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This paper is a plea for the recognition of Freud's syndrome of 'actual' anxiety neurosis as a significant and frequent psychiatric syndrome. After a short historical account of Freud's concept of anxiety neurosis and of his distinction of it from the psychoneuroses, Blau describes the signs and symptoms of the anxiety neurosis and states that such actual-neurotic syndromes are extremely common but are 'currently hidden under other diagnostic names which mask the generic anxiety syndrome'. The author then considers traumatic neuroses, military anxiety neuroses, childhood anxiety neuroses, visceral anxiety neuroses (psychosomatic disorders), and experimental anxiety neuroses (in animals) in the light of the anxiety neurosis syndrome.
He discusses the relationship between anxiety neuroses and psychoneuroses. The psychoneurotic mechanism is but one special way of relieving anxiety. To the extent that a psychoneurosis is unsuccessful in this regard, an anxiety neurosis remains; and even in an established psychoneurosis any upset in the adjustment will lead to an anxiety state. This type of anxiety state is one of the most frequent and might be called a decompensated psychoneurotic anxiety neurosis.
Freud at first believed that suppressed libido is directly changed into anxiety; he later discarded this concept. The precipitating cause of anxiety neurosis is a threatening development in the life of the individual. 'The problem is one of maladjustment in a particular situation—so much so that these might be called situational neuroses.' The basic personality must be taken into account as a possible predisposing or contributing factor.
Freud said, 'whether a neurotic illness occurs at all depends upon a quantitative factor, upon the total load on the nervous system in relation to its capacity for resistance'. This statement suggests that two courses are open in treatment: either