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In Chapter 2 I have explored Freud’s conception of addiction and his views on masturbation as the primal form of addiction. A question arises: Why wasn't Freud sure if masturbation should be considered an actual neurosis?
Trying to answer this question will also shed some light over the issue of classification of toxicomanias. Hence it is indispensable to review Freud's concept of actual neurosis in order to see if this concept can be useful in our understanding of toxicomania
At the beginning of his career Freud established two main categories in his clinical field, the actual neuroses and the psychoneuroses.
Both types of neuroses appear as the result of the psychic inability to master an accumulation of sexual excitation. We need to bear in mind that the source of the sexual excitation comes from the body. The concept of “drive” accounts for this.

a concept on the frontier between the mental and the somatic, as the psychical representative of the stimuli originating from the organism and reaching the mind, as a measure of the demand made upon the mind for work in consequence of its connection with the body (Freud, 1915, p. 118)

The distinction between actual neuroses and psychoneuroses can be found in the nature of the excitation. In psychoneuroses the excitation is of a psychological nature which results in a psychological conflict. The psychological conflict is precisely the psychoanalytic definition of “symptom”. With regard to actual neuroses this excitation is of a somatic nature only; Freud calls it a “somatic sexual excitation” (Freud, 1912 p.2562) which is not linked to a psychical representative. In actual neuroses the cause is “actual” (present) i.e. It does not admit to “being traced back historically or symbolically to operative experiences” (ibid. p.2571). In the actual neuroses the mechanisms found in psychoneurotic symptoms (condensation, displacement) do not take place. Freud considered that the “symptoms” of actual neuroses could not be analysed, leaving the field of actual neuroses outside psychoanalytical relevance.
We could speculate that in actual neuroses a process is lacking. What should be transferred from the body to the psychical sphere via a connection with a representative (i.e. a symbolic element) does not take place.
Freud argued that actual neuroses are the expression of a “toxic direct expression” (1925, p.4203). What is toxic comes from within the body and can’t be dealt with via symbolic means.
Ann De Rick (2002) takes up Freud’s ideas on actual neurosis to attempt an explanation for the mechanisms involved in toxicomania. She argues that this inability to deal symbolically with a toxicity from the body results in tension being “changed into anxiety and somatic equivalents of anxiety instead of being psychologically processed.” (De Rick, 2002 p.122). Her hypothesis is that pathologies like substance abuse, self mutilation, psychosomatic phenomena are borderline personality disorders and can be classified under the nosographic label "actual neuroses".
In order to outweigh the real value of this concept, it is important to remember that the three major diagnostic categories in psychoanalysis do not have the purpose of classifying every human subject (according to their pathologies) but they function as a structural organiser.
Following Lacan’s theorisations these structures are determined by the logic of castration. They don’t pre-exist the subject.
Their theoretical value lies precisely in the fact that they explain the complexities of human psychical structure using the minimum amount of elements (5). Hence, we don’t have a multiplicity of clinical entities according to their signs and symptoms as found in the DSM IV.
De Rick's approach seems to confuse psychoanalysis with psychology. Neurosis, Psychosis and Perversion define structures, and not a group of symptomatic signs.
We should not use psychoanalytic diagnostic categories reproducing the model of medicine and psychiatry as if clinicians “knew” about the patient and therefore could put him or her into one or various categories.
Another problem we face when we analyse toxicomania as belonging to what Freud called an actual neurosis is the question of total lack of symbolic activity. “There is no symbolic imaginary processing of the Real in the actual neurotic, the symptoms only exist at the level of the body” (De Rick, 2002 p.128)
Although the source of these “toxic” stimuli is within the body and the means of treatment affects the body directly, we could argue that saying that there is not a psychical correlate and a symbolic inscription (even thought this could be a rudimentary inscription) is imprecise. There is always a symbolic - imaginary processing, somatisation doesn’t happen without a symbolic meaning. To say “somatisation” without symbolic processing is a contradiction in itself.
Hector Lopez (2005) argues that this toxic shortcut via the body cannot be considered either a reflex action nor unmediated behaviour. The effects produced by the toxic substance are absolutely particular and depend on the discursive context. This indicates the existence of symbolic processes and a particular phantasy activity: the value of the drug lies precisely in its symbolic value.

Rik Loose’s position regarding the use of the concept of actual neuroses to describe the mechanisms involved in addiction also has some conceptual contradictions. He argues that considering addiction as an actual neurosis would make it a clinical entity separated from the other clinical structures and their symptoms (2002, p 218). As chemical intoxication is not a symptom in psychoanalytic terms it can therefore not be resolved.
He argues that some chronic addictions have their root in actual neurosis

“The chemical processing of actual neurosis is a fourth form of addiction and it is a form of addiction that has its own relationship vis-à-vis the Other. This relationship modality is characterized by the independent administration of jouissance which functions as the governing or regulating of an unbearable real; a real that threatens to annihilate the subject in actual neuroses.” (ibid, p.220)

These ideas suggest that actual neurosis can be the root of some addictions and/or actual neurosis describes a fourth form of addiction: i.e. it acquires a function in relation to the Other different from the three classical clinical structures. This use of the Freudian concept does not account for a specific mechanism on addiction for psychoanalysis. Moreover, it adds obscurity to the theorisations.
One should pose the question if this reintroduction of the Freudian concept of actual neurosis into contemporary approaches has been useful.
The answer would be that it can be useful to understand the nature of the mechanisms involved in toxicomania, as long as we keep in mind its relationship with the three major categories in psychoanalysis.
Freud suggests that in the case of Actual Neurosis psychoanalysis can only help in an indirect way.

an analytic treatment can have an indirect curative effect on ‘actual’ symptoms. It can do so either by enabling the current noxae to be better tolerated, or by enabling the sick person to escape from the current noxae by making a change in his sexual régime. These would be desirable prospects from the point of view of
our therapeutic interest. (1912 p. 2571).

If we consider toxicomania to be a form of actual neurosis then we can speculate that the subject is suffering as a result of the influence of two kinds of noxae.
The first comes form the realm of the body and might be of a more “primitive" or structural nature. We could provisionally add that toxicity arises as a result of a deficit in the symbolic processing.
We will explore in the next chapter the relationship between this structural deficit and the conception of pain.
I would add a second type of noxae which also emanates from the body but, in this case, as a result of biological changes in the nervous system produced by continuous use of certain toxic substances.
In any case, the interest in the concept of Actual Neurosis is only descriptive.