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From the point of view of the dynamic, defensive functioning of the psychic apparatus, masturbation and symptoms have much in common. Both demonstrate how the ego operates in attempting to achieve a satisfactory solution of the conflicting claims of the instincts, the pressure of the superego, and the demands of reality. Masturbation and symptom formation both portray the end product of a complicated and overdetermined set of mental operations in the ego, operations which proceed according to the principle of multiple functioning (17). These elements of similarity may be taken as the starting point in discussing the intimate relationship between masturbation and the formation of certain psychoneurotic symptoms.
In an early paper written before he had elaborated his dual concept of instincts and the structural organization of the psyche, Freud (9) commented on the connection between the unconscious fantasy associated with hysterical symptoms and the conscious fantasy connected with masturbation. "It is actually identical with the fantasy which served the person in his sexual gratification during the period of masturbation. … Such unconscious fantasies are the immediate precursors in the mind of a whole series of hysterical symptoms. The hysterical symptoms are nothing but the unconscious fantasies made manifest by 'conversion' and in so far as the symptoms are of a somatic kind, they are often enough drawn from within the range of sexual feelings and motor innervations that regularly accompanied the fantasy while it was still conscious." In this observation Freud was primarily interested in