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From the point of view of causal psycho-therapy, the first task of psycho-analysis is to bring into consciousness the meaning of neurotic anxiety, both manifest and larval; only when this has been done are we in a position to influence the sources of anxiety, which, as Freud has shown, is derived, in the last event, from instinctual energy. This therapeutic modification merely implies a fresh orientation of the instincts in the sense that the latter are regulated in a way more adapted to the requirements of reality. Nevertheless various sources of neurotic anxiety can be distinguished by reference to their dynamic power. Permanent cure, which is the ultimate aim of all psycho-analysis, can only be brought about by successful modification of the most important dynamic sources of anxiety. Etiologically speaking, the significance of sources of anxiety can be judged by their mutual relations: one would regard as secondary those sources of anxiety which (1) become pathogenic for the first time during the neurotic processes of regression and repression, and of which (2) the dynamic force is mainly borrowed from other sources.
Freud was the first to show that sexual abstinence or inadequate gratification are an immediate source of anxiety.1 This 'actual anxiety' is related to a damming-up of somatic libido and disappears when this pathogenic factor is eliminated. Moreover, he found that anxiety can arise when the moral ego is not completely successful in suppressing a libidinal excitation: the repressed impulse returns in the form of anxiety. The latter is an ego-anxiety and is a reaction to the claims of instinct. Since every sexual repression brings about a blockage of somatic libido, actual anxiety is the core of all neurotic anxieties. The situation is complicated by the fact that Freud2