Therefore I suggest that the psychoanalytic theory should be liberated from the purely sexual standpoint. In place of it I should like to introduce an energic view-point into the psychology of neurosis.
All psychological phenomena can be considered as manifestations of energy, in the same way as all physical phenomena are already understood as energic manifestations since Robert Mayer discovered the law of the conservation of energy. This energy is subjectively and psychologically conceived as desire. I call it libido, using the word in the original meaning of this term, which is by no means only sexual. Sallustius applies the term exactly in the way we do here: "Magis in armis et militaribus equis, quam in scortis et conviviis libidinem habebant."
From a broader standpoint libido can be understood as vital energy in general, or as Bergson's élan vital. The first manifestation of this energy in the suckling is the instinct of nutrition. From this stage the libido slowly develops through manifold varieties of the act of sucking into the sexual function. Hence I do not consider the act of sucking as a sexual act. The pleasure in sucking can certainly not be considered as sexual pleasure, but as pleasure in nutrition, for it is nowhere proved that pleasure is sexual in itself. This process of development continues into adult life and is connected with a constantly increased adaptation to the external world. Whenever the libido, in the process of adaptation, meets an obstacle, an accumulation takes place which normally gives rise to an increased effort to overcome the obstacle. But if the obstacle seems to be insurmountable, and the individual renounces the overcoming of it, the stored-up libido makes a regression. In place of being employed in the increased effort, the libido now gives up the present task and returns to a former and more primitive way of adaptation. We meet with the best examples of such regressions very frequently in hysterical cases where a disappointment in love or marriage gives rise to the neurosis. There we find the well-known disturbances of nutrition, resistance against eating, dyspeptic symptoms of all sorts, etc. In these cases the regressive libido, turning away from its application to the work of adaptation, holds sway over the function of nutrition and provokes considerable disturbance. Such cases are obvious examples of regression. Similar effects of regression are to be found in cases where there are no troubles in the function of nutrition, and here we readily find a regressive revival of reminiscences of a time long past. We find a revival of the images of the parents, of the Œdipus-complex. Here things and events of infancy—never before important—suddenly become so. They are regressively reanimated. Take away the obstacle in the path of life and this whole system of infantile phantasies at once breaks down and becomes again as inactive and as ineffective as before. But do not let us forget that, to a certain extent, it is at work influencing us always and everywhere. I cannot forbear to mention that this view comes very near Janet's hypothesis of the substitution of the "parties supérieures" of a function by its "parties inférieures." I would also remind you of Claparède's conception of neurotic symptoms as emotional reflexes of a primitive nature.
Therefore I no longer find the cause of a neurosis in the past, but in the present. I ask, what is the necessary task which the patient will not accomplish? The whole list of his infantile phantasies does not give me any sufficient ætiological explanation, because I know that these phantasies are only puffed up by the regressive libido, which has not found its natural outlet into a new form of adjustment to the demands of life.
You may ask why the neurotic has a special inclination not to accomplish his necessary tasks. Here let me point out that no living being adjusts itself easily and smoothly to new conditions. The principle of the minimum of effort is valid everywhere.
A sensitive and somewhat inharmonious character, as a neurotic always is, will meet special difficulties and perhaps more unusual tasks in life than a normal individual, who as a rule has only to follow the well-established line of an ordinary life. For the neurotic there is no established way, for his aims and tasks are apt to be of a highly individual character. He tries to follow the more or less uncontrolled and half-conscious way of normal people, not fully realizing his own critical and very different nature, which imposes upon him more effort than the normal person is required to exert. There are neurotics who have shown their increased sensitiveness and their resistance against adaptation in the very first weeks of life, in their difficulty in taking the mother's breast, and in their exaggerated nervous reactions, &c. For this portion of a neurotic predisposition it will always be impossible to find a psychological ætiology, for it is anterior to all psychology. But this predisposition—you may call it "congenital sensitiveness" or by what name you like—is the cause of the first resistances against adaptation. In such case, the way of adaptation being blocked, the biological energy we call libido does not find its appropriate outlet or activity and therefore replaces an up-to-date and suitable form of adaptation by an abnormal or primitive one.
In neurosis we speak of an infantile attitude or the predominance of infantile phantasies and desires. In so far as infantile impressions and desires are of obvious importance in normal people they are equally influential in neurosis, but they have here no ætiological significance, they are reactions merely, being chiefly secondary and regressive phenomena. It is perfectly true, as Freud states, that infantile phantasies determine the form and further development of neurosis, but this is not ætiology. Even when we find perverted sexual phantasies of which we can prove the existence in childhood, we cannot consider them of ætiological significance. A neurosis is not really originated by infantile sexual phantasies and the same must be said of the sexualism of neurotic phantasy in general. It is not a primary phenomenon based upon a perverted sexual disposition, but merely secondary and a consequence of a failure to apply the stored-up libido in a suitable way. I realize that this is a very old view, but this does not prevent its being true. The fact that the patient himself very often believes that this infantile phantasy is the real cause of the neurosis, does not prove that he is right in his belief, or that a theory following the same belief is right either. It may look as if it were so, and I must confess that indeed very many cases do have that appearance. At all events, it is perfectly easy to understand how Freud came to this view. Every one having any psychoanalytic experience will agree with me here.
To sum up: I cannot see the real ætiology of a neurosis in the various manifestations of infantile sexual development and their corresponding phantasies. The fact that they are exaggerated and put into the foreground in neurosis is a consequence of the stored-up energy or libido. The psychological trouble in neurosis, and neurosis itself, can be considered as an act of adaptation that has failed. This formulation might reconcile certain views of Janet's with Freud's view, that a neurosis is—under a certain aspect—an attempt at self-cure; a view which can be and has been applied to many diseases.
Here the question arises whether it is still advisable to bring to light all the patient's phantasies by analysis, if we now consider them as of no ætiological significance. Psychoanalysis hitherto has proceeded to the unravelling of these phantasies because they were considered to be ætiologically significant. My altered view concerning the theory of neurosis does not change the procedure of psychoanalysis. The technique remains the same. We no longer imagine we are unearthing the end-root of the disease, but we have to pull up the sexual phantasies because the energy which the patient needs for his health, that is, for his adaptation, is attached to them. By means of psychoanalysis the connexion between the conscious and the libido in the unconscious is re-established. Thus you restore this unconscious libido to the command of conscious intention. Only in this way can the formerly split-off energy become again applicable to the accomplishment of the necessary tasks of life. Considered from this standpoint, psychoanalysis no longer appears to be a mere reduction of the individual to his primitive sexual wishes, but it becomes clear that, if rightly understood, it is a highly moral task of immense educational value.