Theory of The Neuroses

CLASSICAL
PSYCHOANALYTIC SCHOOL
A: The Theory of the Neuroses
Marvin G. Drellich
e-Book 2015 International Psychotherapy Institute
From American Handbook of Psychiatry: Volume 1 edited by Silvano Arietti
Copyright © 1974 by Basic Books
All Rights Reserved
Created in the United States of America

Table of Contents

Introduction
Formative Influences on Freud’s Theories of the Neuroses
The Earliest Psychoanalytic Theories of the Neuroses
The Five Classical Psychoanalytic Hypotheses
Classical Metapsychology after Freud, The Adaptive Hypothesis
The General Theory of the Neuroses
The Special Theory of the Neuroses
Bibliography
www.freepsychotherapybooks.org 4
CLASSICAL PSYCHOANALYTIC SCHOOL

Marvin G. Drellich
Introduction
In 1945 Fenichel published a 703-page volume, The Psychoanalytic

Theory of Neurosis. This encyclopedic treatise quickly became a standard
reference since it contained an exhaustive survey of the classical
psychoanalytic literature to that date. The subsequent 25 years have
produced an unending stream of publications in this area, many of which are

of superior merit and a few are truly seminal. Obviously a summary of the
classical psychoanalytic theory of neuroses in one concise chapter must be
regarded as merely an extended outline.
This outline will attempt an overview of the major theories that are the
core concepts in contemporary classical psychoanalysis. The highlights of the

historical evolution of these theories will be traced, and those concepts that
are most extensively and effectively used by contemporary psychoanalysts
will be indicated.
American Handbook of Psychiatry - Volume 1 5

Preliminary Definitions
The terms “neuroses” and “psychoneuroses” are used here as
essentially synonymous. They refer to the group of psychiatric illnesses

characterized by prominent symptoms that have 110 significant somatic
origin. The symptoms include disturbances of feelings (anxiety, depression,
guilt), disturbances of thought (obsessions), and disturbances of behavior

(compulsions and phobic inhibitions), all of which are experienced as alien to
the comfort and well-being of the individual. There are no prominent
disturbances of the sense of reality as are present in the psychoses.
Classical psychoanalysis is somewhat more difficult to define. The
definition given here will be entirely satisfactory only to the author and
perhaps to a small number of like thinkers. This definition will be
substantially but not completely satisfactory to a majority of those who
consider themselves classical psychoanalysts. A small number of classical
psychoanalysts may hold major disagreements with the definition.
Classical psychoanalytic theory is defined as the theory or group of
theories of human psychological development, functioning, and behavior that

were formulated by Sigmund Freud and progressively evolved over the 50
years (1888-1938) of his creative scientific life. Classical theory today
embraces nearly all of Freud’s theoretical concepts as they were orginally

defined by him and as they have been modified, clarified, and extended both
by him and by numerous others who are closely associated with this body of
knowledge. Classical theory includes all five of the metapsy- chologieal
hypotheses or points of view (dynamic, economic, topographic, genetic, and
structural) that constitute the major building blocks of Freud’s

comprehensive view of human behavior and psychological activity. The five
hypotheses are not judged to be equal in clinical usefulness, in internal
consistency, or in survival value. Rapaport has subjected each
metapsychological theory to careful scrutiny and has made predictions about

which are most likely to be retained, which will undergo major modifications,
and which may be entirely discarded as psychoanalytic theory continues to be
responsive to influences from clinical observations, from the psychological

insights derived from nonelassi- cal psychoanalytic sources and from the non-
analytic behavioral sciences. Significant criticism of the economic and
topographic points of view has come from some analysts who otherwise
subscribe to the classical theories.
Classical psychoanalytic theory retains most of the original vocabulary
of Freud’s formulations, although a few modifications, refinements, and

elaborations of terms have occurred as the science has evolved. Where major
theoretical modifications have been introduced or original concepts have

been formulated, they have been included in the classical theory to the extent
that the new ideas are: (1) consistent with clinical psychoanalytic
observation, (2) consistent with the main body of classical concepts, and (3)

formulated in terms of and integrated into one or more of the five
metapsychological points of view. Greenson has described the elements of
classical psychoanalytic practice and technique. His concepts appear to be
consonant with the statement of classical theory described herein.[1]
It must be emphasized that classical psychoanalytic theory is in no

sense a static entity. It has undergone progressive development during and
after Freud’s lifetime. His nuclear theories evolved piecemeal and were
formulated and published over a span of 33 years (1893-1926) as his clinical
experience increased, as his technique became more penetrating, as his
understanding became more refined, and as existing theories proved
incapable of explaining fully the complexities of the neurotic processes he
was exploring. As each new theory was developed he made radical changes in
some of the concepts. His final theories of sexuality, anxiety, and repression
are strikingly different from his initial concepts. Where possible he attempted
to retain his existing theories, integrate the newer with the older concepts,
and increase the comprehensiveness of the whole.
Formative Influences on Freud’s Theories of the Neuroses
In 1886 at the age of 32, Freud began the practice of neurology in
Vienna. A substantial number of his patients suffered from what was then
called hysteria, a broadly inclusive term applied to several disorders that
would currently be called psychoneuroses. He discovered that his
preparatory education in medicine, psychiatry, and neurology did not equip
him to understand or to treat effectively these disorders.
Freud’s Medical and Neurological Education
He had attended medical school for eight years (1873-1881). During
five of those years (1876-1881) he undertook study and research on the
histology of the nervous system under Ernst Brücke, the great

neuroanatomist and physiologist. Brücke was a leading exponent of the
“Helmholtz School of Medicine,” which held that all functions of the human
organism could be ultimately explained in exclusively physical terms. Brücke
taught that the reflexes are the basis of all activities of the nervous system,
including all mental processes.
Freud was profoundly impressed with Brücke as a person as well as a
teacher, and he worked for an additional year (1882) in Brücke’s laboratory

after obtaining his medical degree. From 1882 to 1885 he was house
physician at the General Hospital in Vienna where he rotated through several
services, including internal medicine, dermatology, surgery, psychiatry, and
neurology. For more than a year he served in the department of nervous
diseases under Franz Scholz, developer of subcutaneous injections. For five

months he worked in the psychiatric clinic under Theodor Mevnert, who

taught that all normal and abnormal mental processes could be related to the
structure of the brain and the reflex activity of the nervous system. During the
entire three years of hospital service, Freud was permitted to use Meynert’s
laboratory of cerebral anatomy where the young house physician carried out
research on human brain anatomy. As a result of his years of research in
neurophysiology under Brücke and his study of neuroanatomy and pathology
in Meynert’s laboratory, Freud was appointed Lecturer in Neuropathology at
the University of Vienna Medical School in 1885, shortly before completing

his hospital service.
A penultimate formal preparation for the practice of neurology occurred
when Freud requested and was given a grant to travel to Paris for study with
Jean Martin Charcot, the internationally known neurologist. Charcot was not
primarily concerned with neuroanatomy or neurophysiology. He was a
clinician whose emphasis was on describing and demonstrating the multitude
of symptoms of hysteria. During the six months that Freud studied in Paris,
Charcot demonstrated that hysterical symptoms could be removed or
induced by direct suggestion to patients who were under hypnosis. He taught

that hysterical symptoms were neither imagined nor feigned. He asserted that
ideas alone could cause hysterical symptoms to occur, especially when these
ideas constituted a psychic trauma. Clearly these psychological theories as
explanations for mental disorders were in direct conflict with the exclusively
physical, neuroanatomical theories of Brücke and Mey- nert.
Private Practice
When Freud finally entered into the private practice of neurology, he
found that there were few effective treatment methods for his patients who
suffered from hysteria and other psychiatric disorders. Initially he used the
then currcnt techniques such as hydrotherapy, electrotherapy, massage, and
the Weir- Mitchell rest cure. Late in 1887 he began to use hypnosis to remove
symptoms by direct suggestion. About a year later he began to use hypnosis
to achieve catharsis, that is, uncovering of painful forgotten thoughts and
ideas and release or discharge of the associated intense feelings. This mode of
using hypnosis he had learned from Joseph Breuer.
The Influence of Joseph Breuer
Joseph Breuer was a prominent Viennese physician whom Freud had

met when both were doing research at Brücke’s institute. Breuer, 14 years
older, was initially a revered senior colleague but gradually became a fatherly
friend who referred many cases when Freud entered into private practice in
1886. Several years earlier (1881-1882) Breuer had treated a young woman
(Anna O.) for various hysterical symptoms. When he recounted the
remarkable story of her illness, treatment, and apparent cure to Freud, it had
a profound impact on Freud’s ideas concerning the causes and treatment of

neuroses.

Breuer described how the patient’s bizarre hysterical symptoms,
paralysis, contractures, and ocular disturbances could be traced back, under
hypnosis, to their origins, that is, to “traumatic” events in her past life. When
these events were remembered and the associated emotions were re-
experienced, the patient had a dramatic disappearance of her symptoms. She
herself called it a “talking cure.” Breuer and Freud called it “catharsis,” and it
is currently known as abreaetion. Breuer’s assumption was that hysterical

symptoms are caused by traumatic experiences that are too painful to be
remembered. These traumata reappear in a symbolic form as hysterical
symptoms.
In 1888 an article entitled “Hysteria” was published in Villaret’s Medical
Handbook. This unsigned essay has been fairly conclusively attributed to
Freud. In it he attempted to bring together the anatomical views of Brucke
and Meynert with his growing recognition of the role of psychical factors, his
inheritance from Charcot and Breuer. He asserted that “hysteria is based
wholly and entirely on physiological modifications of the nervous system,”

but he added that conditions of life, including functional sexual problems,
which have a “high psychical significance,” play a part in the etiology of
neurosis and that psychical traumas are frequent incidental causes of

hysteria.
In 1889 he went to Nancy, France, for three weeks to perfect his
hypnotic techniques in the clinic of Ambroise Liebeault and Hippolyte
Bernheim. He returned to Vienna where for several years he continued to use
hypnosis to relieve symptoms by direct suggestion and also to uncover the
traumatic causes and effect a cathartic cure of hysterical symptoms.
The years 1888 to 1898 were Freud’s most creative, and after several
false starts he produced the fundamental concepts on which have been built
the classical psychoanalytic theories of the neuroses.
The Earliest Psychoanalytic Theories of the Neuroses
Freud continued to treat patients with hypnosis, waking concentration,
and finally free association, a technique that he evolved in the years 1892-
1893. He had gathered an enormous amount of data on the current and past
events in the lives of his patients who suffered from psychoneurotic
disorders. He could not be content with the sketchy and relatively superficial
psychological concepts of Charcot, Breuer, or Bernheim, so he began to
formulate his own more complex and penetrating theories based largely on
inferences drawn from his clinical observations. Several preliminary theories
were formulated but never published because he judged them to be

unsatisfactory. These false starts have been preserved through his
correspondence and his preliminary drafts that were sent to Wilhelm Fliess,
his sole confidant for many years.

