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of the original traumatic anxiety situation even maturity offers
after all no adequate protection; there may exist for every one a
limit beyond which his psyche fails in the attempt to cope with
the demands which the excitation in question makes upon him.

These minor reservations cannot possibly be taken as mili-
tating against the fact which we have been discussing: the fact,
namely, that in their response to danger so many people remain
infantile, continuing to react with anxiety to situations which
should have long ceased to evoke it; to dispute this would be
to deny the very fact of neurosis, for it is exactly such persons
whom we call neurotics. But how does this situation come
about? Why are not all neuroses merely episodes in the indi-
vidual’s development which become a closed chapter when the
next stage of development is reached? Whence comes the
element of permanency in these reactions to danger? Whence
springs the preference over all other affects which the affect of
anxiety seems to enjoy in alone evoking reactions which we
distinguish from others as abnormal and which in their inex-
pediency obstruct the stream of life? In other words, we find
ourselves abruptly confronted once again by the oft repeated
riddle: What is the source of neurosis, what is its ultimate, its
specific, underlying principle? After decades of analytic effort
this problem rises up before us, as untouched as at the
beginning.

X

Anxiety is the reaction to danger. One cannot escape the
thought, indeed, that the very nature of danger has a bearing
upon the fact that the affect of anxiety is able to command
pride of place in the mental economy. But the dangers in
question are those common to all mankind; they are the same
for everybody; so that what we need and do not have at our
disposal is some factor which shall enable us to understand the
basis of selection of those individuals who are able to subject
the affect of anxiety, despite its singularity, to normal psychic
control, or which on the other hand determines those who must
prove unequal to this task. I have in mind two attempts

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which have been made to discover such a factor; and certainly
any such attempt may reasonably expect a sympathetic recep-
tion, since it promises to remedy a crying need. The two
attempts I refer to supplement each other in that they attack
the problem from opposite ends. The first was undertaken
more than ten years ago¹ by Alfred Adler; his thesis, in a
nutshell, is that those individuals fail to solve the problem
which danger imposes in whom an organ inferiority makes
such a task too difficult of accomplishment. Now if it were
true that simplex sigillum veri, one would welcome such a
solution as this as a very salvation. On the contrary, however,
the consensus of criticism during the decade just passed has
amply demonstrated the complete inadequacy of this explana-
tion, which, moreover, totally disregards the wealth of facts
discovered by psychoanalysis.

The second attempt was undertaken by Otto Rank in 1923
in his book, The Trauma of Birth. It would be invidious to
compare this attempt with Adler’s in any other respect than the
single one here emphasized, for Rank’s rests on a psychoanalytic
foundation, pursues psychoanalytic trends of thought, and is
to be regarded as a legitimate effort towards the solution of
analytic problems. In the relation between the individual
and danger Rank assigns less importance to organ inferiority
in the individual and emphasizes rather the varying intensity
of the danger. The process of birth constitutes the first danger
situation, the economic upheaval which birth entails becomes
the prototype of the anxiety reaction; we have already followed
out the line of development which connects this first danger,
this first anxiety-occasioning situation, with all subsequent
ones; and in so doing we saw that they all retain something in
common in that all of them signify in some sense a separation
from the mother, at first only in a biological respect, then in
the sense of a direct object loss, and later of an object loss
mediated in indirect ways. The revealing of this sequence
of events is an undisputed merit of the Rankian construction.
Now the trauma of birth affects different individuals with

¹Now more than twenty years ago.–TR. NOTE.

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differing intensity, the intensity of the anxiety reaction varies
with the severity of the trauma, and, according to Rank, it is
supposed to depend upon the degree to which this initial
development of anxiety takes place whether the individual
ever succeeds in gaining control over it, whether he becomes
a neurotic or a normal person.

The detailed criticism of Rank’s thesis is not our task, but
merely its examination from the standpoint of its service-
ability in the solution of our problem. Rank’s formula, that
those persons become neurotic who on account of the severity
of the birth trauma have never succeeded in abreacting it com-
pletely, is theoretically open to the greatest possible doubt.
It is not entirely clear what is meant by the abreacting of the
trauma. If it is taken literally, one arrives at the quite unten- able conclusion that the neurotic approaches more and more
closely to a state of health the more frequently and the more
intensively he reproduces the affect of anxiety. It was on the
ground of this very non-conformity with reality that I aban-
doned, indeed, the theory of abreaction, the theory which
played so large a part in catharsis. The emphasis upon the
varying severity of the birth trauma leaves no room for the
legitimate ætiological claim of constitutional factors. This
severity is an organic factor, certainly, one which compared
with constitution is a chance factor, and is itself dependent
upon many influences which are to be termed accidental, such
as for example timely obstetrical assistance. But the Rankian
theory has left constitutional as well as phylogenetic factors
entirely out of account. If one were to allow for the impor-
tance of a constitutional factor, such as via the modifica-
tion that it would depend much more upon how extensively the
individual reacts to the variable severity of the birth trauma,
one would deprive the theory of meaning and have reduced
the new factor which Rank has introduced to a subordinate
rôle. That which determines whether or not neurosis is the
outcome lies, then, in some other area, and once again in an
unknown one.

