Neurosis


Neurosis is a term mainly used today by followers of Freudian psychoanalytic theory to describe mental disorders caused by past anxiety, often anxieties that have undergone repression. In recent history, the term has been used to refer to anxiety-related conditions more generally.
The term "neurosis" is no longer used in psychological disorder names or categories by the World Health Organization's International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. According to the American Heritage Medical Dictionary of 2007, the term is "no longer used in psychiatric diagnosis".
Neurosis is distinguished from psychosis, which refers to a loss of touch with reality. Its descendant term, neuroticism, refers to a personality trait of being prone to anxiousness and mental collapse. The term "neuroticism" is also no longer 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".

History

A broad condition (1769–1879)

The term neurosis was coined by Scottish doctor William Cullen to refer to "disorders of sense and motion" caused by a "general affection of the nervous system". The term is derived from the Greek word neuron and the suffix -osis. It was first used in print in Cullen's System of Nosology, first published in Latin in 1769.
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.
French psychiatrist Phillipe Pinnel's Nosographie philosophique ou La méthode de l'analyse appliquée à la médecine was greatly inspired by Cullen. It divided medical conditions into five categories, with one being "neurosis". This was divided into four basic types of mental disorder: melancholia, mania, dementia, and idiotism.
Morphine was first isolated from opium in 1805, by German chemist Friedrich Sertürner. After the publication of his third paper on the topic in 1817, morphine became more widely known, and used to treat neuroses and other kinds of mental distress. After becoming addicted to this highly addictive substance, he warned "I consider it my duty to attract attention to the terrible effects of this new substance I called morphium in order that calamity may be averted."
German psychologist Johann Friedrich Herbart used the term repression in 1824, in a discussion of unconscious ideas competing to get into consciousness.
The tranquilising properties of potassium bromide were noted publicly by British doctor Charles Locock in 1857. Over the coming decades, this and other bromides were used in great quantities to calm people with neuroses. This led to many cases of bromism.
American doctor Weir Mitchell first published an account of his rest cure for non-psychotic mental disorders in 1875. His 1877 book "Fat and Blood: and how to make them" gave a fuller explanation. The cure originally involved women being isolated in bed, only communicating with a nurse trained to talk about unchallenging topics, a fattening diet of milk, plus massage and the application of electricity. Eventually, the cure advocated by the Mitchell family had less strict isolation and diet, and was followed by men as well as women. "Fat and Blood" was revised and reprinted for many decades.

Breuer, Freud and contemporaries (1880-1939)

