History and Evolution of Freudian Theory Understanding Freud's ideas regarding the unconscious mind is foundational to developing a theoretic understanding of human behavior. However, for the doctora

Freud ’s Three Theories of Neurosis: Towards a

Contemporary Theory of Trauma and Defense

Jon Sletvold, Psy.D.

Norwegian Character Analytic Institute

This paper explores the development of Freud ’s thinking on the aetiology of the neurosis. It is shown

that Freud in the years 1893 to 1897 formulated three distinct and mutually incompatible theories of

neurosis centred respectively on (a) psychic trauma and defence, (b) sexual trauma (seduction), and

theory, not from the second to the third. It is examined how Freud gave priority to the libido/fantasy

theory until he returned in 1926 to a general trauma theory with his second theory of anxiety. The

fate of Freud ’s theory of neurosis in later psychoanalytic thinking is described as a process of

dilution rather than an exploration of what is right and what is wrong in the theory. It is argued that

the basic fault common to Freud ’s second and third theories is the insistence on an exclusive sexual

aetiology of the neurosis. On the other hand, it is argued that Freud ’s first theory, centred on

emotional trauma and defence, has turned out to be basically right and is therefore well suited to

constitute a basis for a contemporary theory of neurosis (non-neurological mental disorders).

INTRODUCTION

Freud ’s (1892 –1899b) abandonment of the seduction theory in September 1897 has generally

been regarded as the pivotal turning point in his view of the aetiology of neurosis. Eagle ( 2011 )

put it this way.

In replacing his seduction hypothesis with positing fantasy and endogenous wishes as the primary

source of neurosis, Freud moved from a trauma theory of neurosis in which an external event (e.g.,

seduction) constitutes the trauma to an inner conflict theory of the neurosis. (p. 67)

As we see, Eagle, in accordance with the traditional and dominant view of the development

of Freud ’s thought, equated trauma theory and seduction theory. What I want to show in this text

is that the development from a general trauma theory formulated with Breuer in Studies on

Hysteria (1893/95/1955) to the seduction theory ( 1896b ) is of no less importance. Indeed,

according to Freud himself, this is actually of much greater significance than the later develop-

ment from the seduction (sexual abuse) hypotheses to sexual drive and inner conflict theory.

Hence my title “Freud ’s Three Theories of Neurosis. ”I want to show that Freud in the space of

Correspondence should be addressed to Jon Sletvold, Psy.D., Edmund Neuperts gate 2, 0475 Oslo, Norway. E-mail: [email protected]

less than 5 years formulated three distinct and mutually incompatible theories of hysteria/

neurosis (non-neurological mental disorders).

Greenberg and Mitchell ( 1983 ) came close to the same conclusion in their analysis of Freud ’s

theorizing. What they describe as the defence model, the seduction model, and the wish model

are almost identical to my “three theories. ”However, they, too, failed to acknowledge the

fundamental difference between trauma/defence theory and seduction theory, conceptualizing

the defence, seduction, and wish models as stages on the way to a fully formed drive theory.

During the first [phase], which lasted from his adoption of Breuer ’s cathartic method in the late

1880s until 1905, he worked with concepts of affect and of defense in a way that shares some of the

sensibilities of the relational/structure model and which at times bears a striking resemblance to

contemporary perspectives. … The second phase begins with the abandonment of the seduction

theory. (p. 25)

I see my own text as a development of the seminal work of Mitchell and Greenberg.

However, while I agree with their critique of drive theory, my focus will be more specifically

on Freud ’s unique version of drive theory; the drive for discharge of sexual energy (libido).

Having clarified the fundamental difference between the trauma/defence theory and the

seduction theory, I go on to argue that the first of these theories has turned out to be basically

right. Not only does Freud ’s and Breuer ’s trauma and defence theory “[share] some of the

sensibilities of the relational/structure model ”and show “a striking resemblance to contemporary

perspectives, ”I also argue that it is well suited to serve as the basis for a contemporary

conception of non-neurological mental disorders. The aim of this paper is to clarify a historical

basis for a contemporary understanding of trauma and defence —extended to coping and

resilience. I start by highlighting what was strikingly new and revolutionary in the theory of

hysteria Freud formulated together with Breuer in Studies on Hysteria.

HYSTERIA: A RESULT OF PSYCHIC TRAUMA AND DEFENCE

Breuer and Freud start their Preliminary Communication (1893/1895/1955) on the psychical

mechanism of hysterical phenomena by announcing their discovery of precipitating causes of

hysteria using a method that went beyond simple interrogation, “because what is in question is

often some experience which the patient dislikes discussing; but principally because he is

genuinely unable to recollect it ”(p. 3). This method “has taught us that external events

determine the pathology of hysteria to an extant far greater than is known and recognized ”

(pp. 3 –4).

Breuer and Freud take it as read that what provokes the symptoms in cases of “traumatic ”

hysteria is the accident. Nevertheless, they continue, observations “seem to us to establish an

analogy between the pathogenesis of common hysteria and that of traumatic neurosis, and to

justify an extension of the concept of traumatic hysteria ”(p. 5). What does this mean? In

traumatic neuroses, they explain, the operative cause of the illness is “not the trifling physical

injury [emphasis added] but the affect of fright —the psychical trauma ”(pp. 5 –6). Analogously,

investigations of common hysteria reveal causes that can only be described as psychical traumas.