423

The fact that the human being shares the birth process with
other mammals, whereas a particular disposition to neurosis
is the special privilege which he alone possesses, hardly speaks
very strongly in favor of the Rankian theory. The principal
objection to be raised against it, however, remains the fact
that it hangs in mid-air, instead of being based upon verified
observation. For no trustworthy investigation has ever been
carried out to determine whether difficult and protracted birth
is correlated in indisputable fashion with the development of
neurosis–indeed, whether children whose birth has been of
this character manifest even the nervousness of earliest infancy
for a longer period or more intensely than others. If the asser-
tion is made that precipitate births, those easy for the mother,
may possibly have for the child the significance of a severe
trauma, then a fortiori it would certainly be necessary that
births resulting in asphyxia should produce beyond any doubt
the consequences alleged. It seems an advantage of the
Rankian ætiology that it postulates a factor capable of being
checked empirically; but as long as such a check has never
actually been undertaken, it is impossible to estimate its real
value.

On the other hand, I cannot share the view that the Rankian
theory controverts the ætiological importance of the sexual
instincts as this has so far been recognized in psychoanalysis;
for the theory refers only to the behavior of the individual
towards the danger situation, and leaves the matter open
whether the person who was unable to overcome the initial
dangers which beset him will necessarily fail in the situations
of sexual danger of later occurrence and thereby be forced into
neurosis.

All in all, then, I do not believe that Rank’s endeavor has
supplied us with the solution of the problem of the funda-
mental basis of neurosis, and I think that it cannot yet be
decided how large a contribution to the solution of the prob-
lem it actually makes. If investigation of the influence of
difficult birth upon the disposition to neurosis yields only a

424

negative result, its contribution will be slight indeed. I am
very much afraid that the need for a tangible and simple
“ultimate cause” of neurosis is doomed to remain ungratified.
The ideal possibility, for which probably even today the physi-
cian longs, would be that of a bacillus which can be isolated
and grown in pure culture and the inoculation of which pro-
duces the identical effect in every individual; or, somewhat
less fantastically, the evolving of chemical substances, the
administration of which produces a given neurosis or abolishes
it. But probability is hardly on the side of such solutions of
the problem.
Psychoanalysis yields less simple, less satisfying intelligence.
I have here to repeat only what has long been familiar, adding
nothing new. When the ego has succeeded in defending itself
against a dangerous instinctual impulse, as for example by the
mechanism of repression, it has inhibited and inflicted damage
upon that portion of the id but has at the same time also given
it a bit of independence and renounced a bit of its own
sovereignty. This follows from the nature of repression,
which is, at bottom, an attempt at flight. The repressed
material is now “outlawed”, excluded from the great organi-
zation of the ego, subject only to the laws which prevail in the
domain of the unconscious. If now the danger situation is
altered, so that the ego is without incentive to defend itself
against a newly arisen instinctual impulse analogous to the one
which has been repressed, the consequences of this limitation
of the ego’s sovereignty become manifest. The new instinct
pursues its course in automatic fashion—I should prefer to say,
under the influence of the repetition compulsion; it follows
the same path as did the instinct which had previously been
repressed, as though the successfully surmounted danger situ-
ation were still in existence. The fixating factor in repression
is thus the repetition compulsion of the unconscious id, which
normally is put an end to only through freely mobile ego-
functioning. Now the ego may occasionally succeed in making
a breach in the barriers of repression which it has itself set up,
in reacquiring its influence over the instinctual impulse and

425

in guiding the course of the new instinctual impulse in accord-
ance with the altered danger situation. But as a matter of
fact the ego often fails in this and is unable to undo its repres-
sions. Quantitative factors may play a deciding part in the
outcome of this struggle. In many cases we have the impres-
sion that the outcome is a compulsory one; the regressive
attraction exerted by the repressed impulse and the force of
the repression are so great that the new impulse can only
follow out the repetition compulsion. In other cases we per-
ceive the contribution of another set of forces; the attraction
exerted by the repressed prototype is reënforced by the repul-
sion exerted by reality obstacles which oppose any other
discharge of the newly arisen instinctual impulse.

