‘Actual neurosis’ and psychosomatic medicine: The vicissitudes of an enigmatic concept

Abstract

Out of the concept of neurasthenia, the main non‐psychotic diagnosis of nineteenth‐century psychiatry besides hysteria, and on the basis of psychophysiological problems of his own, self‐diagnosed as neurasthenia, Freud developed the notion of ‘actual neurosis’, a ‘contentless psychic state’ manifested by various somatic symptoms and a depressive mood, which he attributed to a chemical factor associated with aberrant sexual practices and in particular masturbation. Rejected by post‐Freudian analysts as such along with the diagnosis of neurasthenia, the concept of ‘actual neurosis’ has survived under various theoretical schemes that seek to explain psychosomatic illness and somatisation, in general, with its concomitant poverty of affects and dearth of fantasy life. In more recent years, the concept of ‘actual neurosis’ has resurfaced under the label of chronic fatigue syndrome, a medical entity thought to be an immunological deficiency, while in psychoanalysis Freud's idea of a contentless mental state has been replaced by that of unconscious fantasy and symbolisation at a pre‐genital or pre‐verbal level.

On psychosomatics: The search for meaning

“…The condition called neurasthenia was initially described by the American neurologist, George Beard, who developed his main thesis on the subject between 1867 and 1880 (Gay, 2002; Hartocollis, 2002; Wessely, 1990). Beard did not doubt that neurasthenia was a physical disease.…”

Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses

“…This is not too far afield from more contemporary self psychological views that one’s conversion or displacement of overwhelming emotional arousal into somatic concerns involves efforts to stave off the threats of fragmentation of the self (Rodin 1991). Hartocollis (2002) added that the tendency to somatize emanates from “psychodynamics of repression and conversion at a very early pre-verbal level of mental development” (p. 1370).…”

“…Estimated to afflict one to four million adults in the United States (Center for Disease Control 2012; Reeves et al 2007), chronic fatigue syndrome (CFS) involves medically unexplained fatigue and somatic distress such as headaches, muscular and joint pain, unrefreshing sleep, flu-like symptoms, and post-exertional malaise (Fukuda et al 1994). Hartocollis (2002) has described CFS as essentially the same clinical entity that Freud (1912) referred to as neurasthenia, an actual neurosis. CFS sufferers are predominantly women but, contrary to early stereotypes of patients as primarily white and middle- or upper-class, are disproportionately from minority and lower socioeconomic groups (Bierl et al 2004).…”

Constructions in psychoanalysis: On the ‘assured conviction of the truth of a construction’

“…These parallel processes are often overlooked because, although they are of hallucinatory intensity, they are also very ephemeral or because, despite psychosomatic urgency, they seem in the monotony with which they appear to be unproductive psychoanalytically and can so escape the attention and interest of the analyst. This is where Freud’s ‘enigmatic concept’ (Hartocollis, 2002) of actual neurosis merits fresh attention. Not as an entity of disorder (anxiety neurosis, panic attack, hypochondria, neurasthenia) or as the opposite of a psychoneurosis, rather as its Siamese twin, as a reciprocal complement.…”