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As soon as a [[unified ]] [[theory ]] of [[neurosis ]] had been formulated, the factors that determined the [[clinical ]] [[form ]] the neurosis assumed in [[particular ]] cases had to be specified. The study of the [[choice ]] of neurosis was concomitant, for [[Freud]], with the [[development ]] of the general theory of psychoneuroses.

The term neurosis, coined in the eighteenth century by Cullen, first referred to a heterogeneous set of illnesses attributed to a crisis of nerves. During the nineteenth century, the classificatory [[system ]] was revised based on individualization of illnesses as different as exophthalmic goiter (Graves' disease) and Parkinson's disease. The [[idea ]] of consolidating characteristic [[mental ]] disturbances (the [[madness ]] of [[doubt ]] and phobias) and a neurosis ([[hysteria]]) within a single framework occurred after the [[psychological ]] [[nature ]] of hysteria ("the great neurosis") was established at the end of the nineteenth century, by Charcot in [[Paris ]] and [[Breuer ]] in [[Vienna]]. Freud (Charcot's student and Breuer's collaborator) and Janet (Charcot's student) were [[responsible ]] for the two principal [[theoretical ]] constructions that established the unified theory of neurosis. These two constructions differed in their conceptualization of the mechanisms and causes of neurosis, and the two theories also approached the choice of neurosis very differently.

For Freud, the explanation of the choice of neurosis evolved directly from the theory of neurosis, initially described in 1896. This is expressed clearly in Freud's correspondence with [[Fliess ]] (especially the letters dated January 1, May 30, and December 6, 1896) and in two articles, "Heredity and the Etiology of the [[Neuroses]]" (1896a) and "Further Remarks on the Neuro-[[Psychoses ]] of [[Defence]]" (1896b), situated within the framework of the [[traumatic ]] theory of neuroses: [[Nothing ]] in the nature of the [[trauma ]] itself enables us to differentiate the choice of neurosis; the [[cause ]] must be sought for elsewhere. Initially, Freud referred to a disposition of attitude at the [[time ]] of the trauma. [[Sexual ]] incidents passively experienced during [[childhood ]] predisposed the [[subject ]] to hysteria, while those in which the [[child ]] played an [[active ]] [[role ]] predisposed the subject to obsessive neurosis. This theory was soon abandoned in favor of a [[chronological ]] approach, and a decade later, Freud repudiated it explicitly.

Its replacement, the chronological theory, was based on the [[principle ]] that the dates of childhood events play a decisive role. Initially, the date of the trauma was considered crucial. But, in a January 1897 [[letter ]] to Fliess, Freud modified his [[position ]] and claimed the key [[moment ]] took [[place ]] at the time of [[repression]]. In a letter of November of that same year, he concluded, "It is probable, then, that the choice of neurosis (the decision whether hysteria or [[obsessional ]] neurosis or [[paranoia ]] emerges) depends on the nature of the wave of development (that is to say, its chronological placing) which enables repression to occur—i.e. which transforms a source of [[internal ]] [[pleasure ]] into one of internal disgust" (1950a, p. 271).

The question was still not fully resolved, however, as Freud noted two years later in his December 9, 1899, letter to Fliess. Meanwhile, the theory of trauma had given way to the theory of [[libidinal ]] development and intrapsychic [[conflict]]. Freud retained the chronological point of view, but what was important to him now was the type of [[relationship ]] the relevant [[stage ]] of development allowed one to establish with [[others]]: one of [[autoeroticism ]] or alloeroticism (homo- or heteroeroticism). Curiously, hysteria and [[obsessional neurosis ]] are lumped together, the second considered a variant of the first. What was important to him at this point was the [[distinction ]] between [[them ]] and paranoia, which, unlike hysteria and obsessional neurosis, originates in autoeroticism.

The approach that remained the basis for the theory of [[psychoanalysis ]] and makes use of the [[concept ]] of point of [[fixation ]] can be dated to [[Three ]] Essays on the Theory of [[Sexuality ]] (1905d). In the last pages of the [[work]], Freud discusses the role of [[regression]], which, at the time of the conflict, leads the [[libido ]] to [[return ]] to an earlier stage, the choice of stage depending on an attraction factor, the tendency to fixation that characterized the earlier development of the libido. The chronological [[significance ]] was no longer considered proactively (the age of the [[past ]] [[event]]) but [[retroactively ]] (the return to a particular position).