“Any experience which calls up distressing affects —such as those of fright, anxiety, shame or

physical pain —may operate as a trauma of this kind [emphasis added] ”(p. 6). However, in

FREUD ’S THREE THEORIES OF NEUROSIS 461

common hysteria many years will often separate the traumatic event from the outbreak of the

hysterical symptom, and they conclude, “Hysterics suffer mainly from reminiscences ”(p. 7).

And, most remarkably, they go on to describe what in contemporary thought might be referred to

as “relational and developmental trauma. ”

In the case of common hysteria it not infrequently happens that, instead of a single, major trauma, we

find a number of partial traumas forming a group of provoking causes. They have only been able to

exercise a traumatic effect by summation and they belong together in so far as they are in part

components of a single story of suffering [emphasis added]. (p. 6)

What Breuer and Freud are suggesting is nothing short of a revolutionary new conception of

trauma. The medical concept of (physical) trauma is extended to include the affect of fright —the

psychical trauma . It was, of course, nothing new that life events can cause suffering. What was

new was the idea that events in life can not only cause unhappiness but also illness, hysterical

misery . I use here Freud ’s words in his famous last sentences of Studies of Hysteria , where he

tells a patient how her illness is connected with events in life.

But you will be able to convince yourself that much will be gained if we succeed in transforming

your hysterical misery into common unhappiness. With a mental life [before 1925 ‘nervous system ’]

that has been restored to health you will be better armed against that unhappiness. (Freud & Breuer,

1893/95 /1955, p. 305)

And just as they extend the physical concept of trauma, they do likewise to the idea of

defence. From referring to the body ’s defence-reaction to physical trauma, they let it now

embrace an automatically elicited process of defence in response to emotional, psychic trauma.

According to Freud ( 1895 ), the traumatic events

were all of a distressing nature, calculated to arouse the affects of shame, of self-reproach and of

psychical pain, and the feeling of being harmed; they were all of a kind that one would prefer not to

have experienced, that one would rather forget. From all this there arose, as it were automatically, the

thought of defence . (p. 269)

Freud ( 1894 ) elaborated his view of the centrality of defence in his paper on The Neuro-

Psychoses of Defence :“I was repeatedly able to show that the splitting of the contents of

consciousness is the result of an act of will on the part of the patient ”(p. 46). So, Freud ( 1895 )

is clear from the start that he sees the process as intentional: The precipitating events are “all of a

kind that one would prefer not to have experienced, that one would rather forget ”(p. 269).

The longer we have been occupied with these phenomena, the more we have become convinced that

the splitting of consciousness which is so striking in the well-known classical cases … is present to a

rudimentary degree in every hysteria, and that a tendency to such a dissociation … is the basic

phenomena of this neurosis . (Breuer & Freud, 1893 –1895 , p. 12)

There seems to me to be a striking resemblance between these early formulations of Freud

and a contemporary view of dissociation as “the primary unconscious defensive process,

replacing repression ”(Stern, 2010 ), stressing that what is defended against is not so much a

particular feeling but to be a certain person ,“someone who felt disappointed, bereft, frightened,

humiliated, shamed, or otherwise badly hurt or threatened ”(p. 13).

Speaking of trauma and defence in this text, I want to make it clear that I use the term trauma

as shorthand for traumatic experience. It does not refer to specific events. Whether or not an

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event has a traumatic effect, it is never the result of the event alone. It depends on the affected

individual ’s ability to cope with the event(s). Likewise, I use the term defence to denote all types

of coping strategy and resilience an individual might avail herself of in response to very recent

or older traumatic experience(s).

FROM PSYCHICAL TRAUMA TO SEXUAL TRAUMA

The development in Freud ’s thinking from a general trauma theory to a specific sexual aetiology

of the neuroses started even before the final publication of The Studies in 1895. Freud first

became convinced that the “simple neuroses, ”neurasthenia (neurasthenia proper and anxiety-

neurosis), were caused by an unsatisfying discharge of libido; masturbation and coitus inter-

ruptus. In a letter to Flies, February 8, 1893, he wrote, “Traumatic hysteria was well known;

what we [Breuer and Freud] asserted beyond this was that every hysteria that is not hereditary is

traumatic. In the same way I am now asserting that every neurasthenia is sexual ”(1892 –1899/

1950, p. 179). And on the obsessions: “In all the cases I have analysed it was the patient ’ssexual

life that had given rise to a distressing affect of precisely the same quality as that attaching to the

obsession ”(1894, p. 52). It is easy, he adds, “to see that it is precisely sexual life which brings

with it the most copious occasions for the emergence of incompatible ideas ”(p. 52).

