Neurosis

Our minds powerfully process the vicissitudes of life, taking in data from the environment, emotions from the body, knowledge from the past, and then translate all the information into a meaningful whole. However, the data doesn’t always smoothly fit together. Stressful life demands, confusing facts, and conflicting beliefs strain cognitive resources, leading to malfunctions of behavior and thoughts. In psychology, we refer to these malfunctions as neuroses.

A neurosis is not a diagnostic disorder, but a broad category that includes many behavioral and mental disorders that include many of the personality and emotional disorders. Neuroses are mental and behavioral reactions unconsciously implemented to protect the ego. We characterize these as defense mechanisms, that soothe the conflict but fail to address underlying problems.

C. George Boeree wrote that a neurosis may be defined simply 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” (2002).

Definition of Neurosis

Typically, professionals see neuroses as a milder disorders compared to their devasting cousin psychosis. Doctors and psychiatrists typically don’t identify organic disease as the cause of a neuroses. Instead, the medical community believes neurosis to involve behaviors and disruptions that are by-products of stress (depression, anxiety, obsessive behaviour, hypochondria). Individuals suffering from a neurosis do not radically lose touch with reality.

We should not confuse neurosis, the mental disorder, with neuroticism, the personality trait. Authors of the Big Five Personality trait theory included neuroticism as one of the fundamental traits and it is unrelated to neurosis.

Key Definition:

A neurosis is a maladaptive behavior or thinking process adopted to relieve negative affects. Typically, the neurosis relieves anxiety in the present without regard to future impact on self and others.

Etiology of Neurosis

We derive the term ‘neurosis’ from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’), coined by Scottish physician and chemist William Cullen in 1769, describing “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term broadly to describe various nervous disorders and symptoms that clinicians could not explain physiologically.

Early understanding of neuroses saw them as “physical disorders of the nervous system caused by a lack of nerve force resulting from stress on the nervous system” rather than simply excess of emotions or organic factors (Sihn, 2022).

With modern technology, doctors are identifying more and more diseases previously identified as a neurosis. Diseases the medical community once explained by stress and inner conflict, they now can identify physiological components that contribute to the mental affliction. These new physiological correlations confuse which disorders fit the neurosis definition. Perhaps, the 1980 removal of neurosis from the DSM is in response to these advances.

Historical Definitions of Neurosis

Neuroses, because of their theorized non-physiological origin, become a prime target for non-traditional treatments, addressing dysfunctions in the mind rather than medically treating biological irregularities. Sigmund Freud, his Daughter Anna Freud, Alfred Adler, and Carl Jung became notable figures in the early theories to define and treat neurosis.

Sigmund Freud (1856-1939)

Freud believed most psychoneuroses arose from an inner conflict between “the ego-instincts and the sexual instincts.” Freud explained that a neurosis is “really nothing but an attempt at flight from the satisfaction of an instinct” (1920).

In a later work Freud wrote, “neurosis appeared as the outcome of a struggle between the interests of self-preservation and the claims of libido, a struggle in which the ego was victorious, but at the price of great suffering and renunciations” (1930).

For Freud, the human instincts to satisfy sexual desires often collided with society expectations, repressing these desires created great inner stress that sometimes created a neurotic response. Freud wrote “the details of the process by which repression changes a possibility of pleasure into a source of ‘pain’ are not yet fully understood, or are not yet capable of clear presentation, but it is certain that all neurotic ‘pain’ is of this kind, is pleasure which cannot be experienced as such” (1920).

Freud regarded the following as types of neurosis:

Traumatic and war neurosis (PTSD)
Hysteria
Hypochondria
Melancholia
Obsessional neurosis
Phobias
Neurotic anxiety

Anna Freud (1895-1982)

Anna expanded on her father’s concepts of the ego, the id and the superego. These three inner-psychic players represented the basic conflict of humans between instinctual gratification and survival within the expectations of society. The protective reaction to these conflicts, Anna believed, “is that which forms the basis of neurosis in adults.”

She explains “the instinct is regarded as dangerous because the superego prohibits its gratification and, if it achieves its aim, it will certainly stir up trouble between the ego and the superego. Hence the ego of the adult neurotic fears the instincts because it fears the superego. Its defense is motivated by superego anxiety.” She emphasizes that the super-ego is a “redoubtable force” in this drama. Anna points to the superego as “the originator of all neuroses.”

Anna proclaims that the superego “is the mischief maker which prevents the ego’s coming to a friendly understanding with the instincts. It sets up an ideal standard, according to which sexuality is prohibited and aggression pronounced to be antisocial” (1936).

Alfred Adler (1870-1937)

Alfred Adler broke from Sigmund Freud and the Vienna Psychoanalytic Society in 1911. Adler could not “tolerate the pansexual scope of the school.” According to Adler, the human “goal of superiority, as thwarted by constitutional inferiority and the masculine protest” were the basis for the formation of neuroses in the human psyche. Adler developed a system of treatment that he referred to as individual psychology that dealt with the person as a whole, not as individual mechanisms such as the ego, id, and superego in Freudian psychoanalysis (Roback, 1952).

