A modern existence is an extremely stressful one. High stress, long working hours and pressures of performance often cause individuals to behave in what is often defined as a neurotic fashion.
 Meaning of Neuroses
The term neurosis borrows itself from the Greek word ‘neuron’, meaning nerve and ‘osis’, meaning an abnormal condition. Together, they form the word ‘neuroses’ which is a generic term for all kinds of disorders arising from an affectation of the nerves.
- Neuroses are a very prevalent disorder, particularly in this new age order, owing to the enormous amounts of stress, conflict and disharmony that a person is subject to.
- In common parlance, a neurotic is an individual who worries a lot and is prone to anxiety, irritability, confusion, low sense of self worth, aggressive and lacks energy to lead a fruitful life. Going by this definition, it would to almost impossible to identify a person who at some point of time is not a neurotic. So what symptomatic manifestations best describe a ‘neurotic’?
 Who is a Neurotic?
A neurotic, very simply is one who suffers from acute anxiety, stress, and indecision to an extent where it impedes his social behaviour and makes him a maladjusted individual.What is very important is that there is no considerable change or dysfunction in his nerve structure or in the functioning of his organs.
 Origin of the term
- The term was first coined by a William Cullen in 1769 who described neurosis as a "functional derangement arising from disorders of the nervous system". He pronounced neurosis as “disorders of sense and motion”, caused by a general affection of the nervous system”.
- Other definitions include “a mental or personality disturbance not attributable to any neurological or organic dysfunction” or “a functional nervous affection or disease, that is, a disease of the nerves without any appreciable change of nerve structure” .
- Also called psycho-neurosis, it is “a functional disorder in which feelings of anxiety, obsessional thoughts, compulsive acts, and physical complaints without objective evidence of disease, in varying degrees and patterns, dominate the personality”
 Sigmund Freud and the Psychoanalytic View of Neurosis
- Neurosis was defined and used very heavily in his diagnostic procedures by Sigmund Freud. According to the psychoanalytical theory propounded by Freud, "neurosis has its genesis in the psychosexual stages of development wherein the ego suppresses the disturbing and conflicting impulses of the id. Due to this repression, the ego subverts the disturbing desires to the deeper layers of the consciousness."
- This by itself is not the real cause for neurosis. In fact this can be best described as a defence mechanism the body and mind resorts to resolve conflicts that are too difficult to handle.
- Neurosis arises when the ego’s efforts to deal with desires that can produce severe guilt for the individual, fail; the repressed desires or thoughts manifest themselves through a set of symptoms that are psychosomatic in nature, that is, there are no physical dysfunctions that can be ascribed to the behaviour exhibited.
- The debilitating symptoms are the ego’s way of side stepping the real conflict between itself and the id. The symptom or illness is in fact a replacement for the guilt ridden impulses arising out of the id and is in fact distorted, displaced and contorted beyond recognition that it no longer seems like a gratification seeking impulse. Rather, through a process of rationalization, it is manifested as an illness.
- Hence these patterns or symptoms are worse than the conflict they set out to hide from the consciousness because they not only impede in the patients ability to be accepting about himself and his repressed impulses, but also because at a much superficial level, it interferes with the activity and energy level of the individual, but also renders him socially incapable of enjoying a happy and healthy life.
- Neurosis may not always be due to primal impulses that seek gratification. It can also be triggered by traumatic childhood experiences that the individual is incapable of handling. These experiences give rise to huge feelings of guilt that an individual seeks to repress through various mechanisms of displacement, distortion and rationalisation.
- The repressed content sometimes makes its way back into the realm of the consciousness, albeit in a different form.
- These trigger certain disorders that are psychological in nature, produce great amounts of anxiety, seek to block out the real cause of such conditions and interfere with the individual’s capacity to lead a normal, healthy life.
 Classification of Neuroses by Freud
Freud classified Neurosis into two main categories. The first category is
- ‘Transference neuroses or Psycho-neuroses’, wherein in place of the object that produces feelings of desire and subsequent guilt, there is transference from the above to another object.
- Under this category is included hysteria, wherein the symptoms are transferred to the body (conversion hysteria) or to another object that provokes great anxiety (as in phobias).