In the first publications that can properly be called psychoanalytic, we
find diverse concepts that were later to be integrated into an overall theory of
the neuroses. Most important is the now universally recognized concept that
there are elements in the human mind, ideas, thoughts, memories, and
associated feelings that are unconscious, that is, entirely outside of conscious
awareness. These unconscious elements are not easily retrieved or brought to
consciousness. They are not, however, entirely inconsequential. Unconscious

psychical elements (only later were they more precisely described as drives,
defenses, and so forth) are able to find expression through the symptoms of
neuroses.
A second crucial observation was that sexual factors are the most
important of the unconscious psychical elements. The detailed formulation of
the role of sexuality in the etiology of the neuroses was to take another
decade for Freud to work out.
Role of Sex in the Etiology of Neuroses
In 1888 Freud had said that “conditions related functionally to sexual

life play a great part in the etiology of hysteria (as of all neuroses).” Here he
was referring to adult sexual life or to the sexuality of adolescence or young
adulthood. In 1893 he published with Breuer a preliminary communication
based on Breurer’s Anna O. and several of Freud’s own cases. Their expanded
publication in 1895 made explicit the importance of traumatic sexual
experiences occurring in adolescence or young adult life for the etiology of
the neuroses.
Freud’s publications in this decade include several concepts that were
to find prominence in his later systematic formulations. In “The Neuro-
Psychoses of Defense” (1894) the concept of defense is extensively discussed

for the first time. He described the repression of unacceptable sexual ideas
and the conversion of excitation into “something somatic”. The concept of
defense, also called “the theory of repression,” is the cornerstone of the
classical dynamic hypothesis. The discovery of unconscious psychical
elements and the recognition of unconscious defenses are nuclear in the
theory of intrapsychic conflict. The conflict theory is the fundamental dynamic

hypothesis and is indispensable to all psychodynamic theories.
In this paper he went beyond the theory of sexual trauma and
introduced the idea that masturbation plays a crucial role in the etiology of
neurasthenia and coitus interruptus is the pathogenic factor in anxiety
neurosis. These theories were eventually to be abandoned in favor of more
sophisticated theories of sexuality, but there is another theme introduced at

this time (1894-1895) that was to have lasting significance: the first
formulation of Freud’s theory of anxiety.

He described a “quota of affect,” which indicated a quantity of feeling or
emotion, and used it synonymously with “a sum of excitation,” which
indicated a quantity of energy. He asserted that anxiety neurosis occurs when
a sum of undischarged affect or excitation, specifically sexual excitation, is
transformed into anxiety. He called this condition an “actual neurosis” and
distinguished it from the psychoneuroses. The actual neurosis is an
essentially toxicological concept in that dammed up libido is transformed into

anxiety. The psychoneuroses (hysteria, obsessions, phobias) were already
being explained in psychodynamic terms.
The toxic theory of anxiety was to be dramatically modified by Freud in
later years. Anxiety was to be recognized as the outcome of an intrapsychic
conflict. The revised anxiety theory was to become a central element in all
psychodynamic theories as, indeed, it is today. The idea of a “quota of affect”
or a “sum of excitation” was destined to find a place in his economic

hypothesis where it has some acceptance today.
In 1896 Freud began to refer to his method and theory as
psychoanalysis, He advanced his sexual theory in dramatic terms. He asserted

that psychical defenses are in every instance directed against a sexual
experience of a traumatic nature. Further, the traumatic sexual experience
always occurred before the age of puberty and was, in fact, the seduction of
the child by the child’s father. In cases of hysteria the patient as a child was a
passive participant in the seduction, while in the obsessional neuroses the
child played an activc role in the seduction.
The seduction theory was not destined to be retained for long. As early
as September 1897 Freud had privately expressed doubts about the
seduction theory. He had formulated this theory from the histories of many
patients who claimed to have remembered such seductions. He could not

support the implication that there were so many perversely seductive fathers
to account for the legions of hysterical and obsessional patients. Freud was
discouraged by this reversal and despaired of ever finding the connection
between sexuality and neuroses. From these ruins, according to Strachey,
“Freud became aware of the part played by fantasy in mental events and this
opened the door to the discovery of infantile sexuality and the Oedipal
Complex.” He came to realize that his patients’ “seductions” occurred only in
their fantasies, which compelled him to recognize (1) that sexuality is a
significant element in earliest childhood, and (2) that infantile sexuality is the
consequence of unconscious instinctual drives[2] that remain psychically
active throughout life.
In 1897 Freud began his systematic self- analysis by recording and
associating to his own dreams.' He sent much of this material to Fliess in
Berlin, who supplied friendly encouragement for this undertaking, but

appears to have contributed no substantive insights or creative

interpretations. By March 1899 the daily self-analysis was discontinued,
although he continued to analyze his dreams intermittently thereafter.
Most of the substance of his self-analysis forms the core of his
monumental work, The Interpretation of Dreams (1900). Freud always
regarded the dream book as his major creative work. This volume, along with
his Three Essays on the Theory of Sexuality (1905), ushered in a substantially

new and integrated theory of psychoanalysis, a theory that has been
expanded and modified but remains in many respects intact today as the
heart of the classical psychoanalytic theory.
The Five Classical Psychoanalytic Hypotheses
Classical psychoanalytic theory currently consists of five distinct but
overlapping hypotheses or points of view. The foregoing historical discussion
has indicated some of the intellectual antecedents that found their way into
the five theories. Each hypothesis represents an attempt to comprehend and
explain the organization and functioning of the human mind or psychic
apparatus. Each theory, viewed separately, attempts to be inclusive and
thereby explain the motives and vicissitudes of normal as well as neurotic

thinking and behavior.
None of the five theories is, in fact, inclusive, and no claim has been
made for the completeness of any or all. Indeed, these concepts are most
meaningful and explanatory when taken together, that is, when they are
considered to supplement and clarify each other. These five theories are to a
greater or lesser extent metaphorical concepts. Classical psychoanalytic
clinicians and theoreticians will generally use all five as conceptual tools, but,
as will be shown, the dynamic, genetic, and structural theories appear to be

the most extensively used in recent years.
No attempt will be made here to outline a complete summary, much less
a statement of classical theory in all its aspects. Several volumes exist that
present the entire scope of classical theory: psychopathology of neuroses and
psychoses, concepts of normal and abnormal development, the theoretical

basis of psychoanalytic technique, the psychology of dreams and wit, and
applied psychoanalysis. Here the hypotheses will be described to the extent
that they bear upon our understanding of the etiology and psychopathology
of the neuroses.
The Dynamic Hypothesis
The dynamic point of view is concerned primarily with the interaction
of the largely unconscious factors within the mind. The most important
interaction is the conflict of psychical elements within the individual; in fact,
this theory has also come to be called the theory of intrapsychic conflict.
The recognition of the existence of unconscious mental activity is a

central element in this theory. Freud’s earliest discoveries of the
psychological factors in mental illness, discoveries that emerged from his
encounters with Charcot, Breuer, and Bernheim and from his own clinical
work, involved the bringing into consciousness of psychical elements that
were in the patient’s mind but were previously entirely excluded from
conscious awareness. He was first concerned with uncovering the traumatic
events of the patient’s earlier life. These traumata had left the patients with
painful and unacceptable memories that had to be put out of conscious

awareness by means of a psychical defense. The concept of defense, which he
callcd the “theory of repression,” implies a dynamic interaction of opposing
forces in the mind.
What then are the elements involved in these dynamic interactions or
conflicts of intrapsychic forces? At first Freud believed that memories of

sexual traumata were the elements that were repressed, but his sexual
theories were then sidetracked. His concern with adult sexual practices,
masturbation, coitus interruptus, and abstinence were toxicological, not
psychological, theories and had little significance for the theory of

intrapsychic conflict. His short-lived theory of childhood seduction was
within the psychological realm, but more important, it led to his discovery of
infantile sexuality and his formulation of the role of sexual instinctual drives in
the dynamic psychological processes of the mind.
The dynamic hypothesis then is concerned with the conflict between the
instinctual drives that “propel the organism toward gratification” and the
defenses, the counterforces that oppose the expression and gratification of
these impulses.
For many years the instinctual drives were considered to be exclusively

sexual in nature. The instinctual drives were described as “the demands that
the body makes upon the psychological apparatus.” These demands produce
within the psyche a psychical representation of the instinctual drive. Any
fantasy or overt action that directly or indirectly may serve to express or
discharge the instinctual drive is called a drive derivative.
In 1920 Freud published a controversial volume in which he postulated

the existence of a death instinct, one part of which was an aggressive
instinctual drive. The death instinct has had very little acceptance in the
psychoanalytic community, but the recognition of the aggressive instinctual
drives and of the defenses against them has become an integral part of the
dynamic point of view. It should be noted that the aggressive drives are never
spoken of as having a somatic source or origin but rather are judged to be

entirely psychological. Nevertheless, it is possible to speak of an idea that is
the psychical representation of the aggressive drive and also to speak of an
aggressive instinctual drive derivative.

The defenses or counterforces oppose the discharge or expression of
the sexual and aggressive drives because the individual has learned from a
very early age to associate many instances of drive discharge with pain. The
pain includes distressing feelings (anxiety, guilt, shame), physical pain, and
danger to one’s safety, security, or even survival.
From the earliest years of childhood the individual has encountered
external opposition to his immediate gratification of instinctual drives.
Prohibitions and threats from parents, society, and all other external sources,
whether explicit or implicit, are perceived and remembered. This leads to the
unconscious conviction that the direct expression of drive impulses will lead
to serious consequences— pain, retaliation, or punishment. The instinctual
demands upon the psyche are continual but not necessarily constant in
intensity. In circumstances where external factors stimulate either sexual or
aggressive responses, the internal demands are even more insistent.

