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Gray, M. (1954). International Journal of Psychoanalysis. XXXIII, 1952: In Support of Freud's Syndrome of 'Actual' Anxiety Neurosis. Abram Blau. Pp. 363-372.. Psychoanal Q., 23:137-138.
Psychoanalytic Electronic Publishing: International Journal of Psychoanalysis. XXXIII, 1952: In Support of Freud's Syndrome of 'Actual' Anxiety Neurosis. Abram Blau. Pp. 363-372.

(1954). Psychoanalytic Quarterly, 23:137-138

International Journal of Psychoanalysis. XXXIII, 1952: In Support of Freud's Syndrome of 'Actual' Anxiety Neurosis. Abram Blau. Pp. 363-372.

Milton Gray

This paper is a plea for the recognition of Freud's syndrome of 'actual' anxiety neurosis as a significant and frequent psychiatric syndrome. After a short historical account of Freud's concept of anxiety neurosis and of his distinction of it from the psychoneuroses, Blau describes the signs and symptoms of the anxiety neurosis and states that such actual-neurotic syndromes are extremely common but are 'currently hidden under other diagnostic names which mask the generic anxiety syndrome'. The author then considers traumatic neuroses, military anxiety neuroses, childhood anxiety neuroses, visceral anxiety neuroses (psychosomatic disorders), and experimental anxiety neuroses (in animals) in the light of the anxiety neurosis syndrome.

He discusses the relationship between anxiety neuroses and psychoneuroses. The psychoneurotic mechanism is but one special way of relieving anxiety. To the extent that a psychoneurosis is unsuccessful in this regard, an anxiety neurosis remains; and even in an established psychoneurosis any upset in the adjustment will lead to an anxiety state. This type of anxiety state is one of the most frequent and might be called a decompensated psychoneurotic anxiety neurosis.

Freud at first believed that suppressed libido is directly changed into anxiety; he later discarded this concept. The precipitating cause of anxiety neurosis is a threatening development in the life of the individual. 'The problem is one of maladjustment in a particular situation—so much so that these might be called situational neuroses.' The basic personality must be taken into account as a possible predisposing or contributing factor.

Freud said, 'whether a neurotic illness occurs at all depends upon a quantitative factor, upon the total load on the nervous system in relation to its capacity for resistance'. This statement suggests that two courses are open in treatment: either

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the individual's tolerance should be increased or the threats from the environment decreased. As to the first course, the technique of choice is analysis, but at times this is impractical for relieving the immediate situation and supportive reassuring anaclitic measures are indicated, to be followed later by analysis if possible. The second course is to give relief by decreasing the threat from the environment; this offers only immediate symptomatic relief and is the area in which social work contributes much.

An anxiety neurosis is not only at the core of every psychoneurosis but an unresolved degree of anxiety neurosis generally continues along with every psychoneurosis, and this poses the technical problem in psychoanalytic practice of maintaining the anxiety at an optimum level.

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Article Citation

Gray, M. (1954). International Journal of Psychoanalysis. XXXIII, 1952. Psychoanal. Q., 23:137-138

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