Freud explains, “At the time [1893 –95] … I was still faithful to a purely psychological theory

in regard to the psychoneurosis —a theory in which the sexual factor was regarded as no more

significant than any other emotional source of feeling. … We [Breuer and Freud] were led to the

assumption that hysterical symptoms are the permanent results of psychical traumas (Freud,

1906 [1905] /1953), p. 272). However, a year later, Freud writes in Heredity and the Aetiology of

the Neuroses (1896a ) that there are many concurrent or auxiliary causes of neuroses, but then

continues:

What, then, are the specific causes of neuroses? … each of the major neuroses which I have

enumerated has as its immediate cause one particular disturbance of the economics of the nervous

system, and that these functional pathological modifications have as there common source the

subject ’s sexual life, whether they lie in a disorder of his contemporary sexual life or in important

events in his past life . (p. 149)

This might be Freud ’s first formulation of the general, universal sexual theory of neuroses. He

immediately goes on to ascertain that it is not a new idea to see nervous illness as caused by

sexuality, because sexual disorders “have always been admitted among the causes of nervous

illness ”(p. 149), but what “gives its distinctive character to my line of approach is that I elevate

these sexual influences to the rank of specific causes, that I recognize their action in every case

of neurosis ”(1896a , p. 149). What had made Freud so convinced that the source is always to be

found in sexual life? In On the History of the Psycho-Analytic Movement he answers this

question with three off-record oral comments by Breuer, Charcot, and Chrobak, respectively:

“These things are always secrets d´alcôve !”(Breuer); “It’s always a question of the genitals —

always, always, always ”(Charcot), and finally Chrobak´s prescription: “Penis normalis dosim

repetetur! ”(1914/1957, pp. 13 –14). It is also worth remembering that Starr and Aron recently

found evidence that a sexual conception of hysteria and treatment by genital stimulation had

existed more or less continuously from antiquity to the time Freud was writing (Aron & Starr,

FREUD ’S THREE THEORIES OF NEUROSIS 463

2013 ; Starr & Aron, 2011 ). (The widespread practice of medical doctors in the late nineteenth

century to treat hysteria by genital stimulation, masturbation to orgasm, was recently explored in

Tanya Wexler ’s film Hysteria .)

“I owe my results, ”Freud writes, “to a new method of psycho-analysis, Josef Breuer ’s

exploratory procedure. ”(This is the first published appearance of the word psychoanalysis ,

used here to describe Breuer ’s work with Anna O) “By means of that procedure … hysterical

symptoms are traced back to their origin, which is always found in some event of the subject ’s

sexual life appropriate for the production of a distressing emotion [emphasis added] ”(1896a ,

p. 151). We note the change from positing events of any kind that result in distressing emotions

to a narrower set of causes restricted to sexual life. We should also note there is nothing in

Freud ’s formulations so far that do not apply just as well to both the second theory (seduction/

sexual abuse) and the third (repressed libido). Indeed, these formulations could arguably be said

to represent Freud ’s fourth theory; neurosis is caused by sexuality, one way or the other.

However, Freud moves on and states “that at the bottom the same thing was present in all the

cases submitted to analysis —the action of an agent which must be accepted as the specific cause

of hysteria ”(1896a , p. 151). This agent is a memory relating to sexual life that presents two

characteristics.

The event of which the subject has retained an unconscious memory is a precocious experience of

sexual relations with actual excitement of the genitals, resulting from sexual abuse committed by

another person ; and the period of life at which this fatal event takes place is earliest youth —the

years up to the age of eight to ten, before the child has reached sexual maturity. A passive sexual

experience before puberty : this then, is the specific aetiology of the hysteria. ( 1896a , p.152)

And the memory, Freud goes on to explain, “will operate as though it were a contemporary

event . What happens is, as it were, a posthumous action by a sexual trauma ”(p. 154).

However, while Freud now sees hysteria as the result of a passive sexual experience

(seduction, abuse), the obsessional neurosis he sees as the result of an act that has given

pleasure. “The obsessional ideas … are nothing other than reproaches addressed by the subject

to himself on account of this anticipated sexual enjoyment ”(1896a , p. 155). We note how

Freud ’s account of obsessional neurosis resembles his later theory of repressed libido. But

contrary to his later view, Freud is now convinced, he says, “that nervous heredity by itself is

unable to produce psychoneuroses if their specific aetiology, precocious sexual excitation, is

missing ”(1896a , p. 156).

So, according to Freud, by means of the psychoanalytic method initiated by Breuer, experi-

ences were finally reached which belonged to childhood and concerned specifically sexual life.

And this was so even in cases in which an ordinary emotion, not of a sexual kind, had led to the

outbreak of the disease.

Unless these sexual traumas of childhood were taken into account it was impossible either to

elucidate the symptoms … or to prevent their recurrence. In this way the unique significance of

sexual experiences in the aetiology of the psychoneuroses seemed to be established beyond doubt;

and this fact remains to this day one of the corner-stones of my theory [emphasis added]. (1906

[1905]/1953), p. 273)

However, the task of finding a sexual core was not easy by any means, as Freud expressed in

a letter to Flies dated February 7, 1894, and cited in The Neuro-Psychoses of Defence (1894).

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“You are right. The connection between obsessional neurosis and sexuality is not always so

obvious. … If anyone less mono-ideistic [emphasis added] than I am had looked at it, he would

have overlooked it ”(p. 57, Footnote 2). “The theory culminated in this thesis: if the vita sexualis

is normal, there can be no neurosis ”(Freud, 1906 [1905] /1953, p. 274). Freud refers to the

seduction theory as “the form taken by the theory in some of my shorter preliminary publications

during the years 1895 and 1896 ”(p. 273).

FROM SEXUAL TRAUMA TO SEXUAL CONSTITUTION

In my review below of Freud ’s further thinking on the aetiology of the neurosis, I follow his

formulations in My views on the part played by sexuality in the aetiology of the neuroses (1906

[1905]/1953). Here he explains how his earlier material contained a disproportionately large

number of cases in which seduction by adults or other older children had played the chief part.

