Neurosis (plural: neuroses) is a term mainly used today by followers of
Freudian thinking to describe mental disorders caused by past
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, often that has been
repressed. This concept is more usually known today as
psychological trauma
Psychological trauma, mental trauma or psychotrauma is an emotional response to a distressing event or series of events, such as accidents, rape, or natural disasters. Reactions such as psychological shock and psychological denial are typical. ...
.
In recent history, the term has also referred to anxiety-related conditions more generally.
The term "neurosis" is no longer used in condition names or categories by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
's ''
International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
'' (ICD) or the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
's ''
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' (DSM). According to the ''American Heritage Medical Dictionary'' of 2007, the term is "no longer used in psychiatric diagnosis".
Sublimation can be considered neuroses' positive counterpart.
Neurosis should not be mistaken for ''
psychosis
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
'', which refers to a loss of touch with reality.
Nor should it be mistaken for its descendant term ''
neuroticism
In the study of psychology, neuroticism has been considered a fundamental personality trait. For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody ...
'', which refers to a
personality trait
In psychology, trait theory (also called dispositional theory) is an approach to the study of human personality. Trait theorists are primarily interested in the measurement of ''traits'', which can be defined as habitual patterns of behaviour, tho ...
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
The Big Five personality traits is a suggested taxonomy, or grouping, for personality traits, developed from the 1980s onward in psychological trait theory.
Starting in the 1990s, the theory identified five factors by labels, for the US English ...
. A similar concept is included in the ICD-11 as the condition "
negative affectivity
Negative affectivity (NA), or negative affect, is a personality variable that involves the experience of negative emotions and poor self-concept. Negative affectivity subsumes a variety of negative emotions, including anger, contempt, disgust, gui ...
".
History
A broad condition (1769-1879)
![William Cullen](https://upload.wikimedia.org/wikipedia/commons/8/8b/William_Cullen.jpg)
The term ''neurosis'' was coined by Scottish doctor
William Cullen
William Cullen FRS FRSE FRCPE FPSG (; 15 April 17105 February 1790) was a Scottish physician, chemist and agriculturalist, and professor at the Edinburgh Medical School. Cullen was a central figure in the Scottish Enlightenment: He was Dav ...
to refer to "disorders of sense and motion" caused by a "general affection of the
nervous system
In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes th ...
". The term is derived from the Greek word ''
neuron
A neuron, neurone, or nerve cell is an electrically excitable cell that communicates with other cells via specialized connections called synapses. The neuron is the main component of nervous tissue in all animals except sponges and placozoa. N ...
'' (νεῦρον, 'nerve') and the suffix ''-osis'' (-ωσις, 'diseased' or 'abnormal condition'). 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
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated
knee-jerks, loss of the
gag reflex The pharyngeal reflex or gag reflex is a reflex muscular contraction of the back of the throat, evoked by touching the roof of the mouth, the back of the tongue, the area around the tonsils, the uvula, and the back of the throat. It, along with othe ...
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'' (1798) 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
Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly dep ...
,
mania
Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
,
dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
, and
idiot
An idiot, in modern use, is a stupid or foolish person.
'Idiot' was formerly a technical term in legal and psychiatric contexts for some kinds of profound intellectual disability where the mental age is two years or less, and the person cannot ...
ism.
Morphine
Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...
was first isolated from
opium
Opium (or poppy tears, scientific name: ''Lachryma papaveris'') is dried latex obtained from the seed capsules of the opium poppy ''Papaver somniferum''. Approximately 12 percent of opium is made up of the analgesic alkaloid morphine, which i ...
in 1805, by German chemist
Friedrich Sertürner
Friedrich Wilhelm Adam Sertürner (19 June 1783 – 20 February 1841) was a German pharmacist and a pioneer of alkaloid chemistry. He is best known for his discovery of morphine in 1804.
Biography
Friedrich Wilhelm Adam Sertürner was born to J ...
. 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."
The tranquilising properties of
potassium bromide
Potassium bromide ( K Br) is a salt, widely used as an anticonvulsant and a sedative in the late 19th and early 20th centuries, with over-the-counter use extending to 1975 in the US. Its action is due to the bromide ion (sodium bromide is equall ...
were noted publicly by British doctor
Charles Locock
Sir Charles Locock, 1st Baronet (21 April 1799 – 23 July 1875) was an obstetrician to Queen Victoria. He is also credited with the introduction of potassium bromide as a treatment for epilepsy.
Charles Locock was born to Henry Locock and his ...
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
Bromism is the syndrome which results from the long-term consumption of bromine, usually through bromine-based sedatives such as potassium bromide and lithium bromide. Bromism was once a very common disorder, being responsible for 5 to 10% of psyc ...
.
Breuer, Freud and contemporaries (1880-1939)
![Josef Breuer, 1897](https://upload.wikimedia.org/wikipedia/commons/5/5c/Josef_Breuer%2C_1897.jpg)
Austrian psychiatrist
Josef Breuer
Josef Breuer ( , ; 15 January 1842 – 20 June 1925) was a distinguished physician who made key discoveries in neurophysiology, and whose work in the 1880s with his patient Bertha Pappenheim, known as Anna O., developed the talking cure (catharti ...
first used
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
to treat hysteria in 1880–1882.
Bertha Pappenheim
Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (''). Under the pseudonym Anna O., she was also one of Josef Breuer's best-documented pat ...
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
Bad Ischl (Austrian German ) is a spa town in Austria. It lies in the southern part of Upper Austria, at the Traun River in the centre of the Salzkammergut region. The town consists of the Katastralgemeinden ''Ahorn'', ''Bad Ischl'', ''Haiden' ...
. 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 didn't 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.
(Subsequent research has suggested Pappenheim may have had one of a number of neurological illnesses. This includes
temporal lobe epilepsy
Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system which is characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. TLE is the most common f ...
