Neurosis

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:[9]

... 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.

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.

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".[10]^: 140 Accordingly, the majority of his patients "consisted not of believers but of those who had lost their faith".[10]^: 140 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.[11]^: 82

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."[11]^: 85

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis.[12] 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:[12]^: 18

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:[12]^: 22

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.

• 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.