That this is the course of events in the fixation of repression
and in the retention of danger situations no longer current
receives its proof from the fact of analytic therapy, a fact modest
enough in itself but theoretically scarcely to be overestimated.
When in analysis we render the ego assistance enabling it to
undo its repressions, the ego regains its power over the
repressed id and can so steer the course of the instinctual
impulses as if the old danger situations no longer existed.
What we achieve in this way is in complete harmony with
what we accomplish in other spheres of medical activity. As
a rule our treatment has to be satisfied with bringing about
more rapidly, more certainly and with less trouble the satis-
factory outcome which under favorable conditions would have
resulted spontaneously.

The foregoing considerations tell us that there are quanti-
tative elements not directly evident but to be apprehended
only a posteriori, which decide the question whether the old
danger situations are adhered to, whether the repressions
effected by the ego are preserved, whether childhood neuroses
are carried over into later life, or not. Of the factors which
are contributory in the causation of neurosis, the factors which
have created the conditions under which the forces of the
psyche contend among themselves, there are three which pre-
sent themselves for our consideration—a biological, a phylo-
 

426

genetic, and a purely psychological factor. The biological
factor is the protracted helplessness and dependence of the
young of the human species. The intrauterine life of the
human being seems to be relatively abbreviated as compared
with that of the majority of animals; the human infant is sent
into the world more unfinished than the young of the latter.
For this reason the influence of the external environment is
intensified, the differentiating of the ego from the id is pro-
moted very early, the dangers which the environment presents
are increased in importance, and the value attached to the
object who alone can offer protection against these dangers
and effect a substitution for the intrauterine life which has
been lost, is enormously augmented. This biological factor
of helplessness thus brings into being the first situations of
danger and creates the need to be loved which the human
being is destined never to renounce.

The second, the phylogenetic, factor is one which we merely
infer; but a very remarkable fact of libido development has
compelled us to assume its existence. We find that the sexual
life of the human being does not develop in progressive fashion
from incipience to maturity, as in the case of most of the closely
related animals, but that it suffers an abrupt interruption after
an initial early florescence extending to about the fifth year,
after which it commences anew with puberty, dovetailing, as
it were, with the tendencies of the infantile period. We
believe that something momentous to the destinies of the
human species must have taken place which has left behind as
a historical precipitate this interruption of sexual develop-
ment. The pathogenic importance of this phenomenon
accrues from the fact that most of the instinctual demands of
this infantile sexuality are treated as dangers and guarded
against by the ego, so that the sexual impulses of puberty,
which should be ego-compatible, are in danger of succumbing
to the attraction exerted by their infantile prototypes and of
following them into repression. It is here that we come upon
the most definite ætiology of the neuroses. It is noteworthy

427

that early contact with the demands of sexuality has the same
effect upon the ego as premature contact with the environment.
The third or psychological factor is to be found in an imper-
fection of our psychic apparatus which is connected with its
differentiation into ego and id and hence which is traceable
also, in the last analysis, to the influence of the environment.
By reason of the dangers which reality offers, the ego is com-
pelled to adopt an attitude of defense towards certain instinc-
tual impulses in the id, to treat them as dangers. But the ego
cannot protect itself against internal instinctual dangers so
effectively as against a piece of reality which is strange to it.
Itself intimately connected with the id, the ego is able to stave
off an instinctual danger only by putting restrictions upon its
own organization and by tolerating symptom formation as a
substitute for its crippling of the instinct. If then the press
of the repudiated instinct is renewed, there result for the ego
all the difficulties which we know as neurotic suffering.

Further than this, I must believe, our insight into the nature
and causation of neurosis has not at the present time progressed.

XI

ADDENDA

In the course of the foregoing remarks a number of topics were
touched upon which had to be dismissed prematurely, but
which shall now be brought together in order that they may
receive the share of attention which is their due.

A. Certain Modifications of Views Previously Held

(a) Resistance and Anticathexis

It is an important element of the theory of repression that
this process is not one which takes place on a single occasion
but is one demanding a continuous expenditure of effort.
Should this effort be intermitted, the repressed impulse, which
receives a continuous influx from its sources of origin, would
thereupon strike out upon the same path off which it had