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February 8, 1893
[dated by postmark]
I am writing the whole thing down a second time for you, dear friend, and for the sake of our common work. You will of course keep the manuscript away from your young wife.
I. 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 observations is that neurasthenia actually can only be a sexual neurosis.
I (along with Breuer) have advocated a similar point of view in regard to hysteria. Traumatic hysteria was known; we then said every case of hysteria that is not hereditary is traumatic. The same holds for neurasthenia: every neurasthenia is sexual.
We will for the moment leave open the question of whether hereditary disposition and, secondarily, toxic influences can produce genuine neurasthenia, or whether what appears to be hereditary neurasthenia also goes back to early sexual exhaustion. If there is such a thing as hereditary neurasthenia, the questions arise whether the status nervosus in the hereditary cases should not be distinguished from neurasthenia, what relation it actually has to the corresponding symptoms in childhood, and so on.
In the first instance, therefore, my contention will be restricted to acquired neurasthenia. Then what I asserted above can also be formulated as follows. In the etiology 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 the two can be pictured thus. If the necessary precondition has operated sufficiently, the affection sets in as a necessary consequence; if it has not operated sufficiently, the result of its operation is in the first place a disposition to that affection which ceases to be latent as soon as a sufficient amount of one of the second-order factors supervenes. Thus what is lacking for full effect in the first etiology can be replaced by the e