Letter 181 Extracts From the Fliess Papers

… There are still a hundred gaps, large and small, in my ideas about the neuroses; but I am getting closer to a comprehensive view and to some general lines of approach. I know three mechanisms: transformation of affect (conversion hysteria), displacement of affect (obsessions) and (3) exchange of affect (anxiety neurosis and melancholia). In every case what seems to undergo these alterations is sexual excitation, but the impetus to them is not in every case something sexual. That is to say, in every case in which neuroses are acquired, they are acquired owing to disturbances of sexual life; but there are people in whom the behaviour of their sexual affects is disturbed hereditarily, and they develop the corresponding forms of hereditary neuroses. The most general aspects from which I can classify the neuroses are the four following:

1. Degeneracy.

2. Senility. And what does that mean?

3. Conflict.

4. Conflagration.

Degeneracy means the innately abnormal behaviour of the sexual affects; so that the processes of conversion, displacement and transformation into anxiety occur in proportion as the sexual affects play a part in the course of life.

Senility is clear. It is, as it were, a degeneracy normally acquired in old age.2

Conflict coincides with my conception of defence [fending off]; it comprises the cases of acquired neurosis in people who are not hereditarily abnormal. What is fended off is always sexuality.

Conflagration is a new conception. It means what may be called acute degeneration (e.g. in severe intoxications, in fevers, in the preliminary stage of general paralysis)-catastrophes, that is to say, in which there are disturbances of the sexual affects without sexual precipitating causes. Perhaps traumatic neuroses might be approached from this point.3

The core and mainstay of the whole business remains, of course, the fact that, as a result of particular sexual noxae, even healthy people can acquire the different forms of neurosis.