I should not like it to be wrongly thought that I do not wish
to allow that hysteria is an independent neurotic affection,
that I regard it merely as a psychical manifestation of anxiety
neurosis and that I attribute to it ‘ideogenic’ symptoms only
and am transferring the somatic symptoms (such as hystero-
genic points and anaesthesias) to anxiety neurosis. Nothing of
the sort. In my opinion it is possible to deal with hysteria, freed
from any admixture, as something independent; and to do so
in every respect except in that of therapeutics.


For in therapeutics we are concerned with a practical aim, with getting
rid of the pathological state as a whole. And if hysteria generally
appears as a component of a mixed neurosis, the situation
resembles that in which there is a mixed infection, where pre-
serving life sets a problem which does not coincide with that of
combating the operation of one particular pathogenic agent.


It is very important for me to distinguish the part played by
hysteria in the picture of the mixed neuroses from that played
by neurasthenia, anxiety neurosis and so on, because, once I
have made this distinction, I shall be able to express concisely
the therapeutic value of the cathartic method.


For I am inclined to venture the assertion that that method is as a matter of theory very well able to get rid of any hysterical symptom,
whereas, as will be easily understood, it is completely powerless
against the phenomena of neurasthenia and is only able rarely
and in roundabout ways to influence the psychical effects of
anxiety neurosis. Its therapeutic effectiveness in any particular
case will accordingly depend on whether the hysterical com-
ponents of the clinical picture do or do not assume a position
of practical importance in comparison with the other neurotic


There is another obstacle in the way of the effectiveness of
the cathartic method, which we have already indicated in the
‘Preliminary Communication’ [p. 17]. It cannot affect the
underlying causes of hysteria: thus it cannot prevent fresh
symptoms from taking the place of the ones which had been got
rid of. On the whole, then, I must claim a prominent place
for our therapeutic method as employed within the framework
of a therapy of the neuroses; but I should like to advise against
assessing its value or applying it outside this framework. Since,
however, I cannot in these pages offer a ‘therapy of the neuroses’
of the sort needed by practitioners, what I have just said is
equivalent to postponing my account of the subject to a possible
later publication. But I am able, I think, to add the following
remarks by way of expansion and elucidation.



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