(Quantitative questions will be discussed in the section on the economic
hypothesis.)
The opposition to the expression of the instinctual drives is initially the

perceived external threats of pain or danger. Early in life the threats become
internal, generate a sense of greater or lesser danger, and lead to the internal
defenses which are set in opposition to the awareness and the undisguised
expression of the instinctual drives. Fear of annihilation, fear of castration,
fear of isolation, and even fear of being overwhelmed by unbearably intense
excitation are among the unconscious fears that motivate the defenses.
The variety and vicissitudes of the defenses were not systematically
worked out until after the formulation of the structural theory. Within the
dynamic theory it is simply stated that the expectation of pain or injury that is
associated with the gratification of sexual or aggressive drive derivatives

serves to mobilize intrapsychic defenses against these impulses.
It must be emphasized that the foregoing description was at one time

considered to be characteristic of all mental activity, normal and abnormal.
Now there has been a growing tendency to accept Hartmann’s views on the
existence of conflict-free mental activities, but it remains a widely accepted
viewpoint that most mental activity and subsequent behavior, be they normal
or pathological, involve some degree of intrapsychic conflict.
One of the important implications of the dynamic viewpoint is the
principle of psychic determinism. Brenner states, “in the mind, as in physical

nature about us, nothing happens by chance or in a random way. Each psychic
event is determined by the ones which preceded it.” There is a cause or

causes for every mental event, conscious and unconscious. The final overt
manifestation, the dream, the joke, the slip of the tongue, the choice of job, the
choice of spouse, the largest and smallest decision, and, for our immediate

concern, the manifest symptom or symptoms of the psychoneuroses, all are
determined. All are the result of the many unconscious psychic processes that
interact and conflict and thereby determine the final overt manifestations, be
they normal or pathological.
The principle of the dynamic functioning of the mind—the unconscious
intrapsychic conflict—for all its simplicity has been included in all four
subsequent psychoanalytic hypotheses. Each new approach included a place
for the continuing, active, unconscious intrapsychic conflict between
instinctual drives and defenses. The structural concepts will be shown to be
the most direct, though very elaborate and sophisticated, development of the
dynamic concepts.
The conflict theory was the first in which Freud tried to develop a
consistent and enduring preliminary statement about the psychopathology of

the neuroses. The symptoms of neurosis are seen to arise out of intrapsychic
conflict. The sexual and aggressive instinctual drives have intensity (see
economic theory) and phase-specific qualities (see genetic theory). The

defenses, which for many years were thought of as repression, direct
exclusion from consciousness, have been recognized to include many simple
and complex psychic activities (see structural hypothesis). The wide variety
of defenses that come to be used singly or in concert to cope with instinctual
drive demands, and with internal and external prohibitions, have a great deal
to do with the attainment of mental health, the qualities of one’s personality
or character, and the occurrence of psychiatric illness. The foregoing
discoveries are actually an elaborate fleshing out on the sturdy skeleton of the
dynamic hypothesis.
The Economic Hypothesis
The antecedents of the economic hypothesis can be found in the
influence of Brücke’s, Meynert’s, and Freud’s early work in neuroanatomy

and neurophysiology. Brücke was the model of scientific integrity, discipline,
and dedication to truth. These principles found a prominent place in Freud’s
standards of personal and scientific conduct and persisted long after he had
departed from Brücke’s neuroanatomical theories of mental life.
Brücke believed that organisms are products of the physical world,

systems of atoms moved by forces according to the principle of the
conservation of energy. He held that all mental processes were reducible to

physical reflexes of the nervous system. Moreover, all activities of the nervous
system were based on a quantity of excitation, originating in the system,
which travels along the nerve fibers and collects or accumulates at a larger
place in the channel due to summation of stimuli.
As late as 1895 Freud had prepared a draft, “Project for a Scientific
Psychology,” that he hoped would serve as a comprehensive psychology for

neurologists. He tried to explain his burgeoning psychological insights in
terms that were consonant with the current neurophysiological theories. He
tried to “represent psychical processes as quantitatively determined states of
specifiable material particles.” He described the occupation of a neuron by a
quantity of energy as the cathexis (besetzung). Above all, he was concerned

with the “distribution and circulation of quantities of energy within the
hypothetical brain structure.”
He never published the “Project” because he was on the threshold of
moving much further away from the neuroanatomical model of the mind. It
should be noted, however, that concern with quantities of energy and

cathexis was to appear again in his substantially psychological formulations,
especially the economic hypothesis.
The economic theory is concerned primarily with the quantity and

movement of psychic energy within the psychic apparatus. Indeed, the
economic theory has been called an energy transfer theory. It is one logical
development of the dynamic theory in that it tries to explain the outcome of

intrapsychic conflict in quantitative terms. It is concerned with the intensity
of instinctual drives, the strength of psychic defenses, and the internal and
external factors that affect the quantity of their energies.
The first systematic statement of the economic point of view is in
Chapter 7 of The Interpretation of Dreams. He postulated the existence of a
hypothetical psychic energy that has a quantity and displaceability. Psychic
energy was introduced to explain the internal operations of his first
(topographic) model of the psychic apparatus. Psychic energy is alluded to in
many of his subsequent clinical and theoretical publications, culminating in

the thoroughgoing restatement and refinement in his 1915 series on
metapsychology. -
It must be repeated at the outset that psychic energy is a hypothetical
concept, an abstraction that refers to an entity that is neither real nor
measurable in physical terms. Psychic energy has been postulated and

retained in classical psychoanalysis as the most effective way to understand,
explain, and communicate observations about the vicissitudes of the
instinctual drives and the opposing forces.
The instinctual drive, defined as the demand that the body makes upon
the psyche, is conceptualized as producing a hypothetical central stimulation.
This excitation or tension is considered to be constantly present but

undergoes fluctuations in intensity. The increase and decrease of levels of
intensity are described in terms of levels or quantities of psychic energy. The
tension is entirely unconscious, and it is said to make demands upon the

psychic apparatus in order that actions may be initiated that would permit
the tension to be reduced. When instinctual tension increases it is labeled

unpleasure; when appropriate action intervenes to reduce the tension it is
labeled pleasure. This pleasure-unpleasure principle is an essential element in
the economic theory; however, it must be clarified that the term “pleasure” is
not used here in the narrow sense of enjoyment or delight, but rather it
indicates a satisfaction or gratification that is the consequence of the
lessening of unpleasure.
An instinctual drive is considered to have (1) a source, the organ or
tissue from which it arises; (2) an intensity, the quantity of psychic energy
that may accumulate (increasing tension) or discharge (decreasing tension);
(3) an aim, in all instances satisfaction or gratification; and (4) an object, the
person or thing in the external world that may be acted upon or related to in
such a manner that the interaction will effectively discharge or reduce the
inner tension. Actually the psychic energy is said to be directed toward,
attached to, or invested upon the psychical representation of a person or
thing. This investment is called the cathexis of the object.
An instinctual drive invests the psychical representation of the external
object with increasing cathexis. This impels the individual to initiate action
toward the real object in order to achieve gratification. Prohibitions and fears
may oppose the motor activity that would permit gratification. Indeed,
prohibitions may even oppose being conscious of the wish to act. This
opposition to action or to the wish to act is called countercathexis.
Countercathexis is seen to require a quantity of psychic energy to maintain
inhibition of action and unawareness of the drive wish. Here is the dynamic
concept of repression, restated in economic terms as the countercathexis
directed against awareness of the drive wish.
As a result of repression and inhibition, drive tension will persist or
increase and will seek alternate channels for discharge. This involves a
displacement of instinctual energy, an important concept to explain many
behavioral phenomena in economic terms. A hysterical symptom may be
described as the alternate channel or pathway that symbolically discharges
the drive tension but does so in a disguised manner that conceals the true
nature of the drive wish. Indirect, incomplete discharge is thus possible while
the drive wish remains repressed. The same symptom may also symbolically
exact the punishment (pain) that is unconsciously associated with
gratification of the forbidden instinctual drive.
Drives may undergo other vicissitudes besides repression and

displacement. A drive may be reversed into its opposite, as when an active
instinctual wish may be opposed and find an acceptable pathway of discharge
through a passive involvement with the object. Sadistic impulses may be

opposed and lead to a masochistic cathexis of the object. The object itself may
be changed. A young man may have persistent excessive sexual wishes

directed toward his mother, who had been both sexually provocative and

prohibiting. These oedipal wishes will be unconscious and unexpressed, but
they may be directed toward another female who in any way can be
unconsciously associated with his mother. Such change of object will often be
a determinant of the choice of the love object in adult life. When the original
drive wish was very strongly opposed, the opposition may also be transferred
to the new object, and sexual inhibitions (impotence) may be the outcome of
any sexual acts directed toward the woman identified with his mother. When
still stronger opposition to oedipal wishes occurs, it may lead to avoidance of

all women as sexual objects, and the man may be aware only of sexual wishes
toward men. These clinical illustrations are necessarily one-dimensional and
cannot be taken as complete explanations of impotence, homosexuality, or

any other symptom or behavior pattern. All symptoms and behavior are
overdetermined; that is, they are the outcome of many psychic elements,
drives, and defenses in prolonged interaction. In the foregoing clinical
examples the elements mentioned were only a few of the many forces that
combined to produce the symptom.
In 1905 Freud introduced the term “libido,” which he described as the

expression of sexual instinctual energy. At that time he spoke only about the
sexual instinct, postulated no other instinctual drives, and described the

opposition to discharge as coming from internal censors or counterinstinctual
forces. In 1910 he introduced the concept of ego instincts, which he identified
as the selfpreservative instincts and hence the repressive forces. After that he
referred to the conflict between sexual instincts (libido) and ego instincts. In
1920 he again revised his instinctual drive theory. Here he introduced the
concept of the aggressive instincts, that is, instinctual drives directed toward
the destruction of the object. (See section on dynamic theory for additional
comments on the acceptance of the aggressive instinctual drives.)
The wide acceptance of the concept of aggressive drives has given
classical psychoanalysis a dual theory of instinctual drives. This theory
postulates two fundamental drives: (1) the sexual drive, whose energy is
called libido and which is judged to have a somatic source; and (2) the
aggressive drive, whose energy has not been given an acceptable name and
which has not been judged to have a somatic source. The two drives may be in
conflict—-that is, they may vie for priority of expression—but in most