I thus over-estimated the frequency of such events (though in other respects they were not open to

doubt). Moreover, I was at that period unable to distinguish with certainty between falsifications

made by hysterics in their memories of childhood and traces of real events. Since then I have learned

to explain a number of phantasies of seduction as attempts at fending off memories of the subject ’s

own sexual activity (infantile masturbation). When this point had been clarified, the ‘traumatic ’

element in the sexual experiences of childhood lost its importance [emphasis added]. (p. 274)

After correcting his overestimation of the frequency of seduction (sexual abuse), “‘infantile

sexual traumas ’were replaced by the ‘infantilism of sexuality ’” (Freud, 1906 [1905] /1953,

p. 275). Instead of going back to his previous theory, which gave aetiological significance also to

non-sexual traumatic events (distressing emotions of all sorts), Freud remains convinced that “no

neurosis is possible with a normal vita sexualis ”and starts instead to develop a view that places

decisive aetiological weight on sexual constitution. When the frequency of seduction in child-

hood was no longer assumed, Freud explains, there was no need any more to emphasise external

influences on sexuality.

Accidental influences derived from experience having thus receded into the background, the factors

of constitution and heredity necessarily gained the upper hand once more; but there was this

difference between my views and those prevailing in other quarters, that on my theory the ‘sexual

constitution ’took the place of a ‘general neuropathic disposition ’. (Freud, 1906 [1905] /1953,

pp. 275 –276)

Freud then refers to his recently published Drei Abhandlungen zur Sexualtheorie (1905),

where he describes the varieties of “this sexual constitution as well as the composite character of

the sexual instinct in general and its derivation from contributory sources from different parts of

the organism ”(Freud, 1906 [1905] /1953, p. 276).

His investigations into the mental life of normal persons have yielded, he writes, the

unexpected discovery that their infantile history in regard to sexual matters was not necessarily

different from that of the neurotic, and that seduction in particular had played the same part in it.

“As a consequence, accidental influences receded still further into the background as compared

with ‘repression ’(as I now began to say instead of ‘defence ’)[emphasis added] ”(Freud, 1906

[1905] /1953, p. 276). The important thing was no longer the childhood experience of sexual

FREUD ’S THREE THEORIES OF NEUROSIS 465

stimulation, but how the child had reacted to these experiences, whether he had responded to

them with “repression ”or not. “The psycho-analysis of hysterics showed that they fell ill as a

result of the conflict between their libido and their sexual repression and that their symptoms

were in the nature of compromises between the two mental currents [emphasis added] ”(p. 277).

With this formulation, Freud ’s third theory of neuroses is clearly stated. Freud, however, wants

to downplay the difference between his second and third theory.

I think it is worth emphasizing the fact that, whatever modifications my views on the aetiology of the

psychoneuroses have passed through, there are two positions which I have never repudiated or

abandoned —the importance of sexuality and of infantilism. Apart from this, accidental influences

have been replaced by constitutional factors and ’defence ’in the purely psychological sense has been

replaced by organic ’sexual repression ’. (pp. 277 –278)

Freud ’s stressing of the dual basis of his view of the aetiology of the neuroses —sexuality and

infantilism —is worth noting. While his insistence that only sexuality can cause neurosis is

highly disputable, his new and revolutionary insistence on the importance of “infantilism ”—

that normally neurosis is rooted in the earliest years of life —has stood the test of 100 years of

research and clinical experience. In my judgment, Freud ’s“infantilism, ”his developmental view

of neurosis, is the prime reason why psychoanalytic theory —including attachment theory —

remains an influential theory in mental health research.

Nowhere does Freud minimize or deny the difference between the seduction theory and his

new theory of libidinal drive and repression more than in his opening remarks of The Dora

Case .

In 1895 and 1896 I put forward certain views upon the pathogenesis of hysterical symptoms and

upon the mental processes occurring in hysteria. Since that time several years have passed. In now

proposing, therefore, to substantiate those views [emphasis added] by giving a detailed report of the

history of a case and its treatment. … (1905 [1901]/1953, p. 7)

The changes in Freud ’s views are striking, however, to everyone but himself. This is, not

least, apparent in his case presentations. Whereas his case histories up to now reflected trust in

the patients, his mistrust is remarkable in his discussion of the Dora case, as feminist critique has

indeed highlighted. It is as if Dora is saying “My illness is not caused by masturbation ”and

Freud is replying “Yes, it is. ”

Freud goes on to stress that, in his opinion, all that matters is sexuality. “Wherever a

commonplace emotion must be included among the determinants of the onset of the illness,

analysis invariably shows that it is the sexual component of the traumatic experience … which

has produced the pathogenic result ”(Freud, 1906 [1905] /1953, p. 278). It is my impression that

Freud adopts this dogmatic stance mainly in questions concerning his “sexology. ”In others he

adopts a scientific stance, recognizing that the fate of his suggestions will be decided by future

research and clinical experience. For example, on the subject of drives, he writes

I have proposed that two groups of such primal instincts should be distinguished: the ego ,or self-

preservative , instincts and the sexual instincts. But this supposition has not the status of a necessary

postulate … it is merely a working hypothesis, to be retained only so long as it proves useful. (1915,

p. 124)

Jung ( 1985 ) testified to Freud ’s dogmatic stance on sexuality in his autobiography. Referring

to their first meeting he writes,

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There was no mistaking the fact that Freud was emotionally involved in his sexual theory to an

extraordinary degree. When he spoke of it, his tone became urgent, almost anxious, and all signs of

his normally critical and sceptical manner vanished. … I had a strong intuition that sexuality for him

was a numinosum (a sacred thing). This impression was confirmed by a conversation that took place

about 3 years later (1910), again in Vienna.

