Already as a student, Reich became part of Freud's inner circle in Vienna around 1920 and stood out as a brilliant theoretician of psychoanalysis.

From the beginning, his main focus was on the exploration of healthy as well as neurotic sexuality. Orgasm in its healthy form is the complete discharge of excess bodily energies. In most people, due to neurotic character structures that are considered "normal", the capacity for sexual surrender is more or less limited - Reich called this "orgasmic impotent".

Neuroses develop in earliest childhood by forcibly stopping natural emotional impulses. Thus the libido, the life energy, is directed against the individual himself. The sum of all libido deflections is the structured character. With the character analysis, Reich created a standard work of psychoanalysis.

Reich's aim was to use the insights of psychoanalysis to prevent neuroses. He criticised the restriction to curing obsessive neuroses and hysterias among the Viennese upper class - with which most of his colleagues were occupied - as an elitist waste of important insights into the structures of psychological misery.

He was particularly concerned with the prevention of neuroses in children and adolescents as well as the sexual hygiene education of young people. As he met with rejection from the more conservative psychoanalysts in Vienna, he founded the "Sexpol Movement" within the KPD in Berlin, with which he very successfully carried out sex education for young workers. Freud and the established psychoanalysts were highly suspicious of his socialist orientation. So he was expelled from the Psychoanalytic Association - partly because he had opposed the death drive theory of the late Freud. The tacit ingratiation of important circles of psychoanalysis with the National Socialists may have been another important aspect.

Reich also made many enemies through his maladjusted, provocative style, so that he was confronted with malicious rumours about his state of mind throughout his life.