[A General Ætiological Formula)"

I THINK we can effect a presentation of the probably
very complicated ætiological conditions which exist in
the pathology of the neuroses, if we establish the following
ætiological concepts:

(a) Predisposition, (b) Specific Cause, (c) Contributory Cause
and, as a term not equivalent to the former, (d) Exciting
or Releasing Cause.

In order to satisfy all possibilities let us assume that we
are dealing with ætiological factors capable of quantita-
tive alterations, and consequently of increase or decrease.

If we may use the conception of a compound ætio-
logical formula which must be fulfilled if the effect is to
take place, then we may designate as exciting or re-
leasing cause that which last makes its appearance in
the formula, so that it immediately precedes the mani-
festation of the effect. It is this temporal element alone
which constitutes the essence of an incitement; “each of
the other factors can in individual cases play the part of
an incitement, and this part can even alternate within
this same ætiological conglomeration.

The factors which are to be described as predisposition
are those in whose absence the effect would never come
about; but which, however, are incapable of alone
bringing about the effect, no matter to what degree
they may be present. For the specific cause is lacking.

1 [This extract is taken from a paper entitled <A
Reply to Criticisms of the Anxiety-Neurosis” (‘Zur Kritik
der *Angstneurose ?2 Wiener Klinischen Rundschau. 1895.
G.S.i. 343-362. The page heading in this instanceis not the
title of a book or paper. Trans. by Joa Rickman, revised
by Joan Riviere. —Ep.]

68

1895 [A General Ætiological Formula) 69

"The specific cause is one which is never absent when the
effect actually takes place, and which also suffices, in the
required quantity or intensity, to bring about the effect,
provided that the predisposition is present as well.

As contributory causes we may comprehend such factors
as are not necessarily present every time nor able in any
degree to produce the effect alone, but which co-operate
with the predisposition and the specific ætiological cause
to make up the ætiological formula.

The peculiar position of the contributory or auxiliary
causes seems clear; but how are we to distinguish
between predisposition and specific causes, since both
are indispensable and no one of them alone is sufficient
as a cause ?

In these circumstances the following considerations
would seem to make a decision possible. Among the
* indispensable causes” we find several which are also
present in the ætiological formulæ of many other condi-
tions beside anxiety-neurosis, thus showing that they

have no particular relation to individual disorders; one
of these causes, however, stands out with special promin-
ence, in that it is found in no other or in very few
ætiological formulæ, and this has a claim to be called the
specific cause of the disease in question. Further predis-
posing factors and specific causes are particularly clearly
distinguished in cases where the former have the quality
of long duration and little alteration in their condition,
whereas the specific cause corresponds to a factor which
has recently come into action.

I will attempt to give an example of this complete
ætiological scheme:

Effect: Pulmonary tuberculosis.

Predisposition: For the most part an hereditary dis-
position of the organs concerned.

Specific Cause: Koch’s bacillus.

Contributory Causes: Everything that lowers resistance;
emotion as well as infections or colds.