CHAPTER IX.

My Views on THE ROre or SexuALITy IN THE ErroLocy OF
THE NEUROSES.*

I am of the opinion that my theory on the etiological signifi-
cance of the sexttal moment in the neuroses can be best appre-
ciated by following its development. I will by no means make
any effort to deny that it passed through an evolution during
which it underwent a change. My colleagues can find the assur-
ance in this admission that this theory is nothing other than the
result of continued and painstaking experiences. In contra-
distinction to this whatever originates from speculation can cer-
tainly appear complete at one go and continue unchanged.

% obit Vane ke Originally the theory had reference only to the morbid pictures

2] facet

comprehended as “eurasthenia,” among which_I_found two

es which occasionally appeared pure, and which I described
Ss factual neurasthenia” and “anxiety neurosis.” For it was
always known that sextial moments could play a part in the
causation of these forms, but they were found neither regularly
effective, nor did one think of conceding to them a precedence
over other etiological influences. I was above all surprised at
the frequency of coarse disturbances in the vita sexualis of
nervous patients. The more I was in quest of such disturbances,
during which I remembered that all men conceal the truth in
things sexual, and the more skilful I became in continuing the
examination despite the incipient negation, the more regularly
such discase-forming moments were discovered in the sexual life,
until it seemed to me that they were but little short of universal.
But one must from the first be prepared for similar frequent
occurrences of sexual irregularities under the stress of the social
relations of our society, and one could therefore remain in doubt
as to what part of the deviation from the normal sexual function
js to be considered as a morbid cause. I could therefore only
place less value on the regular demonstration of sexual noxas
than on other experiences which appeared to me to be: less

From Léwenfeld, “Sexualleben und Nervenleiden,” IV ed., 1906.
186

ON PSYCHOTHERAPY, 187

equivocal. It was found that the form of the malady, be it

tions, while in anxiety neurosis we could find such factors as
coitus interruptus, “ frustrated excitement,” etc. The moment
of insufficient discharge of the generated libido seemed to be
common to both. Only after this experience, which is easy to
gain and very often confirmed, had I the courage to claim for the
sexual influences a prominent place in the etiology of the
neurosis. It also happened that the mixed forms of neurasthenia
and anxiety neurosis occurring so often, showed the admixture
of the etiologies accepted for both, and that such a bipartition in
the form of the manifestations of the neurosis seemed to accord
well with the polar characters of sexuality (male and female),
At the same time, while I assigned to sexuality this Significance
in the origin of the simple neurosis, I still professed for the
Psychoneuroses (hysteria and obsessions) a purely Psychological
theory in which the sexual moment was no differently considered
than any other emotional sources. Together with J. Breuer, and
in addition to observations which he has made on his hysterical
patients fully a decade before, I have studied the mechanism of
the origin of hysterical symptoms by the awakening of memories
in hypnotic states. We obtained information which permitted us
to cross the bridge from Charcot’s traumatic hysteria to the
common non-traumatic hysteria. We reached the conception
that the hysterical symptoms are permanent results of psychic
traumas, and that the amount of affect belonging to them was
Pushed away from conscious elaboration by special determina-
tions, thus forcing an abnormal road into bodily innervation.
The terms “ strangulated affect,” “ conversion,” and “ ab-reac-
tion,” comprise the distinctive characteristics of this conception,
In the close relations of the psychoneuroses to the simple
neuroses, which can go so far that the diagnostic distinction is
not always easy for the unpracticed, it could happen that the
cognition gained from one sphere has also taken effect in the
other. Leaving such influences out of the question, the deep
study of the psychic traumas also leads to the same results. If
by the “analytic” method we continue to trace the psychic

Meurer

neurasthenia or anxiety neurosis, shows a constant relation to the% 7
orm of the sexual injury. In the typical cases of neurasthenia Y
we could-always demonstrate masturbation or accumulated pollu-

J

2). Ayilnin

188 PAPERS ON HYSTERIA AND OTHER PSYCHONEUROSES,

traumas from which the hysterical symptoms are derived, we
finally reach to experiences which belong to the patient’s childhood,
and concern his sexual life. This can be found even in such
cases where a banal emotion of a non-sexual nature has occa-
sioned the outburst of the disease. Without taking into account
these sexual traumas of childhood we could neither explain the
symptoms, find their determination intelligible, nor guard against
their recurrence. The incomparable significance of sexual ex-
periences in the etiology of the psychoneuroses seems therefore
firmly established, and this fact remains until today one of the
main supports of the theory.