,
["Freud Evaluated", Malcolm Macmillan, Elsevier, 1991, pg. 631][Webster, Richard (1996). ''Why Freud was wrong. Sin, science and psychoanalysis''. London: Harper Collins.] tuberculous meningitis
Tuberculous meningitis, also known as TB meningitis or tubercular meningitis, is a specific type of bacterial meningitis caused by the ''Mycobacterium tuberculosis'' infection of the meninges—the system of membranes which envelop the central nerv ...
, and
encephalitis
Encephalitis is inflammation of the brain. The severity can be variable with symptoms including reduction or alteration in consciousness, headache, fever, confusion, a stiff neck, and vomiting. Complications may include seizures, hallucinations, ...
.
Whatever the nature of her condition, she went on to run an orphanage, and then found and lead the for twenty years.)
The term ''psychoneurosis'' was coined by Scottish psychiatrist
Thomas Clouston
Sir Thomas Smith Clouston (22 April 1840 – 19 April 1915) was a Scottish psychiatrist.
Life
Clouston was the youngest of four sons of Robert Clouston (1786–1857) 3rd of Nisthouse, in the Birsay parish of Orkney, and his wife Janet (né ...
for his 1883 book ''Clinical Lectures on Mental Diseases''. He describes a condition that covers what is today considered the
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and
autism
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
spectrums (a combination of symptoms that would soon become better known as
dementia praecox
Dementia praecox (meaning a "premature dementia" or "precocious madness") is a disused psychiatric diagnosis that originally designated a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginnin ...
).
French neurologist
Jean-Martin Charcot
Jean-Martin Charcot (; 29 November 1825 – 16 August 1893) was a French neurology, neurologist and professor of anatomical pathology. He worked on hypnosis and hysteria, in particular with his hysteria patient Louise Augustine Gleizes. Charcot ...
came to believe that psychological trauma was a cause of some cases of
hysteria
Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that ...
. He wrote in his book ''Leçons sur les maladies du système nerveux'', (1885-1887) (and published in English as ''Clinical Lectures on the Diseases of the Nervous System):''
Quite recently male hysteria has been studied by Messrs. Putnam 884
__NOTOC__
Year 884 ( DCCCLXXXIV) was a leap year starting on Wednesday (link will display the full calendar) of the Julian calendar.
Events
By place Europe
* March 1 – Diego Rodríguez Porcelos, count of Castile, founds and repo ...
and Walton 883
__NOTOC__
Year 883 ( DCCCLXXXIII) was a common year starting on Tuesday (link will display the full calendar) of the Julian calendar.
Events
By place Europe
* Spring – Viking raiders ravage Flanders, and sack the abbey at Saint- ...
in America, principally as it occurs after injuries, and especially after railway accidents. They have recognised, like Mr. Page, 885
Year 885 ( DCCCLXXXV) was a common year starting on Friday (link will display the full calendar) of the Julian calendar.
Events
By place Europe
* Summer – Emperor Charles the Fat summons a meeting of officials at Lobith (moder ...
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
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
was a student of Charcot in 1885–6.
French psychiatrist
Pierre Janet
Pierre Marie Félix Janet (; 30 May 1859 – 24 February 1947) was a pioneering French psychologist, physician, philosopher, and psychotherapist in the field of dissociation and traumatic memory.
He is ranked alongside William James and ...
believed that the main aspect of psychological trauma is
dissociation
Dissociation, in the wide sense of the word, is an act of disuniting or separating a complex object into parts. Dissociation may also refer to:
* Dissociation (chemistry), general process in which molecules or ionic compounds (complexes, or salts) ...
(a disconnection of the conscious mind from reality) in 1889. (Freud would later claim Janet as a major influence.)
[Sigmund Freud, ''On Metapsychology'' (PFL 11) p. 52.]
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. (Vorläufige Mittheilung.)" (known in English as "On the physical mechanism of hysterical phenomena: preliminary communication") in January 1893. It opens with:
![Sigmund Freud LIFE](https://upload.wikimedia.org/wikipedia/commons/1/12/Sigmund_Freud_LIFE.jpg)
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'' (Studies on Hysteria'').'' Of the book's five case studies, the most famous became that of Breuer's patient
Bertha Pappenheim
Bertha Pappenheim (27 February 1859 – 28 May 1936) was an Austrian-Jewish feminist, a social pioneer, and the founder of the Jewish Women's Association (''). Under the pseudonym Anna O., she was also one of Josef Breuer's best-documented pat ...
(given the pseudonym "Anna O."). This book established the field of
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
.
French neurologist
Paul Oulmont was mentored by Charcot. In his 1894 book ''Thérapeutique des névroses'' (Therapy of neuroses), he lists the neuroses as being
hysteria
Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that ...
,
neurasthenia
Neurasthenia (from the Ancient Greek νεῦρον ''neuron'' "nerve" and ἀσθενής ''asthenés'' "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the nerves and became a major diagnosis in North A ...
,
exophthalmic goitre,
epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
,
migraine
Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
,
Sydenham's chorea
Sydenham's chorea, also known as rheumatic chorea, is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea is an autoimmune disease that results from childhood infecti ...
,
Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
and
tetany
Tetany or tetanic seizure is a medical sign consisting of the involuntary contraction of muscles, which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them.
Muscle cramps cause ...
.
The fifth edition of German psychiatrist
Emil Kraepelin
Emil Wilhelm Georg Magnus Kraepelin (; ; 15 February 1856 – 7 October 1926) was a German psychiatrist.
H. J. Eysenck's ''Encyclopedia of Psychology'' identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychi ...
’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
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
and hysterical insanity.
Pierre Janet published the two volume work ''Névroses et Idées Fixes'' (Neuroses and Fixations) in 1898.
According to Janet, neuroses could be usefully divided into
hysteria
Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that ...
s and
psychasthenia
Psychasthenia was a psychological disorder characterized by phobias, obsessions, compulsions, or excessive anxiety. The term is no longer in psychiatric diagnostic use, although it still forms one of the ten clinical subscales of the popular self-r ...
s. 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
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
and
executive functions
In cognitive science and neuropsychology, executive functions (collectively referred to as executive function and cognitive control) are a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and succe ...