I still remember vividly what Freud said to me: “My dear Jung, promise me never to abandon the

sexual theory. It is the most essential. You see, we must make of it a dogma, a steadfast

bulwark. ”He said that to me with great emotion, in the tone of a father saying, ‘And promise

me this one thing, my dear son: that you will go to church every Sunday ”… First of all, it was

the words “bulwark ”and “dogma ”that alarmed me. … As I saw it, a scientific truth was a

hypothesis that might be adequate for the moment, but was not to be preserved as an article of

faith for all time. (p. 144, my translation)

I agree with Jung. The highly detrimental effect of Freud ’s theory of sexuality results from its

being turned into a dogma, and furthermore that this dogma is placed, so to speak, at the heart of

psychoanalytic theory and therapy with far-reaching consequences for the other, non-dogmatic

aspects of theory and therapy. If he had hypothesized instead that sexuality was a core factor in

the aetiology of all or most neuroses, the effect would not have been so detrimental because it

would have allowed for research and debate.

FURTHER ELABORATIONS ON THE SEXUAL THEORY OF NEUROSIS

Not only had Freud come to see sexuality as the cause of the neurosis, he also saw it as

constituting the essence of the neuroses.

It is scarcely possible to avoid picturing these processes as being … of a chemical nature; so

that in what are termed the ‘actual ’neurosis we may recognize the somatic effects of distur-

bances of the sexual metabolism, and in the psychoneuroses the psychical effects of those

disturbances as well. (Freud, 1906 [1905] /1953, p. 279)

This explains why Freud now saw repression, as opposed to defence, not only as a psycho-

logical defence, but an organic defence.

In parallel with the development of the third theory —or rather as an integral and indispen-

sable part of it — Freud developed his notion of the Oedipus complex. In a letter to Fliess,

October 15, 1897, he writes, “A single idea of general value dawned on me. I have found, in my

own case too, being in love with my mother and jealousy of my father, and I now consider it a

universal event in early childhood ”(Masson, 1985 , p. 272). And in Totem and Taboo (1912 –13),

he states that “we have arrived at the point of regarding a child ’s relation to his parents,

dominated as it is by incestuous longings [emphasis added], as the nuclear complex of neurosis ”

(as cited in Radnytsky, 2002 , p. 60). What I find fascinating about this formulation is that it

shows how Freud again combines a revolutionary new discovery —seeing “a child ’s relation to

his parents … as the nuclear complex of neurosis ”— with the highly disputable assertion that it is

“dominated … by incestuous longings. ”He combines important new insights —quite correct

ones in my opinion —with an insistence on the libido theory. Here I just want to round off the

subject of the Oedipus complex by quoting from a footnote by Freud in 1920 to Three Essays on

the Theory of Sexuality :“Every new arrival on this planet is faced by the task of mastering the

Oedipus complex; anyone who fails to do so falls a victim to neurosis. … Its [The Oedipus

FREUD ’S THREE THEORIES OF NEUROSIS 467

complex ’s] recognition has become the shibboleth that distinguishes the adherents of psycho-

analysis from its opponents ”(1905, p. 226).

The causes of neurotic illness, Freud explains, fall into a “complemental series ”within which

the two factors —sexual constitution and experience — are represented in such a manner that if

there is more of the one there is less of the other. “In this series I can perhaps allow a certain

preponderance in significance to the predisposing factors ”(Freud, 1917 [1916 –1917 ]/1963,

p. 347). As we see, apart from a certain preference for constitution, Freud now takes a balanced

position on outer versus inner causes. Having thus far explained the cause of neuroses as an

interaction of a sexual constitution (fixation) and sexual experience, there remains a decisive

role, Freud adds, for non-sexual influences in the aetiology of the neuroses. These influences, he

answers, are the non-sexual instinctual forces, the ‘ego-instincts. ’The pathogenic conflict is thus

one between the ego-instincts and the sexual instincts.

Symptoms, according to Freud ( 1917 [1916/1917 ]/1963), sometimes represent events that really

took place and influenced the fixation of the libido, but “sometimes they represent phantasies of the

patient ’s which are not, of course, suited to playing an aetiological role [emphasis added] ”(p. 367).

Nonetheless he decided to give fantasies not repres enting real events a decisive aetiological role. “It

remains a fact that the patient has c reated these phantasies for himsel f, and this fact is of scarcely less

importance for his neurosis than if he had really experienced what the phantasies contain ”(p. 368). So it

is precisely the “phantasies of the patient ’s which are not, of course, suited to playing an aetiological

role ”(p. 367) that do get to play an aetiological role. “The phantasies possess psychical as contrasted

with material reality, and we gradually learn to understand that in the world of the neurosis it is

psychical reality which is the decisive kind ”(p. 368).

