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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.
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.
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| Image:Sigmund Freud |
"We all warm our hands in Freud's fires."
Prochaska & Norcross
YouTube Videos:
Sigmund Freud - BBC Record
Sigmund Freud - The Biography 1
Sigmund Freud - The Biography 2
Sigmund Freud - The Biography 3
Sigmund Freud - The Biography 4
Sigmund Freud - The Biography 5
Sigmund Freud - Analise the uma mente
Sigmund Freud - The Last Decade
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