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At this juncture another remark is perhaps not out of place. I know that the emphasis which I lay upon the part played by sexuality in creating the psychoneuroses has become generally known. But I know, too, that qualifications and exact particularization are of little use with the general public; there is very little room in the memory of the multitude; it only retains the bare gist of any thesis and fabricates an extreme version which is easy to remember. It may be, too, that some physicians vaguely apprehend the content of my doctrine to be that I regard sexual privation as the ultimate cause of the neuroses. In the conditions of life in modern society there is certainly no lack of sexual privation. On this basis, would it not be simpler to aim directly at recovery by recommending sexual activity as a therapeutic measure, instead of pursuing the circuitous and laborious path of mental treatment?(I know of nothing which could impel me to suppress such an inference if it were justified. The real state of things, however, is otherwise. Sexual need and privation are merely one factor at work in the mechanism of neurosis; if there were no others the result would be dissipation, not disease. The other, no less essential, factor, which is all too readily forgotten, is the neurotic’s aversion from sexuality, his incapacity for loving, that feature of the mind which I have called ‘repression’. Not until there is a conflict between the two tendencies does nervous illness break out, and therefore to advise sexual activity in the psychoneuroses can only very rarely be described as good advice.

Let me end upon this defensive note. And let us hope that your interest in psychotherapy, when freed from every hostile prejudice, may lend us support in our endeavour to achieve success in treating even severe cases of psychoneurosis.