Among the oft-repeated phenomena in the youthful history of neurotics, Freud ( 1917

[1916/1917 ]/1963) adds, there are a few of particular importance. “As specimens of this class

I will enumerate these: observation of parental i ntercourse [the primal scene], seduction by an

adult [sexual abuse] and threat of being castrated ”(pp. 368 –369). Fantasies of being seduced

are of particular interest, Freud finds, because they so often are not fantasies but real

memories. Seduction by an older child or one of the same age, according to Freud, is even

more frequent than by an adult. But in the case of girls who produce such an event with their

father as the seducer,

there can be no doubt either of the imaginary nature of the accusation or of the motive that has led to

it. A phantasy of being seduced when no seduction has occurred is usually employed by a child to

screen the autoerotic period of his sexual activity. He spares himself shame about masturbation by

retrospectively phantasysing a desired object into these earliest times. You must not suppose,

however, that sexual abuse of a child by its nearest male relatives belongs entirely to the realm of

phantasy. Most analysts will have treated cases in which such events were real and could be

unimpeachably established [emphasis added]. (p. 370)

We see Freud stressing again and again how scenes of seduction and sexual abuse in childhood can

be real or fantasised and how such events are among the essential elements of neurosis. So far so good!

However, the astonishing conclusion he reaches is this: “The outcome is the same, and up to the present

we have not succeeded in pointing to any differences in the consequences, whether phantasy or reality

has had the greater share in these events of childhood [emphasis added] ”(p. 370).

It is hard to imagine why this line of reasoning was largely accepted by the psychoanalytical

community and the broader fields of psychology and psychiatry for most of the twentieth

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century; that in terms of consequences it makes no difference whether fantasy or reality has

played the greater part in events of childhood . There were, however, important exceptions to

this. As we know, Ferenczi ( 1933 ), in his later years, came to regard traumatic experiences, not

least sexual abuse, as being of utmost importance. In Norway, Schjelderup in the thirties rejected

libido theory and put his faith in trauma theory (Sletvold, 2011 ,2014 ). And by the 1990s, hardly

anyone was disputing the necessity of differentiating fantasy from reality (Dalenberg et al.,

2012 ; Davies & Frawley, 1991 ; van der Kolk, 1994 ).

Freud never denied the reality of sexual abuse, but he created a theory that said that it had no

practical consequence whether one paid attention to it or not. What made it possible for him to

believe that fantasies, contrary to common sense, as he himself admitted, could have such grave

consequences? Freud ’s( 1917 ) answer was that these primeval fantasies are a phylogenetic

endowment.

It seems to me quite possible that all things that are told to us to-day in analysis as phantasy —the

seduction of children, the inflaming of sexual excitement by observing parental intercourse, the threat

of castration (or rather castration itself) —were once real occurrences in the primaeval times of the

human family, and that children in their phantasies are simply filling in the gaps in individual truth with

prehistoric truth. I have repeatedly been led to suspect that the psychology of the neuroses has stored

up in it more of the antiquities of human development than any other source [emphasis added]. (p. 371)

Tosumupsofar.Freud ’s first error was in my mind his decision to pursue an exclusively sexual

aetiology and nature of the neuroses. His second erro r was to conclude that sexual constitution (sexual-

drive-based fantasies and wishes) and traumatic expe riences amount to the same thing. This latter error,

it seems to me, has had the most detrimental effect inasmuch as (childhood) traumas were neglected for

greater parts of the twentieth century both in psychotherapy and more generally. (I am not, of course,

saying that Freud bears sole responsibility for this.)

FREUD ’S SECOND THEORY OF ANXIETY AND HIS RETURN TO TRAUMA THEORY

Freud ’s conception of anxiety as a direct result of an unsatisfactory sexual life dates back to his

very first formulations of the aetiology of the neurosis. “It is no use denying the fact … that I

have on many occasions asserted that … the libido belonging to the instinctual impulse is

transformed into anxiety ”(1926 [1925]/1959). However, in his revised theory (1926 [1925]/

1959), anxiety is no longer the result of libidinal repression but rather a sign or symptom of a

danger situation. In this way he severs the innate connection between anxiety and sexuality and

re-opens the path from danger (trauma) to anxiety and neurosis independently of sexuality.

Contrary to his earlier view, Freud now declares: “It is always the ego ’s attitude of anxiety which

is the primary thing and which sets repression going. Anxiety never arises from repressed libido ”

(1926 [1925]/1959).

In this new conception, anxiety is not the result of repressed libido but a reaction to a

situation of danger. The dangerous situation Freud had been considering was that of castration or

something traceable to castration. But then Freud reasons further and acknowledges challenges

to libido theory.

If anxiety is a reaction of the ego to danger, we shall be tempted to see the traumatic neuroses … as a direct

result of a fear of death (or a fear of life) and dismiss from our minds the question of castration. … Most of

FREUD ’S THREE THEORIES OF NEUROSIS 469

those who observed the traumatic neuroses of the last war [First World War] took this line, and triumphantly

announced that proof was now forthcoming that a threat to the instinct of self-preservation could by itself

produce a neurosis without any admixture of sexual factors [emphasis added]. (1926 [1925]/1959).

Starr and Aron ( 2011 ) had a thorough discussion of the challenges to Freudian theory posed by the

war neuroses of the First World War. Freud, however, goes on to state that he knows of no proof that war

neurosis can be explained “without any admixture of sexual factors, ”specifically castration fear.

