Page:Freud - Selected papers on hysteria and other psychoneuroses.djvu/218

204 All this seems very clear and still it must be admitted that there is one factor which often hinders the passing of sentence. Some of the nervous affections, the so-called actual neuroses, such as the typical neurasthenia and the pure anxiety neuroses, apparently depend on the somatic factor of the sexual life, while we have not yet any definite conception concerning the role played in them by the psychic factors and the repression. In such cases it is natural for the physician to have in view, first of all, an actual therapy, an alteration of the somatic sexual activity and he would be fully justified in so doing were his diagnosis correct. The woman who consulted this young physician complained above all of states of anxiety. He thus probably concluded that she was suffering from anxiety neurosis and felt justified in recommending her a somatic therapy. Again a convenient misunderstanding! He who suffers from anxiety does not necessarily have an anxiety neurosis. This diagnosis is not to be derived from the name. One must know what manifestations constitute anxiety neurosis and how to differentiate them from other morbid states which are also manifested through fear. According to my impression the yvoman in question suffered from an anxiety hysteria and the whole as well as the full value of such nosographic distinctions lies in the fact that they point to a different etiology and a different therapy. Whoever has in mind the possibility of such an anxiety hysteria would not have failed to neglect the psychic factors as shown in the alternative advice of the physician.

Strangely enough in the therapeutic alternative of this supposed psychoanalyst there is no place left for psychoanalysis. This woman could be freed of her anxiety only were she to return to her husband, or gratify herself by resorting to onanism, or to a paramour. And where would the analytical treatment enter which is the principal remedy in states of anxiety?

We thus come to the technical errors which we recognize in the procedure of the physician in the admitted case. It is easy to refer it to ignorance. It is a conception long since combated, based on a most superficial judgment, that the patient suffers from a lack of knowledge and when this ignorance is removed through enlightenment (concerning the causative relation of his illness with his life, regarding his childhood experiences, etc.) he must become well. It is not this lack of knowledge in itself that is the