.
Barbiturate
Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as we ...
is a class of highly addictive
sedative
A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but t ...
drug. The first barbiturate,
barbital
Barbital (or barbitone), marketed under the brand names Veronal for the pure acid and Medinal for the sodium salt, was the first commercially available barbiturate. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. The chemic ...
, was synthesized in 1902 by German chemists
Emil Fischer
Hermann Emil Louis Fischer (; 9 October 1852 – 15 July 1919) was a German chemist and 1902 recipient of the Nobel Prize in Chemistry. He discovered the Fischer esterification. He also developed the Fischer projection, a symbolic way of dra ...
and
Joseph von Mering
Josef, Baron von Mering (28 February 1849, in Cologne – 5 January 1908, at Halle an der Saale, Germany) was a German physician.
Working at the University of Strasbourg, Mering was the first person to discover (in conjunction with Oskar Minkowsk ...
and was first marketed as "Veronal" in 1904. The similar barbiturate
phenobarbital
Phenobarbital, also known as phenobarbitone or phenobarb, sold under the brand name Luminal among others, is a medication of the barbiturate type. It is recommended by the World Health Organization (WHO) for the treatment of certain types of ep ...
was brought to market in 1912 under the name "Luminal". Barbituate became a popular drug in many countries to reduce neurotic anxiety, and displaced the use of bromides.
Janet published the book ''Les Obsessions et la Psychasthénie'' (The Obsessions and the Psychasthenias) in 1903.
Janet followed this with the books ''The Major Symptoms of Hysteria'' in 1907, and ''Les Névroses'' (The Neuroses) 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.
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
Salzburg (, ; literally "Salt-Castle"; bar, Soizbuag, label=Bavarian language, Austro-Bavarian) is the List of cities and towns in Austria, fourth-largest city in Austria. In 2020, it had a population of 156,872.
The town is on the site of the ...
in April 1908. Subsequent Congresses continue today.
Freud published the detailed case study ''Bemerkungen über einen Fall von Zwangsneurose'' (Notes Upon a Case of Obsessional Neurosis) in 1909, documenting his treatment of "
Rat Man
"Rat Man" was the nickname given by Sigmund Freud to a patient whose "case history" was published as ''Bemerkungen über einen Fall von Zwangsneurose'' Notes Upon a Case of Obsessional Neurosis"(1909). This was the second of six case histories ...
".
Freud established the
International Psychoanalytical Association
The International Psychoanalytical Association (IPA) is an association including 12,000 psychoanalysts as members and works with 70 constituent organizations. It was founded in 1910 by Sigmund Freud, from an idea proposed by Sándor Ferenczi.
His ...
(IPA) in March 1910. He arranged for
Carl Jung
Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
to be its first president. This organisation chose to only provide psychoanalytic training and recognition to medical doctors.
The
American Psychoanalytic Association
The American Psychoanalytic Association (APsaA) is an association of psychoanalysts in the United States. APsaA serves as a scientific and professional organization with a focus on education, research, and membership development.
APsaA comprises 3 ...
was founded in 1911
by Welsh neurologist
Ernest Jones
Alfred Ernest Jones (1 January 1879 – 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first En ...
, 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
The ''Internationale Zeitschrift für Psychoanalyse'' (English: ''International Journal of Psychoanalysis'') was a German-language psychoanalytic journal, which was published from 1913 to 1937 and from 1939 to 1941 by the International Psychoanaly ...
'' was established in 1913, and continued until 1941.
The battlefield stresses of
World War I
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
(1914–18) lead to many cases of strong short-term psychological symptoms, known today as "
combat stress reaction
Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used ...
" (CSR). 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
The fight-or-flight or the fight-flight-or-freeze response (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first des ...
was first described by American physiologist
Walter Bradford Cannon
Walter Bradford Cannon (October 19, 1871 – October 1, 1945) was an American physiologist, professor and chairman of the Department of Physiology at Harvard Medical School. He coined the term "fight or flight response", and developed the theory ...
in 1915.
American military psychiatrist
Thomas W. Salmon (the chief consultant in psychiatry in the
American Expeditionary Force
The American Expeditionary Forces (A. E. F.) was a formation of the United States Army on the Western Front of World War I. The A. E. F. was established on July 5, 1917, in France under the command of General John J. Pershing. It fought alon ...
) released the book ''The care and treatment of mental diseases and war neuroses ("shell shock") 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" (1916–17), forming part 3 of the book ''Vorlesungen zur Einführung in die Psychoanalyse'' (1917), later published in English as ''
A General Introduction to Psychoanalysis
''Introduction to Psychoanalysis'' or ''Introductory Lectures on Psycho-Analysis'' (german: Einführung in die Psychoanalyse) is a set of lectures given by Sigmund Freud, the founder of psychoanalysis, in 1915–1917 (published 1916–1917, in Engl ...
'' (1920).
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 (1880–82). It is true that P. Janet independently reached the same result...
The euroticsymptom 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'' (From the History of an Infantile Neurosis) published in 1918, which is a detailed case study of Freud's treatment of the "
Wolfman
In folklore, a werewolf (), or occasionally lycanthrope (; ; uk, Вовкулака, Vovkulaka), is an individual that can shapeshifting, shapeshift into a wolf (or, especially in modern film, a therianthropy, therianthropic mythological hybr ...
".
The International Journal of Psychoanalysis
''The International Journal of Psychoanalysis'' is an academic journal in the field of psychoanalysis. The idea of the journal was proposed by Ernest Jones in a letter to Sigmund Freud dated 7 December 1918. The journal itself was established in 1 ...
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.
In 1929, Austrian psychiatrist
Alfred Adler
Alfred Adler ( , ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist, and founder of the school of individual psychology. His emphasis on the importance of feelings of belonging, family constellation and birth order ...
published the book ''Problems of Neurosis: A Book of Case-Histories'', furthering the school of
individual psychology
Individual psychology (german: Individualpsychologie) is a psychological method or science founded by the Austrian people, Viennese psychiatrist Alfred Adler. The English language, English edition of Adler's work on the subject (1925) is a collecti ...
he had established in 1912.
