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<blockquote>[[Symptoms ]] result from the injuring of the [[instinctual ]] impulse through [[repression]].<ref>{{PoA}} Ch. 2</ref></blockquote>

<blockquote>Symptoms are supposed to be an indication of and [[substitute ]] for an unachieved instinctual [[gratification]]; they are, that is, a result of a [[process ]] of repression.<ref>{{PoA}} Ch. 2</ref></blockquote>

<blockquote>[[Symptom ]] [[formation ]] thus has the actual result of putting an end to the [[danger ]] [[situation]].<ref>{{PoA}} Ch. 9</ref></blockquote>

<blockquote>All phenomena of symptom-formation can be fairly described as "the [[return ]] of the [[repressed]]," The disitnctive [[character ]] of [[them]], however, lies in the extensive [[distortion ]] the returning elements have undergone, compared with their original [[form]].<ref>{{M&M}} Part III, Section II</ref></blockquote>

Symptom-formation is the process leading to the production of a symptom—the production, that is to say, of a "[[sign]]" or "indication" of a functional [[disturbance]].

The [[word ]] symptom was borrowed by [[psychoanalysis ]] from medical [[language]]. Even its etymology (Greek, "that which is held together") suggests a link between the symptom and what it indicates (and it is worth noting, too, that syndrome, a set of symptoms, is likewise derived from Greek elements, [[meaning]], in this [[case]], "that which proceeds together"). That having been said, it is important to bear in [[mind ]] that there is a broad [[difference ]] between a sign (implying an intentional designation) and a mere indication (implying merely coincidence, without [[intentionality]]).

As early as his first [[psychoanalytical ]] writings, [[Freud ]] plumbed for the former [[sense]], arguing that to produce a symptom was to produce a sign, that a symptom always had a meaning, even if that meaning were lost on the [[patient ]] himself. Studies on [[Hysteria ]] (1895d), or at any rate Freud's contribution to it, is largely dedicated to the illustration of this [[thesis]]: "I have examples at my disposal," he wrote, "which seem to prove the genesis of [[hysterical ]] symptoms through [[symbolization ]] alone" (p. 179).

Indeed, for Freud, the symptom, like the [[dream]], was a [[compromise-formation ]] via which a [[wish ]] struggled to achieve fulfillment, albeit merely a [[partial ]] one: "A symptom arises," he wrote to Wilhelm [[Fliess ]] on February 19, 1899, "where the repressed and the repressing [[thought ]] can come together in the wish-fulfillment" (SE, 1, p. 278). Like dream-[[images]], the symptom was overdetermined, and its formation relied on the [[processes ]] of [[condensation ]] and [[displacement]]. Unlike the dream-[[work]], however, which led to the creation of images, symptom-formation resulted in the kind of [[bodily ]] expression of which hysterical conversion was the paradigm; in the emergence of obsessive [[ideas ]] as in [[obsessional ]] [[neurosis ]] (in which case secondary symptoms might arise also as defenses against the primary ones); in [[phobic ]] avoidances; and so on.

More generally, the work of symptom-formation gave rise to [[mental ]] processes and types of [[behavior ]] that were [[repetitive ]] and relatively "isolated"—that were not, in [[other ]] [[words]], integrated into other aspects of the patient's [[personality]]. The patient would usually recognize these as pathological in [[nature]], and seek [[treatment]], a fact which distinguished such symptoms from fixed "character traits."

The fact is that Freud's entire work, in its attempt to elucidate the [[neuroses]], continually strove for a better [[understanding ]] of the processes of symptom-formation. Thus in a [[letter ]] to [[Jung ]] dated June 15, 1911, distancing himself from his first [[theory ]] of the [[trauma]], he made the following essential correction: "symptoms spring not directly from the [[memories ]] but from the [[fantasies ]] built on them" (1970a, p. 260). He would later review the [[whole ]] problem once more in the light of his second [[topography ]] ([[structural ]] theory) and his second theory of the [[instincts]], in Inhibitions, Symptoms and [[Anxiety ]] (1926d).

To summarize, Freud's theory viewed the formation of symptoms from the standpoint of "[[semiology]]" in both the medical and the [[linguistic ]] senses of the term (a fact pointed up notably by Jacques [[Lacan]], whose [[position ]] is famously encapsulated in the [[claim ]] that "the [[unconscious ]] is [[structured ]] like a language"). This view did not hold [[good]], however, beyond the sphere of neurosis proper: in the "actual neuroses," the [[manifest ]] symptoms had no [[psychic ]] meaning (Freud, 1916-17a). [[Absent ]] the mentalization of fantasies, [[libidinal ]] [[energy ]] flowed directly into somatic processes—a [[mechanism ]] that has been studied in more [[recent ]] [[times ]] by the [[Paris ]] [[school ]] of [[psychosomatic ]] [[medicine ]] (Marty, 1976, 1980).

Inasmuch as the symptom expressed a compromise between instinctual [[satisfaction ]] and [[defense]], its motor was a [[dynamic ]] that in all cases sought to reestablish an equilibrium, but that also determined the form of [[individual ]] symptoms as well as the [[place ]] each would occupy within a specific [[clinical ]] entity.