Austrian psychiatrist Josef Breuer first used psychoanalysis to treat hysteria in 1880–1882. Bertha Pappenheim was treated for a variety of symptoms that began when her father suddenly fell seriously ill in mid-1880 during a family holiday in Ischl. His illness was a turning point in her life. While sitting up at night at his sickbed she was suddenly tormented by hallucinations and a state of anxiety. At first the family did not react to these symptoms, but in November 1880, Breuer, a friend of the family, began to treat her. He encouraged her, sometimes under light hypnosis, to narrate stories, which led to partial improvement of the clinical picture, although her overall condition continued to deteriorate.
According to Breuer, the slow and laborious progress of her "remembering work" in which she recalled individual symptoms after they had occurred, thus "dissolving" them, came to a conclusion on 7 June 1882 after she had reconstructed the first night of hallucinations in Ischl. "She has fully recovered since that time" were the words with which Breuer concluded his case report. Accounts differ on the success of Pappenheim's treatment by Breuer. She did not speak about this episode in her later life, and vehemently opposed any attempts at psychoanalytic treatment of people in her care. Breuer was not quick to publish about this case.
The term psychoneurosis was coined by Scottish psychiatrist Thomas Clouston for his 1883 book Clinical Lectures on Mental Diseases. He describes a condition that covers what is today considered the schizophrenia and autism spectrums.
French neurologist Jean-Martin Charcot came to believe that psychological trauma was a cause of some cases of hysteria. He wrote in his book Leçons sur les maladies du système nerveux, :
Quite recently male hysteria has been studied by Messrs. Putnam and Walton in America, principally as it occurs after injuries, and especially after railway accidents. They have recognised, like Mr. Page, who in England has also paid attention to this subject, that many of those nervous accidents described under the name of Railway-spine, and which according to them would be better described as Railway-brain, are in fact, whether occurring in man or woman, simply manifestations of hysteria.
Charcot documented around two dozen cases where psychological trauma appears to have caused hysteria. In some cases, the results are described like the modern concept of PTSD.
Austrian psychiatrist Sigmund Freud was a student of Charcot in 1885–6. In 1893 Freud credited Charcot with being the source of "all the modern advances made in the understanding and knowledge of hysteria."
French psychiatrist Pierre Janet released his book L'automatisme psychologique in 1889, its third chapter detailing his understanding of hypnosis and the unconscious. At this time, he claimed that the main aspect of psychological trauma is dissociation.
In 1891, Thomas Clouston published Neuroses of Development, which covered a wide range of physical and mental developmental conditions.Breuer came to mentor Freud. The pair released the paper "Ueber den psychischen Mechanismus hysterischer Phänomene. " in January 1893. It opens with:
A chance observation has led us, over a number of years, to investigate a great variety of different forms and symptoms of hysteria, with a view to discovering their precipitating cause the event which provoked the first occurrence, often many years earlier, of the phenomenon in question. In the great majority of cases it is not possible to establish the point of origin by a simple interrogation of the patient, however thoroughly it may be carried out. This is in part because what is in question is often some experience which the patient dislikes discussing; but principally because he is genuinely unable to recollect it and often has no suspicion of the causal connection between the precipitating event and the pathological phenomenon. As a rule it is necessary to hypnotize the patient and to arouse his memories under hypnosis of the time at which the symptom made its first appearance; when this has been done, it becomes possible to demonstrate the connection in the clearest and most convincing fashion...
It is of course obvious that in cases of 'traumatic' hysteria what provokes the symptoms is the accident. The causal connection is equally evident in hysterical attacks when it is possible to gather from the patient's utterances that in each attack he is hallucinating the same event which provoked the first one. The situation is more obscure in the case of other phenomena.
Our experiences have shown us, however, that the most various symptoms, which are ostensibly spontaneous and, as one might say, idiopathic products of hysteria, are just as strictly related to the precipitating trauma as the phenomena to which we have just alluded and which exhibit the connection quite clearly.
This paper was reprinted and supplemented with case studies in the pair's 1895 book Studien über Hysterie. Of the book's five case studies, the most famous became that of Breuer's patient Bertha Pappenheim. This book established the field of psychoanalysis.
French neurologist Paul Oulmont was mentored by Charcot. In his 1894 book Thérapeutique des névroses, he lists the neuroses as being hysteria, neurasthenia, exophthalmic goitre, epilepsy, migraine, Sydenham's chorea, Parkinson's disease and tetany.
The fifth edition of German psychiatrist Emil Kraepelin's popular psychiatry textbook in 1896 gave "neuroses" a well-accepted definition:
In the following presentation we want to summarize a group of disease states as general neuroses, which are accompanied by more or less pronounced nervous dysfunctions. What is common to these manifestations of insanity is that we are constantly dealing with the morbid processing of vital stimuli; what they also have in common is the occurrence of more transitory, peculiar manifestations of illness, sometimes in the physical, sometimes in the psychic area. These attacks of fluctuations in mental balance are therefore not independent illnesses, but only the occasional increase in a persistent illness...
It seems useful to me, for the time being, to distinguish between two main forms of general neuroses, epileptic and hysterical insanity.
Pierre Janet published the two volume work Névroses et Idées Fixes in 1898. According to Janet, neuroses could be usefully divided into hysterias and psychasthenias. Hysterias induced such symptoms as anaesthesia, visual field narrowing, paralyses, and unconscious acts. Psychasthenias involved the ability to adjust to one's surroundings, similar to the later concepts of adjustment disorder and executive functions.
Janet founded the French "Société de psychologie" in 1901. This later became the "Société française de psychologie", and continues today as France's main psychology body.
Barbiturates are a class of highly addictive sedative drugs. The first barbiturate, barbital, was synthesized in 1902 by German chemists Emil Fischer and Joseph von Mering and was first marketed as "Veronal" in 1904. The similar barbiturate phenobarbital was brought to market in 1912 under the name "Luminal". Barbiturates became popular drugs in many countries to reduce neurotic anxiety and displaced the use of bromides.
Janet published the book Les Obsessions et la Psychasthénie in 1903. Janet followed this with the books The Major Symptoms of Hysteria in 1907, and Les Névroses in 1909.
According to Janet, one cause of neurosis is when the mental force of a traumatic event is stronger than what someone can counter using their normal coping mechanisms.
