In the newly-married woman who is
anaesthetic, anxiety only appears if the first cohabitations arouse
a sufficient amount of somatic excitation. When the local
indications of such excitement (spontaneous sensations of
stimulation, desire to micturate and so on) are lacking, anxiety is
also absent. The case of ejaculatio praecox and of coitus
interruptus can be explained on the same lines as in men, namely
that the libidinal desire for the psychically unsatisfying act
gradually disappears, while the excitation which has been aroused
during the act is expended subcortically. The
alienation
between the somatic and the psychical sphere is established more
readily and is more difficult to remove in women than in men. The
cases of widowhood and of voluntary abstinence, and also that of
the climacteric, are dealt with in the same way in both sexes; but
where abstinence is concerned there is in the case of women no
doubt the further matter of intentional repression of the sexual
circle of ideas, to which an abstinent woman, in her struggle
against temptation, must often make up her mind. The horror which,
at the time of the menopause, an ageing woman feels at her unduly
increased libido may act in a similar sense.

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

347

   The two last aetiological
conditions on our list seem to fall into place without difficulty.
The tendency to anxiety in masturbators who have become
neurasthenic is explained by the fact that it is very easy for them
to pass into a state of ‘abstinence’ after they have
been accustomed for so long to discharging even the smallest
quantity of somatic excitation, faulty though that discharge is.
Finally, the last case, - the generation of anxiety neurosis
through severe illness, overwork, exhausting sick-nursing, etc., -
finds an easy interpretation when brought into relation with the
effects of coitus interruptus. Here the psyche, on account of its
deflection, would seem to be no longer capable of mastering the
somatic excitation, a task on which, as we know, it is continuously
engaged. We are aware to what a low level libido can sink under
these conditions; and we have here a good example of a neurosis
which, although it exhibits
no sexual aetiology, nevertheless
exhibits a sexual mechanism
.

   The view here developed depicts
the symptoms of anxiety neurosis as being in a sense
surrogates
of the omitted specific action following on
sexual excitation. In further support of this view, I may point out
that in normal copulation too the excitation expends itself, among
other things, in accelerated breathing, palpitation, sweating,
congestion, and so on. In the corresponding anxiety attacks of our
neurosis we have before us the dyspnoea, palpitations, etc. of
copulation in an isolated and exaggerated form.

   A further question may be asked.
Why, under such conditions of psychical insufficiency in mastering
sexual excitation, does the nervous system find itself in the
peculiar affective state of anxiety?  An answer may be
suggested as follows. The psyche finds itself in the
affect
of anxiety if it feels unable to deal by appropriate reaction with
a task (a danger)
approaching from the outside
;  it
finds itself in the
neurosis
of anxiety if it notices that
it is unable to even out the (sexual) excitation originating
from within
- that is to say,
it behaves as though it
were projecting that excitation outwards
. The affect and its
corresponding neurosis are firmly related to each other. The first
is a reaction to an exogenous excitation, the second a reaction to
the analogous endogenous one. The affect is a state which passes
rapidly, the neurosis is a chronic one; because, while exogenous
excitation operates with a single impact, the endogenous excitation
operates as a constant force.
In the neurosis, the nervous
system is reacting against a source of excitation which is
internal, whereas in the corresponding affect it is reacting
against an analogous source of excitation which is
external
.

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

348

IV

RELATION TO OTHER NEUROSES

   There are still a few words to be
said about the relations of anxiety neurosis to the other neuroses
as regards their onset and their internal connections.

   The purest cases of anxiety
neurosis are usually the most marked. They are found in sexually
potent youthful individuals, with an undivided aetiology, and an
illness that is not of too long standing.

   More often, however, symptoms of
anxiety occur at the same time as, and in combination with,
symptoms of neurasthenia, hysteria, obsessions or melancholia. If
we were to allow ourselves to be restrained by a clinical
intermixture like this from acknowledging anxiety neurosis as an
independent entity, we ought, logically, also to abandon once more
the separation which has been so laboriously achieved between
hysteria and neurasthenia.

   For the purposes of analysing
‘mixed neuroses’ I can state this important truth:
Wherever a mixed neurosis is present, it will be possible to
discover an intermixture of several specific aetiologies
.

   A multiplicity of aetiological
factors such as this, which determine a mixed neurosis, may occur
purely fortuitously. For instance, a fresh noxa may add its effects
to those of an already existing one. Thus, a woman who has always
been hysterical may begin at a certain point in her marriage to
experience coitus reservatus; she will then acquire an anxiety
neurosis in addition to her hysteria. Or again, a man who has
hitherto masturbated and has become neurasthenic, may get engaged
and become sexually excited by his fiancée; his neurasthenia
will now be joined by a new anxiety neurosis.

   In other cases the multiplicity
of aetiological factors is by no means fortuitous: one of the
factors has brought the other into operation. For example, a woman
with whom her husband practises coitus reservatus without regard to
her satisfaction may find herself compelled to masturbate in order
to put an end to the distressing excitation that follows such an
act; as a result, she will produce, not an anxiety neurosis pure
and simple, but an anxiety neurosis accompanied by symptoms of
neurasthenia. Another woman suffering from the same noxa may have
to fight against lascivious images against which she tries to
defend herself; and in this way she will, through the coitus
interruptus, acquire obsessions as well as an anxiety neurosis.
Finally, as a result of coitus interruptus, a third woman may lose
her affection for her husband and feel an attraction for another
man, which she carefully keeps secret; in consequence, she will
exhibit a mixture of anxiety neurosis and hysteria.

   In a third category of mixed
neuroses the interconnection between the symptoms is still more
intimate, in that the same aetiological determinant regularly and
simultaneously provokes both neuroses. Thus, for instance, the
sudden sexual enlightenment, which we have found present in
virginal anxiety, always gives rise to hysteria as well; by far the
majority of cases of intentional abstinence become linked from the
beginning with true obsessional ideas; coitus interruptus in men
never seems to me to be able to provoke a pure anxiety neurosis,
but always a mixture of it with neurasthenia.

On The Grounds For Detaching A Particular Syndrome From Neurasthenia

349

   From these considerations it
appears that we must further distinguish the aetiological
conditions for the
onset
of the neuroses from their specific
aetiological factors. The former - for example, coitus interruptus,
masturbation or abstinence - are still ambiguous, and each of them
can produce different neuroses. Only the aetiological factors which
can be picked out in them, such as
inadequate disburdening,
psychical insufficiency or defence accompanied by substitution
,
have an unambiguous and specific relation to the aetiology of the
individual major neuroses.