The concept of “neurosis” was introduced into medicine in 1776 by the Scottish physician William Cullen. The content of the term has been revised more than once, and to this day it has no single generally accepted definition. It should also be borne in mind that in medicine and biology “neurosis” may be the name for various functional disturbances of higher nervous activity.
Neurosis (neurotic disorder) is a disturbance of mental behaviour that lasts a long time and often becomes a heavy burden for the person. Neurosis shows no organic cause. The border of neurosis is psychosis. The difference is this: the neurotic is aware of their disorder. The psychotic, on the other hand, perceives a distorted reality but is not aware of it.
The reactions of a neurotic are understandable in principle, but not in their degree. Although the behaviour of the person concerned may be severely disturbed, as a rule it stays within socially acceptable bounds. The personality is preserved (this is not psychosis).
The people around them (family, colleagues, friends) accept the behaviour of neurotics and take it for character traits, or explain some of that behaviour away by external negative factors. That is why most neurotics come for therapy only once a certain amount of suffering has built up.
Psychoanalytic theories present neurosis and its symptoms mainly as a consequence of a deep-seated psychological conflict. Such a conflict is thought to form under a social situation that persists for a long time and either prevents a person’s basic needs from being met or poses a threat to their future which they try, but fail, to overcome.
Sigmund Freud saw this conflict in the basic contradiction between the instinctual drives of the id and the prohibiting pressure of the super-ego, which stands for the morals and norms existing in society.
Karen Horney held that the basic conflict of neurosis is the result of a contradiction between incompatible defensive tendencies of the personality. To shield itself from such unfavourable social factors as humiliation, social isolation, the totally controlling love of parents, dismissive and aggressive treatment, the child forms ways of defending itself based on movement “toward people”, “against people” and “away from people”. Moving toward people is chiefly the need for submission, love and protection. Moving against people is the need for power over others, for fame, recognition and success, for being strong and coping with life. Moving away from people is the need for independence, freedom, withdrawal and isolation from others. The neurotic is subject to all three tendencies at once, yet one of them predominates, and so neurotics can be loosely classified as “compliant”, “aggressive” and “detached”. Karen Horney gave a great deal of attention to the problems created by the contradictions between defensive tendencies.
On the whole, the factors currently regarded as predisposing to the development of neurosis are both psychological (features of the personality, the conditions in which it matures and is brought up, the way relations with society take shape, the level of aspiration) and biological factors (a functional insufficiency of certain neurotransmitter or neurophysiological systems, which makes patients vulnerable to certain psychogenic influences).
Mental symptoms
- Emotional instability (often for no visible reason).
- Indecisiveness.
- Difficulties in communicating.
- Inadequate self-esteem: too low or too high.
- Frequently experiencing anxiety, fear, the “anxious expectation of something”, phobias; panic attacks and panic disorder are possible.
- A vague or contradictory system of values, of wishes and preferences in life, of ideas about oneself, about others and about life. Cynicism is common.
- Irritability (often for no reason, or the reason is “made up” and not real.
- High sensitivity to stress — people react to a minor stressful event with despair or aggression.
- Tearfulness.
- Touchiness, vulnerability.
- Anxiety.
- Getting stuck in loops (mental chewing gum, retelling a negative, stressful situation over and over).
- Estrangement (depersonalisation: “I am no longer myself”, derealisation: “everything around me is so strange”).
- Hypochondria (an unfounded, anxious fear or suspicion that one is ill or has fallen ill),
- Diffuse, so-called free-floating states of anxiety.
- In neurotic patients one may find a fixation (an attachment to a habit or an attitude adopted at some point) on certain childhood (childish) complexes or traumas (an unconscious process). This fixation prevents elementary areas of life from developing, for example: physical and sexual self-assertion, tender or even aggressive spontaneity, devotion, trust and so on.
Physical symptoms
- Headaches, pains in the heart, pains in the abdomen.
- A frequent feeling of tiredness, increased fatigue, a general drop in the capacity to work, poorer memory and attention, an inability to hold on to a thought.
- Panic attacks, dizziness and blacking out from swings in blood pressure.
- Disturbances of the vestibular system: difficulty keeping balance, dizziness.
- Appetite disturbance (overeating; undereating; feeling hungry but filling up quickly when eating).
- Sleep disturbance (insomnia): trouble falling asleep, waking early, waking during the night, not feeling rested after sleep, nightmares.
- Sensitivity to loud sounds, bright light, changes in temperature.
- Physical pain experienced psychologically (psychalgia), excessive concern for one’s health to the point of hypochondria.
- Autonomic disturbances: sweating, palpitations, fluctuations in blood pressure, stomach upsets, coughing, frequent urges to urinate, loose stools.
- Reduced libido and potency.
- Speech defects (stammering).
- Enuresis (urinary incontinence),
- Encopresis (faecal incontinence),
- Various physical impairments without an organic basis (for example, disturbances of gait, disturbances of movement, rigidity, weakness, paralysis, disturbances of sensation).
As my reader can see, in principle every one of these symptoms can show up in anyone, to one degree or another and depending on the situation in their life.
So how can we speak of neurosis at all, that is, of something that is not a healthy state for a person? The whole horror of it is that, in the opinion of many psychologists (who do not count themselves among the healthy, but rather among those coming close to a healthy state), there are only 5% of them on Earth, and nobody knows who they are. It sounds absurd, but that is how it is.
As was said above, neurotics come for therapy when they can no longer bear their own states, when they are already at rock bottom.
Better to do everything in good time!
