In his article "Types of Onset of Neurosis" (1912c), Freud used the word "frustration" (Versagung) for the first time to describe both internal and external factors that cause neurosis. He wrote, "Psycho-analysis has warned us that we must give up the unfruitful contrast between external and internal factors, between experience and constitution, and has taught us that we shall invariably find the cause of the onset of neurotic illness in a particular psychical situation which can be brought about in a variety of ways" (p. 238). In essential particulars he continued to hold this view, going on to write, for example, about a narcissistic form of frustration. The concept of frustration seems to cover the idea of privation, while sometimes going beyond it. Freud was aware of a conceptual difficulty here, and he attributed its resolution to psychoanalysis rather to the innate genius of the German language. In The Future of an Illusion (1927c), he wrote, "For the sake of a uniform terminology we will describe the fact that an instinct cannot be satisfied as a 'frustration,' the regulation by which this frustration is established as a 'prohibition' and the condition which is produced by the prohibition as a 'privation' " (p. 10). Later in this work he specified the drive urges subject to frustration, prohibition, and privation: incestuous, murderous, and cannibalistic wishes. Source: http://www.enotes.com/frustration-reference/frustration

1. TYPES OF ONSET OF NEUROSIS
Sigmund Freud (1912)
Revised by www.freud-sigmund.com
TYPES OF ONSET OF NEUROSIS
In the pages which follow, I shall describe, on the basis of impressions arrived at empirically, the changes
which conditions must undergo in order to bring about the outbreak of a neurotic illness in a person with a
disposition to it. I shall thus be dealing with the question of the precipitating factors of illnesses and shall
have little to say about their forms. The present discussion of the precipitating causes will differ from
others in that the changes to be enumerated will relate exclusively to the subject’s libido. For psycho-
analysis has taught us that the vicissitudes of the libido are what decide in favor of nervous health or
sickness. Nor are words to be wasted in this connection on the concept of disposition. It is precisely
psycho-analytic research which has enabled us to show that neurotic disposition lies in the history of the
development of the libido, and to trace back the operative factors in that development to innate varieties
of sexual constitution and to influences of the external world experienced in early childhood.
(a) The most obvious, the most easily discoverable and the most intelligible precipitating cause of an onset
of neurosis is to be seen in the external factor which may be described in general terms as frustration. The
subject was healthy so long at his need for love was satisfied by a real object in the external world; he
becomes neurotic as soon as this object is withdrawn from him without a substitute taking its place. Here
happiness coincides with health and unhappiness with neurosis. It is easier for fate to bring about a cure
than for the physician; for it can offer the patient a substitute for the possibility of satisfaction which he
has lost.
Thus with this type, to which, no doubt, the majority of human beings on the whole belong, the possibility
of falling ill arises only when there is abstinence. And it may be judged from this what an important part in
the causation of neuroses may be played by the limitation imposed by civilization on the field of accessible
satisfactions. Frustration has a pathogenic effect because it dams up libido, and so submits the subject to a
test as to how long he can tolerate this increase in psychical tension and as to what methods he will adopt
for dealing with it. There are only two possibilities for remaining healthy when there is a persistent
frustration of satisfaction in the real world. The first is by transforming the psychical tension into active
energy which remains directed towards the external world and eventually extorts a real satisfaction of the
libido from it. The second is by renouncing libidinal satisfaction, sublimating the dammed-up libido and
turning it to the attainment of aims which are no longer erotic and which escape frustration. That these
two possibilities are realized in men’s lives proves that unhappiness does not coincide with neurosis and
that frustration does not alone decide whether its victim remains healthy or falls ill. The immediate effect
of frustration lies in its bringing into play the dispositional factors which have hitherto been inoperative.
Where these are present and sufficiently strongly developed, there is a risk of the libido becoming
‘introverted’.№ It turns away from reality, which, owing to the obstinate frustration, has lost its value for
the subject, and turns towards the life of phantasy, in which it creates new wishful structures and revives
the traces of earlier, forgotten ones. In consequence of the intimate connection between the activity of
phantasy and material present in everyone which is infantile and repressed and has become unconscious,
and thanks to the exceptional position enjoyed by the life of phantasy in regard to reality-testing, І the
libido may thenceforward move on a backward course; it may follow the path of regression along infantile
lines, and strive after aims that correspond with them. If these strivings, which are incompatible with the
subject’s present-day individuality, acquire enough intensity, a conflict must result between them and the
other portion of his personality, which has maintained its relation to reality. This conflict is resolved by the
formation of symptoms, and is followed by the onset of manifest illness. The fact that the whole process
originated from frustration in the real world is reflected in the resulting event that the symptoms, in which
the ground of reality is reached once more, represent substitutive satisfactions.