![Portrait Hans Selye](https://upload.wikimedia.org/wikipedia/commons/e/e7/Portrait_Hans_Selye.jpg)
The
general adaptation syndrome
Stress, either physiological, biological or psychological, is an organism's response to a stressor such as an environmental condition. Stress is the body's method of reacting to a condition such as a threat, challenge or physical and psycholo ...
(GAS) theory of stress was developed by Austro-Hungarian physiologist
Hans Selye
János Hugo Bruno "Hans" Selye (; hu, Selye János; January 26, 1907 – October 16, 1982) was a pioneering Hungarian-Canadian endocrinologist who conducted important scientific work on the hypothetical non-specific response of an organism to s ...
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
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong ...
.
1939-1952
Followers of Freud's
psychoanalytic
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might be ...
thinking, including the Swiss
Carl Jung
Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
, German-American
Karen Horney
Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst who practised in the United States during her later career. Her theories questioned some traditional Freudian views. This was particularly true of her theories of ...
, and the French
Jacques Lacan
Jacques Marie Émile Lacan (, , ; 13 April 1901 – 9 September 1981) was a French psychoanalyst and psychiatrist. Described as "the most controversial psycho-analyst since Freud", Lacan gave yearly seminars in Paris from 1953 to 1981, and pu ...
, continued to develop his neurosis ideas after his death in 1939. The term continues to be used in the way Freud did in psychology and philosophy.
[Jacobson, Kirsten. 2006. "The Interpersonal Expression of Human Spatiality: A Phenomenological Interpretation of ''Anorexia Nervosa.''" '']Chiasmi International
''Chiasmi International: Trilingual Studies Concerning the Thought of Merleau-Ponty'' is a peer-reviewed academic journal that publishes articles, reviews, and discussions in Italian, French, and English on the thought of the French philosopher Mau ...
'' 8:157–74.
By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so were getting pensions for 'soldier's heart' or
effort syndrome
Da Costa's syndrome (also known as "soldier's heart", cardiac neurosis, chronic asthenia, effort syndrome, functional cardiovascular disease, neurocirculatory asthenia, primary neurasthenia, subacute asthenia and irritable heart) is a psychiatr ...
. British historian
Ben Shephard
Benjamin Peter Sherrington Shephard (born 11 December 1974) is an English television presenter and journalist who is currently employed by ITV. He was a main presenter on the now defunct breakfast programme '' GMTV'' and since April 2014 has ...
notes, "There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg."
[ Shephard, Ben. ''A War of Nerves: Soldiers and Psychiatrists, 1914–1994''. London: Jonathan Cape, 2000. ]
Approximately 20% of U.S. troops displayed symptoms of
combat stress reaction
Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used ...
during
WWII
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
(1939-1945). It was assumed to be a temporary response of healthy individuals to witnessing or experiencing traumatic events. Symptoms included depression, anxiety, withdrawal, confusion, paranoia, and sympathetic hyperactivity.
Thomas W. Salmon's battle neurosis principles were adopted by the U.S. forces during this conflict.
The American Journal of Psychoanalysis
''The American Journal of Psychoanalysis'' is a healthcare journal covering psychoanalysis.
Abstracting and indexing
The ''American Journal of Psychoanalysis'' is abstracted and indexed in Scopus.
See also
* List of psychotherapy journals
...
was founded by Karen Horney in 1941.
Austrian psychiatrist
Otto Fenichel
Otto Fenichel (2 December 1897 in Vienna – 22 January 1946 in Los Angeles) was a psychoanalyst of the so-called "second generation".
Education and psychoanalytic affiliations
Otto Fenichel started studying medicine in 1915 in Vienna. Already ...
's encyclopaedic textbook ''The psychoanalytic theory of neurosis'' (1945) set the post-war Freudian orthodoxy on the subject. It has been heavily cited by academic papers in the years since.
![Karen Horney 1938](https://upload.wikimedia.org/wikipedia/commons/3/30/Karen_Horney_1938.jpg)
Karen Horney's ''Our Inner Conflicts: A Constructive Theory of Neurosis'' (1945) was a popular book on the topic.
Austrian psychiatrist
Viktor Frankl
Viktor Emil Frankl (26 March 1905 – 2 September 1997)
was an Austrian psychiatrist who founded logotherapy, a school of psychotherapy that describes a search for a life's meaning as the central human motivational force. Logotherapy is part ...
's best selling book ''
Man's Search for Meaning
''Man's Search for Meaning'' is a 1946 book by Viktor Frankl chronicling his experiences as a prisoner in Nazi concentration camps during World War II, and describing his psychotherapeutic method, which involved identifying a purpose in life to f ...
'' (1946) launched the psychotherapy school of
logotherapy
Logotherapy was developed by neurologist and psychiatrist Viktor Frankl and is based on the premise that the primary motivational force of an individual is to find a meaning in life. Frankl describes it as "the Third Viennese School of Psychothe ...
.
For his 1947 book, ''Dimensions of Personality'', German-British psychologist
Hans Eysenck
Hans Jürgen Eysenck (; 4 March 1916 – 4 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other ...
created the term "
neuroticism
In the study of psychology, neuroticism has been considered a fundamental personality trait. For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody ...
" to refer to someone whose "constitution may leave them liable to break down
motionallywith the slightest provocation".
The book outlines a two-factor theory of personality, with neuroticism as one of those two factors. This book would be greatly influential on future personality theory.
Karen Horney's ''
Neurosis and Human Growth'' (1950) further expanded the understanding of neuroses.
French-Swiss psychologist
Germaine Guex
Germaine Guex (April 17, 1904 in Arcachon, France–November 20, 1984 in Lausanne, Switzerland) was a Swiss psychologist. She was particularly known for her work on abandonment syndrome in psychoanalysis.