It is within this new [[conceptual ]] framework that Freud developed the perspectives in "Formulations on the Two Principles of Mental Functioning" (1911b) and the psychopathological study that concludes the [[Schreber ]] [[case ]] (1911c). Moreover, this "canonical" version was used didactically in the twenty-second chapter of the Introductory Lectures on Psychoanalysis (1916-1917a). On the basis of a [[metaphor ]] (the migration of a [[people]], elements of which are established at different intermediate [[stages]]) and a [[biological ]] [[model ]] (his own histological work on the embryology of eel gonads), he introduces the [[concepts ]] of fixation and regression before emphasizing the multiple factors that go into determining a neurosis and the role of "complemental series." By insisting on the role of intrapsychic conflict, he is led to consider the role of the ego and the [[defense ]] mechanisms, a consideration he had already developed in "The Disposition to [[Obsessional Neurosis]]: A Contribution to the Problem of Choice of Neurosis" (1913i).

In this last [[text]], Freud describes the chronological factor as dependent on the development of [[infantile ]] sexuality. But, while providing a now-classic description of the stages of this development, he suggests that the predisposition to the choice of neurosis has as much to do with the libidinal relationship to the [[object ]] as it does to the ego [[defense mechanisms ]] associated with each of the steps. He firmly maintains the chronological reference, as long as the development of the ego as well as that of the libido is taken into consideration.

This [[change ]] in the [[Freudian ]] outlook cannot be [[understood ]] without reference to the early work of Karl [[Abraham]]. In a series of articles published between 1921 and 1925, Abraham made significant contributions to the establishment and refinement of the relation between libidinal development and nosological [[categories]]. In 1924 he published "A Short Study of the Development of the Libido, Viewed in the Light of Mental Disorders," an essay that falls well within the bounds of the Freudian perspective but goes beyond it in its description of the neuroses, proposing a chronological model that explains all aspects of mental [[pathology]].

A few years before this, in "Stages in the Development of the [[Sense ]] of [[Reality]]" (Ferenczi, 1913/1980), Ferenczi had expanded the hypothesis advanced by Freud according to which the choice of neurosis is determined by the development of the ego and the libido, specifying that development of the ego could be understood with reference to the sense of reality.

Subsequently, the term "choice of neurosis" disappeared from the [[vocabulary ]] of Freud and his successors. The term itself had not been very well chosen in the sense that it was not describing choice actively made by the subject but a [[complex ]] [[process ]] resulting from a set of determinants. Subsequent interest turned to the comparative determination of neuroses and psychoses.

In the field of neuroses the issue then shifted from the causes determining the "choice" of neurosis (or the factors predisposing to it) to the study of [[structural ]] traits that could be used to distinguish [[obsession ]] from hysteria. There was less interest in [[symptoms ]] than in the underlying [[structure]]. The distinction was based on a theory of the ego and libido, in keeping with the [[thinking ]] that inspired it. An especially illustrative example of this type of approach is the work of Jacques [[Lacan ]] and a [[number ]] of his students. But these structural models tend to describe the process more than its genesis.

At the end of the twentieth century and beginning of the twenty-first, the [[psychoanalytic ]] theory of neurosis and choice of neurosis were been approached from two different perspectives. The first, inspired by behaviorism, questions the principle of a [[neurotic ]] structure and focuses instead on the mechanisms of conditioning that explain the production of the [[symptom]]. The second questions the unitary concept of neurosis and, within the framework of [[recent ]] American nosological classifications, many clinical neuroses have lost their labels and are found scattered among heterogeneous nosological categories, implying the [[existence ]] of a number of pathogenic explanations. In both cases the question of choice of neurosis never appears, at least not in the [[terms ]] in which psychoanalysis has traditionally presented it. Thus the concept that had so strongly aroused Freud's interest at the beginning of psychoanalysis seems to attract less attention from [[psychoanalysts ]] a century later. The question may again become relevant if the unified concept of neurosis returns to a prominent place in nosography.

See also: [[Constitution]]; Conversion; Doubt; Libidinal stage; [[Organic ]] repression; Somatic compliance.[[Bibliography]]