ReferringtoSpitz ’s famous studies of the catastrophic effec ts of maternal deprivation on children

during World War II, Eagle ( 2011 ) reminded us of how it was possible to explain the effects of

seemingly non-sexual events with an admixture of sexual factors . Spitz ( 1960 ) was able to do this by

suggesting that maternal deprivation prevents the discharge of libidinal and aggressive drives. “The loss

of the love object interrupts the discharge of both drives ”(p. 90). But clearly Freud is on the defensive

on this question as he goes on to ask what makes a danger situation traumatic, and suggests that it might

be helplessness.

Let us call a situation of helplessness of this kind that has been actually experienced a traumatic situation .…

Taking this sequence, anxiety —danger —helplessness (trauma), we can now summarize what has been said.

A danger-situation is a recognized, remembered, expected situation of helplessness. Anxiety is the original

reaction to helplessness in the trauma and is reproduced later on in the danger-situation as a signal for help.

(1926 [1925]/1959).

There is a striking resemblance between Freud ’s reasoning here and the trauma theory developed by

the Norwegian psychoanalyst Harald Sch jelderup in the thirties (Sletvold, 2011 ,2014 ).He,too,sawthe

sense of helplessness in a danger situation as t he main constituent of the traumatic situation.

It is also interesting to note how Freud, in his “modification of earlier views ”(1926 [1925]/1959)

reintroduced the concept of defence that for 30 years had been replaced by repression .Itwillbean

undoubted advantage, Freud contends, to revert to the old concept of defence, “provided we employ it

explicitly as a general designation for all the techni ques which the ego makes use of in conflicts which

may lead to a neurosis ”(p. 163)

While Freud seems to be returning to his original theory of trauma and defence, it is still

necessary to underline that he in no way is giving up his libido theory. But by seeing anxiety as

no longer exclusively connected to libido, but rather as a response to any kind of danger

situation, and neuroses as constituted from danger, anxiety, helplessness and defence, I think

we are allowed to say that Freud again embraces his first theory of neurosis. It should also be

noted that historically three explanations for hysteria/neurosis have been suggested: sexuality,

heredity/constitution and trauma. Freud grappled with all three throughout his life.

AFTER FREUD: THE DILUTING OF LIBIDO THEORY

The response of Freud ’s psychoanalytic colleagues to his theory was in my view quite paradoxical.

Nobody seemed to accept the libido theory wholeheartedly, but neither did anybody criticise it

openly —after Adler and Jung —or point to what they found wrong in it. To my knowledge, there

were only two exceptions, one in favour and one against. Wilhelm Reich ( 1942 ) was adamant in his

defence of libido theory and added to it concepts such as orgastic potency, orgasm reflex, and sex

economy. He was also quick to criticise his colleagues for turning away from libido theory. However,

like Freud, Reich entertained opposing views; referring to the first psychoanalytic views based on the

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conflict between need and the outer world he wrote: “The psychic process reveals itself as the result

of the conflict between instinctual demand and the external frustration of this demand. Only

secondary does an inner conflict between desire and self-denial result from this opposition ”

(Reich, 1933/49 /1972, p. 287).

Only one person rejected libido theory outright, and that was, as already mentioned, Harald

Schjelderup (Sletvold, 2011 ,2014 ). He was convinced that behind what might seem to be

expressions of oedipal and castration complexes lay traumatic experiences often of a nonsexual

nature. The deepest causes of neuroses, he suggested, are to be found in traumatic experiences of

any kind that leave the child in a helpless situation. An oppressive upbringing and constitution

were other contributing factors.

The psychoanalytical mainstream (and, I would add, psychiatry and clinical psychology)

began a process of what I characterize as the dilution of Freud ’s theory. It was accomplished

by looking away from the core of the theory, the unique significance of sexual experiences ,to

focus instead on supplementary and secondary aspects of the theory. This took three main

forms.

1. A reformulation of libido theory into a theory of sexuality and aggression.

2. A reformulation of it as drive theory .

3. A reformulation of it as inner conflict theory .

Sexuality and Aggression

I consider this version first, as it is seemingly closest to the original in that it refers explicitly to

sexuality. For example, Morris Eagle ( 2011 ) described the Freudian view of psychopathology as

“the product of conflict between sexual and aggressive [emphasis added] wishes and prohibi-

tions and defenses against them ”(p. 190).

However, as we have seen, Freud never places aggression alongside sexuality. Even if he did

come to ponder aggression more in his later writings and specifically theorized a death instinct,

he never gave it an independent role in the aetiology of the neuroses; “we have always believed

that in a neurosis it is against the demands of the libido and not against those of any other

instinct the demands of the ego is defending itself ”(1926 [1925]/1959).

The consequence of juxtaposing aggression and sexuality was, however, formidable. It is

almost immediately read as synonymous with love and hate, not least because Freud himself

often used love as an alternative word for sexuality. Further, love and hate naturally become

more or less synonymous with positive and negative emotions. So the libido theory is reformu-

lated as a view foregrounding emotion. Not a bad thing at all! But Freud ’s explanation of how

we acquire nervous illness is lost on the way.