If we represent this theory by saying that the course of the life
long hysterical neurosis lies in the sexual experiences of early
childhood which are usually trivial in themselves, it surely would
sound strange enough. But if we take cognizance of the his-
torical development of the theory, and transfer the main content
of the same into the sentence: hysteria is the expression of a
special behavior of the sexual function of the individual, and that
this behavior was already decisively determined by the first
effective influences and experiences of childhood, we will perhaps
be poorer in a paradox but richer in a motive for directing our
attention to a hitherto very neglected and most significant after-
effect of infantile impressions in general. .

‘As I reserve the question whether the etiology of hysteria (and
compulsion neurosis) is to be found in the sexual infantile experi-
ences for a later more thorough discussion, I now return to the
construction of the theory expressed jn some small preliminary
publications in the years 1895-1896.2, The bringing into prom-
inence of the assumed etiological moments permitted us at the
time to contrast the common neuroses which are maladies with
an actual etiology, with the psychoneuroses which etiology was
in the first place to be sought in the sextial experiences of remote
times. The theory culminates in the sentence: In a normal vita
sexualis no neurosis is possible.

Tf T still consider today this sentence as correct it is really
not surprising that after ten years labor on the knowledge of
these relations I passed a good way beyond my former point of

*See Chapter VIL, and Zur Aetiologie der Hysteric, Wiener, Klinische
Rundschau, 1896.

ROLE OF SEXUALITY IN ETIOLOGY OF NEUROSES. 189

view, and that I now think myself in a position to correct by
detailed experience the imperfections, the displacements, and the
misconceptions, from which this theory then suffered. By chance
my former rather meagre material furnished me with a great
number of cases jn which infantile histories, sexual seduction by
grown-up persons OF older children, played the main role.
overestimated the frequency of these (otherwise not to be
doubted) occurrences, the more so because T was then in no posi-
tion to distinguish definitely the deceptive memories of hysterical
patients concerning their childhood, from the traces of the real
processes, whereas, I have since then learned to explain many @
seduction fancy as an attempt at defense against the reminiscence
of their own sexual activity (infantile masturbation). The em-
phasis laid on the “traumatic” element of the infantile sexual
experience disappeared with this explanation, and it remained
obvious that the infantile sexual activities (be they spontaneous
or provoked) dictate the course of the later sexual life after ma-
turity. The same explanation which really corrects the most sig-
nificant of my original errors perforce also changed the concep-
tion of the mechanism of the hysterical symptoms. These no
Jonger appeared as direct descendants of repressed memories of
sexual infantile experiences, but between the symptoms and the
infantile impressions there slipped in the fancies (confabulations
of memory) of the patients which were mostly produced during
the years of puberty and which on the one hand, are raised from
and over the infantile memories, and on the other, are jmmed-
jately transformed into symptoms. Only after the jntroduction
of the element of hysterical fancies did the structure of the neu-
rosis and its relation to the life of the patient become transparent.
Tt also resulted in a veritable surprising analogy between these
unconscious hysterical fancies and the romances which became
conscious as delusions jn paranoia.