It was [[unpleasure]], first and foremost, that triggered the mechanism of symptom-formation—an unpleasure that derived from [[pleasure ]] and that could not be accounted for save in [[terms ]] of the confrontation between the [[internal ]] pressure exerted by [[fantasy ]] and the [[idea ]] of the [[external ]] danger that depended directly upon it. Hitherto, this calculus of pleasure has been the [[responsibility ]] of repression, along with the other defenses that either collaborated with repression or ensured [[mastery ]] over the instincts by their own efforts. The formation of a symptom was invariably necessitated by a strengthening of the [[instinct]], whether this increased pressure was attributable to [[biology]], to fantasy, to [[reality]], or to external events. The failure of defense in all cases resulted in the first [[instance ]] in the emergence of anxiety. Whereas in the actual neuroses anxiety was [[nothing ]] more than an almost reflexive return to the pathways of [[discharge ]] of the first great traumas, the situation here made it into a [[signal ]] of danger and a call for the symptom to arise.

The interplay between affects and ideas—the components of the instinct, whose reciprocal [[links ]] and independence from each other constituted the dynamic of mental life—was thus the crucible of the symptom (Freud, 1894a). Repression functioned by dissociating the two, [[working ]] on the idea in [[order ]] to contain the [[affect ]] and the [[action ]] that the affect prefigured. The symptom, for its part, was effective because it operated in the interstice, restoring the rights of the instincts by creating new links, more acceptable to the ego, between affect and idea. The simplest instance of this in the context of [[neurotic ]] repression was doubtless displacement, which was a function of the instinctual shift with respect to the [[symbol ]] and the resulting decline in the symbol's [[significance]], but other more [[complex ]] defensive ploys were the locus of the same dynamic: thus the "[[Wolf Man]]" used displacement to transform his [[homosexual ]] [[desire ]] into a phobic [[fear ]] of wolves (1918b [1914]), while [[Schreber ]] was well able to handle fantasy by means of a similarly discrete action of the component instincts, but one which relied not on repression or displacement, but rather on the [[projection ]] of the idea and the turning of the affect into its opposite, so producing the symptom of [[feelings ]] of [[persecution ]] (1911c).

This amounted to an introduction of differences with respect to the formation and the form of the symptom. Both clearly depended on the nature of the [[conflict]]: the [[threat ]] of [[castration]], the [[loss ]] of the [[object]], [[narcissism ]] at risk, or [[alienation]]; neurosis, [[depression]], borderline [[state]], or [[psychosis]]. It has rightly been pointed out that in this account no symptom can [[exist ]] independently of a corresponding clinical entity.

Two caveats apply in this connection. The first concerns the specificity of defensive modes to given pathological [[structures]], so that each mode is perforce related to a corresponding symptomatic form of decompensation: whether object-dependency is defended against [[external reality ]] by [[disavowal]], [[idealization]], projection, or some other means, will serve to explain why breakdown occurs in a [[particular ]] [[subject]], [[delusion ]] in [[another]], and so on. Within a single neurosis, to take the case of the obsessional, the [[oedipal ]] situation is the starting-point of a [[regression ]] to the [[anal ]] level of [[fixation ]] which will determine the compulsiveness and mental retentiveness characterizing the symptoms (Freud, 1926d). Apropos of [[phobia]], however, Freud describes [[three ]] different phases of symptom-formation: [[preconscious ]] [[decathexis]], [[anticathexis ]] of the [[substitutive ]] idea, and an expansion of this idea's [[associations ]] and of the vigilance it [[demands ]] (1915e, pp. 181ff).

The second difficulty is related to the strength of the symptom with respect to the point reached in a particular clinical [[development]]. Thus in schizophrenics phobia may rapidly be overwhelmed by the haziness of the dividing-line between [[inside ]] and [[outside]], so that all projection becomes ineffective. Projection is scarcely more functional in agoraphobics, whose [[narcissistic ]] inadequacy precludes the establishment of any external protective focus. Cancerophobics, on the other hand, [[being ]] mentally more obsessional and more [[objective ]] in their verification procedures, can keep the conflict out of the clutches of depression for some [[time ]] before it eventually succeeds in bringing the [[struggle ]] back within the ego. It should be noted, though, that while the neurotic conflict between the ego and the id confines phobia, in its exclusiveness, to a single line of defense, it nevertheless confers on the symptom, not efficacity, for that remains limited, but durability and solidity.

See also: Actual neurosis/neurosis of defense; Allergy; "[[Analysis ]] of a Phobia in a Five-year-Old Boy"; [[Choice ]] of neurosis; Compromise-formation; Conflict; [[Constitution]]; Conversion; Daydream; Defense; Displacement; Ego; [[Eros]]; ; Fantasy; Fixation; Hypnoid states; [[Identification]]; Identification fantasies; Instinctual impulse; [[Need ]] for [[punishment]]; [[Overdetermination]]; [[Paranoid ]] position; Phobias in [[children]]; [[Principle ]] of constancy; Psychosomatic; Regression; Repression; "Repression"; [[Reversal ]] into the opposite; [[Self]]-punishment; Somatic compliance; [[Splitting ]] of the ego; Symptom; Unpleasure; Wish fulfillment.[[Bibliography]]