Neurasthenia and 'Anxiety Neurosis'
"NEURASTHENIA AND 'ANXIETY NEUROSIS' "
Written around June 1894 and published on January 15, 1895, after it had been read by Josef Breuer, the article "On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description 'Anxiety Neurosis' " earned Freud considerable recognition, for the syndrome that he isolated in it was discussed at length at neuropsychiatric congresses in the early twentieth century.
Freud's correspondence with Wilhelm Fliess reveals the extent to which the problem of neurasthenia preoccupied the two men: They had decided to undertake a major joint study of this topic, though it was never published. As early as 1892, Freud wrote in Manuscript A, "No neurasthenia or analogous neurosis exists without a disturbance of the sexual function" (1950a [1887-1902], p. 178). In fact, what separated anxiety neurosis (Angstneurose ) from George Beard's broad, all-purpose category of neurasthenia was essentially the thesis of a sexual etiology (very common, according to Freud), which he presented in the 1895 article.
Freud began his article with a description of the syndrome itself: a general susceptibility to stimuli (especially auditory ones), chronic states of anxious expectation, excessive moral scruples, and the well-known somatic problems associated with anxiety attacks (such as dizziness, night terrors, animal phobias, and agoraphobia). It did not, however, involve repressed ideas. Freud also distinguished anxiety neurosis from a simple anxiety attack, which he still conceptualized on a biological model that he abandoned only later.
In the next part of the article, Freud examined the etiology and occurrence of anxiety neurosis. Its onset, Freud noted, comes in the form of virginal anxiety (he referred to it in connection with Katharina in Studies in Hysteria, published that same year), or in newlyweds or in those practicing abstinence or coitus interruptus. It results from an accumulation and a "deflection of somatic sexual excitation," together with a deficiency in mental participation, which would normally discharge in "adequate action" (1895b , p. 108).
In the third section, titled "First Steps towards a Theory of Anxiety Neurosis," Freud explains that the mind experiences anxiety when it is unable to face an external danger, and anxiety neurosis when the source of sexual excitation is internal.
In the fourth and concluding section, titled "Relationship to Other Neuroses," Freud hypothesized that anxiety neurosis is the "somatic counterpart to hysteria" (1895b , p. 115), which is provoked by psychic conflict. While anxiety neurosis and neurasthenia have a common somatic origin, they are different in that neurasthenia comes from an impoverishment of excitation, whereas anxiety neurosis is linked to its accumulation.
Although the birth and development of these ideas can be traced over the course of Freud's correspondence with Fliess, the 1895 article on anxiety neurosis, published a few months before Studies on Hysteria (1895d), was their first public expression.
Following publication of the paper, Freud was very upset by the criticism of a Munich psychiatrist, Leopold Löwenfeld, whom he held in esteem. "What I must contest," wrote Löwenfeld, "is only the regularity and specificity of the sexual etiology posited by Freud in 'acquired' anxiety states." This immediately occasioned one of Freud's rare polemical responses, "A Reply to Criticisms of My Paper on Anxiety Neurosis" (1895f), in which he specified that "anxiety neurosis is caused by everything that keeps somatic sexual tension away from the psychical sphere, which interferes with its being worked over psychically" (p. 124), adding that "the neuroses are overdetermined" (p. 131). He also noted the distinctions that needed to be established among the conditions of a syndrome (here, heredity), its specific causes (here, sexual etiology), its auxiliary causes, and its triggers.
"I am pretty well alone here in tackling the neuroses. They regard me rather as a monomaniac, while I have the distinct feeling that I have touched on one of the great secrets of nature," Freud wrote to Fliess on May 21, 1894 (1954, p. 83). Indeed, most commentators in the decades to come accepted Freud's isolation of anxiety neurosis, but its sexual etiology, which Freud consistently made a condition, continued to be challenged.
Meanwhile, the idea of anxiety neurosis continued to circulate and drew support from an 1897 study by Felix Gattel involving about a hundred cases observed in Richard vonKrafft-Ebing's psychiatric clinic in Vienna. Several French authors, alerted by a review of Freud's article published in the Revue neurologique (vol. 3) in 1895, discussed anxiety neurosis, and their views were included by Paul Hartenberg in La névrose d'angoisse (Anxiety neurosis; 1902). Hartenberg concluded, "The ideas of Freud and some other authors on the sexual origin of the neuroses are far from being accepted by the majority of doctors, especially in France. And no doubt many practitioners would refuse to accept an etiology that is so exclusive. Thus, by introducing these restrictions, it seems to me that I have fostered the success of anxiety neurosis. By recognizing that it has a more general etiology, which includes overwork and exhaustion of the organic [that is, the biological], I am presenting it under a more easily acceptable physiognomy." Charles Féré, Joseph Capgras, Gilbert Ballet, A. Cullère, and numerous other authors followed this same route.
