Neurosis

Neurosis, also known as psychoneurosis or neurotic disorder refers to any of a number of mental or emotional disorders, most of which involve a significant amount of anxiety or fear. Neuroses do not involve any sort of physical cause, and do not include psychotic symptoms such as delusions or hallucinations. The term is often associated with the field of psychoanalysis, but is no longer used in most psychiatric evaluation. In colloquial use, the term "neurotic" (one affected by neurosis) is used to describe a person with any degree of depression or anxiety, depressed feelings, lack of emotions, low self-confidence, and/or emotional instability.

Treatment of these disorders ranges from psychotherapy, to behavior therapy, to drugs, or a combination of these. While some types of neurotic disorder respond relatively well to treatment, others are less amenable or may recur. The origin and continued recurrence, generation after generation, of such disorders has yet to be solved.

History and use of the term

The term neurosis was coined by the Scottish doctor William Cullen in 1769, and derives from the Greek word neuron (nerve) with the suffix -osis (diseased or abnormal condition). Cullen used the term to refer to "disorders of sense and motion" caused by a "general affection of the nervous system." For him, it described various nervous disorders and symptoms that could not be explained physiologically. The term was however most influentially defined by Sigmund Freud and other psychoanalysts over a century later.

Neurosis was a popular term with Freud and other psychoanalysts. Freud defined neuroses as being manifestations of anxiety producing unconscious material that is too difficult to think about consciously, but must still find a means of expression.^[1] Hence, repressed events, disappointments, or traumas manifest later in life as neuroses.

The use of the term "neurosis" has declined in the scientific community. The American DSM-III has eliminated the category of Neurosis altogether, replacing it with specific types of disorders such as obsessive compulsive disorder (OCD). This largely reflects a decline in the popularity of psychoanalysis, and the progressive expurgation of psychoanalytical terminology from the DSM. Those who retain a psychoanalytical perspective continue to use the term 'neurosis', as well as practitioners of other therapies, such as Arthur Janov's Primal Therapy. According to The American Heritage Dictionary, however, it is "no longer in scientific use."^[2]

Symptoms of Neurosis

While neuroses are not rooted in physical causes, they can most certainly have physical effects. As a mental illness, the term "neurosis" represents a variety of psychiatric conditions in which emotional distress or unconscious conflict is expressed through various physical, physiological, and mental disturbances, and which may include physical symptoms. One of the most common and definitive symptoms of neurosis is anxiety.

Additional symptoms of neurosis can include:

...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.^[3]

Neurosis has perhaps been most simply defined as a "poor ability to adapt to one's environment, an inability to change one's life patterns, and the inability to develop a richer, more complex, more satisfying personality."^[3]

Types of Neuroses

Neuroses manifest in a variety of specific forms:

• Anxiety disorders (both acute and chronic) are a common type of neurosis. With these disorders, patients suffer irrational or illogical worry or fear that is not based in fact. Anxiety disorders can include panic disorder, where the patient suffers from severe bouts of anxiety, as well as generalized anxiety disorder, phobias, and PTSD (post-traumatic stress disorder), a disorder that often affects veterans and victims of traumatic situations.

• Related to anxiety disorders is hysteria, where a person experiences unmanageable fear or emotional excess, often in response to an imagined problem with a specific part of the body.

• Clinical depression is another common type of neurosis. When clinically depressed, a person experiences a state of intense sadness or despair that is disruptive to their social functioning and daily life.

• Obsessive-compulsive disorder is a type of anxiety disorder primarily characterized by obsessions and/or compulsions. With this type of disorder, a person will often develop rituals and thought patterns that are similar to superstitions. For example, walking in a certain pattern or turning a light on and off a specific number of times may be employed to alleviate the obsession that something bad will happen.

• Personality disorders such as borderline personality disorder are also possible manifestations of neurosis. Those who suffer from borderline personality disorder experience impulsivity such as reckless driving or substance abuse, feelings of worthlessness, inappropriate anger, an unstable self-image and series of relationships, suicidal behavior, and dissociative symptoms.

