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I am writing the whole thing down a second time, for you, my dear friend, and for the sake of our common labours. You will of course keep the draft away from your young wife.
It may be taken as a recognized fact that neurasthenia is a frequent consequence of an abnormal sexual life. The assertion, however, which I wish to make and to test by my observations is that neurasthenia is always only a sexual neurosis.
I have adopted a similar point of view (along with Breuer) in regard to hysteria. Traumatic hysteria was well known; what we asserted beyond this was that every hysteria that is not hereditary is traumatic.2 In the same way I am now asserting that every neurasthenia is sexual.
We will for the moment leave on one side the question of whether hereditary disposition and, secondarily, toxic influences can produce genuine neurasthenia, or whether what appears to be hereditary neurasthenia in fact also goes back to early sexual exhaustion. If there is such a thing as hereditary neurasthenia, the questions arise of whether the status nervosus in the hereditary cases should not be distinguished from neurasthenia, what relation at all it has to the corresponding symptoms in childhood, and so on.
In the first instance, therefore, my contention will be restricted to acquired neurasthenia. What I am asserting can accordingly be formulated as follows. In the aetiology of a nervous affection we must distinguish (1) the necessary precondition without which the state cannot come about at all, and (2) the precipitating factors. The relation between these two can be pictured thus. If the necessary precondition has operated sufficiently, the affection sets in as an inevitable consequence; if it has not operated sufficiently, the result of its operation is in