After this correction the “infantile sexual traumas » were in a
sense supplanted by the “infantilism of sexuality.” A second
modification of the original theory was not remote. With the
accepted frequency of seduction in childhood there also disap-
peared the enormous emphasis of the accidental influences of sex-
uality to which J wished to shift the main réle in the causation of
the disease without, however, denying constitutional and heredi-

190 PAPERS ON HYSTERIA AND OTHER PSYCHONEUROSES.

tary moments. I even hoped to solve thereby the problem of the
selection of the neurosis, that is, to decide by the details of the sex-
ual infantile experience, the form of the psychoneurosis into which
the patient may merge. Though with reserve I thought at that
time that passive behavior during these scenes results in the spe-
cific predisposition for hysteria, while active behavior results in
compulsion neurosis, This conception I was later obliged to
disclaim completely though some facts of the supposed connection
between passivity and hysteria, and activity and compulsion neu-
rosis, can be maintained to some extent. With the disappearance
of the accidental influences of experiences, the elements of con-
stitution and heredity had to regain the upper hand, but differing
from the view generally in vogue I placed the “ sexual constitu-’
tion” in place of the general neuropathic predisposition. In
my recent work, “Three Contributions to the Sexual Theory.”* I
have attempted to discuss the varieties of this sexual constitution,
the components of the sexual impulse in general, and its origin
from the contributory sources of the organism.

Still in connection with the changed conception of the “sexual
infantile traumas,” the theory continued to develop in a course
which was already indicated in the publications of 1894-1896.
Even before sexuality was installed in its proper place in the eti-
ology, I had already stated as a condition for the pathogenic effi-
caciousness of an experience that the latter must appear to the
ego as unbearable and thus evoke an exertion for defense. To
this defense I have traced the psychic splitting—or as it was
then called the splitting of consciousness—of hysteria. If the
defense succeeded, the unbearable experience with its resulting
affect was expelled from consciousness and memory; but under
certain conditions the thing expelled which was now unconscious,
developed its activity, and with the aid of the symptoms and their
adhering affect it returned into consciousness, so that the disease
corresponded to a failure of the defense. This conception had
the merit of entering into the play of the psychic forces, and
hence approximate the psychic processes of hysteria to the nor-
mal instead of shifting the charactcristic of the neurosis into an
enigmatic and no further analyzable disturbance.

Further inquiries among persons who remained normal furnished

* An English translation in preparation,

ROLE OF SEXUALITY IN ETIOLOGY oF NEUROSES, igt

the unexpected result, that the sexual histories of their child-
hood need not differ essentially from the infantile life of neurot-
ics, and that especially the réle of seduction is the same in the
former, so the accidental influences receded still more in compar-
ison to the moments of “ repression” (which I began to use in-
stead of “defense”). It really does not depend on the sexual
excitements which an individual experiences in his childhood
but above all on his reactions towards these experiences, and
whether these impressions responded with “ repression ” or not.
Tt could be shown that spontaneous sexual manifestations of
childhood were frequently interrupted in the course of develop-
ment by an act of repression. The sexual maturity of neurotic
individuals thus regularly brings with it a fragment of “sexual
repression” from childhood which manifests itself in the require-
ments of real life. Psychoanalyses of hysterical individuals show
that the malady is the result of the conflict between the libido and
the sexual repression, and that their symptoms have the value of
a compromise between both psychic streams.

Without a comprehensive discussion of my conception of re-
pression I could not explain any further this part of the theory.
It suffices to refer here to my “ Three Contributions to the Sexual
Theory,” where I have made an attempt to throw some light on
the somatic processes in which the essence of sexuality is to be
sought. I have stated there that the constitutional sexual predis-
Position of the child is more irregularly multifarious than one
would expect, that it deserves to be called “ polymorphous-
Perverse,” and that from this predisposition the so called normal
behavior of the sexual functions results through a repression of
certain components. By referring to the infantile character of
sexuality, I could form a simple connection among normal, per-
versions, and neurosis. The normal resulted through the repres-
sion of certain partial impulses and components of the infantile
Predisposition, and through the subordination of the rest under the
primacy of the genital zones for the service of the function of
Procreation. The perversions corresponded to disturbances of
this connection due to a superior compulsive-like development of
some of the partial impulses, while the neurosis could be traced
to a marked repression of the libidinous strivings. As ost,
all perversive impulses of the infantile predisposition are demon-

Hy Slersic :

192 PAPERS ON HYSTERIA AND OTHER PSYCHONEUROSES.

strable as forces of symptom formation in the neurosis, in which,
however, they exist in a state of repression, I could designate the
neurosis as the “negative” of the perversion.