(b) The second type of precipitating cause of falling ill is by no means so obvious as the first; and it was in
fact only possible to discover it through searching analytic investigations following on the Zurich school’s
theory of complexes.№ Here the subject does not fall ill as a result of a change in the external world which
has replaced

2. satisfaction by frustration, but as a result of an internal effort to obtain the satisfaction which is accessible
to him in reality. He falls ill of his attempt to adapt himself to reality and to fulfill the demands of reality -
an attempt in the course of which he comes up against insurmountable internal difficulties.
It is advisable to draw a sharp distinction between the two types of onset of illness - a sharper distinction
than observation as a rule permits. In the first type what is prominent is a change in the external world; in
the second type the accent falls on an internal change. In the first type the subject falls ill from an
experience; in the second type it is from a developmental process. In the first case he is faced by the task
of renouncing satisfaction, and he falls ill from his incapacity for resistance; in the second case his task is to
exchange one kind of satisfaction for another, and he breaks down from his inflexibility. In the second case
the conflict, which is between the subject’s effort to remain as he is and the effort to change himself in
order to meet fresh purposes and fresh demands from reality, is present from the first. In the former case
the conflict only arises after the dammed-up libido has chosen other, and incompatible, possibilities of
satisfaction. The part played by the conflict and the previous fixation of the libido is incomparably more
obvious in the second type than in the first, in which such unserviceable fixations may perhaps only emerge
as a result of the external frustration.
A young man who has hitherto satisfied his libido by means of phantasies ending in masturbation, and who
now seeks to replace a regime approximating to auto-erotism by the choice of a real object - or a girl who
has given her whole affection to her father or brother and who must now, for the sake of a man who is
courting her, allow her hitherto unconscious incestuous libidinal wishes to become conscious - or a married
woman who would like to renounce her polygamous inclinations and phantasies of prostitution so as to
become a faithful consort to her husband and a perfect mother to her child - all of these fall ill from the
most laudable efforts, if the earlier fixations of their libido are powerful enough to resist a displacement;
and this point will be decided, once again, by the factors of disposition, constitution and infantile
experience. All of them, it might be said, meet with the fate of the little tree in the Grimms’ fairy tale,
which wished it had different leaves. From the hygienic point of view - which, to be sure, is not the only
one to be taken into account - one could only wish for them that they had continued to be as undeveloped,
as inferior and as useless as they were before they fell ill. The change which the patients strive after, but
bring about only imperfectly or not at all, invariably has the value of a step forward from the point of view
of real life. It is otherwise if we apply ethical standards: we see people falling ill just as often when they
discard an ideal as when they seek to attain it.
In spite of the very clear differences between the two types of onset of illness that we have described, they
nevertheless coincide in essentials and can without difficulty be brought together into a unity. Falling ill
from frustration may also be regarded as incapacity for adaptation to reality - in the particular case, that is,
in which reality frustrates satisfaction of libido. Falling ill under the conditions of the second type leads
directly to a special case of frustration. It is true that reality does not here frustrate every kind of
satisfaction; but it frustrates the one kind which the subject declares is the only possible one. Nor does the
frustration come immediately from the external world, but primarily from certain trends in the subject’s
ego. Nevertheless, frustration remains the common factor and the more inclusive one. In consequence of
the conflict which immediately sets in in the second type, both kinds of satisfaction - the habitual one as
well as the one aimed at - are equally inhibited; a damming-up of libido, with all its consequences, comes
about just as it does in the first case. The psychical events leading to the formation of symptoms are if
anything easier to follow in the second type than in the first; for in the second type the pathogenic
fixations of the libido do not need to be freshly established, but have already been in force while the
subject was healthy. A certain amount of introversion of libido is, as a rule, already present; and there is a
saving of some part of the subject’s regression to the infantile stage, owing to the fact that his forward
development has not yet completed its course.
(c) The next type, which I shall describe as falling ill from an inhibition in development, looks like an
exaggeration of the second one - falling ill from the demands of reality. There is no theoretical reason for
distinguishing it, but only a practical one; for those we are here concerned with are people who fall ill as
soon as they get beyond the irresponsible age of childhood, and who have thus never reached a phase of
health - a phase, that is, of capacity for achievement and enjoyment which is on the whole unrestricted.
The essential feature of the dispositional process is in these cases quite plain. Their libido has never left its
infantile fixations; the demands of reality are not suddenly made upon a wholly or partly mature person,
but arise from the very fact of growing older, since it is obvious that they constantly alter with the subject’s
increasing age. Thus conflict falls into the background in comparison with insufficiency. But here, too, all
our other experience leads us to postulate an effort at overcoming the fixations of childhood; for otherwise
the outcome of the process could never be neurosis but only a stationary infantilism.