Born in Arcachon, France, Guex achiev ...
's 1950 book ''La névrose d'abandon'' proposed the existence of the condition of "abandonment neurosis". It also detailed all the forms of treatment Geux had found effective in treating it. (It was published in English as ''The Abandonment Neurosis'' in 2015).
In October 1951, highly influential American psychologist
Carl Rogers
Carl Ransom Rogers (January 8, 1902 – February 4, 1987) was an American psychologist and among the founders of the humanistic approach (and client-centered approach) in psychology. Rogers is widely considered one of the founding fathers of ps ...
presented a paper in which he described the relationship between neurosis and his understanding of effective therapy. He wrote:
The emotionally maladjusted person, the "neurotic", is in difficulty first because communication within himself has broken down, and second because as a result of this his communication with others has been damaged. If this sounds somewhat strange, then let me put it in other terms. In the "neurotic" individual, parts of himself which have been termed unconscious, or repressed, or denied to awareness, become blocked off so that they no longer communicate themselves to the conscious or managing part of himself... The task of psychotherapy is to help the person achieve, through a special relationship with the therapist, good communication within himself.
The
North American Society of Adlerian Psychology
The North American Society of Adlerian Psychology (NASAP) was created in 1952 and is the primary organization in the United States for the promotion of the psychological and philosophical theories of Alfred Adler, known as Adlerian Psychology or I ...
was established in 1952, becoming the predominant society of its cause in the world.
DSM-I (1952-1968)
The first edition of the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
's ''
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' (DSM-I) in 1952 included a category named "Psychoneurotic Disorders".
Regarding the definition of this category, the Manual stated:
Grouped as Psychoneurotic Disorders are those disturbances in which “anxiety” is a chief characteristic, directly felt and expressed, or automatically controlled by such defenses as depression, conversion, dissociation, displacement, phobia formation, or repetitive thoughts and acts.
For this nomenclature, a psychoneurotic reaction may be defined as one in which the personality, in its struggle for adjustment to internal and external stresses, utilizes the mechanisms listed above to handle the anxiety created. The qualifying phrase, x.2 with neurotic reaction, may be used to amplify the diagnosis when, in the presence of another psychiatric disturbance, a symptomatic clinical picture appears which might be diagnosed under Psychoneurotic Disorders in this nomenclature. A specific example may be seen in an episode of acute anxiety occurring in a homosexual.
Conditions in the category included:
*
Anxiety reaction
*
Dissociative reaction
*
Conversion reaction
Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness ...
*
Phobic reaction
*
Obsessive compulsive reaction
*
Depressive reaction
* Psychoneurotic reaction, other
The DSM-I also included a category of "transient situational personality disorders". This included the diagnosis of "
gross stress reaction".
This was defined as a normal personality using established patterns of reaction to deal with overwhelming fear as a response to conditions of great stress.
The diagnosis included language which relates the condition to combat as well as to "civilian catastrophe".
The other situational disorders were "
adult situational reaction" and a variety of time-of-life delineated "
adjustment reaction
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
s". These referred to short-term reactions to stressors.
Monoamine oxidase inhibitor
Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B). They are best known as effective antidepressants, espe ...
s (MAOIs) and
tricyclic antidepressant
Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants, which is important for the management of depression. They are second-line drugs next to SSRIs. TCAs were discovered in the early 1950s and wer ...
s (TCAs) were developed for the treatment of neurosis and other conditions from the early 1950s. Because of their undesirable adverse-effect profile and high potential for
toxicity
Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subst ...
, their use was limited.
The use of modern
exposure therapy
Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thou ...
for neuroses began in the 1950s in South Africa.
South African-American
Joseph Wolpe
Joseph Wolpe (20 April 1915 in Johannesburg, South Africa – 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behavior therapy.
Wolpe grew up in South Africa, attending Parktown Boys' ...
was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioral issues.
In May 1950, pharmacologist
Frank Berger
Frank Milan Berger (June 25, 1913 - March 18, 2008) was a Czechoslovakian pharmacologist who discovered meprobamate, carisoprodol, and felbamate, while working at Wallace Laboratories.
He also discovered the 'tranquilising' effects of mephenesin i ...
(Czech-American) and chemist Bernard John Ludwig engineered
meprobamate
Meprobamate—marketed as Miltown by Wallace Laboratories and Equanil by Wyeth, among others—is a carbamate derivative used as an anxiolytic drug. It was the best-selling minor tranquilizer for a time, but has largely been replaced by the benz ...
to be a non-drowsy tranquiliser. Launched as "Miltown" in 1955, it rapidly became the first blockbuster psychotropic drug in American history, becoming popular in Hollywood and gaining fame for its effects. It is highly addictive.
After the
Korean War
, date = {{Ubl, 25 June 1950 – 27 July 1953 (''de facto'')({{Age in years, months, weeks and days, month1=6, day1=25, year1=1950, month2=7, day2=27, year2=1953), 25 June 1950 – present (''de jure'')({{Age in years, months, weeks a ...
(1950-1953),
Thomas W. Salmon's battle neurosis treatment practices became summarised as the PIE principles:
* Proximity – treat the casualties close to the front and within sound of the fighting.
* Immediacy – treat them without delay and not wait until the wounded were all dealt with.
* Expectancy – ensure that everyone had the expectation of their return to the front after a rest and replenishment.
The
International Association of Analytical Psychology was founded in 1955. It is the predominant organisation devoted to the psychology of
Carl Jung
Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
.
In 1956, American psychologist
Albert Ellis
Albert Ellis (September 27, 1913 – July 24, 2007) was an American psychologist and psychotherapist who founded rational emotive behavior therapy (REBT). He held MA and PhD degrees in clinical psychology from Columbia University, and was certi ...
published his first paper on his methodology "rational psychotherapy"''.'' This and later works defined what is now known as
rational emotive behavior therapy
Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioral prob ...