instances the two drives are fused. This means that the object representation
is cathected and drive wishes initiate actions that serve to gratify both drives
simultaneously. All behavior, normal and pathological, is determined by the

conflicts between the fused drives and the counterforces. Obviously in any
specific instance one or the other drive may be the more prominent
instinctual element.
If the economic hypothesis seems somewhat obscure, that is precisely
Freud’s own evaluation of these concepts. He asserted that “the instincts are
the most obscure element of psychological research” and that this theory

must undergo constant alteration with advances in knowledge. Although
many objections have been raised over the years to the energic concept, it has
also received some thoughtful and persuasive support. Brenner’s comments
seem to be representative of the current classical position; he wrote, “it

cannot be emphasized too strongly that the division of drives that we use is
based on clinical grounds and will stand or fall on these grounds alone.”
At this time there remains a distinct need for a theory that deals with
quantification, increase and decrease of tensions, intensity of drives, strength
of defenses, thresholds, displacement, and discharge. These quantitative
formulations, while hypothetical and abstract, are, nevertheless, the most
effective frame of reference in which to organize the quantitative variables of
psychology and behavior.
The Topographic Hypothesis
This is the name that Freud gave to his first published model of the
mental apparatus. In Chapter 7 of The Interpretation of Dreams he described
the psyche as consisting of three systems: the conscious (Cs), the
preconscious (Pcs), and the unconscious systems (Ucs). He theorized a linear,
spatial relationship between these systems. The Cs included the perceptual
apparatus that received external stimuli and responded with a hypothetical

excitation that could flow from one system to another. In the absence of
internal opposition the flow of excitation will reach the motor apparatus, and
action will ensue directed toward discharging the excitation.
He made it clear that “psychical topography has nothing to do with
anatomy,” and the psychical systems do not correspond to any location in the
brain. The Ucs consisted of the instinctual drive representations that seek to
discharge their cathexes, that is, to move their excitation into the Pcs and Cs
and thence to impel the motor apparatus to discharge the excitation.
Unconscious processes are timeless, have little regard for external reality, and
press relentlessly for satisfaction. The mode of functioning of the Ucs is called
the primary process, the tendency to discharge without delay and without
awareness or regard for reality factors or internal interference. Primary
process includes a readiness to displace its energies on to any object

representation that permits immediate gratification; hence it is said to have a
mobility of cathexes. In contrast, the secondary process, the mode of
functioning of mental content in Pcs and Cs, takes into consideration the
external realities, prohibitions, appropriateness of objects, and the need for
delay or postponement of gratification.
The topographic theory provides a model of the mind within which the
energy of instinctual drives moves as it presses for discharge. The psychic
energy becomes attached to ideas and representations of external objects,

and it encounters the censoring counterforces that are “located” in the Pcs.

These forces function to control or bind the mobile cathexes that seek to
move into the Pcs and Cs from their origin in the Ucs.
The topographic theory has been summarized here very briefly because
in its original spatial or hydraulic form it has not retained its usefulness for a
substantial number of classical psychoanalysts. The decline of this model has
been accelerated since 1923 when Freud postulated the more sophisticated
structural model of the psychic apparatus. Freud never intended the
structural model to replace the topographic one. In his later publications he
continued to use both models in his formulations. Nevertheless, the
topographic vocabulary has undergone changes as it continued to be used by
classical psychoanalysts.
Current theory retains the concept that mental content may be fully
conscious and in immediate awareness; it may be preconscious and relatively
easily brought into consciousness, or it may be unconscious and therefore
recoverable with considerable difficulty because of the opposing repressive

forces. In this sense the terms are no longer used to designate systems but
rather to describe qualities of mental content. As adjectives the words find
almost unanimous acceptance.
Beliak has advanced a still more precise approach in asserting that
degrees of consciousness-unconsciousness must lie on a continuum. Mental
content may occupy (figuratively, not spatially) any position or degree along
this continuum. Obviously the three systems of the topographic model do not
provide the means of distinguishing the many degrees of consciousness-
unconsciousness of mental content. Gill, after a thoroughgoing examination of
the topographic model, concluded “there should not be a topographic point of

view in addition to a structural one.” Arlow and Brenner concurred: “there is
essentially little in the topographic model . . . which cannot be more
satisfactorily explained by the structural model.” Lewin, on the other hand,

supports the topographic terminology when discussing dreams, but he finds
the structural theory more valuable when discussing the neuroses.
Primary process has been retained as a clinical term to describe a
certain kind of thinking. It is primitive, irrational, wishful thinking that is
dominated by emotions and is relentlessly pleasure-seeking. Primary process

thinking is characteristic of the normal infant; it is more prominent in dreams
and can be seen to be dominant in the psychoses. Secondary process thinking
is characteristic of the more mature, rational, integrated adult personality. It
takes into account the external realities, judges the appropriateness of objects
and opportunities for satisfaction, and delays gratification in accordance with
these considerations.
The Genetic Hypothesis

The concepts that comprise the genetic theory are widely known and
are popularly associated with Freud because they include many of his most
creative insights into human sexuality. Actually the genetic hypothesis is first
and foremost a developmental theory, specifically a theory of psychosexual
development. According to Hartmann and Kris, “Genetic propositions describe
how any condition under observation has grown out of an individual’s past
and extended throughout his total life span.”
Genetic theory is concerned with the regular, predictable phases of
development, with the tasks and problems that are inevitably encountered in
each phase, and with the attempt to solve these problems in the course of
maturation. Particular attention is directed toward the child’s psychosexual
development, the characterisitcs of the sexual instinctual drives at specific
phases of the maturational process. The formal publication of the genetic
theory occurred in 1905, but it represents the culmination of 15 years of

investigation and several unsuccessful theories of the significance of
sexuality, especially infantile sexuality, for the genesis of the neuroses. His
earlier theories of sexual traumata, unhea’thy adult sexual practices, and
childhood sexual seduction all had to be abandoned (see discussion of earliest
psychoanalytic theories). From the ashes of the seduction theory came the
discovery of the sexual fantasies of the child, the concept of infantile sexuality,
and the timetable of psychosexual development as described in his Three

Essays on the Theory of Sexuality.
In many of its aspects the genetic theory is based on and dependent on
the economic hypothesis. Attention to the origins, quantity, displacements,
and vicissitudes of sexual instinctual energy (libido) are an integral part of
the developmental scheme; hence the term “libido theory” is used as
synonymous with psychosexual theory.
Freud began by postulating that the sexual instinctual drive is present in
all persons from the earliest days of life. The drive originates from somatic
sources and makes demands on the psychic apparatus for discharge of the
accumulating sexual energies or libido. The major somatic source of libido
appears to shift in a regular, predictable pattern in the course of development.
These major sources are called the libidinal or erogenous zones.
In earliest infancy and roughly until the age of 18 months, the infant’s
libidinal tensions originate primarily from the mouth, lips, and tongue. In
addition to being the chief source of libidinal tension, this oral zone is also the
primary organ for gratification of this tension. The only way the infant can
relieve tension (unpleasure) in the oral area is by regular opportunities to
engage in vigorous sucking and later biting and chewing. The prominence of
the oral zone as the source of libidinal tension and the organ of achieving
pleasure has logically led to calling the first year to 18 months of life the oral
phase of psychosexual development.

At approximately 18 months the major source of libidinal tension
gradually shifts to the anal zone. The anus and surrounding area make up the
chief erogenous zone. Unpleasure is experienced as the tension in the anal
area associated with the accumulation of feces in the rectum and the
conscious urge to defecate. Pleasure occurs in the anal area when defecation
occurs and anal tension is relieved. Later in the anal phase the retention of
feces and controlled defecation come to be experienced as pleasurable, and

the feces themselves become an object of the child’s interest.
Sometimes in the third year of life the chief erogenous zone again shifts,
this time to the genitals, the penis in boys and the clitoris in girls. This is the
phallic phase of development, when the phallic organs are the sources of
libidinal tension and the organs for achieving pleasure through infantile
masturbation. It appears that pleasure is also achieved by seeing the genitals
of others (voyeuristic component instinct), showing one’s genitals to others

(exhibitionistic component instinct), and urinating (urethral erotism). The
phallic phase lasts for about three years, but it must be understood that this is
in no sense an infantile equivalent of adult genital sexuality.
It is essential that we take into consideration the role of object relations
in psychosexual development. In the oral phase the first object of the sexual
drive is the infant’s own body, especially his own mouth. Soon he begins to
have a hazy awareness of things outside himself. At first it is an awareness of
the mother, the feeding person, or more accurately the visually or tactilely
perceived breast, which acquires a psychic representation (memory trace)
and becomes cathected as an essential object for gratification. In the anal
phase the mother seeks to begin toilet training. She takes a position in
opposition to the child’s spontaneous pleasure of defecation. She is now an
object who interferes with gratification. She seeks to assume control of the
anal activity and introduces the issue of discipline. Control and discipline are
issues that are destined to have far-reaching consequences on the child’s

ultimate character structure.
The child becomes concerned with such questions as: Who has control
of my body and its functions? Must I conform, obey, and surrender control to
mother, or may I somehow defy her and retain control of where and when I
defecate? What is the punishment for defiance? What are the rewards for
conformity? None of these occur as verbal questions but rather as nonverbal
concerns of the preverbal child.
In the phallic phase an event of momentous importance occurs,
coincidental with the shift to the dominance of the genital erogenous zone.
This event is the Oedipus complex, which occurs inexorably during the phallic
phase, and therefore this period is also referred to as the oedipal phase of
object relations.

