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Freud's The Neuro-psychoses of Defence (1894), essentially a paper on differential diagnosis, concludes with a unifying principle: “a quota of affect or sum of excitations—which possesses all the characteristics of a quantity (though we have no means of measuring it), which is capable of diminution, displacement, or discharge” (p. 60). While acknowledging the provisional nature of this principle, which would evolve into the much-disputed economic viewpoint of metapsychology, Freud maintained that it was justified by its “utility in co-ordinating and explaining a great variety of psychical states” (p. 61). When in 1912 Freud wanted to describe the coordinate relations between the actual neuroses and the psychoneuroses, he once again referred to a quantitative factor. The actual neuroses, he said, “provide the psychoneuroses with the necessary ‘somatic compliance’; they provide the excitatory material, which is then psychically selected and given a ‘psychical coating,’ so that, speaking generally, the nucleus of the psychoneurotic symptom—the grain of sand at the centre of the pearl—is formed of a somatic sexual manifestation” (Freud 1912, p. 248).
Analogously, the issue of actual neurosis or actual trauma has acted like a grain of sand that has stimulated the formations and