Carl Gustav Jung (1875-1961)

Carl Jung also felt that Freud overly focused on sexual elements as a cause for neurosis. Jung wrote in his memoirs that he was “familiar with numerous cases of neurosis in which the question of sexuality played a subordinate part, other factors standing in the foreground—for example, the problem of social adaptation, of oppression by tragic circumstances of life, prestige considerations, and so on. Later I presented such cases to Freud; but he would not grant that factors other than sexuality could be the cause. That was highly unsatisfactory to me” (2011).

Jung developed analytical psychology after his break with Freud, also known as Jungian psychology.

Liberating the Patient From the Inner Conflict

Jung believed the cure of a neurosis occurred from liberating the patient from the conflict. “Once his liberation was accomplished, the neurosis disappeared.” A major source of conflict Jung theorized was that people formed “inadequate or wrong answers to the questions of life.” Jung went on to explain that a person may seek “seek position, marriage, reputation, outward success or money, and remain unhappy and neurotic, even when they have attained what they were seeking.”

He felt these superficial strivings failed to satisfy the underlying human needs. He wrote, “such people are usually confined within too narrow a spiritual horizon.” Their aspirations have not sufficient content or meaning. He prescribes the remedy “if they are enabled to develop into more spacious personalities, the neurosis generally disappears” (2011).

Jung believed that the neurotic is “divided against themselves.” He continues, “these victims of the psychic dichotomy of our time are merely optional neurotics; their apparent morbidity drops away the moment the gulf between the ego and the unconscious is closed.” Jung felt the emphasis on the intellect was partially to blame, separating experience from emotion. The intellectualizers “cultivate a ‘compartment psychology.’ Anything can be settled by an intellect that is not subject to the control of feeling—and yet the intellectual still suffers from a neurosis if feeling is undeveloped” (2011).

Causes of Neurosis

Conflict, Anxiety, and Adaptation

Sigmund, Anna, Alfred, and Carl presented varying theories on the specific cause for the development of a neurosis. They did, however, agree that conflict was the basic mechanism motivating the appearance of a neurosis.

Physicians and psychiatrists still consider anxiety, a product of conflict, one of the primary factors in the formation of mental disorders. Joseph LeDoux, a neuroscientist, explains that “because anxiety reduction brings about relief or security, it is a powerful reinforcer of instrumental behaviors.” He continues “responses that reduce anxiety are thus learned and maintained…this is often useful, but sometimes it leads to neurotic symptoms” (1986, Kindle location 232).

Drives to Resolve Negative Affect

We soothe anxieties. Whether we resolve the anxiety through removing the object stressing our system or through a neurotic defense doesn’t matter. Our drive is to resolve the anxiety. If maladaptive behaviors accomplish this, the success reenforces the behavior. Subsequently, the neuronal connection forge a connection, marking the new behavior as an effective strategy. We then repeat the neurotic behavior when similar circumstances arise. A neurosis forms under this process.

LeDoux explains, “just as a rat could learn any response that allowed it to escape from or avoid an anxiety provoking situation, humans learn all sorts of instrumental responses that allow them to escape or avoid anxiety and guilt caused by neurotic conflict” (location 234).

Erik Erickson defines the psychotic and neurotic crisis as these self-perpetuating cycles that feed on themselves without addressing the underlying cause of the anxiety. He explains “the individual feels free when he can choose to identify with his own ego identity and when he learns to apply that which is given to that which must be done’ (1994, location 640).

Erich Fromm also suggests that defensive responses to conflict that fail to address the underlying cause eventually “manifests itself only unconsciously in increased stress, neurotic symptoms, or feeling guilty for the wrong reasons.” Fromm explains that “neurosis can be understood best as the battle between two tendencies” which he describes as regressive or progressive ways of achieving salvation, dealing with anxiety ridden conflicts.

Regressive Ways of Dealing with Inner Conflict

Fromm adds that regressive ways of dealing with conflict, such as a wash compulsion or groundless anxieties, are irrational because they are the outcome of a dysfunction of the mind and tend to further disturb its proper functioning (1992, location 5,230). Comparatively, this is similar to theories of cognitive dissonance.

These behaviors are neurotic in nature, responding to anxieties without addressing the organic cause. George Valliant adds that “most of what is called illness in textbooks and in our diagnostic nomenclature – the neuroses, the depressions, and the personality disorders – are merely outward evidence of inward struggles to adapt” (2012).

Rollo May adds significantly to the discussion on neurosis. He explains that the “psychologically healthy person is able to confront and manage the anxiety directly in such situations, in contrast to the neurotic, in whom anxiety sooner or later blocks off his consciousness of freedom and he feels as if he is in a strait jacket” (1999, p. 11).