The child’s sexual interest in the parent of the opposite sex and his
rivalrous hostile wish to displace the parent of the same sex are too well
known to bear detailed discussion. This is a normal developmental event; it
does not necessarily lead to pathology, sexual or otherwise, in later life.
Depending on the quality of the mother-child relationship, the father-child
relationship, and the parents’ relationship to each other, there is precipitated
in the child’s mind the elements (memories, attitudes, beliefs, convictions,

fears, prohibitions) that will shape the character of his or her adult
heterosexual life.
It must be made clear that the stages of psychosexual development do
not come to an abrupt end. Under all circumstances there remain elements of
the oral, anal, and phallic libidinal drives that remain active and become
incorporated in the adult psychic life and behavior. Under favorable
circumstances these partial instinctual drives will serve to enhance and enrich
the adult personality and sexuality. Under unfavorable circumstances the
persistent partial drives or the defenses against them will produce character
peculiarities, rigidities, or, as we shall see, psychoneurotic symptoms.
Another necessary clarification is that the word “sexual” as used in this
theory and all classical psychoanalytic theories does not have the narrow
meaning by which it is ordinarily defined. Freud and classical psychoanalysts

use the word “sex” as a very broad and inclusive term to indicate all psychical
and behavioral processes associated with pleasure-seeking. Pleasure is
associated with discharge of instinctual drive tension. There remains,
regretfully, an adamant refusal on the part of many critics of psychoanalysis
to understand or to remember the psychoanalytic use of the word “sex,” and

they base their criticism on the assumption that “sex” can only refer to adult
genital sexual activity.
In order to understand the value of the genetic hypothesis for the theory
of the neuroses, it is necessary to consider the phenomena of fixation and
regression. Fixation indicates an arresting of development, wherein
characteristic elements of an early phase persist to an excessive degree in
later stages of development. Fixation is likely to occur when there have been
unusual frustrations or, less often, excessive gratifications during a given

stage. When there have been unusual frustrations the unfulfilled drives of
that stage remain unchanged and active in seeking the phase-specific
satisfactions into later phases of life. An exaggerated preoccupation and

pursuit of oral or anal gratifications, either directly or indirectly, are examples
of the consequence of fixations at these stages.
An excess of gratification during a given phase may cause the individual

to renounce this level with great reluctance and defer moving on to the
challenges and satisfactions of the next phase, which may seem so much more
difficult to achieve. It follows that the most favorable outcome of any phase of

development occurs when there has been an optimal balance between
gratifications and frustrations at that time.
Regression is seen to occur when there already exists a fixation or
predisposition to fixation that had not yet produced phase-specific symptoms.
At times of great stress, trauma, or frustration in a later stage of development,
the individual may regress to symptoms, behavior, or defenses that are

specific for the phase of fixation. In a sense a regression is either the process
whereby a latent or potential fixation becomes manifest or the process
whereby a minor or moderate overt fixation becomes more flagrant and
dominates current behavior.
The Structural Hypothesis
In 1923 Freud worked out a new model of the mental apparatus. This
theory was expected to have far more explanatory potential than did the
topographic model. This expectation has clearly been realized. The structural
hypothesis represents the most widely accepted statement of the functional
divisions of the human mind. It has been proven to have enormous usefulness
and an almost inexhaustible potential for refined formulations based on
clinical observations.
The structural theory divides the mind into three functional divisions,
the id, the ego, and the superego. These are neither physical structures nor
physical divisions. They correspond to no physical locations in the brain. The
mental processes that are “grouped” together within each “structure” have
essentially similar or closely related functions, relatively constant objectives,
and consistent modes of operation. Beres has warned against the danger of
reifying or concretizing the psychic structures. Id, ego, and superego are
abstract conceptual metaphors; they must not be treated as concrete entities.
These structures are nothing more than functional systems; they can only be
defined by the functions of the elements in each structure.
The id includes the psychic representations of the sexual and aggressive
instinctual drives. Its contents are totally unconscious. It includes “the sum
total of ‘wishes’ which are the resultant of certain perceptions and memories
of the earlier gratification of basic physiological needs.”
The ego is the structure that includes the widest variety of functions. It
is well to remember that Freud used the word “ego” from the beginning of his
scientific career. He used it loosely and at various times he meant it to refer to
the self, the defensive agency of the mind, and the seat of the self-preservative
instinct. With the formulation of the structural theory the word “ego” now has
assumed and retained a firm meaning, and the casual, unfocused use of the
term has all but disappeared.
The ego includes all the mental elements that regulate the interaction

between the instinctual drives and the demands of the external world. This
includes the perception of the needs of the individual (physical and
psychological needs) and the characteristics and demands of the
environment. The ego coordinates and regulates these disparate elements. It
strives to achieve maximum gratification of instinctual wishes while

maintaining the individual in a realistic relationship to the external
environment.
It is impossible to say too much about the ego because the major thrust
of classical psychoanalytic theory over the past 40 years has been in the
direction of ego psychology. The latter is the conceptualization of nearly all

mental activities in terms of the functions of the ego as it mediates between
instinctual drives, external demands, and superego judgments. Ego
psychology is concerned with understanding the many defense mechanisms

that are available to cope with and protect against threats, real or imagined,
from internal and external sources. Many symptoms of psychoneurotic illness
are recognized as reflecting specific defensive operations that have been
evolved by the individual to protect against the demands of the instinctual

drives. Anna Freud is credited with the major role in describing the important
defense mechanisms in the repertory of the ego.
Repression, the first defense mechanism to be recognized as such, is the
exclusion of an idea and its associated feelings from consciousness. It may
exclude a thought that was once conscious but was too painful and had to be
banished from conscious awareness. It may keep ideas or inclinations from
ever reaching conscious awareness.
Isolation is the defense whereby ideas are split off from the feelings that
are associated with and appropriate to them. An obsessional idea such as “my
brother is going to have an accident” may be permitted to reach

consciousness if it is isolated from its associated feelings of wishfulness and
guilt. The thought without feelings is experienced as an alien, intrusive idea
that has no real connection with the thinker.
Reaction formation maintains repression by replacing an unacceptable
drive derivative with its opposite. A person may remain entirely unaware of
anal erotic impulses to make a great mess by maintaining a conscious, active
concern with order, neatness, and cleanliness.
Displacement refers to the tendency to direct an unacceptable
instinctual wish away from the original object and on to an essentially neutral
or less threatening object. A young woman is unaware of her hatred toward
her mother but feels an often inexplicable resentment toward older women in
positions of authority.
Projection is the defense whereby a painful or unacceptable impulse or
idea is attributed to someone else. A young woman who cannot allow herself

to recognize sexual feelings toward her married employer will be convinced
that he is sexually interested in her and that he is communicating his interest

in many indirect ways.
Undoing is a reparative defense whereby the individual makes amends
for having thought or acted in an unacceptable, guilt- producing way. An
unscrupulous businessman will make generous charitable contributions to
his church on Sunday and thereby permit himself to resume his dishonest
business practices on Monday. He “paid the price” and “wiped his slate clean.”
Turning against the self is a variety of displacement whereby the

instinctual impulse, usually aggressive in nature, is displaced from the
original external hated object and directed toward the self as self-hatred, self-
accusation, and self-deprecation. This is an important mechanism in
depression and masochistic character neuroses.
Denial is a very primitive defense whereby the individual remains
unaware of certain tangible, visible aspects of external reality that would be

painful to acknowledge. The persistent feeling that the death of a loved one
has not occurred and that the deceased is still alive is an obvious instance of
denial.
Rationalization occurs when a person convinces himself that he is
carrying out or avoiding an action for some neutral or acceptable reason in
order to remain unaware of the unacceptable instinctual drive derivative that
is the actual but unconscious motive.
Identification is far more than a defense mechanism. It is a ubiquitous

aspect of maturation and learning through which a child becomes like
another person, usually a loved or feared parent or parent substitute. By
identification the child acquires some of the values, morality, mannerisms,
behavioral style, and even the pathological symptoms of the object.

Identification is used as a defense as a way of coping with separation or loss
of the love object.
It must be stressed that defense is not to be equated with pathology. All
persons need and use a variety of defense mechanisms without signs of
mental disturbance. What is significant is the specific repertory of defenses,
their flexibility and appropriateness, which determine a person’s character

structure and manifest symptoms of psychoneurosis when it occurs.
The ego includes many mental elements that are unconscious as well as
almost all that are conscious. Remembering, concentrating, decision making,
judgment, intellectual activities of all kinds, planning, and learning are among
the functions of the ego. Initiation and control of motor activity and the
development and maintenance of relations with others (object relations) are
also within the province of the ego. Reality testing is an obvious ego function,

as is “regression in the service of the ego,” a phenomenon whereby the artistic
or creative person can draw upon repressed mental content in the service of
the creative process.
The third psychic structure, the superego, is actually a highly specialized
aspect of the ego. It is the structure that represents the ethical and moral
attitudes, the readiness to feel guilt, the unconscious roots of the sense of
conscience. The superego content is the result of internalization of the moral
and ethical standards of society, especially as these values have been
communicated and to some extent interpreted and modified by one’s parents.
One of the virtues of the structural hypothesis is that it meshes very
effectively with the dynamic and genetic points of view. The three psychic
structures are not considered to be fixed or immutable; rather they are
viewed as developing under the influence of inborn constitutional factors and

the individual’s unique developmental experiences. Ego development,
especially, has received a great deal of study and is recognized as proceeding
parallel with and complementary to libido development.
Ego development has not been as thoroughly worked out as has libido
development, in part because the structural hypothesis was a later arrival on
the theoretical scene, but primarily because ego development is a far more
complex matter. It can only be understood in terms of the development of the
many ego functions: defense, thinking, dealing with reality, object relations,
regulation and control of instinctual drives, the various autonomous functions
(to be discussed in the next section), and the organizing or integrative
function of the ego. Only a brief sketch of ego development is possible here;
for additional details see Hartmann and Kris,’’ Hartmann, Kris, and
Loewenstein, and Jacobson.
The earliest pre-ego process is believed to be the stimulus barrier. This
barrier protects the infant from the multitude of external stimuli that
constantly impinge upon him and would produce an intolerable
overstimulation were it not for the dampening by the stimulus barrier. The
barrier serves to protect against the “traumatic situation,”’ the situation in
which the organism is flooded with an excess of stimulation that it is helpless
to escape or discharge. It is further postulated that an innate pre-ego

perceptual capacity is present at birth. At the outset this perception may
simply be able to experience and differentiate painful states (increasing drive
tension) and pleasurable states (decreasing tension).
The ego and the id develop from an undifferentiated matrix of instinctual
energy in the earliest weeks of life. As the infant begins to endure the first
painful consequences of contact with the external world (for example, when
he is not fed at the first signs of hunger), there is an instantaneous attempt to
relieve this tension by a hallucination. This hallucination consists of memory

traces of previous satisfactions (being fed) and the fragmentary perceptions
of the external object (mother) that had been associated with previous
gratifications. This is the beginning of what will later be fantasy formation.
Hallucinatory fulfillment is only momentary because the actual tension of