• Neurosis can also manifest as pyromania, where a person has an intense obsession with fire, explosives, and their related effects.

It is important to note that neurosis should not be mistaken for psychosis, which refers to loss of touch with reality, and should also not be confused with symptoms that are caused by a physical abnormality. Anxiety, for example, is a common symptom of neurosis, but can also have physical causes. When diagnosing neurosis, it is important to first rule out any possible physical causes of the symptoms.

Neurosis in Psychoanalysis

Historically, two of the most influential figures in psychoanalysis, Freud and Jung, disagreed on what created neuroses. Freud believed that neurosis was rooted in early disappointments or traumas, particularly in childhood. To Freud, neuroses were individual representations of frustrations encountered during a psychosexual phase of development, and were therefore sexual in nature. Jung, on the other hand, believed that neuroses were simply exaggerations of what would otherwise be a normal expression of the self. Because of these differences in belief, the two approached treatment of neuroses very differently. Freud focused intently on a patient's past, while Jung believed that the focus is better put on that which the patient was avoiding in the present. Jung felt that focusing on past wrongs and problems only fueled a sense of self pity, and not a desire to effect change.^[4]

In clinical diagnosis, neurosis is an actual disorder or disease, but by general definition, neurosis is a normal human experience and part of the human condition. Most people are affected by neurosis in some form. A psychological problem develops when neuroses begin to interfere with normal functioning and cause the individual anxiety. Frequently, the coping mechanisms enlisted to help "ward off" this anxiety only exacerbate the situation, causing more distress. Neurosis has even been defined in terms of this coping strategy, as a "symbolic behavior in defense against excessive psychobiologic pain [which] is self-perpetuating because symbolic satisfactions cannot fulfill real needs."^[5]

According to psychoanalytic theory, neuroses may be rooted in ego defense mechanisms, but 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), while only those thought and behavior patterns that produce difficulties in living should be termed neuroses.

Treatment

Although neuroses are targeted by psychoanalysis, psychotherapy, counseling, or other psychiatric techniques, there is still controversy over whether some professionals can perform accurate and reliable diagnoses, and whether many of the resulting treatments are also appropriate, effective, and reliable. Methods of treatment such as talk therapies may or may not alleviate a patient's symptoms, but a certain amount of benefit can certainly be gained through personal companionship and discussion. In psychoanalysis, neuroses are thought to be symptomatic of a pain or trauma that does not register consciously, and many treatments have the aim of bringing this trauma or pain into the conscious mind, where it can be fully experienced and dealt with. Some types of neurosis, such as dissociative disorders (earlier referred to as "hysteria") are sometimes treated using hypnosis or drugs to help the patient return to the original traumatic event that caused the neurosis.

Behavior therapy is often used to treat many types of neurosis. Phobias and anxieties, for example, are often viewed as inappropriate learned responses. As such, these responses can often be unlearned through behavioral therapy. Obsessive compulsive disorder is often treated with drugs, as well as behavior therapy that includes exposure and response prevention. For example, a patient who obsessively washes their hands from fear of contamination may be helped to purposefully get their hands dirty and refrain from washing them for a period of time. Phobias may be treated by gradual exposure to the feared object. Anxiety disorders are often treated with a combination of drugs and therapy.

Notes

References

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• Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Trans. James Strachey. 24 vols. London: Hogarth, 1953-74.
• Horney, Karen. The Collected Works. (2 Vols.) Norton, 1937.
• Jung, C.G., et al. 1964. Man and his Symbols. New York, N.Y.: Anchor Books, Doubleday. ISBN 0385052219
• Jung, C.G. 1966. Two Essays on Analytical Psychology, Collected Works, Volume 7. Princeton, N.J.: Princeton University Press. ISBN 0691017824
• Jung, C.G. [1921] 1971. Psychological Types, Collected Works, Volume 6. Princeton, N.J.: Princeton University Press. ISBN 0691018138
• Jung, C.G. [1961] 1989. Memories, Dreams, Reflections. New York, N.Y.: Vantage Books. ISBN 0679723951
• Winokur, Jon. Encyclopedia Neurotica. 2005. ISBN 0312325010