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A noteworthy connection between the symptoms of the true neuroses and the psychoneuroses adds a valuable contribution to our knowledge of symptom formation in the latter . The symptom in the true neuroses is frequently the nucleus and incipient stage of development of the psychoneurotic symptom . Such a connection is most easily observed between neurasthenia and the transference neuroses , which are termed conversion hysteria , between anxiety neurosis and anxiety hysteria , but also between hypochondria and paraphrenia ( dementia praecox and paranoia ) , forms of neuroses of which we shall speak subsequently . Let us take as an illustration the hysteric headache or backache . Analysis shows that through elaboration and displacement this pain has become the gratification substitute for a whole series of libidinous phantasies or reminiscences . But once upon a time this pain was real , a direct sexual toxic symptom , the physical expression of libidinous excitation . We do not wish to assert , by any means , that all hysteric symptoms can be traced to such a nucleus , but it is true that this is frequently the case , and that all influences upon the body through libidinous excitation , whether normal or pathological , are especially significant for the symptom development in hysteria . They play the part of the grain of sand which the mollusc has enveloped in mother - of - pearl . In the same way passing signs of sexual excitation , which accompany the sexual act , are used by psychoneurosis as the most convenient and appropriate material for symptom formation . A similar procedure is of diagnostic and therapeutic interest especially . Persons who are disposed to be neurotic , without suffering from a flourishing neurosis , frequently set in motion the work of symptom development as the result of an abnormal physical change — often an inflammation or an injury . This development rapidly makes the symptom given by reality the representative of the unconscious phantasies that had been lurking for an opportunity to seize upon a means of expression . In such a case the physician will try different ways of therapy . Either he will try to do away with the organic basis without bothering about its noisy neurotic elaboration , or he will struggle with the neurosis brought out by the occasion , and ignore its organic cause . The result will justify now one , now the other method of procedure ; no general laws can be laid down for such mixed cases . TWENTY - FIFTH LECTURE GENERAL THEORY OF THE NEUROSES Fear and Anxiety PROBABLY you will term what I told you about ordinary nervousness in my last lecture most fragmentary and unsatisfactory information . I know this , and I think you were probably most surprised that I did not mention fear , which most nervous people complain of and describe as their greatest source of suffering . It can attain a terrible intensity which may result in the wildest enterprises . But I do not wish to fall short of your expectations in this matter . I intend , on the contrary , to treat the problem of the fear of nervous people with great accuracy and to discuss it with you at some length .
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