hunger persists and increases. Next an overt motor-affective response
ensues; the infant begins to cry and thrash his arms and legs about. When the
mother responds promptly by feeding and fondling the infant, there is a
reduction of drive tension, a sense of gratification, and in the earliest months

the infant falls asleep.
This event includes the earliest perceptions, memory traces, and object
representations. Here, too, is the beginning of the sense of differentiation of
the self and the object representation. In the earliest months it is postulated
that during or after gratification the differentiation is not maintained, and a
sense of fusion of self and object ensues. This blissful fusion persists until
hunger or other painful tension occurs to disturb the ecstatic, intrapsychic

union. The fusion of self and object is a precursor of the mechanism of
identification.
It is the frustration and the failure of the hallucinatory wish fulfillment

that provide the impetus for the activation of the ego functions of
consciousness, differentiation of self, and object and motor affective

responses. The latter have an impact on the environment (are “successful” in
bringing about feeding) and also contribute to the perception of one’s body
and body parts. Primitive perception of reality and focusing of attention occur
with this event. The hallucinatory wish fulfillment is a primary process
response for instant gratification. The failure of hallucination and the

sequence of subsequent activities are secondary process responses. A series
of similar events produces memory traces that are the basis for learning from
experience.
Every day brings frustrations and unpleas- urable perceptions that
evoke ego responses that are to a greater or lesser extent successful in
achieving gratification. The ego functions become more refined and
additional functions are activated as different tensions arise. Differentiation
of self and mother becomes more distinct, and secondary process thinking,
with ability to endure longer delays in gratification (frustration tolerance),
becomes more prominent.
Before the end of the first year the infant has some sense of the success
of his motor-affective responses in evoking consistently gratifying responses
from the mother. With this comes the capacity to be awake and alone for
short periods of time with the expectation that mother will be available and
responsive when needed. This growing sense of object constancy has lasting
impact on the development of basic trust. It also produces a sense of one’s

effective influence upon the external world, an important ingredient for

feelings of self-esteem. The repeated frustrations, gratifications, and
separations in the second and third years are part of what Mahler calls the
separation-individuation phase of ego development.
The crucial question of anxiety is related to these first three years. The
traumatic situation of flooding the organism with excess, undischargeable
excitation has already been described. The excitation may come from external
sources or from instinctual drives. As development progresses, the likelihood
of flooding from external sources is lessened, but the danger of flooding by
undischargeable drive tensions remains prominent. The earliest instances of
increasing drive tension (hunger) and the absence of mother are probably
recorded as unified memory traces; that is, the extended absence of mother
and the mounting drive tension are “remembered” as inseparably associated

events. Later the mere absence of mother may evoke the association with
increasing drive tension. Before the tension reaches the level of flooding, the
ego diverts a small quantity of instinctual energy to produce the subjective

feeling of anxiety. This anxiety serves as a signal to warn that the traumatic
situation is imminent and to mobilize the executive functions of the ego.

Anxiety as a signal of danger is one of the first defensive operations of the ego
and is fated to have the most lasting consequences.
The anxiety signal is evoked by all subsequent perceptions of danger

from external or internal sources, whether these perceptions are real or
imagined. The role of anxiety in the genesis of psychoneurotic symptoms
cannot be overestimated. In all instances where an unacceptable instinctual
impulse threatens to overwhelm the ordinary defenses, the anxiety signal is
evoked and new or intensified defenses are set into operation in order to
maintain repression. Throughout life the persistence of anxiety in the absence
of external danger, the commonest symptom of all psychoneuroses, is a clear
indication that the ego unconsciously perceives a continuing danger of
instinctual drive derivatives reaching conscious thought or action. The

theoretical and clinical publications on the psychoanalytic theory of anxiety
are numerous and of high caliber.
Separation anxiety appears to be the earliest occurrence of the signal
function. In the oedipal phase a new surge of phallic instinctual drive tension
introduces new dangers. First, the possibility exists that the sexual interest in
the parent will erupt into conscious thought or action, and then the parent of
the same sex will retaliate against such expressions of sexuality. The
punishment is unconsciously conceptualized as castration, that is, loss of the
“offending” organ that is simultaneously, the source of the excitation and also
the organ of expression of the forbidden impulse. In the face of castration
anxiety the child takes in the real or imagined parental prohibitions and
threats, the psychic representation of which forms the nucleus of a separate
structure, the superego.

Development and elaboration of ego functions proceeds into later
childhood, where motor, intellectual, and social skills are evolved as the child
must meet new demands of the external world. In adolescence the capacity
for efficient regulation and control of sexual drives is developed in response
to the increased libidinal demands of this period. The ability to restrain
effectively and to express appropriately the sexual drive and the capacity to
relinquish excessive self-love (narcissism ) in favor of object love are ego

activities that must be developed in adolescence. The maturation of ego
functions continues into adult life, especially in the areas of work and love.
Classical Metapsychology after Freud, The Adaptive Hypothesis
One outgrowth of the increasing concern with ego psychology has been
the special attention that has been paid to normal development and
nondefensive ego functions, the so-called adaptive hypothesis. Since this area
is not immediately concerned with the neuroses it will be mentioned in the

briefest way.
In 1939 Hartmann took up the problem of adaptation in ego psychology.
In this and subsequent works he postulated a conflict-free area of ego
activities. He referred to development of conflict-free ego functions as
autonomous ego development. Many ego functions that arise independent of

the drive-defense conflict are described as primary autonomous ego functions.
Further, he went on to describe certain ego functions that originate in the
drive-defense conflict but become detached from conflict and come to
function in the service of the ego. These he called secondary autonomous ego
functions.
Autonomous ego functions operate with neutralized libido or
neutralized aggressive energy and include aspects of perception, memory,

motility, and the stimulus barrier thresholds. Taking an evolutionary
approach, Hartmann postulated that the primary autonomous ego
apparatuses are adaptive elements whose functions have evolved as
preparedness for coping with an “average expectable environment.”
Many of Hartmann’s theoretical concepts are accepted in the
mainstream of classical psychoanalytic theory. Somewhat less widely
accepted but clearly on the threshold of acceptance are the theoretical
innovations of Erikson. In the adaptational spirit he has formulated a
timetable of psychosocial development. He has emphasized the

interdependence of libido development, ego development, and social
experience, not only in childhood, but throughout the entire life cycle. Erikson
describes an epigenetic sequence of developmental phases, parallel to libido

and ego development. The epigenetic concept emphasizes the inevitable,
universal ground plan. There are specific social developmental tasks and
challenges occurring at predictable developmental phases of social

adaptation. Each person develops unique solutions to the phase- specific
social tasks.
It is noteworthy that neither Hartmann nor Erikson made any attempt
to integrate their theories into a unified adaptive point of view. Perhaps each
regarded his formulations as preliminary. Certainly these most recent
additions to classical theory will require further clinical observation and

evaluation, but Rapaport has judged them both to have a high likelihood of
survival.
The General Theory of the Neuroses
The foregoing summary of psychoanalytic metapsychology is in no

sense complete. It is intended to provide an organized statement of the major
theories that permit the formulation of a general theory of the neuroses in
classical psychoanalytic terms. It is apparent that this formulation draws

upon all five metapsychological points of view to the extent that each system
permits meaningful and consistent generalizations that can be based, first and
last, on clinical observations. Much of what follows has been discussed in the
sections on the five hypotheses. Here the implications for the genesis of
neuroses will be brought together.
Intrapsychic Conflict
The most important element in the psychoanalytic theory of the
neuroses is the concept of intrapsychic conflict. The conflict is considered to
be between an unconscious instinctual impulse that presses to reach
consciousness and an opposing force or forces. To be more precise, the
unconscious impulse is a mental derivative (an unconscious fantasy or wish)
of an instinctual drive (either sexual or aggressive). The derivative is seeking
to enter consciousness as a conscious thought or through overt physical

action. The opposition has been attributed to countercathexis in the economic
theory, to a censor in the topographic theory, and to the defensive functions
of the ego in the structural theory. This opposition occurs because of the real
or apparent dangers that are associated with the emergence of the forbidden
instinctual derivative into consciousness. Many prohibitions derive from
reality- adaptive factors, such as the needs to survive, to remain physically
intact, to avoid pain, to assure stable and gratifying object relations, all of
which operate through the ego functions of perception, learning from
experience, memory, and capacity for anticipation. Other prohibitions derive
from moral forces, which are said to be superego demands upon the ego to
maintain repression.
Unconscious intrapsychic conflict is a universal occurrence in all

persons, healthy or psychologically disturbed. Conflict is postulated to begin
sometime in the first year of life when the earliest ego functions appear to
develop and are called upon to oppose the immediate and indiscriminate

discharge of the inborn instinctual drives.
Psychoanalytic theory is concerned with quantitative factors in the

conflict between drive derivatives and repressive forces. The quantitative
factors are inferred from clinical observations of the result of the conflict, and
there is no intent to suggest that such quantities are measurable in any

concrete sense. When the strength of the drive is greater than the repressive
forces, the drive derivative will reach conscious awareness as a thought, idea,
or fantasy, or as a physical action that is directed toward direct gratification.
The strength of the instinctual drives is judged to be increased at critical

times in psychosexual development. The oral, anal, and phallic instinctual
drives are maximal at the phases of development that correspond to the
dominance of each of these erogenous zones. At puberty the instinctual drives

are considered to be strengthened by the psychophysiological changes of this
period. The instinctual drives are judged to be weakened at times of physical
illness and in later life.
When the repressive forces are sufficient to prevent the emergence of
the instinctual drive into consciousness, repression is said to occur.
Repression cannot be expected to be permanent; the instinctual drives

continue to exert a pressure toward discharge, and the repressive functions
must exert a continuous counterforce in order to maintain repression. Such

continuing unconscious conflict is ubiquitous in all persons at all times. The
outcome of the conflict will have consequences for the character and mental
health of the individual.
Stable Outcome of Conflict
The most favorable outcome occurs when there is a stable relationship
between drive and defense, and the conflict has little or no intrusive impact
on conscious waking life, although it may be detected in dreams. During sleep
the defensive functions are somewhat relaxed or reduced; the unacceptable