- An obsessional neurosis, which is a part of transference neuroses, includes Compulsive Obsessive Disorders wherein the impulses that produce guilt are transferred to more accepted behaviour by way of rationalization, i.e. obsessive thoughts and compulsive behaviour. The individual experiences great anxiety if he does not indulge in these thoughts and behaviour. For example if a person is obsessed with the idea of cleanliness he is compelled to wash his hands innumerable times during the day. An obstruction results in anxiety and in certain cases even episodes of depression and violence.
- The second type of neuroses that Freud identified was due to certain real traumatic experiences. He called these Traumatic or Actual Neuroses. In this type of neuroses the cause does not arise from imagined or psychological impulses or conflicts, rather from actual events.
 Lacuna in the Freudian categorisation
Freud’s theorization, although complete in itself, lent itself to a very restrictive and constricted definition. It argued that almost all neurotic behaviour rose from unfulfilled sexual impulses. The libidinal impulses were repressed by the ego and when these sexual feelings surfaced they produced guilt, anxiety and set off a whole gamut of behavioural patterns which not only interfered in the individual’s diurnal functioning, but also seemed to have no physical basis.
 Jungian Theory of neuroses
Carl Gustav Jung’s understanding of neuroses was more human- centric and was more focused on the individual.
- He was of this view that whenever a person tries to project himself as someone else, it results in a condition called neuroses.
- Any interference in the ability of the individual to grow as a complete whole and reach the highest levels of self actualization is sufficient to produce a condition of intense anxiety or neuroses.
- The role of dreams, fantasies and imagination helps in understanding of the behaviour that the ego seeks to compensate.
- Therefore the treatment plan that he suggested tried to intensify all efforts at helping the individual grow up in accordance to his real or authentic self.
Psychoanalysis and its novelty wore out with the times and were fast replaced by theorists who brought in a more wholesome approach to the basis of psychological disorders. The American DSM-III eliminated the term ‘Neuroses’ as analysts from other schools of thought propounded their own theories that were more human centric, primary among them being Arthur Janov and Dr. C. Goerge Boeree.
 Primal Therapy by Arthur Janov
Dr. Janov in his Primal Therapy states that
- any un-fulfilment in the primal needs of the individual, during his infantile years forces him to seek symbolic gratification as an adult.
- These primal needs are not very complicated and are: to be fed, kept dry, caressed, loved, held, encouraged, and stimulated.
- These unfulfilled desires cause the child immense pain.
- As a way of coping, he divorces these painful sensations from his consciousness.
- These repressed sensations are however not altogether lost. In fact they are reallocated to a different area that provides a similar kind of relief. So they become disguised and erupt in a more symbolic way.
- For example a child who is weaned off very early in life is more likely to get symbolic gratification as an adult in the habit of smoking. A child who is not loved enough or does not get attention as much as he would like to, is more likely as an adult to seek gratification from areas where people know his name, recognize him, want to be close to him etc.
- Hence a neurosis is more a product of unfulfilled biological needs which attain a psychological dimension with the passage of time.
Janov in his theory stresses that
- Physiological needs are the real needs.
- Psychological needs are the unreal ones which get manifested in the absence of the former being thwarted.
- Any one incident is not enough for a child to become neurotic.
- All it does is start off the neurotic process.
- With time, a series of unfulfilled sensations get collected and form what Janov called the primal pool.
- The individual gets frighteningly close to becoming a neurotic.
- A singular anxiety giving incident could then trigger it off.
- This trigger, he called the primal scene.
- Therefore the whole procedure does not happen overnight over a single episode. Rather it is an amalgamation of a series of unfulfilled infantile desires.
Arthur Janov squarely blames the primary family in their role of raising a neurotic individual.
- Parents’ according to him are too busy grappling with infantile needs of their own or are neither too familiar nor desirous of fulfilling their child’s specific biological needs. Whatever it is, this leads to a void where a child is left to struggle on his or her own.
- With the passage of time, physiological needs are replaced by a set of symbolic psychological needs. So a child who does not get enough attention and time from his parents is more likely to, as an adult, demand it from elsewhere. These adult demands would be his symbolic quest for the parental love he so missed as a child.
