The Function of the Precipitating Factor in the Aetiology of the Neuroses: A Historical Note1

The problem which we are to discuss this evening has dogged psycho-analysis from its very birth. It was dealt with by Breuer and Freud in their original contribution on the psychical mechanism of hysterical phenomena nearly forty years ago, and it has cropped up again and again in Freud's writings, either directly or by implication, down to the present time.

I should like to remind you, very shortly, of the main developments of his views in this connection. But I must first explain the sense in which I propose to use the words 'precipitating factors'. In cases in which the onset of a neurosis can be observed to occur at a particular time, two groups of ætiological factors can be separated, which may be described as the 'predisposing causes' and the 'precipitating causes', the latter being the causes determining the fact that the illness breaks out at that particular time rather than at any other. It is obvious that the importance and interest of studying precipitating causes will vary according to the magnitude and nature of the part they play beyond the mere determining of the time of the onset of the illness. Thus, to take a simile, supposing that the trunk of a tree has rotted almost through, so that a very slight pressure will knock the tree down. It will in fact be blown down at some particular moment by some particular gust of wind, and that gust will be the precipitating cause of the tree's falling; but the investigation of the gust would be of very little interest in the study of the diseases of trees. Now the view of the ætiology of hysteria taken by Charcot was precisely of this kind. For he believed that a hereditary predisposing cause was of governing importance in that disease, and consequently paid little attention to the precipitating factors. The Breuer and Freud view was in direct opposition; for according to them the precipitating factor—a psychical trauma—was actually decisive both for the disease and for the form it took. Nevertheless th