What is a neurosis?

Causes and Symptoms

The distinction between neurosis and psychosis
is that those suffering from neuroses are in touch with reality and usually realize that they have a problem. In contrast, psychotics frequently lose touch with reality and do not recognize that they are sick and in need of immediate professional help.

The most common neurosis is depression. Those with major depression experience, for no overt reason, a persistent and overwhelming sadness coupled with an all-encompassing sense of despair. It is normal for people who suffer such ills as the death of a loved one, the loss of a job, or severe financial reverses to be depressed. In such cases, their depression is usually mitigated when the cause is removed or when they distance themselves from it. On the other hand, those who suffer from major depression cannot attribute their suffering to an immediate cause. They are frequently sad and usually do not know why. Depression is also a major component of bipolar disorders, in which episodes of major depression are followed by periods of mania, or elevated mood.

Other common forms of neurosis are obsessive-compulsive disorder (OCD), somatization disorder, hypochondria, various phobias or fears, anxiety disorders, psychosexual disorders, and hysterical amnesia. All these problems occur less frequently than major depression.

An example of obsessive-compulsive disorder
may be the compulsion of its victims to wash their hands thirty or forty times a day. Those who have a somatization disorder complain of largely imagined illnesses for which no physical cause can be detected. Often termed hypochondria, this disorder is more frequent in women, especially middle-aged women, than in men.

Most people suffer from one or more phobias that do not disable them. Fear of heights (acrophobia) and abnormal fear of public or open areas (agoraphobia) are quite common, as are the fear of some living things such as spiders or scorpions (arachnophobia) or the fear of closed places (claustrophobia). Many of those suffering from such phobias can usually control them by confronting them rationally, although some phobias may be so intense that they result in panic.

Hysterical amnesia, a dissociative disorder, is relatively rare. Often it is connected with anxiety disorder. Victims tend to panic to the point that they suffer temporary memory loss. Although they remain in touch with reality, they may not be able to remember their names, addresses, telephone numbers, and other obvious bits of information.

Post-traumatic stress disorder
(PTSD) has become increasingly common. In extreme cases, it may result in psychotic behavior, although it is more often neurotic in its manifestation. PTSD usually occurs in people who have been subjected to combat situations or to life-threatening natural disasters such as earthquakes, hurricanes, floods, and fires.

Treatment and Therapy

The usual treatment in persistent cases of neurosis is psychotherapy rendered by a clinical psychologist or psychiatrist, frequently over an extended period. Severe cases may require meetings with a professional three or four times a week in order to be effective. Mild cases can sometimes be dealt with in only two or three visits, especially if the patient is cooperative and committed to dealing with the problem.

Neuroses usually do not require such drastic treatment as electric shock therapy or brain
surgery, although such treatment was sometimes prescribed in the past. Currently, more than twenty prescription drugs exist to treat such neuroses as bipolar and somatization disorders. Often, patients need to try several of these medications before finding the one that suits them best. Patients must be cautioned, however, not to expect immediate results. When they find a medication that works well for them, they are advised to continue taking it even after their initial symptoms disappear.

Perspective and Prospects

Substantial biochemical advances during the early years of the twenty-first century have resulted in improved understanding of the relationship between body chemistry and both neuroses and psychoses. Such advances have also been accompanied by changes in the way psychiatric therapy is delivered. Group therapy reduces the cost of treatment. In many situations, because it is so interactive, it proves superior to the one-on-one therapy that psychotherapy and psychoanalysis provide.

The public at large has become more sophisticated than past generations in dealing with neuroses. Nevertheless, the management of the most common neurosis, depression, remains challenging. Most suicides are committed by those suffering from the depths of depression, a condition that gives them a sense of hopelessness.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association, 2013.

Craske, Michelle G. Origins of Phobias and Anxiety Disorders: Why More Women than Men? New York: Elsevier, 2003.

Frankl, Victor E. On the Theory and Therapy of Mental Disorders: An Introduction to Logotherapy and Existential Analysis. New York: Brunner-Routledge, 2004.

Gossop, Michael. Theories of Neurosis. New York: Springer, 1981.

Rapee, Ronald M., and David H. Barlow, eds. Chronic Anxiety: Generalized Anxiety Disorder and Mixed Anxiety-Depression. New York: Guilford Press, 1991.

Russon, John. Human Experience: Philosophy, Neurosis, and Elements of Everyday Life. Albany: State University of New York Press, 2003.