Now your impression will be that abstinence has become an insignificant factor, since there are so many methods of enduring it. Yet this is not the case, for its pathological power is unimpaired. The remedies are generally not sufficient. The measure of unsatisfied libido which the average human being can stand is limited. The plasticity and freedom of movement of libido is by no means retained to the same extent by all individuals; sublimation can, moreover, never account for more than a certain small fraction of the libido, and finally most people possess the capacity for sublimation only to a very slight degree. The most important of these limitations clearly lies in the adaptability of the libido, as it renders the gratification of the individual dependent upon the attainment of only a very few aims and objects. Kindly recall that incomplete development of the libido leaves extensive and possibly even numerous libido fixations in earlier developmental phases of the processes of sexual organization and object-finding, and that these phases are usually not capable of affording a real gratification. You will then recognize libido fixation as the second powerful factor which together with abstinence constitutes the causative factors of the illness. We may abbreviate schematically and say that libido fixation represents the internal disposing factor, abstinence the accidental external factor of the etiology of neurosis.
I seize the opportunity to warn you of taking sides in a most unnecessary conflict. In scientific affairs it is a popular proceeding to emphasize a part of the truth in place of the whole truth and to combat all the rest, which has lost none of its verity, in the name of that fraction. In this way various factions have already separated out from the movement of psychoanalysis; one faction recognizes only the egoistic impulses and denies the sexual, another appreciates the influence of objective tasks in life, but ignores the part played by the individual past, and so on. Here is occasion for a similar antithesis and subject for dispute: are neuroses exogenous or endogenous diseases, are they the inevitable results of a special constitution or the product of certain harmful (traumatic) impressions; in particular, are they called forth by libido fixation (and the sexual constitution which goes with this) or through the pressure of forbearance? This dilemma seems to me no whit wiser than another I could present to you: is the child created through the generation of the father or the conception of the mother? Both factors are equally essential, you will answer very properly. The conditions which cause neuroses are very similar if not precisely the same. For the consideration of the causes of neuroses, we may arrange neurotic diseases in a series, in which two factors, sexual constitution and experience, or, if you wish, libido-fixation and self-denial, are represented in such a way that one increases as the other decreases. At one end of the series are the extreme cases, of which you can say with full conviction: These persons would have become ill because of the peculiar development of their libido, no matter what they might have experienced, no matter how gently life might have treated them. At the other end are cases which would call forth the reversed judgment, that the patients would undoubtedly have escaped illness if life had not thrust certain conditions upon them. But in the intermediate cases of the series, predisposing sexual constitution and subversive demands of life combine. Their sexual constitution would not have given rise to neurosis if the victims had not had such experiences, and their experiences would not have acted upon them traumatically if the conditions of the libido had been otherwise. Within this series I may grant a certain preponderance to the weight carried by the predisposing factors, but this admission, too, depends upon the boundaries within which you wish to delimit nervousness.
Allow me to suggest that you call such series complementary series. We shall have occasion to establish other series of this sort.
The tenacity with which the libido clings to certain tendencies and objects, the so-called adhesiveness of the libido, appears to us as an independent factor, individually variable, the determining conditions of which are completely unknown to us, but the importance of which for the etiology of the neuroses we can no longer underestimate. At the same time we must not overestimate the closeness of this interrelation. A similar adhesiveness of the libido occurs — for unknown reasons — in normal persons under various conditions, and is a determining factor in the perverse, who are in a certain sense the opposite of nervous. Before the period of psychoanalysis, it was known (Binet) that the anamnesia of the perverse is often traced back to an early impression — an abnormality in the tendency of the instinct or its choice of object — and it is to this that the libido of the individual has clung for life. Frequently it is hard to say how such an impression becomes capable of attracting the libido so intensively. I shall give you a case of this kind which I observed myself. A man, to whom the genital and all other sex stimuli of woman now mean nothing, who in fact can only be thrown into an irresistible sexual excitation by the sight of a shoe on a foot of a certain form, is able to recall an experience he had in his sixth year, which proved decisive for the fixation of his libido. One day he sat on a stool beside his governess, who was to give him an English lesson. She was an old, shriveled, unbeautiful girl with washed-out blue eyes and a pug nose, who on this day, because of some injury, had put a velvet slipper on her foot and stretched it out on a footstool; the leg itself she had most decorously covered. After a diffident attempt at normal sexual activity, undertaken during puberty, such a thin sinewy foot as his governess’ had become the sole object of his sexuality; and the man was irresistibly carried away if other features, reminiscent of the English governess, appeared in conjunction with the foot. Through this fixation of the libido the man did not become neurotic but perverse, a foot fetishist, as we say. So you see that, although exaggerated and premature fixation of the libido is indispensable for the causation of neuroses, its sphere of action exceeds the limits of neuroses immeasurably. This condition also, taken by itself, is no more decisive than abstinence.
And so the problem of the cause of neuroses seems to become more complicated. Psychoanalytic investigation does, in fact, acquaint us with a new factor, not considered in our etiological series, which is recognized most easily in those cases where permanent well-being is suddenly disturbed by an attack of neurosis. These individuals regularly show signs of contradiction between their wishes, or, as we are wont to say, indication of psychic conflict. A part of their personality represents certain wishes, another rebels against them and resists them. A neurosis cannot come into existence without such conflict. This may seem to be of small significance. You know that our psychic life is continually agitated by conflicts for which we must find a solution. Certain conditions, therefore, must exist to make such a conflict pathological. We want to know what these conditions are, what psychic powers form the background for these pathological conflicts, what relation the conflict bears to the causative factors.
I hope I shall be able to give you satisfactory answers to these questions even if I must make them schematically brief. Self-denial gives rise to conflict, for libido deprived of its gratification is forced to seek other means and ends. A pathogenic conflict arises when these other means and ends arouse the disfavor of one part of the personality, and a veto ensues which makes the new mode of gratification impossible for the time being. This is the point of departure for the development of the symptoms, a process which we shall consider later. The rejected libidinous desires manage to have their own way, through circuitous byways, but not without catering to the objections through the observance of certain symptom-formation; the symptoms are the new or substitute satisfaction which the condition of self-denial has made necessary.
We can express the significance of the psychic conflict in another way, by saying: the outer self-denial, in order to become pathological, must be supplemented by an inner self-denial. Outer denial removes one possibility of gratification, inner denial would like to exclude another possibility, and it is this second possibility which becomes the center of the ensuing conflict. I prefer this form of presentation because it possesses secret content. It implies the probability that the inner impediment found its origin in the prehistoric