(REBT). Ellis believed that people's erroneous beliefs about their adversities was a major cause of neurosis, and his therapy aimed to dissolve these neuroses by correcting people's understandings. Ellis published the first REBT book, ''How to live with a neurotic,'' in 1957. Ellis' therapy was also the beginning of what is now called
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT).
Albert Ellis and others founded The Institute for Rational Living in April 1959, which later became the Albert Ellis Institute.
The concept of "
institutional neurosis" was coined by British psychiatrist Russell Barton, and explained in his well-cited 1959 book ''Institutional Neurosis''. Barton believed that many of the mental health symptoms had by people living in mental hospitals and similar institutions were caused by being in those environments, rather than other causes. Barton was a leader in the
deinstitutionalisation
Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late ...
movement. (The form of neurosis later came to be known as "
institutional syndrome
In Clinical psychology, clinical and abnormal psychology, institutionalization or institutional syndrome refers to deficits or disabilities in social and life skills, which develop after a person has spent a long period living in mental hospitals ...
").
Benzodiazepine
Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...
is a class of highly addictive sedative drugs that reduce anxiety by depressing function in certain parts of the brain. The first of these drugs,
chlordiazepoxide
Chlordiazepoxide, trade name Librium among others, is a sedative and hypnotic medication of the benzodiazepine class; it is used to treat anxiety, insomnia and symptoms of Drug withdrawal, withdrawal from Alcohol (drug), alcohol and other drugs.
...
(Librium), was made available for sale in 1960. (It was discovered by Polish-American chemist
Leo Sternbach
Leo Sternbach (May 7, 1908 – September 28, 2005) was a Polish American chemist who is credited with first synthesizing benzodiazepines, the main class of tranquilizers.
Background and family
Sternbach was born on May 7, 1908, in Opatija, K ...
in 1955.) Librium was followed with the more popular
diazepam
Diazepam, first marketed as Valium, is a medicine of the benzodiazepine family that acts as an anxiolytic. It is commonly used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, a ...
(Valium) in 1963.
These drugs soon displaced Miltown.
Spanish history writer Jose M. Lopez Pinero published ''Origenes historicos del concepto de neurosis'' in 1963. It was published in English as ''Historical Origins of the Concept of Neurosis'' in 1983.
Neurotics Anonymous
Neurotics Anonymous (N/A), founded in 1964, is a twelve-step program for recovery from mental and emotional illness. To avoid confusion with Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.
History
The conception of N ...
began in February 1964, as a
twelve-step program
Twelve-step programs are international mutual aid programs supporting recovery from substance addictions, behavioral addictions and compulsions. Developed in the 1930s, the first twelve-step program, Alcoholics Anonymous (AA), aided its members ...
to help the neurotic. It was founded in Washington, D.C. by American psychologist Grover Boydston,
and has since spread through the Americas.
Alfred Adler
Alfred Adler ( , ; 7 February 1870 – 28 May 1937) was an Austrian medical doctor, psychotherapist, and founder of the school of individual psychology. His emphasis on the importance of feelings of belonging, family constellation and birth order ...
released the book ''Problems of Neurosis'' in 1964, explaining his understanding of what neurosis exist, and how best to treat them.
Also in 1964, Polish psychiatrist
Kazimierz Dąbrowski
Kazimierz Dąbrowski (1 September 1902 in Klarów – 26 November 1980 in Warsaw) was a Polish psychologist, psychiatrist, and physician. He is best known for his theory of " positive disintegration" as a mechanism in personality development. H ...
released his book ''Positive Disintegration''.
The book argues that developing and resolving psychoneurosis is a necessary part of healthy personality development.
The popular textbook ''The causes and cures of neurosis; an introduction to modern behaviour therapy based on learning theory and the principles of conditioning'' was published in 1965 by Hans Eysenck and South African-British psychologist
Stanley Rachman
Stanley Jack Rachman (January 19, 1934 – September 2, 2021) was a psychologist and Professor Emeritus of the Department of Psychology at the University of British Columbia in Vancouver, British Columbia, Canada.
Career
Rachman worked primarily w ...
. It aimed to replace the Freudian approach to neurosis with
behaviorism
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent (behavioral psychology), antecedent stimuli in the environment, o ...
.
In 1966, psychologists began to observe large numbers of children of Holocaust survivors seeking mental help in clinics in Canada. The grandchildren of Holocaust survivors were overrepresented by 300% among the referrals to psychiatry clinics in comparison with their representation in the general population.
Further study lead to the better understanding of
transgenerational trauma
Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epige ...
.
The noted book ''Psychological stress and the coping process'' was released by American psychologist
Richard Lazarus
Richard S. Lazarus (March 3, 1922 – November 24, 2002) was an American psychologist who began rising to prominence in the 1960s. A ''Review of General Psychology'' survey, published in 2002, ranked Lazarus as the 80th most cited psychologist of ...
in 1966.
The
Association for Advancement of Behavioral Therapies was founded in 1966. (In 2005, it became the
Association for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies (ABCT) was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therap ...
.)
DSM-II (1968-1980)
After Freudian thinking became less prominent in psychology, the term "neurosis" came to be used as a near synonym for "
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
". The second edition of the DSM (''
DSM-II
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'') in 1968 described neuroses thusly:
Anxiety is the chief characteristic of the neuroses. It may be felt and expressed directly, or it may be controlled unconsciously and automatically by conversion
Conversion or convert may refer to:
Arts, entertainment, and media
* "Conversion" (''Doctor Who'' audio), an episode of the audio drama ''Cyberman''
* "Conversion" (''Stargate Atlantis''), an episode of the television series
* "The Conversion" ...
nto physical symptoms displacement
Displacement may refer to:
Physical sciences
Mathematics and Physics
*Displacement (geometry), is the difference between the final and initial position of a point trajectory (for instance, the center of mass of a moving object). The actual path ...
nto mental symptomsand various other psychological mechanisms. Generally, these mechanisms produce symptoms experienced as subjective distress from which the patient desires relief. The neuroses, as contrasted to the psychoses
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...