Drive Theory

The widespread perception of Freud ’s view as a drive theory omits any direct mention of

sexuality/libido. However, drive theory is not a theory of what causes neurosis (psychopathol-

ogy); it is a way of conceptualizing motivation. It is quite correct to say that Freud was a drive

theorist. But this view was by no means specifically Freudian. Conceptualizing human motiva-

tion in terms of drives or instincts was something he shared with almost everyone who theorized

FREUD ’S THREE THEORIES OF NEUROSIS 471

about human motivation a 100 years ago. In particular, it was shared by behaviourists (Hull,

1939 ), as Eagle ( 2011 ) recently reminded us. What divided Freud from Adler, Jung, and the

behaviourists was not drive theory as such but the particular significance he ascribed to the

discharge of sexual drives or libido.

Freud hypothesized a process in which stimuli create a state of excitation in the body

that needs to be discharged and that ideally returns the body to a state of zero excitation.

This conception, inspired by the electrochemical linking of neurons, was replaced by the

idea of optimal regulation (rather than zero excitation) with Cannon ’s( 1932 ) introduction

of the principal of homeostasis. So the idea of the (optimal) regulation of body states

rather than discharge gradually became the accepted view of what bodily needs or drives

push for. Today, the idea of optimal regulatio n includes in addition to physiological body

states emotional body states as well, and is often referred to as the principle of affect

regulation .

Inner Conflict Theory

Conflict was, as we have seen, an aspect of wh at Freud considered a necessary condition

for the creation of a neurosis, but this applied only to such conflicts in which sexuality

constituted a part. So it is right to say that Freud championed a theory of inner conflict,

but not of inner conflicts of any kind. The latter, however, was the version of the Freudian

conception of neurosis that the Diagnostic and Statistical Manual of Mental Disorders (3rd

ed. [ DSM-III ]; American Psychiatric Association, 1980 ) took as its point of departure when

it abandoned the entire concept of neurosis . They defined neurosis as an etiological

process constituted by an “unconscious conflict arousing anxiety and leading to the

maladaptive use of defensive mechanisms ”(p. 9). But then they added that there are

other theories about how neurotic disorders develop; “there are social learning, cognitive,

behavioral, and biological models that attempt to explain the development of various

neurotic disorders ”(p. 10).

Thus, the term neurotic disorder is used in DSM-III without any implication of a special etiological

process. Neurotic disorder, defined descriptively, is roughly equivalent to the psychoanalytic concept

of “symptom neurosis. ”This is distinguished from “character neurosis ”which is roughly equivalent

to the DSM-III concept of Personality Disorder. (p. 10)

As we know, DSM-III replaced the idea of a neurotic process with a cluster of symptoms,

a catalogue of complaints and problems, without anyconsiderationofae tiology and process.

The only exception was the introduction of post-traumatic stress disorder (PTSD) ,thus

indirectly reinforcing the idea that traumatic experiences do not generally play a part in the

development of neurotic disord ers. The ICD adopted the same way of thinking not long after.

From the time medicine started to apply scien tific methods, efforts have been directed not

only at classifying symptoms but understanding causes and processes, and basing diagnostics

on such understanding. Freud wanted to establis h such a medical and scientific understanding

of the causes and nature of the neuroses. It is the ambition of this text is to help revitalize

that project.

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CONCLUSION

Traumatic experience and defence (again conceptualized as splitting/dissociation rather than

repression) are today widely accepted as causes of neuroses. This holds true not least within

relational and interpersonal psychoanalysis (Brothers, 2008 ; Bromberg, 2011 ; D. B. Stern,

2010 ). By recognizing how the aetiology of neuroses lies in emotional trauma and defence,

often dating back to early childhood, a foundation is laid for a developmental and process view

of mental health diagnostics/case formulations.

Much of the knowledge on which a contemporary theory of trauma, defence, coping

and resilience relies is already in place. It is foun d inter alia in attachment research, trauma

research, infant research, neuroscience, an d in clinical experience within contemporary

psychoanalysis and psychotherapy. Even though Breuer and Freud held a broad definition

of psychical trauma, an expansion of the scope of emotional trauma is derived from micro-

analytic research on traumatic and defensive processes in infant –caregiver interaction that

is not available to ordinary observation. For example, Beebe & Lachmann ( 2014 ) link

disorganized infant attachment at 4 months to young adult dissociation. Their studies show

that maternal “disrupted communication ”predicts young adult attachment insecurity and

dissociation. In addition, disrupted matern al communication itself predicts a number of

other problematic outcomes in young adulthood. At the same time the most severe form of

dissociation, DID, seems etiologically co nnected to the most severe forms of abuse and

neglect, not least sexual abuse (Howell, 2011 ). And recently, Crastnopol ( 2015 ) has been

analysing the micro-trauma s of everyday life. This expansion of our understanding of

traumatic emotional and relational experie nce in no way undermines the essential truth

of Breuer and Freud ’s formulations, but rather extends their reach and exploratory scope.

It is my hope that bringing Freud ’s (and Breuer ’s) original formulations to the attention of a

wider field will strengthen our contemporary understanding of the development of mental health.

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CONTRIBUTOR

Jon Sletvold, Psy.D., is Faculty, Training, and Supervising Analyst at the Norwegian Character

Analytic Institute. He is the author of The Embodied Analyst: From Freud and Reich to

Relationality , winner of the Gradiva Award, 2015.

FREUD’S THREE THEORIES OF NEUROSIS 475

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