- In Arthur Janov’s own words “Struggle is what keeps a child from feeling his hopelessness. It lies in overwork, in slaving for high grades, in being the performer. Struggle is the neurotic's hope of being loved. Instead of being himself, he struggles to become another version of himself. Sooner or later the child comes to believe that this version is the real him. The "act" is no longer voluntary and conscious; it is automatic and unconscious. It is neurotic.”
Arthur Janov’s work heavily borrows from the psychoanalytic view of Freud. However he has also amalgamated the other social and biological factors in his theory and has steered clear of emphasizing too much on repressed sexuality as leading to neuroses.
 Bio-Social Theory- George Boeree
According to this theory, neurosis is the lack of individual capacity and ability to adapt oneself to one’s changing environment. This is the cause of stress, dissatisfaction, low self esteem etc.
- The theory premises that the cause for neuroses is not singular, rather it is an amalgamation of three factors:
- the biological makeup or inherited traits that predispose one individual to a neurotic condition. Any trait present in an extreme could well make the person more predisposed towards neurosis.
- Another identified factor is the social condition; essentially the socio-cultural background of the individual. This would include the family, the value system, education, faculties that would help individual deal with stress etc. In the absence of adequate social skills, the person is more likely to become neurotic.
- The third identified factor is the presence of certain stressors which trigger off acute anxiety, uncertainty, confusion, over emphatic emotional responses and also depression.
- A person could become neurotic if all the above factors are present or either one or the other factors are present.
- A person reacts to his environment in accordance with his inherited traits and learned skills.
- Neuroses sets in when the stress limits exceed a person's inherited and learned responses. This produces enormous amount of anxiety that ultimately renders the person incapable of conducting even his daily activities. The coping mechanism in short takes a beating.
- When this becomes a pattern, the individual, though certain mechanisms of repression, denial, displacement and rationalization, develops a set of behavioural patterns to cope with the original source of anxiety.
- This is when a person is diagnosed as a neurotic.
This theory lays huge emphasis on the family, first as a transmitter of genetic factors and second, as providers of the faculties required to cope with the stressful environment.
- It stresses equally on heredity and environment influences as possible contributors to the problem of neuroses.
- Hence it is more acceptable to therapists who find it easier to find lacunae and suggest solutions.
 Symptoms related to Neuroses
A neurosis is manifested by various physical and psychological symptoms. Primary among them is anxiety attacks, panic attacks leading to breathlessness, seizure, hysteria and insomnia.
Among the psychological symptoms, the patient experiences depression, phobias, obsessive-compulsive disorders, multiple personality disorders or a split personality disorder. He also exhibits psychosomatic disorders. All these symptoms interfere in his daily functioning and kill his appetite for a wholesome, healthy life.
What is very important here is to understand that a neurotic individual under no circumstance looses his link with reality. This loss of touch with reality happens in psychosis which is personality disorder characterised by delusional experiences.
Most of the time it has been argued that the patient should be given a kind of reality check, i.e. he must be made aware of the unconscious desires and the symbolic conscious behaviour he has employed. This advocates a mix of psychotherapy, hypnosis, counselling, understanding early influences etc.
Many therapists are of the opinion that this may not really help as the repressed material may be too difficult to tackle. Instead the treatment should also aim at providing symptomatic relief with the help of methods such as Bio-feedback, shock therapy, especially to deal with phobias, expressive therapies to unlock inner most feelings and behavioural conditioning techniques to combat anxiety.
In addition, companionship, compassion, empathy and complete acceptance of the individual may be the key to unlock the unconscious, repressed matter and release the person from his struggle to cope with life.
 Neuroses- A Part of Human Functioning
Most of us are affected by neuroses at some part of our life. Most of us resort to defence mechanisms to deal with stressful situations. However as long as it does not have any pathological consequences, it is not significant and does not fall in the defined purview of ‘neuroses’. Coping mechanisms should be used for the purpose of coping and must remain so. It is only when coping mechanisms trigger off more distress, set off more problems for the individual…it is then that the person is diagnosed as a neurotic.
- College of Liberal Arts
 Suggested Reading
- Horney Karen: Neurosis and Human Growth: The struggle Toward Self-Realization.