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CLINICAL NOTES
ON OBSESSIONAL NEUROSIS
Sigmund Freud (1913). ‘The Disposition to Obsessional Neurosis: A Contribution to
the Problem of Choice of Neurosis,’ On Psychopathology, translated by James
Strachey, edited by Angela Richards (London: Penguin Books, 1987), pp. 129-144.
These clinical notes summarize the main points raised by Sigmund Freud’s paper of
1913 on obsessional neurosis.
This paper was translated into English in 1924 and 1958. It was first presented to a
gathering of psychoanalysts at Munich in September 1913.
Freud’s main concern is not only with the subject’s disposition to obsessional
neurosis, but to the meta-psychological problem of the ‘choice of neurosis.’
The term ‘choice of neurosis’ should remind Freud’s readers of two other forms of
choice that are of interest to analysts: choice of object and the choice of the analyst.
The forms of choice available to the subject, and how he actually makes those
existential choices constitute important clues to the state of the subject’s dispositions
to health and illness.
It is also an indication of how the patient relates to the fantasies induced by the
oedipal matrix; and the state of his ‘pre-transference’ to the analyst in the locus of the
sujet supposé savoir.
In this paper, the focus is on how and when the subject chooses to fall ill.
Why should the subject fall ill of an obsessional neurosis when he can choose to be a
hysteric or a pervert instead?
This, to put it simply, is the ‘choice of neurosis’ problem.

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Freud starts by defining the term ‘disposition’ in his theory of neurosis.
A disposition, for Freud, is an inhibition in individual development.
When Freud wrote this paper in 1913, he wasn’t clear as how these dispositions – in
the form of inhibitions – come into place in the course of individual development.
It was only later on, in 1926-27, that Freud was able to explain the difference
between an ‘inhibition’ and a ‘symptom’ clearly in his paper titled ‘Inhibitions,
Symptoms, and Anxiety.’
Freud started by thinking about the course of individual development as a sequence
of events that takes the shape of a chronological order.
It appeared to be the case that whether the subject chose to fall ill of hysteria,
obsessional neurosis, paranoia, or dementia praecox was a matter of the age during
which the subject fell ill.
The psychoneuroses mentioned above are listed in a particular sequence above
because they bring out the importance of chronology.
Hysteria is the first of these illnesses to appear; obsessional neurosis is most likely to
appear between the ages of six to eight; the paraphrenias are most likely to afflict the
subject during the pubertal years or in young adulthood.
In other words, Freud seems to be saying that the disposition to a neurosis is a
matter of when the subject falls ill.
Likewise, in the case of megalomania, Freud thought it must be located in the phase
of ‘auto-erotism and narcissism’ before the subject has made an object choice.
Freud therefore concludes his description of the chronology model of the choice of
neurosis by saying that ‘these forms of illness, which make their appearance so late,
go back to very early inhibitions and fixations.’
If hysteria and obsessional neurosis go way back to inhibitions in childhood, how
should Freud differentiate between them in terms of the subject’s choice of an
illness?
Freud attempts to answer this question by invoking observations from a case where
a female patient who came to him with anxiety hysteria suddenly found that the
ailment had become an obsessional neurosis.
Why did Freud think that this case and what it had to teach was significant for the
choice of neurosis problem?

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The answer was that the neurosis took the form of a ‘bilingual document.’ In other
words, identical content was being expressed in ‘different languages.’
Freud then began to wonder whether there could be a number of inhibitions and
fixations during childhood that might be the cause of the subject’s neurosis.
Freud concluded that the patient became obsessional because of another trauma that
had taken primacy over the earlier trauma.
This trauma related to the fact that she had remained childless and when her
husband had a bout of impotence, she came down with obsessional symptoms.
So it was not – as Freud feared – that the same content was being expressed in
different languages but the displacement of an earlier trauma by a later trauma. That
is why the anxiety neurosis unexpectedly gave way to an obsessional neurosis.
The analyses of megalomania and the paraphrenias taught Freud the importance of
narcissism in the choice of neurosis problem.
In narcissistic neuroses, the choice of object is the ego itself; the ego chooses itself as the
only object worthy of itself.
Freud also differentiates between forms of object choice before and after ‘the
primacy of the genital zones’ has been ‘established’ in the psyche.
If the object choice pre-dates the genital organization of the libido then component
instincts like erotism and sadism will dominate. In the case that Freud analyses in
this paper, the patient’s libido regressed to the pre-genital level of organization.
So when the patient’s husband had a bout of impotence, her libido as a wife
regressed to a state of pre-genital organization and activated sadistic behaviour on
her part.
That is why the anxiety neurosis suddenly gave way to an obsessional neurosis.
In Freud’s model of causality, the component instincts play an important role; hence
the difference between what is ’sexual’ and what is ‘genital.’
Regression activates the component instincts of the subject’s sexuality making it
difficult to perform at the genital level.
That is why psychic impotence is the most important symptom in psychoanalysis.
In impotent subjects, the component sexual instincts have not been able to converge
together to further the genital function.

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The neurotic subject, to conclude, is always regressing to the oral, anal, or phallic
levels of libidinal organization.
When the subject regresses, it leads to an activation of character traits associated
with pre-genital levels of libidinal organization.
It is not only true, Freud points out, of obsessional neurosis where the character
traits are sadism and hate, but for all the neuroses.
That is why the analytic model of character traits and character development is
related to the libidinal economy of the subject.
SHIVA KUMAR SRINIVASAN