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In the last of his writings, “An Outline of Psychoanalysis,” Freud (1940) wrote, “The symptoms of neuroses are exclusively, it might be said, either a substitute satisfaction of some sexual impulse or measures to prevent such a satisfaction, and are as a rule compromise between the two.” In a large part of classic psychoanalytic literature not only neurotic behavior but every kind of behavior, including creative activity, is interpreted as motivated by sexual instincts, aggressivity, and other relatively simple emotional states, or as based on the displacement or sublimation of such states. It is to the merit of other schools of psychoanalysis, especially those which constitute the bulk of the American Academy of Psychoanalysis, to have recognized that the instinctual life and the simple levels of physiopsychological organization do not constitute the only sources of psychogenic motivation, and that the three major psychological phenomena that Freud was the first to illustrate—the unconscious, the intrapsychic conflict, and symbolism—involve many other levels of the psyche.
Even when psychological phenomena originate at instinctual or simple psychophysiological levels, they soon become connected with the cognitive functions of the psyche. To take a very common example, many patients complain of sexual difficulties. But sexual problems become rapidly connected with such concepts as being accepted or rejected, desirable or undesirable, loved or unloved, capable or incapable, normal or abnormal. If it is true that sexual dysfunctions lead to these concepts and to a state of general anxiety, it is also true that these cognitive appraisals of the self bring about a state of anxiety, which in its turn causes sexual dysfunctions. Sexual gratification, deprivation, and dysfunction are phenomena that affect the whole self-image, and the self-image often affects sexual functions.
It is to the merit of such people as Harry Stack Sullivan, Erich Fromm, Karen Horney, Erik