3. (d) Just as the third type has brought the dispositional determinant before us almost in isolation, so the
fourth type, which now follows, draws our attention to another factor, which comes into consideration in
every single case and might easily for that very reason be overlooked in a theoretical discussion. We see
people fall ill who have hitherto been healthy, who have met with no fresh experience and whose relation
to the external world has undergone no change, so that the onset of their illness inevitably gives an
impression of spontaneity. A closer consideration of such cases, however, shows us that none the less a
change has taken place in them whose importance we must rate very highly as a cause of illness. As a
result of their having reached a particular period of life, and in conformity with regular biological
processes, the quantity of libido in their mental economy has experienced an increase which is in itself
enough to upset the equilibrium of their health and to set up the necessary conditions for a neurosis. It is
well known that more or less sudden increases of libido of this kind are habitually associated with puberty
and the menopause - with the attainment of a certain age in women; in some people they may in addition
be manifested in periodicities that are still unknown. Here the damming-up of libido is the primary factor;
it becomes pathogenic as a consequence of a relative frustration on the part of the external world, which
would still have granted satisfaction to a smaller claim by the libido. The unsatisfied and dammed-up libido
can once again open up paths to regression and kindle the same conflicts which we have demonstrated in
the case of absolute external frustration. We are reminded in this way that the quantitative factor should
not be left out of account in any consideration of the precipitating causes of illness. All the other factors -
frustration, fixation, developmental inhibition - remain ineffective unless they affect a certain amount of
libido and bring about a damming-up of libido of a certain height. It is true that we are unable to measure
this amount of libido which seems to us indispensable for a pathogenic effect; we can only postulate it
after the resulting illness has started. There is only one direction in which we can determine it more
precisely. We may assume that it is not a question of an absolute quantity, but of the relation between the
quota of libido in operation and the quantity of libido which the individual ego is able to deal with - that is,
to hold under tension, to sublimate or to employ directly. For this reason a relative increase in the quantity
of libido may have the same effects as an absolute one. An enfeeblement of the ego owing to organic
illness or owing to some special demand upon its energy will be able to cause the emergence of neuroses
which would otherwise have remained latent in spite of any disposition that might be present.
The importance in the causation of illness which must be ascribed to quantity of libido is in satisfactory
agreement with two main theses of the theory of the neuroses to which psycho-analysis has led us: first,
the thesis that the neuroses are derived from the conflict between the ego and the libido, and secondly,
the discovery that there is no qualitative distinction between the determinants of health and those of
neurosis, and that, on the contrary, healthy people have to contend with the same tasks of mastering their
libido - they have simply succeeded better in them.
It remains to say a few words on the relation of these types to the facts of observation. If I survey the set of
patients on whose analysis I am at the moment engaged, I must record that not one of them is a pure
example of any of the four types of onset. In each of them, rather, I find a portion of frustration operating
alongside of a portion of incapacity to adapt to the demands of reality; inhibition in development, which
coincides, of course, with inflexibility of fixations, has to be reckoned with in all of them, and, as I have
already said, the importance of quantity of libido must never be neglected. I find, indeed, that in several of
these patients their illness has appeared in successive waves, between which there have been healthy
intervals, and that each of these waves has been traceable to a different type of precipitating cause. Thus
the erection of these four types cannot lay claim to any high theoretical value; they are merely different
ways of establishing a particular pathogenic constellation in the mental economy - namely the damming-up
of libido, which the ego cannot, with the means at its command, ward off without damage. But this
situation itself only becomes pathogenic as a result of a quantitative factor; it does not come as a novelty
to mental life and is not created by the impact of what is spoken of as a ‘cause of illness’.
A certain practical importance may readily be allowed to these types of onset. They are to be met with in
their pure form, indeed, in individual cases; we should not have noticed the third and fourth types if they
had not in some subjects constituted the sole precipitating causes of the illness. The first type keeps before
our eyes the extraordinarily powerful influence of the external world, and the second the no less important
influence - which opposes the former one - of the subject’s peculiar individuality. Pathology could not do
justice to the problem of the precipitating factors in the neuroses so long as it was merely concerned with
deciding whether those affections were of an ‘endogenous’ or ‘exogenous’ nature. It was bound to meet
every observation which pointed to the importance of abstinence (in the widest sense of the word) as a
precipitating cause with the objection that other people tolerate the same experiences without falling ill. If,
however, it sought to lay stress on the peculiar individuality of the subject as being the essential factor
decisive between illness and health, it was obliged to put

4. up with the proviso that people possessing such a peculiarity can remain healthy indefinitely, just so long
as they are able to retain that peculiarity. Psycho-analysis has warned us that we must give up the
unfruitful contrast between external and internal factors, between experience and constitution, and has
taught us that we shall invariably find the cause of the onset of neurotic illness in a particular psychical
situation which can be brought about in a variety of ways.
Other Works by Sigmund Freud:
 Civilization and its discontents
 Creative writers and day-dreaming
 The interpretation of dreams