The Swiss psychiatrist Paul Charles Dubois published the book Les psychonévroses et leur traitement moral in 1904, which was translated into English as "Psychic Treatment of Nervous Disorders " in 1905. Dubois believed that neurosis could be successfully treated by listening carefully to patients, and rationally convincing them of the truth — what he called "rational psychotherapy". This was a form of cognitive behavioural therapy. He also followed Weir Mitchell's rest cure, though with a broad fattening diet and other modifications.
Meanwhile, Freud developed a number of different theories of neurosis. The most impactful one was that it referred to mental disorders caused by the brain's defence against past psychological trauma. This redefined the general understanding and use of the word. It came to replace the concept of "hysteria".
He held the First Congress for Freudian Psychology in Salzburg in April 1908. Subsequent Congresses continue today.
Progressive muscle relaxation was first developed by American psychiatrist and physiologist Edmund Jacobson. This began at Harvard University in 1908. PMR involves learning to relieve the tension in specific muscle groups by first tensing and then relaxing each muscle group. When the muscle tension is released, attention is directed towards the differences felt during tension and relaxation so that the patient learns to recognize the contrast between the states. This reduces anxiety and the effect of phobias.
Freud published the detailed case study "Bemerkungen über einen Fall von Zwangsneurose" in 1909, documenting his treatment of "Rat Man".
Freud established the International Psychoanalytical Association in March 1910. He arranged for Carl Jung to be its first president. This organisation chose to only provide both psychoanalytic training and recognition to medical doctors.
The American Psychoanalytic Association was founded in 1911 by Welsh neurologist Ernest Jones, with the support of Freud. It followed the IPA's practice of only supporting psychoanalysis provided by medical doctors.
Jung gave a speech explaining his understanding of Freud's work called Psychoanalysis and Neurosis in New York in 1912. It was published in 1916.
The journal Internationale Zeitschrift für Psychoanalyse was established in 1913, and continued until 1941.
The battlefield stresses of World War I lead to many cases of strong short-term psychological symptoms, known today as "combat stress reaction". Other terms for the condition include "combat fatigue", "battle fatigue", "battle neurosis", "shell shock" and "operational stress reaction". The general psychological term acute stress disorder was first used for this condition at this time.
The fight-or-flight response was first described by American physiologist Walter Bradford Cannon in 1915.
American military psychiatrist Thomas W. Salmon released the book The care and treatment of mental diseases and war neuroses in the British army in 1917, dealing primarily with what was considered was the best treatment for hysteria. His recommendations were broadly adopted in the US armed forces.
Freud's most explanatory work on neurosis was his lectures later grouped together as "General Theory of the Neuroses", forming part 3 of the book Vorlesungen zur Einführung in die Psychoanalyse, later published in English as A General Introduction to Psychoanalysis.
In that work, Freud noted that:
The meaning of neurotic symptoms was first discovered by J. Breuer in the study and felicitous cure of a case of hysteria which has since become famous. It is true that P. Janet independently reached the same result...
The symptom develops as a substitution for something else that has remained suppressed. Certain psychological experiences should normally have become so far elaborated that consciousness would have attained knowledge of them. This did not take place, however, but out of these interrupted and disturbed processes, imprisoned in the unconscious, the symptom arose...
Our therapy does its work by means of changing the unconscious into the conscious, and is effective only in so far as it has the opportunity of bringing about this transformation...
Freud added to this with his paper "Aus der Geschichte einer infantilen Neurose" published in 1918, which is a detailed case study of his treatment of the "Wolfman".
The International Journal of Psychoanalysis was founded by Ernest Jones in 1920.
In response to stress injuries from World War I, the British government produced the Report of the War Office Committee of Inquiry into "Shell-Shock", which was published in 1922.
Its recommended course of treatment included:
While recognizing that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority by the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided by such physical methods as baths, electricity and massage. Rest of mind and body is essential in all cases.
The committee are of opinion that the production of deep hypnotic sleep, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.
They do not recommend psycho-analysis in the Freudian sense.
In the state of convalescence, re-education and suitable occupation of an interesting nature are of great importance. If the patient is unfit for further military service, it is considered that every endeavor should be made to obtain for him suitable employment on his return to active life.
The common neuroses and their treatment by psychotherapy was a book released by British psychiatrist Thomas Arthur Ross in 1923, to instruct medical doctors in general.. He also followed the practice of Paul Charles Dubois, and believed "Freudian analysis" was only necessary for the most difficult cases. Ross would later write the books Introduction to analytical psychotherapy and An enquiry into prognosis in the neuroses.
In April 1923 Freud published his monograph Das Ich und das Es,'' which included a revised theory of mental functioning, now considering that repression was only one of many defence mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety.
Austrian literary theorist Otto Rank was a close ally of Freud. His book The ''Trauma of Birth focused more on people's choices, rather than Freud's focus on drives. He believed in the idea of psychotherapy as opposed to psychoanalysis — that understanding someone's neuroses wasn't sufficient for effective therapy.
Freud released his book Hemmung, Symptom und Angst in 1926, in reaction to Rank's book. It detailed his further developed understanding of neurosis and anxiety. This book expressed his new view that anxiety created repression, rather than the other way around.
Freud also published the book Die Frage der Laienanalyse in 1926, in which he endorsed non-doctors performing psychoanalysis.
In 1929, Austrian psychiatrist Alfred Adler published the book Problems of Neurosis: A Book of Case-Histories, furthering the school of individual psychology he had established in 1912.
1929 also saw Edmund Jacobson publishing of the professional instruction book Progressive Relaxation. It explained the benefits of relaxation for addressing neuroses and other mental conditions. He followed this with the more publicly-oriented You Must Relax in 1934.
Walter Bradford Cannon's 1932 book The Wisdom of the Body popularised the concept of fight-or-flight.
The American Medical Association released its Standard Classified Nomenclature of Diseases'' in 1933, the first widely accepted such nomenclature in the United States. By the second edition of 1935, its category of "psychoneuroses" included:
The general adaptation syndrome theory of stress was developed by Austro-Hungarian physiologist Hans Selye in 1936.
In 1937, Austrian-American psychiatrist Adolph Stern proposed that there were many people with conditions that fitted between the definitions of psychoneurosis and psychosis, and called them the "border line group of neuroses". This group would later become known as borderline personality disorder.
By 1937, the concept of "occupational neuroses" was known by many American health practitioners. It referred to neuroses caused by any aspect of someone's employment.