NEUROSES AND PSYCHONEUROSES

THE investigations of the writer started with the major anxiety attack. This somatic syndrome is composed of intense vasoconstriction of the skin (paresthesias, sensation of cold, pallor), tachycardia up to 150, inhibition of salivation, cold sweating, mydriasis, arterial hypertonus up to 150 mm. (of mercury), and relaxation of the voluntary muscle system. This indicates a stormy excitation of the sympathetic system, which may be combined at the end with parasympathetic phenomena. It was found that this syndrome could be removed by choline preparations, which by their stimulating effect on the parasympathetic nerve produced an effect exactly the opposite to the anxiety syndrome: by an intramuscular injection of 0-1 c.cm. acetylcholine the anxiety attack can be stopped also in its psychical effects, and even chronic anxiety attacks can disappear after a few days by oral administration of the choline preparations pacyl or hypotan. We can therefore suppose that the fear of an anxiety neurosis arises primarily in a somatic way. The vasoconstriction here plays an important part, and the character of the anxiety syndrome corresponding to the adrenaline effect may be traced back to a primary action of the adrenal glands. Since some sexual damage is found, such as the inhibition of normal relief, and since the anxiety could be removed both by the prevention of this and by choline preparations, this confirms Freud's theory of the damming up of libido, and Reich's theory of the origin of anxiety in a sympathetic-toxic action of the sexual hormone. The somatic genesis of neurotic anxiety can be designed in the following way. There is always a disturbance of the course of sexual irritation to be found. This results either from sexual abstinence caused by external or neurotic reasons, or from neurotic sexual hypaesthesia while relatively great libido is present, and leads, with a' certain sympatheticotonic disposition, to a strong excitation of the sympathetic system. At this point the mechanism can be interrupted by choline medication. According to the working through of the state of sympathetic excitation there results either the syndrome phrenocardia, or, with corresponding psychic preparedness, the anxiety neurosis. If this continues for some time it can become fixated and psychically worked through so that anxiety can then also arise from the psyche. The somatic neurosis only lasts for a certain time and then becomes built over in a psychoneurotic manner so that then it may only be treated by a longcontinued psychotherapy.