In April 1907 Wilhelm Stekel (who in 1908 would publish Nervöse Angstzustande und ihre Behandlung [Conditions of Nervous Anxiety and Their Treatment ; 1923]) delivered a lecture entitled "Psychology and Pathology of Anxiety Neurosis" to the Vienna Psychoanalytic Society. In it Stekel said that contrary to the opinion of Freud, according to whom "anxiety neurosis is provoked by coitus interruptus" and who saw "the source of anxiety in the fact that somatic sexual excitation is diverted from the psyche," he (Stekel) "remains convinced that in anxiety neurosis—as in all neuroses—psychic conflict is essential" (Nunberg and Federn, 1962-1975). Alfred Adler, for his part, then suggested that anxiety neuroses are found in anyone manifesting psychic weaknesses.
In his response of February 16, 1908, to a question from Karl Abraham, Freud distanced himself somewhat from what he had written thirteen years earlier: "As for the reducibility of the anxiety in anxiety neurosis, you will find full information in Stekel's book on anxiety hysteria (expected in April). I myself still regard the old position as theoretically unassailable, but I see that pure cases of anxiety neurosis are great rarities and perhaps once again only abstractions, and that the not actually typical phobias permit and call for psycho-analytic resolution. I 'fancy' there is nearly always an element of hysteria in them. In practice what happens is that actual therapy is first attempted, and resort is then had to psycho-analytic therapy to deal with what turns out to be resistant" (Freud and Abraham, 1965, p. 26).
Discussion increasingly shifted toward hysterical anxiety, and this shift went hand in hand with diminished interest in the notion of "actual [anxiety] neurosis," except by Sándor Ferenczi and Freud, who continued to focus on it. According to Paul Federn's (1933) memories of Ferenczi, Freud confided to Ferenczi his belief that hypochondria was a narcissistic actual neurosis with an excessive libidinal cathexis of the affected organ. This opinion was later taken up by Otto Fenichel (1945). In addition, several American authors (Grete Bibring, Abram Blau, Leo Rangell, Angela Richards, and Elizabeth Zetzel, among others) found correlations between anxiety neurosis and some sexual conditions reported in Masters and Johnson (Fink, 1970). Investigators of psychosomatic disorders (Pierre Marty, Joyce MacDougall) also made sure to refer to anxiety neurosis.
In A Phylogenetic Fantasy (1985 ), according to Peter Gay's account in Freud: A Life for Our Time (1988), Freud speculated, "Anxiety hysteria might prove to be a legacy from the ice age, when early mankind, threatened by the great freeze, had converted libido into anxiety. This state of terror must have generated the thought that in such a chilling environment, biological reproduction is the enemy of self-preservation, and primitive efforts at birth control must in turn have produced hysteria" (1988, p. 368).
Freud elaborated several theories of "anxiety," properly speaking, the last of these in Inhibitions, Symptoms, and Anxiety (1926).
Alain de Mijolla
See also: Disorganization; Neurasthenia; Working-through.
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——. (1926d ). Inhibitions, symptoms, and anxiety. SE, 20: 75-172.
——. (1950a [1887-1902]). Extracts from the Fliess Papers. SE, 1: 173-280.
——. (1954). The origins of psychoanalysis: Letters to Wilhelm Fliess, drafts, and notes, 1887-1902 (Marie Bonaparte, Anna Freud, Ernst Kris, Eds.). London: Imago Publishing.
——. (1985 ). A phylogenetic fantasy: Overview of the transference neuroses (Axel Hoffer and Peter T. Hoffer, Trans.). Cambridge, MA: Harvard University Press, 1987.
Freud, Sigmund, and Abraham, Karl. (1965). A psychoanalytic dialogue: The letters of Sigmund Freud and Karl Abraham, 1907-1926 (Bernard Marsh and Hilda C. Abraham, Trans.). New York: Basic Books.
Freud, Sigmund, and Breuer, Josef. (1895d). Studies on hysteria. SE, 2: 48-106.
Gay, Peter. (1988). Freud: A life for our time. London: Dent.
Hartenberg, Paul. (1902). La névrose d'angoisse. Paris: Félix Alcan.
Nunberg, Hermann, and Federn, Ernst. (1962-1975). Minutes of the Vienna Psychoanalytic Society. New York: International Universities Press.
Stekel, Wilhelm. (1923). Conditions of nervous anxiety and their treatment (Rosalie Gabler, Trans.). New York: Dodd, Mead. (Original work published 1908)