Selected papers on hysteria and other psychoneurosesFreud, Sigmund
Science
Selected papers on hysteria and other psychoneuroses
Freud, Sigmund
Hysteria; Neuroses; Psychoanalysis
In this way it was found that neurasthenia really corresponds to a
monotonous morbid picture in which, as shown by the analysis, “psychic
mechanisms” play no part. From neurasthenia we sharply distinguished the
compulsion neurosis (Zwangsneurose), [obsessions, doubts, impulses], the
neurosis of the genuine obsessions, in which we can recognize a
complicated psychic mechanism, an etiology resembling the one of
hysteria, and a far reaching possibility of an involution by
psychotherapy. On the other hand it seemed to me undoubtedly imperative
to separate from neurasthenia a neurotic symptom-complex which depends
on a totally divergent, strictly speaking, on a contrary etiology. The
partial symptoms of this complex have been recognized by E. Hecker[27]
as having a common character. They are either symptoms, or equivalents,
or rudiments of anxiety manifestations, and it is for that reason that
this complex, so different from neurasthenia, was called by me anxiety
neurosis. I maintain that it originates from an accumulation of physical
tension which is in turn of a sexual origin. This neurosis, too, has no
psychic mechanism, but regularly influences the psychic life, so that
among its regular manifestations we have anxious expectation, phobias,
hyperesthesias to pain, and other symptoms. This anxiety neurosis, as I
take it, certainly corresponds in part to the neurosis called
hypochondria, which in some features resembles hysteria and
neurasthenia. Yet in none of the earlier works can I consider the
demarcation of this neurosis as correct, and moreover, I find that the
usefulness of the name hypochondria is impaired by its close relation to
the symptom of “nosophobia.”
After I had thus constructed for myself the simple picture of
neurasthenia, anxiety neuroses, and obsessions, I turned my attention to
the commonly occurring cases of neuroses which enter into the diagnosis
of hysteria. I now said to myself that it would not do to mark a
neurosis as hysterical on the whole, merely because its symptom complex
evinced some hysterical signs. I could readily explain this practice by
the fact that hysteria is the oldest, the most familiar, and the most
striking neurosis under consideration, but still it was an abuse which
allowed the placing of many features of perversion and degeneration
under the caption of hysteria. Whenever a hysterical symptom, such as
anesthesia or a characteristic attack, could be discovered in a
complicated case of psychic degeneration, the whole thing was called
“hysteria,” and hence one could naturally find united under this same
trade mark the worst and most contradictory features. As certain as this
diagnosis was incorrect it is also certain that our classification must
be made from the neurotic standpoint, and as we know neurasthenia,
anxiety neurosis, and similar conditions in the pure state, there is no
need of overlooking them in combination.
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