instinctual drives are relatively stronger and threaten to reach consciousness.
In this situation the dream functions to provide a hallucinatory gratification
(wish fulfillment) of the instinctual drive derivative, while the residual
defensive forces operate to disguise the direct nature of the wish fulfillment
lest the dreamer be awakened by confrontation with the drive derivative in
its direct, undisguised form.
Another consequence of the stable relationship between drive and

defense is the development of the individual’s character. The variety of
defenses and tactics that the ego has employed to admit, repel, or modify the
instinctual drive demands are unique for each individual. A relatively fixed
pattern of defenses is established for each person, and these defenses shape
the regularly recurring tactics for coping with internal conflicts. Depending
upon the specific experiences of psychosexual development (traumas,

frustrations, gratifications) and upon the effectiveness of ego development
(variety, strength, and flexibility of defenses), the individual may come to
adulthood with a “normal” character structure or with a character neurosis. A
normal character structure involves the capacity for a degree of direct

gratification at realistically appropriate times and places, a successful use of
modified drive gratification (sublimation), and the relative flexibility of
defensive patterns. In the character neuroses the individual is burdened with
a very narrow spectrum of defensive options. The limited number of defenses

are endowed with excessive strength and interfere with direct drive
gratification even when such satisfaction would be appropriate. Successful
sublimation of drives is limited, and the constricted but intense defenses

produce rigid, stereotyped patterns of behavior.
Neurotic Outcome of Conflict
When there is a significant disturbance in the stable equilibrium

between the instinctual drives and the repressive forces, particularly when
the strength of the instinctual drive threatens to overcome the defenses, the
development of psychoneurotic symptoms is a likely outcome. The symptom
occurs as a result of a compromise formation as follows: (1) the drive

derivative and its associated unconscious fantasy wishes find a channel that
permits an incomplete gratification; (2) the repressing forces impose a highly
disguised form upon the gratifying process in order to make the specific drive
derivative consciously unrecognizable; and (3) the superego imposes an
element of suffering onto the drive expression in order to disguise the fact
that gratification of unacceptable drive derivatives has indeed occurred. The
superego-imposed suffering also functions as a self-punishment that is

unconsciously introduced to ward off the expected external punishment for
drive gratification. These dynamics explain why the symptom is often called
the return of the repressed.
The psychoneurotic symptom, whatever may be its external form, can
be explained as the outcome of an intrapsychic conflict that has resulted in a

compromise between partial expression of the drive, profound disguise of
final expression of the drive, and the imposition of conscious suffering as
punishment for drive gratification. In the section on the special theory of the
neuroses (see below), specific psychoneurotic symptoms will be discussed in
the framework of the theory of conflict.
Psychosexual Development, Ego Development, and Neurotic Conflict
The foregoing description of the psychoneurotic outcome of the
intrapsychic conflict has included brief comments on the strength and
character of instinctual drives and defensive forces. Here there must be a
more detailed consideration of the elements that influence the strength and
character of the drives and the ego functions. These influences are regularly

traced back to childhood developmental experiences, especially the course of
infantile psychosexual development and the course and outcome of ego
development. Psychosexual development and ego development occur
simultaneously, and each is profoundly influenced by the other; both are also
influenced by the child’s interaction with the significant persons in his
immediate external environment. (See sections above on psychosexual and
ego development.)
Freud’s discovery of the role of childhood experiences and especially
the role of infantile sexuality in the genesis of the neuroses is firmly held
today and is conceptualized in the framework of the genetic hypotheses.
Fixation at a particular phase of psychosexual development is an arresting of
development where the partial instinctual drive of that phase is said to

persist with an excessive intensity into the later stages. There is a
concomitant arresting of ego development wherein the ego defenses that are
a permanent feature of the phase of fixation retain an excessive prominence

in the repertoire of ego functions in later life. Excessive frustration is the chief
basis for fixation, although in some instances excessive gratification will also
contribute. Fixation requires that extraordinary or unusually strong ego
defenses be mobilized in order to contain the intense, persistent partial

instinctual drive. Such diverting of defensive energy to oppose persistent
drives of an earlier phase (which should have achieved relative stability) will
impair the ego’s energy and versatility in coping with the partial impulses of
the current phase.
Regression occurs in later life in response to stress, trauma, and

frustration; it involves reverting back to the libidinal drive derivatives and
also to the prominent ego defenses that are characteristic of the specific
phase of fixation.
The Special Theory of the Neuroses
The extended discussion of classical psychoanalytic theory is a
necessary preliminary for a presentation of the psychogenesis of the
psychoneuroses. It will be helpful, before proceeding, to reiterate a highly
condensed statement of the genesis of psychoneurotic symptoms: (1)

Unconscious intrapsychic conflict between instinctual drive and defense is
ubiquitous. (2) Some of the functions of the ego are: (a) to maintain
repression of unacceptable drives, (b) to permit the expression of acceptable

drive derivatives, and (c) to arrange compromises through which
unacceptable drives may find expression in a disguised form. (3) One form of
compromise is the psychoneurotic symptom. Its manifest elements are
determined by the nature of the drive, the form of the disguise imposed on it,
the defense involved in maintaining the disguise, and the addition of painful
elements as punishment for drive discharge. (4) Anxiety is the sine qua non
that signals the possible or imminent emergence of repressed impulses. The

anxiety signal usually causes an increased intensity of defenses as well as
evoking new defenses to assure that repression is maintained and thereby
anxiety is reduced or eliminated. (5) In this last sense it is convenient to
speak of defenses against anxiety as a shorthand for defenses against the

instinctual drive whose threatened emergence produces an anxiety signal.
Anxiety Reaction
Anxiety reaction is the psychoneurosis characterized by chronic, free-

floating anxiety and episodes of acute intense anxiety. Earlier this was called
anxiety neurosis and actual neurosis and was considered to be caused by a
damming up of libido and direct transformation of libido into anxiety. This
was a purely physiological or toxic theory and has now been replaced by a
psychological theory. The distressing anxiety is caused by the failure of all the
defenses to maintain effective stable control over the instinctual drives.
Patients with anxiety reaction may have phobic, obsessional, compulsive, or

depressive symptoms. They are likely to have passive-dependent personality
traits, sexual and work inhibitions, and occasional paranoid feelings, but
neither the neurotic symptoms nor the neurotic character traits are sufficient
to stabilize the conflict, so the patient is rarely free of anxiety.
Persistent feelings of helplessness are indicators of traumatic

experiences that date from the earliest developmental phase and recur in
later phases. Separation anxiety and fear of being overwhelmed by one’s one
feelings derive from traumata in the oral phase. Fear of losing control of
oneself and fear of having no control over the diffusely dangerous external
environment result from anal phase difficulties. Sexual inhibitions and gender
identity problems are traced to persistent oedipal phase problems.
Throughout early development the child was subjected to a heightened

influx of stimuli from severe traumatic experiences (external sources) or from
unusual degrees of infantile frustration (internal source). Available channels
for discharge of excitation are likely to have been reduced because of
extraordinary parental neglect or prohibitions.
There is some question whether the acute anxiety attack is not only a
sudden signal of danger but may also be a diffuse, nonspecific discharge or
safety valve for the internal excitation.' This is unsettled, but if it is a
discharge phenomenon as well as a signal, it is unsuccessful because little or
no relief of chronic anxiety is experienced after the acute anxiety attack.
Phobic Reaction
Phobic reaction is the psychoneurosis that has also been called anxiety
hysteria. The patient has one or more prominent phobias. A phobia is an
intense feeling of anxiety that is evoked by a specific, ordinarily neutral place
or thing called the phobic object or situation. The patient will experience

mounting anxiety as he approaches or comes into contact with the phobic
situation or object.
A patient with a bridge phobia will have intense anxiety as he comes

near a bridge and as he crosses it. As he drives off the bridge there is a sharp
decline in anxiety, and when he can stay away from bridges he may be
relatively free of anxiety.
The phobic object or situation symbolically represents a forbidden or
painful instinctual impulse; it simultaneously represents an external object or
situation that is likely to increase the intensity of the forbidden or dreaded

instinctual drive. By the mechanism of displacement the anxiety becomes
diverted from the internal drive and from the realistically threatening
external stimulus and attaches to the otherwise neutral phobic object. To the
extent that the patient can avoid the phobic object he remains generally free
of anxiety.
Displacement and avoidance are the definitive defense mechanisms in
phobias, but they are only partially successful. When the phobic object cannot
be avoided the anxiety returns. Furthermore, the phobic object is frequently a
thing of uncanny fascination to the phobic patient. The fascination occurs
because the phobic object, while ostensibly neutral, contains symbolic
qualities that cryptically reveal the feared object and the feared instinctual
drive. The cryptic representation functions in much the same manner as the
manifest dream disguises, but it also reveals or leads to the revealing of the
latent dream wish.
The phobic object represents a temptation, an unacceptable sexual or
aggressive impulse, and simultaneously represents the punishment believed
to occur if the impulse were to be acted upon. Claustrophobia, the fear of

closed places and crowds, illustrates some of these dynamics. A man who
slept in his parents’ bedroom for more than eight years had frequently
overheard and observed parental intercourse. This recurring primal scene is a
trauma in that it floods the youngster with sexual excitation for which there is
no discharge channel. His fear of closed places in later life was traced in part
to these oedipal origins. The closed place represents first the bedroom from
which he couldn’t escape. It also represents the wish to intrude into the
parental sexual act, not only to separate his parents but also to become a
participant in the sexual act. In some unspecific way he sought to relieve the
painful undischargeable sexual excitation by participation in the parents’
sexual activity. Finally his adult fear of being smothered and actual difficulty
in breathing in the claustrum represent the punishment for the incestuous
wishes.
Phobias may originate from earlier phase traumas. A young woman had
had a talented, dramatic, overstimulating mother whose behavior toward the

daughter was highly inconsistent. The little girl had experienced
unpredictable, impulsive attentions and equally unpredictable indifference
from her mother. The attentions included singing, dancing, endless talking,
reading aloud, all accompanied by dramatic hugging and other physical

contact. The girl was excited, delighted, and also terrified by these attentions.
When her mother was preoccupied and unresponsive the child was initially
relieved, but later she sought out, with unpredictable success, more
interaction with her mother. As an adult she had claustrophobic symptoms

especially pronounced during sexual intercourse. With her husband in the
superior position and manifesting great sexual excitement and activeness, the
patient would develop feelings of being overwhelmed and smothered by him.

