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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.

See also: Conversion; [[Disorganization]]; Excitation; Hypochondria; Psychosomatic; [[Symptom-formation]].[[Bibliography]]