Actual neurosis/defense neurosis
The distinction between the actual neurosis and the neurosis of defense was made by Freud very early on in the context of his theory of the sexual origins of neurosis. In 1898, in an article entitled "Sexuality in the Aetiology of the Neuroses," he clearly described these two categories of neurosis in terms of both aetiology and treatment: "In every case of neurosis there is a sexual aetiology; but in neurasthenia it is an aetiology of a present-day kind, whereas in the psychoneuroses the factors are of an infantile nature" (1898a, p. 268). This contrast between actual and infantile sexuality in the causation of the two kinds of neurosis entailed correspondingly different therapeutic approaches, namely prophylaxis and deconditoning in the case of actual neuroses (pp. 275-76) and psychoanalysis in that of the defense neuroses.
Into the class of actual neuroses fell, chiefly, neurasthenia and anxiety neurosis. Later (1914c, p. 83), Freud added hypochondria. In his view the distinction between neurasthenia and anxiety neurosis depended on the specificity of the sexual noxa in each: "Neurasthenia can always be traced back to a condition of the nervous system such as is acquired by excessive masturbation or arises spontaneously from frequent emissions; anxiety neurosis regularly discloses sexual influences which have in common the factor of reservation or of incomplete satisfaction" (1898a, p. 268). The mechanism of actual neurosis was essentially linked to a disjunction between the somatic sexual excitation and object representations in the unconscious. This failure of somatopsychic communication was caused by particular conditions of mental functioning and generally led to symptoms.
The defense neuroses subsumed conversion hysteria, anxiety hysteria (phobic neurosis), and obsessional neurosis. In contrast to the actual neuroses, they were caused by psychic conflict. In "The Neuro-Psychoses of Defense" (1894a), Freud described the mechanism of these conditions as a disjunction between ideas and affects. The idea, erotic in character, underwent repression, whereas the affect had a specific fate for each type of neurosis: somatic conversion in hysteria, displacement in obsessional neurosis, and projection in phobic neurosis.
Freud rounded out his psychodynamic conception of the defense neuroses in 1906, in "My Views on the Part Played by Sexuality in the Aetiology of the Neuroses," describing neurotic symptoms as compromises between two mental currents: the libidinal current, determined by the subject's sexual "constitution," and the repression carried out by the ego (1906a, p. 277).
The distinction between actual and defense neuroses has taken on fresh significance in present-day psychoanalysis as a result of new thinking on psychosomatic disorders. The fact that it corresponds so closely with the distinction drawn by Pierre Marty in his classification of psychosomatic conditions between well and badly-mentalized neuroses has led to its becoming both a model for the economic assessment of psychosomatic processes and a frame of reference for the analysis of clinical findings.
In this perspective, the symptoms of actual neuroses belong to the same instinctual framework as those of hysteria and, more generally, those of the transference neuroses. What differentiates them is the specific process affecting sexuality and the relations between the instincts. This postulate is the foundation of Freud's psychosomatic monism and shifts the duality into the instinctual realm.
The somatic symptoms of actual neurosis express more or less far-reaching material degradation of organs and functions. From the psychoanalytical standpoint, however, we must treat them, along with Freud, as resulting from the intensification of the organ's erotogenic function and from the distortion of the action of the instinct in its own terms. It is only logical, if psychosomatic phenomena are to be considered from the standpoint of psychoanalysis, that all reference to any conceptual framework other than the instinctual one be excluded from a comprehensive approach to the somatic symptom or to somatic illness.
Such an approach must be congruent with the internal coherence of the psychoanalytic apparatus, a coherence with three dimensions, clinical, theoretical, and therapeutic. From the psychic point of view, which is to say from the point of view of psychosexuality, the organization of the actual neuroses is characterized by an overall incapacity for working matters out, and this for determinate reasons of both a structural and a developmental kind. This is the reason why patients suffering from such neuroses have been excluded from psychoanalysis intervention, the sole purpose of which for Freud was to uncover the role of the unconscious in mental life—a point about which he was categorical. In his twenty-fourth Introductory Lecture, entitled "The Common Neurotic State," he noted that, "It was more important for me that you should gain an idea of psycho-analysis than that you should obtain some pieces of knowledge about the neuroses; and for that reason the 'actual' neuroses, unproductive so far as psycho-analysis is concerned, could no longer have a place in the foreground" (1916-17a, p. 389). Thus the classification of actual neurosis could not be applied to any mental organization in which psychoanalysis was led to identify psychic conflicts or defense mechanisms such as repression—these being firm indications, in Freud's eyes, of psychoneurosis.
In his broad conception of the neuroses, however, Freud included the actual neuroses, clearly defining their place and according them an important role with not inconsiderable theoretical consequences: "A noteworthy relation between the symptoms of the 'actual' neuroses and of the psychoneuroses makes a further important contribution to our knowledge of the formation of symptoms in the latter. For a symptom of an 'actual' neurosis is often the nucleus and first stage of a psychoneurotic symptom" (1916-17a, p. 390). This view of things opens up a whole area of psychosomatic research; it also provides the theoretical context for Freud's notion of somatic compliance.
* Freud, Sigmund. (1894a). The neuro-psychoses of defence. SE, 3: 41-61. * ——. (1898a). Sexuality in the aetiology of the neuroses. SE, 3: 259-285. * ——. (1906a). My views on the part played by sexuality in the aetiology of the neuroses. SE, 7: 269-279. * ——. (1914c). On narcissism: An introduction. SE, 14: 67-102. * ——. (1916-17a [1915-1917]). Introductory lectures on psycho-analysis. SE, 15-16.