Wednesday, 12 November 2014

Sigmund Freud / Psychoanalysis / Neurosis

Image:Sigmund Freud


    

What is neurosis ?


Neurosis is a mental disorder which causes distress and deficit in functioning arising from disorders of the nervous system, coined by Scottish physician William Cullen (1710-1790) from Greek neuron "nerve"+ Modern Latin “osis”= "abnormal condition." Used in a general psychological sense since 1871; clinical use in psychiatry dates from 1923 ( APA, 2014). Neurosis can be also defined as a poor ability to adapt to their own environment, change one's life patterns, or develop a satisfying personality (Boeree, C. G., 2002).

The DSM has eliminated the category "neurosis" in order to provide only descriptions of behavior rather than descriptions of hidden psychological mechanisms (Horwitz & Wakefield, 2007).

In Psychoanalysis, obsessive compulsive disorder, obsessive compulsive personality disorder, Impulse Control Disorder, anxiety disorder, hysteria, and a great variety of phobias are classified as neurosis (Boeree, C. G., 2002).

Some of the symptoms of neurosis are: anxiety, depression, sadness, anger, irritability, mental confusion, low sense of self-worth, phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc (Boeree, C. G., 2002). Interpersonally, neurosis involves dependency, aggressiveness,perfectionism, schizoid isolation, socio-culturally inappropriate behaviors. Neurosis may impair all areas of life and relationships but do not incapacitate the person and they do not suffer from the loss of the sense of reality as in psychoses(Boeree, C. G., 2002).

Sigmund Freud, the founder of Psychoanalysis, stated that neurosis is caused by intra-psychic conflicts between conscious and unconscious forces, as well as between sexual and aggressive instinctive desires of the id, ego, and superego restrains (Prochaska & Norcross, 2010, p 21). In attempting to control all these impulses and the anxiety and guilt generated by them, the person develops unconscious defence mechanisms (Prochaska & Norcross, 2010, p. 21). The defences developed depend on the age when the conflicts occur (Prochaska & Norcross, 2010, pp. 22-27).

Freud stated four stages of human sexual development: oral, anal, phallic, and genital. How caretakers attend to the baby's needs during these phases, will determine the person's future personality (Prochaska & Norcross, 2010, pp. 22-27). If the child's needs are not met during the oral stage, the child will develop a passive and pessimist expectation of life with regard satisfaction of their needs (Prochaska & Norcross, 2010, pp. 22-27). The defence mechanisms formed in this phase are more primitive: denial, projection and incorporation (Prochaska & Norcross, 2010, pp. 22-27).

The anal stage happen from two to three years of age (Prochaska & Norcross, 2010, pp. 22-27). Fixation in this phase will occur if the parents are too strict or permissive during the toilet training (Prochaska & Norcross, 2010, pp. 22-27). Future personality characteristics when parents are too strict will be punctuality, neatness, lack of generosity, and stubbornness (Prochaska & Norcross, 2010, pp. 22-27). The opposite of these is the result if the parents are permissive (Prochaska & Norcross, 2010, pp. 22-27). Defences resulting from this phase are reaction formation, undoing, intellectualism and isolation (Prochaska & Norcross, 2010, pp. 22-27).

The period from three to six years of age is called the phallic stage, when sexual curiosity and desires are focused on the genitalia (Prochaska & Norcross, 2010, pp. 22-27). Boys' and girls' sexual desires are projected toward the opposite sex parent, accompanied by anxiety and fear of punishment from the same sex parent (Prochaska & Norcross, 2010, pp. 22-27). Therefore, the Oedipal conflict will repress the desire and the child will identify with the same sex parent (Prochaska & Norcross, 2010, pp. 22-27). How parents react to the child's feelings during this phase may cause fixation, consequent specific behaviours and repression as a defence mechanism (Prochaska & Norcross, 2010, pp. 22-27).

From six to eleven is the latency stage, where pre-genital desires are completely repressed, while the ego develops and social rules are learned (Prochaska & Norcross, 2010, pp. 22-27). The genital stage occurs from twelve years of age, when the young person will direct the libido to appropriate objects of love (Prochaska & Norcross, 2010, pp. 22-27).

Due to the atemporality of the unconscious feelings, stressful life events in adulthood activate the need for control and unconscious reactions, evoking childhood anxieties and impulses at the same level and intensity as in the past (Prochaska & Norcross, 2010, p. 27). Hence, defence mechanisms are over-mobilised aiming to keep the childhood impulses and anxieties unconscious, and may become pathological causing neurosis (Prochaska & Norcross, 2010, pp. 27-28). Freud called secondary-process, the logical conscious thinking (Prochaska & Norcross, 2010, pp. 28-29). The illogical, partial conscious and partial unconscious atemporal process is the primary-process of thinking (Prochaska & Norcross, 2010, pp. 28-29).

Psychoanalysis, or Psychoanalytical Psychotherapy changes the mind state, by bringing unconscious feelings to the conscience, facilitating the replacement of immature and distorted mechanisms, for more appropriate defence mechanisms, in order to control socially unaccepted impulses, as well as learning more mature behaviours to express feelings (Prochaska & Norcross, 2010, pp. 29-37). This process will lead to achievement of well-being (Prochaska & Norcross, 2010, pp. 29-37).

The analyst or therapist must be aware of their counter-transference and also show warmth, empathy, genuine concern and respect (Prochaska & Norcross, 2010, pp. 29-37). He/she must provide a safe therapeutic space, to build a good therapeutic alliance and relationship with the healthy part of the client's ego, facilitating a corrective emotional experience (Prochaska & Norcross, 2010, pp. 29-37).

The goals are the utilisation of demonstration, confrontation, interpretation and working-through techniques, so as to analyse the resistance of the client's free association of ideas, transference of feelings to the analyst, and dreams (Prochaska & Norcross, 2010, pp. 29-37). Insight and change will occur only if the client has a cognitive and emotional experience of the content that was previously unconscious (Prochaska & Norcross, 2010, pp. 29-37).

At the end of the process, clients should have learned more mature defences and how to manage their impulses or express their feelings (Prochaska & Norcross, 2010, pp. 29-37). By focussing on the individual interpersonal conflicts, the ultimate goal of the Psychoanalysis or Psychoanalytical Psychotherapy is to increase consciousness (Prochaska & Norcross, 2010, pp. 29-37).

Mrs Glaucia Barbosa,
PACFA Reg. Provisional 25212 
MCouns, MQCA(Clinical)  
  
ABN: 19 476 932 954


References

Boeree, Dr. C. George (2002). “A Bio-Social Theory of Neurosis”. Retrieved 2009-04-21.  

Horwitz and Wakefield (2007). The Loss of Sadness. Oxford. ISBN 978-0-19-531304-8

Mifflin, H.(2007). The American Heritage Medical Dictionary. ISBN 978-0-618-82435-9.

Online Etymology Dictionary. Retrieved November 11, 2014, from Dictionary.com website: http://dictionary.reference.com/browse/neurosis

Prochaska, J. O., & Norcross, J. C. (2013). Systems of Psychotherapy. A transtheoretical Analysis. Stanford-USA: Cengage Learning.

Wilson, Mitchell, (1993), "DSM-III and the Transformation of American Psychiatry: A History". The American Journal of Psychiatry, 150,3, pp. 399–410.     
   
               
                                      
Image:Sigmund Freud
              
                          "We all warm our hands in Freud's fires." 
                                                                     Prochaska & Norcross        

                                            YouTube Videos:
      
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