February 1962

Choice of Illness

Author Affiliations

Department of Research, The Menninger Foundation.

Arch Gen Psychiatry. 1962;6(2):149-156. doi:10.1001/archpsyc.1962.01710200041005

In the paper,5 "Notes upon a Case of Obsessional Neurosis," Freud makes the following statement regarding the dynamics in his case:

"If we consider a number of analyses of obsessional neurotics we shall find it impossible to escape the impression that the relation between love and hatred such as we have found in our present patient is among the most frequent, the most marked, and probably, therefore, the most important characteristics of obsessional neurosis. But, however tempting it may be to bring the problem of the 'choice of neurosis' into connection with instinctual life, there are reasons enough for avoiding such a course. For we must remember that in every neurosis we come upon the same suppressed instincts behind the symptoms. After all, hatred, kept suppressed in the unconscious by love, plays a great part in the pathogenesis of hysteria and paranoia. We know too little

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