Breve revisión de “Sobre la justificación de separar de la neurastenia un determinado síndrome en calidad de ‘neurosis de angustia’(1895)

The golden days (Balthus, 1946)

El artículo data de 1895, y forma parte de los primeros escritos científicos de Freud. En su búsqueda por delimitar una nosografía propia del Psicoanálisis, se hace necesario diferenciar aquellos cuadros inabordables por el método psicoanalítico. Por esto, es preciso separar la neurosis de angustia de la neurastenia. De un lado quedarán las psiconeurosis de defensa: histeria de angustia, histeria de conversión y neurosis obsesiva. Estas se distinguen por el mecanismo de formación de síntomas, pero comparten la misma etiología, a saber, un conflicto psíquico producto de un deseo sexual infantil reprimido. Del otro lado, la neurosis de angustia y la neurastenia formarán parte de otro grupo, a la que se sumará la hipocondría (1914), dentro de las llamadas neurosis actuales. Su orígen no es psíquico, sino que la causa será somática: “la acumulación de excitación sexual frustránea, que no halla descarga en el ámbito psíquico” (p. 88). 

En la neurosis de angustia y la neurastenia existen perturbaciones de la vida sexual actual. Lo que está actualizado en el presente, es decir, aquello que está en acto y no en el pensamiento. No hay defensa, ni mecanismo psíquico; no hay ni desplazamiento, ni sustitución. La fórmula etiológica la encontramos en las prácticas sexuales de los enfermos. Freud (1895) sostiene que:

           […] es preciso distinguir entre las condiciones etiológicas para la producción de las primeras (neurosis) – p. ej., coitus interruptus, la masturbación, la abstinencia- son todavía multívocas y capaces de producir cualquiera entre diferentes neurosis; sólo los factores etiológicos de aquellas abstraídos, como un aligeramiento inadecuado, una insuficiencia psíquica, una defensa con sustitución, poseen un nexo inequívoco y específico con la etiología de cada una de las grandes neurosis (p. 114). 

Estos son casos donde aparece la angustia o sus equivalentes dominando el cuadro, como por ejemplo el malestar difuso, ataques de angustia, irritabilidad generalizada, entre otros. Siguiendo esta línea, se sostiene que el psicoanálisis no es un método aplicable a este tipo de cuadros psicopatológicos, pues no se trata de un conflicto intersistémico ni de un deseo sexual infantil reprmidido, la etiología la encontramos en la actualidad. La cura será por la vía de una adecuada práctica sexual, podría decirse de una sana higiene sexual. ¿Qué se entiende por sana higiene sexual?, ¿hasta qué punto influye la moral sexual de la época en esta noción? 

La noción de higiene era utilizada para referirse a las prácticas sexuales que se consideraban correctas en términos de mecánica del coito, y es una de las concepciones que se desprende de las tesis de este artículo. En este punto, conviene explorar el contexto histórico de producción del artículo, y explayar la idea de moral sexual victoriana. La Reina Victoria llegó al trono británico en 1837 y reinó hasta su muerte en 1901. Este período se lo conoce como época victoriana, en su honor, y supuso grandes cambios en la política, la economía, la cultura y la ciencia. Además, su reinado exigió estrictos regímenes de conducta que engloba la llamada moral victoriana: caracterizada por una fuerte represión sexual y por un puritanismo extremo. Este es el contexto en el que Freud realiza su obra, y también dedica parte de ella a criticar muchos de estos aspectos. En La sexualidad en la etiología de las neurosis (1898) se dedica a tomar partido y criticar la mojigatería de los médicos, el malthusianismo, y opina sobre el uso de anticonceptivos. Cabe preguntarnos, que si bien por un lado critica la fuerte represión sexual de la época, por otro lado ¿puede estar reproduciendo algo del imaginario sobre una práctica sexual normal en su teoría?

En los textos citados se hace referencia a que el sujeto debe cancelar la tensión libidinosa que configura el estado psíquico previo al posible desarrollo de una neurosis actual. Freud dice que ese “alivio psíquico sólo es posible por el camino que designare acción específica o adecuada” (p). ¿Cuál es la práctica sexual que tiene Freud en mente? ¿Puede estar reproduciendo una práctica heterosexual, cisexual y coitocéntrica? Estas preguntas emergen a la hora de pensar la clínica de nuestro tiempo, ¿qué anatomía tenemos los psicoanalistas a la hora de pensar las prácticas sexuales? ¿Cómo impacta a la hora de realizar un diagnóstico diferencial? Podemos jugar con cierto paralelismo de las teorías sexuales infantiles desarrolladas por Freud en sus Tres ensayos de una teoría sexual (1905), que plasman una forma infantil de imaginarización de la diferencia de los géneros, y preguntarnos ¿cuáles son las teorías sexuales de los psicoanalistas?. A la consulta clínica llegan pluralidades de identidades, de modos de goce y prácticas eróticas. Pensemos en la pluralidad de rasgos de nuestros pacientes: transexuales, identidades indígenas, vinculaciones no monógamas, en relatos de prácticas sexuales no coitocéntricas. El modo que tenemos de pensar esas subjetividades y esos cuerpos puede responder a un recorte disciplinado sobre el cuál hemos edificado una teoría, porque la producción de subjetividad de nuestra época se filtra hacia ambos lados del diván. Luego de considerar críticamente los fundamentos de la teoría psicoanalítica y reconocer la posible influencia de núcleos ideológicos, especialmente en relación con cuestiones de género, surge la imperiosa necesidad de reevaluar y revitalizar esta disciplina. Desde una perspectiva epistemológica, la presencia de elementos ideológicos podría cuestionar la base científica del psicoanálisis. Por tanto, asumir este desafío se convierte en un deber ético esencial, destinado a desentrañar los paradigmas y sesgos que podrían obstaculizar su efectividad. Este proceso de revisión no solo implica adaptar la teoría a la diversidad de identidades, prácticas eróticas y modos de goce contemporáneos, sino también enriquecerla y actualizarla. Al abrazar una perspectiva más inclusiva y receptiva, el psicoanálisis puede mantener su relevancia y contribuir de manera significativa a la comprensión de la complejidad de la psique humana en el siglo XXI. En última instancia, este llamado a la reflexión y transformación busca consolidar al psicoanálisis como un campo dinámico y vital, capaz de sostener sus paradigmas sin desconocer los cambios socioculturales y científicos, y así continuar siendo una herramienta valiosa para mitigar el sufrimiento humano. 

Referencias Bibliográficas

  • Freud, S. (1898). La sexualidad en la etiología de las neurosis.  A. E., III.
  • Freud, S. (1895 [1894]). Sobre la justificación de separar de la neurastenia un determinado síndrome en calidad de ‘neurosis de angustia’. A. E., III.
  • Vera-Gamboa, L. (1998). Historia de la sexualidad. Recuperado en: http://www2.udec.cl/~erhetz/privada/sexualidad/unidad_01/historia_sexualidad.pdf  

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