, manifest neither gross distortion or misinterpretation of external reality, nor gross personality disorganization...
Included in this category were the conditions:
*
Hysterical neurosis
**
Hysterical neurosis, conversion type
**
Hysterical neurosis, dissociative type
*
Phobic neurosis
*
Obsessive compulsive neurosis
*
Depressive neurosis
Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from ...
* Neurasthenic neurosis (
Neurasthenia
Neurasthenia (from the Ancient Greek νεῦρον ''neuron'' "nerve" and ἀσθενής ''asthenés'' "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the nerves and became a major diagnosis in North A ...
)
* Depersonalization neurosis (
Depersonalization syndrome)
*
Hypochondriacal neurosis
* Other neurosis
* Unspecified neurosis
What was previously "gross stress reaction" and "adult situational reaction" was combined into the new "
adjustment disorder
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
of adult life", a condition covering mild to strong reactions. Other adjustment disorders for other times-of-life were also included. (Also, the category "transient situational personality disorders" was renamed "transient situational disturbances.")
''Anxiety and Neurosis'' was a popular mass-market book released in 1968 by British psychologist
Charles Rycroft
Charles Frederick Rycroft (; 9 September 1914 – 24 May 1998) was a British psychiatrist and psychoanalyst. He studied medicine at University College London, and worked briefly as a psychiatrist for the Maudsley Hospital. For most of his caree ...
.
''Neuroses and Personality Disorders'' was a popular textbook released by American psychologist Elton B McNeil in 1970.
The book ''
Primal Scream. Primal Therapy: The Cure for Neurosis'' by American psychologist
Arthur Janov
Arthur Janov (; August 21, 1924October 1, 2017), also known as Art Janov, was an American psychologist, psychotherapist, and writer. He gained notability as the creator of primal therapy, a treatment for mental illness that involves repeatedly de ...
was released in 1970. It established
primal therapy
Primal therapy is a trauma-based psychotherapy created by Arthur Janov, who argues that neurosis is caused by the repressed pain of childhood trauma. Janov argues that repressed pain can be sequentially brought to conscious awareness for resolutio ...
as a treatment for neurosis. It is based on the idea that neurosis is caused by the
repressed pain of childhood trauma. Janov argued that repressed pain can be sequentially brought to conscious awareness for resolution through re-experiencing specific incidents and fully expressing the resulting pain during therapy. Janov criticizes the
talking therapies
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome prob ...
as they deal primarily with the
cerebral cortex
The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. The cerebral cortex mostly consists of the six-layered neocortex, with just 10% consisting of ...
and higher-reasoning areas and do not access the source of Pain within the more basic parts of the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all par ...
.
[Janov, A., ''Prisoners of Pain'', Introduction] (A second edition of the book was published in 1999).
Dąbrowski expanded on his earlier book with ''Psychoneurosis Is Not An Illness: Neuroses And Psychoneuroses From The Perspective Of Positive Disintegration'' in 1972.
In 1975, Americans the nurse
Ann Burgess
Ann C. Wolbert Burgess (born October 2, 1936; middle name also spelled Wolpert) is a researcher whose work has focused on developing ways to assess and treat trauma in rape victims. She is a professor at the William F. Connell School of Nursing a ...
and sociologist Lynda Lytle Holmstrom defined
rape trauma syndrome
Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape survivor that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior. The theory was first described by nurse Ann Wolbert Burgess and ...
in order to draw attention to the striking similarities between the experiences of soldiers returning from war and of rape victims.
Beta-blockers
Beta blockers, also spelled β-blockers, are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack after a first heart attack (secondary prevention). They are al ...
are a class of medication that block the receptor sites for
epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
(adrenaline) and
norepinephrine
Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as both a hormone and neurotransmitter. The name "noradrenaline" (from Latin '' ad'', ...
(noradrenaline) on
beta receptor
The adrenergic receptors or adrenoceptors are a class of G protein-coupled receptors that are targets of many catecholamines like norepinephrine (noradrenaline) and epinephrine (adrenaline) produced by the body, but also many medications like beta ...
s, of the
sympathetic nervous system
The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of th ...
, which mediates the
fight-or-flight response
The fight-or-flight or the fight-flight-or-freeze response (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first des ...
.
By the mid-1970s, beta blockers were used to reduce symptoms of anxiety. (Scottish pharmacologist
James Black had synthesized the first clinically significant beta blockers (
propranolol
Propranolol, sold under the brand name Inderal among others, is a medication of the beta blocker class. It is used to treat high blood pressure, a number of types of irregular heart rate, thyrotoxicosis, capillary hemangiomas, performance anx ...
and
pronethalol
Pronethalol (also known as nethalide or compound 38,174; trade name Alderlin) was an early non-selective beta blocker clinical candidate. It was the first beta blocker to be developed by James Black and associates at Imperial Chemical Industries ...
) in 1964).
In 1977,
benzodiazepine
Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...
s had become the most prescribed medications globally. That was the year the highly addictive benzodiazepine
lorazepam
Lorazepam, sold under the brand name Ativan among others, is a benzodiazepine medication. It is used to treat anxiety disorders, trouble sleeping, severe agitation, active seizures including status epilepticus, alcohol withdrawal, and c ...
(Ativan) entered the US market, (having earlier been invented by American chemist Stanley C Bell in 1963.)
American psychiatrist and historian
Kenneth Levin
Kenneth Levin (born 1944) is a Newton, Massachusetts psychiatrist and historian and author of '' The Oslo Syndrome: Delusions of a People Under Siege''.
Levin is clinical instructor of psychiatry at Harvard Medical School. He holds a B.A from th ...
's ''Freud's early psychology of the neuroses: a historical perspective'' was published in 1978.
Albert Ellis
Albert Ellis (September 27, 1913 – July 24, 2007) was an American psychologist and psychotherapist who founded rational emotive behavior therapy (REBT). He held MA and PhD degrees in clinical psychology from Columbia University, and was certi ...