Analysis established that the phobia represented the wish to achieve
primitive oral gratification with her mother, to achieve a psychical sense of
fusion with the “loving,” nourishing mother. The fear represented the
memory trace of the overwhelming, overstimulating mother who, she

believed, was capable of actually enveloping and incorporating her. The
claustrum was the wished for mother who simultaneously loved and
threatened to devour her and also included punishment for the patient’s
aggressive feelings, which were responses to the mother’s inconsistency and

unpredictable rejections.
Conversion Reaction
Conversion reaction was more common in Freud’s time when it was
known merely as hysteria, but it is by no means rare today. The most
prominent feature is the conversion of instinctual drive derivatives into one or
more apparently somatic symptoms. In the absence of physical disease the
patient may have spasms, paralyses, weakness, anesthesia, paresthesia,
coughing, shortness of breath, pains, or any other symptom ordinarily
associated with somatic illness.
The patient is likely to be unsophisticated about psychological matters
and is naively unable to see through the often tissue-thin disguises that are
intended to conceal the instinctual impulses that are both expressed and
punished by the symptom. For many years the conversion reaction was
considered to be the result of a phallic phase fixation. The symptom
represented the disguised gratification of forbidden oedipal wishes as well as
the symbolic retribution. The woman who is unable to swallow is discovered

to be expressing her fellatio fantasy directed toward her father. Weakness,
paralysis, or pains in the hands are expressive of (1) masturbatory impulses

associated with unconscious oedipal fantasies, and (2) destructive impulses
toward the parent of the same sex who “interferes” with oedipal gratification.
The hysterical patient invariably shows a pronounced preoccupation
with sexual matters, transparent seductiveness as well as an apparent sexual

“innocence,” strong sense of sexual morality and sexual inhibitions, all of

which are immature sexual responses and are consistent with the concept of
oedipal phase fixation.
In the past two decades clinical evidence points toward a primary role
for oral fixations and an important but secondary role for oedipal fixations.
The patient shows gross immaturity, constant seeking of love and attention,
and minimal capacity to tolerate frustration. The prominent defense

mechanisms of the hysterical personality, identification, denial, and fantasy
formation, are that which are regularly evoked during the normal
development in the oral phase. By identification the hysteric, who is highly
suggestible, takes on as his own the symptoms and behavior of those who are
closest to him. Identification by oral incorporation is normally the first type of
object relationship, but for the hysteric it persists into later phases and even
into adult life as a mode of relating to others. One consequence is the absence
of a distinct sense of self and an ease in changing to whatever behavior and
response appear to promise instant gratification of needs.
Fantasy formation is another prominent ego activity in hysterics. The
fantasies are not mature rehearsals for real experiences but rather are
wishful gratifications. The most unrealistic wishful fantasies are retained

against all the evidence of experience; this is because denial of external
realities is a regularly encountered ego defense.
The oedipal phase is not coped with in a satisfactory fashion because
the prehysteric child brings to this phase exaggerated oral dependency
strivings and ego functions that were more suited to cope with oral phase
issues. Small wonder that the adult heterosexual life has many infantile
features. It betrays strivings for anaclitic gratifications and oral phase ego
defenses in what is only superficially adult genital activity.
Obsessive-Compulsive Neurosis
Obsessive-compulsive neurosis is a widely recognized disorder. The
patient is troubled by persistent obsessional thoughts, usually of a painful,
guilt-producing, or otherwise distressing nature. The obsessions will often

dominate his thinking, will interfere with full participation in intellectual,
social, sexual, and work activities, and, above all, will be experienced as alien
and intrusive. The compulsions are the stereotyped recurring acts and rituals
that the patient feels an irresistible urge to carry out. Anxiety is felt if the
compulsion is not performed, and temporary relief of anxiety occurs when
the act is carried out in the “proper” fashion and the “correct” number of
times. Checking over and over again to see that the door is locked, that the gas
is turned off, or that the baby is still breathing are obvious examples. Dressing
or undressing in a fixed sequence, counting rituals, compulsive touching, or
avoidance of touching are also typical.

The obsessive-compulsive is likely to have a characteristic life style that
does not seem alien to him but may be a trial to others. He is a serious,
conscientious, hardworking person who seems to be more comfortable as a
follower rather than as a leader. He is careful to obey the law and follow the
wishes and orders of others. He is honest, orderly, thrifty, inflexible,
unimaginative, overly intellectual, and literal. These traits describe the
individual who is said to have an anal personality.-
Psychoanalytic investigation has traced the genetic roots of obsessive-
compulsive neurosis to disturbances of development in the anal stage. One of
the major issues in this phase has to do with the child’s struggle to retain
control over the evacuation of the bowels and over the pleasure associated
with expulsion and retention. The struggle includes the mother’s attempt to
institute toilet training; she attempts to impose her will as to where and when
the evacuations will occur. When toilet training has been harsh, rigid, and
carried out in an atmosphere of fear and threats, the child will submit out of
fear and will manifest an apparent compliance while concealing profound

rage, resentment, and the need to find opportunities for disguised defiance.
The prototype of all later disciplinary, conforming experiences is established
here.
The child will be burdened with unusually strong aggressive and

destructive drives, which can rarely be allowed into consciousness or
expressed directly lest he experience intense anxiety and guilt. Disguised
expressions of the aggressiveness and defiant and oppositional impulses are
reflected in many character traits and actions. The development of genital
sexuality is impaired by the intrusion of anal-sadistic and aggressive drive

derivatives into the adult sexual situation. Sometimes it is the defenses
against these drives that are most obvious in the form of inhibitions of sexual
performance.
The defenses that are prominent in opposition to anal-sadistic drive
derivatives include reaction formation, changing impulses into their opposite.
Rage and resentment are expressed as exaggerated kindness and
considerateness; tendencies toward messiness and disorder are outwardly
seen in neatness, orderliness, and cleanliness. Undoing is a technique that

allows defiance, rage, and negativism to be expressed with less disguise
provided a severe penalty, punishment, or compensatory corrective action is
arranged for to undo the original destructive action. Isolation of feelings from
ideas permits the obsessive-compulsive to have grossly destructive
obsessional fantasies and keep them unreal and less painful because they are
isolated from their associated feelings. Magic thinking finds a function with
these patients and is the basis of many of the private rituals and fantasied
pacts with fate. Regression to anal erotic forms of pleasure and to primitive,
anal phase ego activities is a response to new stress or traumata in later life.

The compulsions themselves serve a defensive function to channel off
the aggressive energies into “approved,” non-guilt-producing, outwardly
harmless activities. All defenses are directed toward maintaining
unawareness of aggressive tendencies and preventing any overt, undisguised
aggressive or destructive acts. The unconscious “knowledge” of his intense
rage requires that the obsessive-compulsive never allows himself to lose
control of himself. Freedom, spontaneity, and impulsive behavior are

associated with loss of control of oneself and the unleashing of one’s wide-
ranging murderousness and destructiveness.
The foregoing discussion of the genesis and dynamics of several
psychoneuroses is far from exhaustive and is intended only to illustrate in a
preliminary way how the concepts of classical psychoanalytic theory may
begin to be applied to specific diagnostic entities. The reader is referred to the
separate chapters in this Handbook that are devoted to the individual

psychoneurotic syndromes for further details.
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Theory of The Neuroses

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CLASSICAL

A: The Theory of the Neuroses

From American Handbook of Psychiatry: Volume 1 edited by Silvano Arietti

Copyright © 1974 by Basic Books

All Rights Reserved

Created in the United States of America

A: The Theory of the Neuroses

Formative Influences on Freud’s Theories of the Neuroses

The Earliest Psychoanalytic Theories of the Neuroses

The Five Classical Psychoanalytic Hypotheses

Classical Metapsychology after Freud, The Adaptive Hypothesis

The General Theory of the Neuroses

The Special Theory of the Neuroses

A: The Theory of the Neuroses

In 1945 Fenichel published a 703-page volume, The Psychoanalytic

reference since it contained an exhaustive survey of the classical

psychoanalytic literature to that date. The subsequent 25 years have

produced an unending stream of publications in this area, many of which are

classical psychoanalytic theory of neuroses in one concise chapter must be

regarded as merely an extended outline.

core concepts in contemporary classical psychoanalysis. The highlights of the

are most extensively and effectively used by contemporary psychoanalysts

American Handbook of Psychiatry - Volume 1 5

The terms “neuroses” and “psychoneuroses” are used here as

essentially synonymous. They refer to the group of psychiatric illnesses

origin. The symptoms include disturbances of feelings (anxiety, depression,

guilt), disturbances of thought (obsessions), and disturbances of behavior

the comfort and well-being of the individual. There are no prominent

disturbances of the sense of reality as are present in the psychoses.

Classical psychoanalysis is somewhat more difficult to define. The

substantially but not completely satisfactory to a majority of those who

consider themselves classical psychoanalysts. A small number of classical

psychoanalysts may hold major disagreements with the definition.

Classical psychoanalytic theory is defined as the theory or group of

theories of human psychological development, functioning, and behavior that

years (1888-1938) of his creative scientific life. Classical theory today

embraces nearly all of Freud’s theoretical concepts as they were orginally

hypotheses or points of view (dynamic, economic, topographic, genetic, and

structural) that constitute the major building blocks of Freud’s

hypotheses are not judged to be equal in clinical usefulness, in internal

consistency, or in survival value. Rapaport has subjected each

metapsychological theory to careful scrutiny and has made predictions about

and which may be entirely discarded as psychoanalytic theory continues to be

responsive to influences from clinical observations, from the psychological

analytic behavioral sciences. Significant criticism of the economic and

subscribe to the classical theories.

Classical psychoanalytic theory retains most of the original vocabulary

of Freud’s formulations, although a few modifications, refinements, and

theoretical modifications have been introduced or original concepts have

American Handbook of Psychiatry - Volume 1 7

metapsychological points of view. Greenson has described the elements of

classical psychoanalytic practice and technique. His concepts appear to be

consonant with the statement of classical theory described herein.[1]

It must be emphasized that classical psychoanalytic theory is in no

formulated and published over a span of 33 years (1893-1926) as his clinical

experience increased, as his technique became more penetrating, as his

understanding became more refined, and as existing theories proved

incapable of explaining fully the complexities of the neurotic processes he

and increase the comprehensiveness of the whole.