May defines neurosis and psychosis using a Kierkegaard expression of ‘shut-upness.’ He explains that psychosis and neurosis stems from lack of communication, ‘shut-upness,’ both within ourselves and within society. He adds that we “hasten to conceal the frightening facts with the handiest solutions, which dull our anxiety and enable us to temporarily forget.”

Part of the solution to heal neurotic anxiety, according to May, is “the acceptance of the normal paradoxes of life—love-hate, life-death—is necessary if we are to achieve freedom from the compulsive and neurotic aspects of our problems” (1999, p. 68).

Modern Society and Neurosis

Many authors have referred to neurosis as an illness of modern society, explaining the pressures attributed to industrialization and modernization are key elements to elevated stress, and thus creating the conditions for neurotic reactions to relieve the anxiety.

Many physicians and psychiatrists regard neurosis as a ‘disease of civilization’ since its causes were rooted in the social and cultural pressures of modern society (Sihn, 2022).

American neurologist George Miller Beard (1839-1883) wrote that “civilization was paid for by nervousness” (2008). Afterwards, Beard coined the term ‘neurasthenia’ that he defined as exhaustion of the nervous system (p. 7-8), occurring when people ran out of “energy reserves in the nervous system, which caused organ malfunctions and symptoms such as indigestion, fatigue, muscle and back pain, impotence, infertility, depression and irrationality” (Sihn, 2022). Many of these diseases mentioned by Beard have organic identifiable causes. However, in neurosis a person may experience the symptom but the doctor’s can’t find the physical correlates causing the symptom. We refer to these illnesses as psychosomatic.

Complex Demands of Western Society

Michael Shepperd explained in a speech to a psychiatric society that in “Western societies numerous and complex demands are made on the individual during years of young maturity.” Shepperd goes on to explain that during these key years “social roles are changing rapidly and his responsibilities are increasing; a difficult transition period may ensue…” (1960).

Mostly, we adapt to these pressures; however, some fail to achieve successful harmony with the major role changes placed on the developing young mind by society and illness ensues.

Fromm dedicated an entire book to the anxieties created by modern society and the associated illnesses produced by these anxieties.

In Sane Society he wrote, “the aim of life is to live it intensely, to be fully born, to be fully awake.” Fromm explains that industrialization interferes with our ability to be fully awake, disconnecting us from the product of our work. He continues, “this lack of self creates deep anxiety. The anxiety engendered by confronting him with the abyss of nothingness is more terrifying than even the tortures of hell. In the vision of hell, I am punished and tortured—in the vision of nothingness” (2013, location 2,873).

Diathesis Stress Model and Neurosis

According to the diathesis stress model, an illness is the combination of predisposed biological vulnerabilities and stress. T. Franklin Murphy wrote that according to the diathesis stress model “psychological disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress from life experiences” (2021).

Sheppard explains that genetic factors “influence the threshold at which symptoms show themselves in response to stress…” (1960). He adds that trauma in both “physical and psychological connotations” has been found to be a particularly common in the development of neurotic illnesses.

When stress surpasses our individual window of tolerance, comprised of both learned coping skills and biological sensitivities, the strain begins to damage our bodies and minds. Subsequently, we adopt psychological defensive protections, maladaptive behaviors, and breakdowns in our biological systems from the weight of the stress.

Personality and Neurosis

Some researchers suggest there is a connection between personality type and the type of neurosis that an individual may develop. “The differences between the premorbid personalities define predispositions to different kinds of neurosis” (Maddi, 1967).

Perhaps, this is similar to Anna Freud’s belief that certain defense mechanisms are related to particular neuroses, such as with the undoing defense that she considered related to the obsession-compulsion disorder.

A Few Words by Psychology Fanatic

As scientific progress continues to delve deeper and deeper into the brain, the dividing line between a neurosis, psychosis, and other mental disorders becomes increasingly blurred. No longer can we point to vague concepts of stress, independent of biological components as a cause. There are always physical correlates related to the development of disease. Scientist have discovered some of these biological maladies. Other maladies, we must keeping looking to understand.

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References:

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Boeree, C. George (2002). A Bio-Social Theory of Neurosis.

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Freud, Anna (1936/1992) The Ego and the Mechanisms of Defense. Routledge.

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Fromm, Erich (1973/1992). The Anatomy of Human Destructiveness. Holt Paperbacks; Revised and Rev edition.

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May, Rollo (1981/1999). Freedom and Destiny. W. W. Norton & Company.

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Sihn, K. (2022). Distinguishing between neurosis and psychosis: discourses on neurosis in colonial Korea. History of Psychiatry, 33(3), 350-363.

Vaillant, G. E. (1977/2012). Adaptation to Life. Harvard University Press.

Neurosis