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TWENTY - THIRD LECTURE GENERAL THEORY OF THE NEUROSES The Development of the Symptoms IN the layman's eyes the symptom shows the nature of the disease , and cure means removal of symptoms . The physician , however , finds it important to distinguish the symptoms from the disease and recognizes that doing away with the symptoms is not necessarily curing the disease . Of course , the only tangible thing left over after the removal of the symptoms is the capacity to build new symptoms . Accordingly , for the time being , let us accept the layman's viewpoint and consider the understanding of the symptoms as equivalent to the understanding of the sickness . The symptoms , — of course , we are dealing here with psychic ( or psychogenic ) symptoms , and psychic illness — are acts which are detrimental to life as a whole , or which are at least useless ; frequently they are obnoxious to the individual who performs them and are accompanied by distaste and suffering . The principal injury lies in the psychic exertion which they cost , and in the further exertion needed to combat them . The price these efforts exact may , when there is an extensive development of the symptoms , bring about an extraordinary impoverishment of the personality of the patient with respect to his available psychic energy , and consequently cripple him in all the important tasks of life . Since such an outcome is dependent on the amount of energy so utilized , you will readily understand that " being sick " is essentially a practical concept . But if you take a theoretical standpoint and disregard these quantitative relations , you can readily say that we are all sick , or rather neurotic , since the conditions favorable to the development of symptoms are demonstrable also among normal persons . As to the neurotic symptoms , we already know that they are the result of a conflict aroused by a new form of gratifying the libido . The two forces that have contended against each other meet once more in the symptom ; they become reconciled through the compromise of a symptom development . That is why the symptom is capable of such resistance ; it is sustained from both sides . We also know that one of the two partners to the conflict is the unsatisfied libido , frustrated by reality , which must now seek other means for its satisfaction . If reality remains inflexible even where the libido is prepared to take another object in place of the one denied it , the libido will then finally be compelled to resort to regression and to seek gratification in one of the earlier stages in its organizations already out - lived , or by means of one of the objects given up in the past . Along the path of regression the libido is enticed by fixations which it has left behind at these stages in its development . Here the development toward perversion branches off sharply from that of the neuroses . If the regressions do not awaken the resistance of the ego , then a neurosis does not follow and the libido arrives at some actual , even if abnormal , satisfaction . The ego , however , controls not alone consciousness , but also the approaches to motor innervation , and hence the realization of psychic impulses . If the ego then does not approve this regression , the conflict takes place . The libido is locked out , as it were , and must seek refuge in some place where it can find an outlet for its fund of energy , in accordance with the controlling demands for pleasurable gratification .
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