The sexual impulse of the psychoneurotic shows all the aberrations which we have studied as variations of the normal and as manifestations of morbid sexual life.

(a) In all the neurotics without exception we find feelings of inversion in the unconscious psychic life, fixation of libido on persons of the same sex.  It is impossible, without a deep and searching discussion, adequately to appreciate the significance of this factor for the formation of the picture of the disease; I can only assert that the unconscious propensity to inversion is never wanting and is particularly of immense service in explaining male hysteria.[26]

(b) All the inclinations to anatomical transgression can be demonstrated in psychoneurotics in the unconscious and as symptom-creators.  Of special frequency and intensity are those which impart to the mouth and the mucous membrane of the anus the role of genitals.

(c) The partial desires which usually appear in contrasting pairs play a very prominent role among the symptom-creators in the psychoneuroses.  We have learned to know them as carriers of new sexual aims, such as peeping mania, exhibitionism, and the actively and passively formed impulses of cruelty.  The contribution of the last is indispensable for the understanding of the morbid nature of the symptoms; it almost regularly controls some portion of the social behavior of the patient.  The transformation of love into hatred, of tenderness into hostility, which is characteristic of a large number of neurotic cases and apparently of all cases of paranoia, takes place by means of the union of cruelty with the libido.

The interest in these deductions will be more heightened by certain peculiarities of the diagnosis of facts.

Alpha.  There is nothing in the unconscious streams of thought of the neuroses which would correspond to an inclination towards fetichism; a circumstance which throws light on the psychological peculiarity of this well understood perversion.

Beta.  Wherever any such impulse is found in the unconscious which can be paired with a contrasting one, it can regularly be demonstrated that the latter, too, is effective.  Every active perversion is here accompanied by its passive counterpart.  He who in the unconscious is an exhibitionist is at the same time a voyeur, he who suffers from sadistic feelings as a result of repression will also show another reinforcement of the symptoms from the source of masochistic tendencies.  The perfect concurrence with the behavior of the corresponding positive perversions is certainly very noteworthy.  In the picture of the disease, however, the preponderant role is played by either one or the other of the opposing tendencies.

Gamma.  In a pronounced case of psychoneurosis we seldom find the development of one single perverted impulse; usually there are many and regularly there are traces of all perversions.  The individual impulse, however, on account of its intensity, is independent of the development of the others, but the study of the positive perversions gives us the accurate counterpart to it.