Neurosis

This article is about the term in psychology. For the band, see Neurosis (band).

Not to be confused with Psychosis or Neuroticism.

Neurosis
Other names	Psychoneurosis, neurotic disorder
Specialty	Psychiatry, clinical psychology

Neurosis (plural: neuroses) is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety. It has in recent history also referred to anxiety-related conditions more generally.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for it's descendant term neuroticism, a personality trait that is one of the Big Five personality traits.

History

The term is derived from the Greek word neuron (νεῦρον, 'nerve') and the suffix -osis (-ωσις, 'diseased' or 'abnormal condition').

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to "disorders of sense and motion" caused by a "general affection of the nervous system." Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century.

The meaning of the term was redefined by Austrian psychiatrist Sigmund Freud. Freud's first theory of neurosis was that it referred to mental disorders caused by the brain's defence against past psychic trauma. It is this concept that has best persisted.

Followers of his psychoanalytic thinking, including the Swiss Carl Jung, German-American Karen Horney, and the French Jacques Lacan, continued to develop Freud's neurosis ideas during the early and middle 20th century. It continues to be used in this sense in psychology and philosophy.

For a 1947 book, German-British psychologist Hans Eysenck created the term "neuroticism" to refer to someone whose "constitution may leave them liable to break down [emotionally] with the slightest provocation." The book outlines a two factor theory of personality, with neuroticism as one of those two factors. This book would be greatly influential on future personality theory.

After Freudian thinking became less important in psychology, the term "neurosis" came to be used as a near synonym for "anxiety". The second edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1968 described neuroses thusly:

Anxiety is the chief characteristic of the neuroses. It may be felt and expressed directly, or it may be controlled unconsciously and automatically by conversion, displacement and various other psychological mechanisms. Generally, these mechanisms produce symptoms experienced as subjective distress from which the patient desires relief. The neuroses, as contrasted to the psychoses, manifest neither gross distortion or misinterpretation of external reality, nor gross personality disorganization...

The DSM eliminated it's neurosis category in 1980, because of a decision by its editors to provide descriptions of behavior rather than descriptions of hidden psychological mechanisms. This change was controversial. The various anxiety-rich conditions previously considered neuroses are now classified differently.

The term "neurosis" is also no longer used in condition names or categories by the World Health Organization's International Classification of Diseases (ICD). According to the American Heritage Medical Dictionary, the term is "no longer used in psychiatric diagnosis."

The Freudian meaning is conveyed through the DSM-5's "Trauma and Stress-Related Disorders" and the ICD-11's "Disorders specifically associated with stress" categories of conditions.

The term "neuroticism" is also not used for DSM or ICD conditions, however, it is a common name for one of the Big Five personality traits. A similar concept is included in the ICD-11 as the condition "negative affectivity".

Symptoms and causes

Historic versions of the DSM and ICD

The term is no longer used in a professional diagnostic sense, having been eliminated from the DSM in 1980 with the publication of DSM III, and having the last remnants of being removed from the ICD with the enacting of the ICD-11 in 2022. (In the ICD-10 it was used in section F48.8 to describe certain minor conditions.)

According to the "anxiety" concept of the term, there were many different neuroses, including:

• obsessive–compulsive disorder
• obsessive–compulsive personality disorder
• impulse control disorder
• anxiety disorder
• histrionic personality disorder
• dissociative disorder
• a great variety of phobias

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

... anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc.

Psychoanalytic (Freudian) theory

Main article: Psychoanalysis

According to psychoanalytic theory, neuroses may be rooted in ego defense mechanisms, though the two concepts are not synonymous. Defense mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e., an ego). However, only those thoughts and behaviors that produce difficulties in one's life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive–compulsive disorder, a phobia, or a personality disorder.

Jungian theory

Main article: Jung's theory of neurosis

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have "frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life". Accordingly, the majority of his patients "consisted not of believers but of those who had lost their faith". A contemporary person, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by 'powers' that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual's inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: "Our world is, so to speak, dissociated like a neurotic."

Horney's theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from their early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child's initial reality is then distorted by their parents' needs and pretenses. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child's imagination creates an idealized self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular "solution" of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once they identify themselves with their idealized image, a number of effects follow. They will make claims on others and on life based on the prestige they feel entitled to because of their idealized self-image. They will impose a rigorous set of standards upon themselves in order to try to measure up to that image. They will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, they will despise themselves for all their limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as they grow to adulthood, a particular "solution" to all the inner conflicts and vulnerabilities will solidify. They will be either

• expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness
• self-effacing and compulsively compliant, displaying symptoms of neediness or codependence
• resigned, displaying schizoid tendencies

In Horney's view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realization, a state of being in which the person responds to the world with the full depth of their spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualize their inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.

See also

• Individuation
• Neurotics Anonymous
• Positive disintegration

References

Bibliography

• Angyal, Andras. 1965. Neurosis and Treatment: A Holistic Theory, edited by E. Hanfmann and R. M. Jones.
• Fenichel, Otto. 1945. The Psychoanalytic Theory of Neurosis. New York: Norton.
• Freud, Sigmund. 1953–1974. The Standard Edition of the Complete Psychological Works of Sigmund Freud. (24 vols.), translated by J. Strachey. London: Hogarth.
• Horney, Karen. 1937. The Collected Works. (2 vols.). Norton.
• —— 1945. Our Inner Conflicts. Norton.
• 1950. Neurosis and Human Growth. Norton.
• Horwitz, A. V. and J. C. Wakefield. 2007. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford University Press. ISBN 978-0-19-531304-8.
• Jung, Carl G. [1921] 1971. Psychological Types, (The Collected Works of C. G. Jung 6). Princeton University Press. ISBN 0-691-01813-8.
• —— 1966. Two Essays on Analytical Psychology, (The Collected Works of C. G. Jung 7). Princeton University Press. ISBN 0-691-01782-4.
• Jung, Carl G., and Aniela Jaffé. [1961] 1989. Memories, Dreams, Reflections. New York: Vantage Books. ISBN 0-679-72395-1
• Jung, Carl G., et al. 1964. Man and His Symbols. New York: Anchor Books / Doubleday. ISBN 0-385-05221-9.
• Ladell, R. M., and T. H. Hargreaves. 1947. "The Extent of Neurosis." British Medical Journal 2(4526):548–49. doi:10.1136/bmj.2.4526.548. PMC 2055884. PMID 20267012.
• López-Piñero J.M. (1983) Historical Origins of the Concept of Neurosis (Translated by D. Berrios) Cambridge, Cambridge University Press
• McWilliams, Nancy. 2011. Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd ed.). Guilford Press. ISBN 978-1-60918-494-0.
• Russon, John. 2003. Human Experience: Philosophy, Neurosis, and the Elements of Everyday Life. Albany: State University of New York Press. ISBN 0-7914-5754-0
• Winokur, Jon. 2005. Encyclopedia Neurotica. ISBN 0-312-32501-0.

External links

• Janov, Arthur (1991). "Neurosis". Retrieved 2009-04-21.