T think it worth emphasizing that with all changes my ideas on
the etiology of the psychoneuroses still never disavowed or
abandoned two points of view, to wit, the estimation of sexuality
and infantilism. In other respects we have in place of the acci-
dental influences the constitutional moments, and instead of the
pure psychologically intended defense we have the organic “ sex-
wal repression.” Should anybody ask where a cogent proof can
be found for the asserted etiological significance of sexual factors
in the psychoneuroses, and argue that since an outburst of these
diseases can result from the most banal emotions, and even from
somatic causes, a specific etiology in the form of special exper-
jences of childhood must therefore be disavowed; I mention as
an answer for all these arguments the psychoanalytic investiga-
tion of neurotics as the source from which the disputed conviction
emanates. If one only makes use of this method of investigation
he will discover that the symptoms represent the whole or a par-
tial sexual manifestation of the patient from the sources of the
normal or perverse partial impulses of sexuality. Not only does
a good part of the hysterical symptomatology originate directly
from the manifestations of the sexual excitement, not only are a
series of erogenous zones in strengthening infantile attributes
raised in the neurosis to the importance of genitals, but even the
most complicated symptoms become revealed as the converted
representations of fancies having a sexual situation as a content.
He who can interpret the language of hysteria can understand
that the neurosis only deals with the repressed sexuality. One
should, however, understand the sexual function in its proper
sphere as circumscribed by the infantile predisposition. Where
a banal emotion has to be added to the causation of the disease,

the analysis regularly shows that the sexual components o the
traumatic experience, wht

are never missing, have exercised the

pathogenic elect. _
We have unexpectedly advanced from the question of the caus-
ation OF the psychonetiroses to the problem of its essence. we

wisl Zance of what we discovered by psychoanalysis
we can only say that the essence of these maladies lies in disturb-

ROLE OF SEXUALITY IN ETIOLOGY OF NEUROSES. 193

ances of the sexual processes, in those processes in the organism
which determine the formation and utilization of the sexual libido.
We can hardly avoid perceiving these processes in the last place
as chemical, so that we can recognize in the so-called actual neu-
roses the somatic effects of disturbances in the sexual metabolism,
effects of the same Uistirbances. The rescniblance sr Ieee
Toses to the manifestations of intoxication and abstinence follow-
ing certain alkaloids, and to Basedow’s and Addison’s diseases,
obtrudes itself clinically without any further ado, and just as these
two diseases should no more be described as “nervous diseases,”
so will the genuine “neuroses” soon have to be removed from
this class despite their nomenclature.

Everything that can exert harmful influences in the processes
serving the sexual Tunction therefore belongs to The etiology of Ry of
the neurosis. Tn the first place we have the noxas directly affect-
ing the Sexual functions insofar as they are accepted as injurics
by the sexual constitution which is changeable through culture
and breeding. In the second place, we have all the different
Noxas and traumas which may also injure the sexual processes by
injuring the organism as a whole. But we must not forget that
the etiological problem in the neuroses is at least as complicated
as in the causation of any other disease. One single pathogenic
influence almost never suffices, it mostly requires a multiplicity
of etiological moments reinforcing one another, and which can
fot be Brought in contrast to one another. Tt is for that reason
that the state of neurotic illness is not sharply separated from the
normal. The disease is the result of a summation, and the
measure of the etiological determinations can be completed from
any one part. To seek the etiology of the neurosis exclusively in
heredity or in the constitution would be no less one sided than to
attempt to raise to the etiology the accidental influences of sex-
uality alone, even though the explanations show that the essence
of this malady lies only in a disturbance of the sexual processes
of the organism.

Mints Vv.
pyle winnie