ABSTRACT
As we have stated, the domain of organ neuroses extends from hysteria to hypochondriasis; the term, organ neurosis would, therefore, include monosymptomatic conversion hysterias as well as genuine narcissistic neuroses which are characterized by hypochondriacal mechanisms. However, when we speak of organ neuroses we usually have in mind the reactions lying between these two extremes, and, as has already been mentioned, it is in this intermediary region that we find the clinical pictures which we shall consider under the general heading of pregenital conversion neuroses. The symptoms of these neuroses, like those of conversion hysteria, represent an expression of a psychic conflict between the infantile sexual wishes which are directed towards an object and the defense reactions against these wishes. In contradistinction to conversion hysteria, these sexual wishes, directed towards an object, are pregenital in nature, i. e., they are anal sadistic or oral sadistic, and their aim is the incorporation of the object; for this reason, these neuroses appear to have been built up on a more definite narcissistic foundation than are the usual hysterias. Hence, while the symptomatology is of a conversion hysterical nature, the patients’ behavior corresponds more to that of the compulsion neurotic than that of a hysteric. The pregenital nature of such individuals’ sexuality is imprinted not only on the unconscious ideational content of their symptoms, but their whole behavior shows all the characteristics which, in compulsive neurotics, we recognized as the result of anal regression; we have in mind such characteristics as increased ambivalence, increased bisexuality, sexualization of the process of thinking and talking, and partial regression to the magic-animistic type of thinking. Using the same method as in dealing with compulsion neuroses, it is often possible to demonstrate in such cases that the regressive nature of their pregenital tendencies represents an attempt to make them serve as a substitute for the rejected oedipus trends; in other words, in all details, in psychological content as well as mechanisms, except for the conversional character of the symptoms, they completely resemble compulsion neuroses. Occasionally, although quite rarely, one fails to find this resemblance, and the question then arises whether these cases are not based upon an arrest in development which left the individuals fixed on a pregenital level and thus prevented them from reaching the phallic oedipus complex. Putting it somewhat incorrectly for the sake of emphasis, we might say that these cases are fundamentally compulsion neuroses with all the characteristic psychological content and mechanisms, but that the clinical symptomatology appears to be that of a hysteria. This fact confronts us with the problem: what is it that makes one person develop a compulsion neurosis while another develops a pregenital conversion hysteria? The external clinical picture of the latter neuroses is that of hysteria; consequently, it was only in analytical practice that their inner psychological structure was found to be different.