' work was expanded on by fellow American, psychiatrist
Aaron Beck
Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania. . The well-cited book ''Cognitive therapy of depression'' was written by Beck, American psychiatrist
A. John Rush, Canadian psychologist Brian F. Shaw and American psychologist Gary Emery. It was released in 1979. It launched the
Beck's cognitive triad
Beck's cognitive triad, also known as the negative triad, is a cognitive-therapeutic view of the three key elements of a person's belief system present in depression. It was proposed by Aaron Beck in 1967. The triad forms part of his cognitive th ...
explanation of depression, and lead to CBT becoming the main talking-therapy used to treat depression.
Beck's
cognitive therapy
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cogn ...
became popular, eventually becoming the most popular form of CBT and often being known by that name.
In January 1980,
Stanley Rachman
Stanley Jack Rachman (January 19, 1934 – September 2, 2021) was a psychologist and Professor Emeritus of the Department of Psychology at the University of British Columbia in Vancouver, British Columbia, Canada.
Career
Rachman worked primarily w ...
published a well-cited working definition of "emotional processing", aiming to define the "certain psychological experiences" Freud had mentioned in his 1923 book (and had earlier referred to).
DSM-III (1980-1994)
The DSM eliminated its ''neurosis'' category in 1980 with the release of the
''DSM-III'', because of a decision by its editors to provide descriptions of behavior rather than descriptions of hidden psychological mechanisms.
This change was controversial.
[Wilson, Mitchell. 1993. "DSM-III and the Transformation of American Psychiatry: A History." '']The American Journal of Psychiatry
''The American Journal of Psychiatry'' is a monthly peer-reviewed medical journal covering all aspects of psychiatry, and is the official journal of the American Psychiatric Association.
The first volume was issued in 1844, at which time it was k ...
'' 150(3):399–410. The various anxiety-related conditions previously considered neuroses are now classified differently.
This edition of the book also included a condition named "
post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
" for the first time, as one of the "anxiety disorders".
This was similar in definition to the "gross stress reaction" of the DSM-I.
The time-of-life based subtypes of "
adjustment disorder
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
" were abolished, replaced with combinations with co-morbid syndromes (such as "Adjustment Disorder with Depressed Mood" and "Adjustment Disorder with Anxious Mood").
Adjustment disorder returned to being a short-term condition.
The
Phobia Society of America was founded by psychologist
Jerilyn Ross
Jerilyn Ross (December 20, 1946, in the Bronx, New York – January 7, 2010, at Sibley Memorial Hospital in Washington, D.C.) was an American psychotherapist, phobia expert, and mental health activist. ''The New York Times'' Benedict Carey describ ...
and others in 1980.
It would later expand its scope to cover all
anxiety disorder
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s and
depression, which was reflected in it becoming known as the
Anxiety and Depression Association of America
The Anxiety and Depression Association of America (ADAA) is a U.S. nonprofit organization dedicated to increasing awareness and improving the diagnosis, treatment, and cure of anxiety disorders in children and adults. Anxiety disorder is a class ...
.
In 1981, American psychologists
Richard Lazarus
Richard S. Lazarus (March 3, 1922 – November 24, 2002) was an American psychologist who began rising to prominence in the 1960s. A ''Review of General Psychology'' survey, published in 2002, ranked Lazarus as the 80th most cited psychologist of ...
and
Susan Folkman
Susan Kleppner Folkman (born March 19, 1938) is an American psychologist, author, and emerita professor of medicine at the University of California at San Francisco (UCSF). She is internationally recognized for her contributions to the field of ...
suggested that stress can be thought of as resulting from an "imbalance between demands and resources" or as occurring when "pressure exceeds one's perceived ability to cope". They developed the ''transactional model'' of stress.
Also in 1981, American psychologists
Christina Maslach
Christina Maslach (born January 21, 1946) is an American social psychologist and professor emerita of psychology at the University of California, Berkeley, known for her research on occupational burnout. She is a co-author of the Maslach Burnout I ...
and
Susan E. Jackson published an instrument for assessing
occupational burnout
According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s ...
, the
Maslach Burnout Inventory
The Maslach Burnout Inventory (MBI) is a psychological assessment instrument comprising 22 symptom items pertaining to occupational burnout. The original form of the MBI was developed by Christina Maslach and Susan E. Jackson with the goal of asse ...
.
The two researchers described burnout in terms of emotional exhaustion, depersonalization (feeling low empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment.
The highly addictive benzodiazepine
alprazolam
Alprazolam, sold under the brand name Xanax, among others, is a fast-acting, potent tranquilizer of medium duration in the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring. It is most commonly u ...
(Xanax) was approved for medical use in the United States in 1981,
(having been invented by American chemist Jackson Hester in 1971.) This and accounts of Valium addiction issues (particularly that of
Barbara Gordon
Barbara Gordon is a superheroine appearing in American comic books published by DC Comics, commonly in association with the superhero Batman. The character was created by television producer William Dozier, editor Julius Schwartz, writer Gardne ...
) led to the latter no longer being the most prescribed drug in the United States in 1982.
Acceptance and commitment therapy
Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfu ...
(ACT) was started by American psychologist
Steven C. Hayes
Steven C. Hayes (born August 12, 1948) is an American clinical psychologist and Nevada Foundation Professor at the University of Nevada, Reno Department of Psychology, where he is a faculty member in their Ph.D. program in behavior analysis. He is ...
in around 1982. The core conception of ACT is that psychological suffering is usually caused by
experiential avoidance
Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long run. The process of EA is thought to be mainta ...
, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values.
American psychiatrist George F. Drinka released the history book ''Birth of Neurosis: Myth, Malady, and the Victorians'' in 1984.
The 1984 book ''Stress, Appraisal and Coping'' by Lazarus and Folkman is the 17th most cited book in social science.
The
Society for Traumatic Stress Studies (STSS) was founded in the United States in March 1985 for professionals to share information about the effects of trauma. It later became the International Society for Traumatic Stress Studies (ISTSS).
Stress inoculation training
Stress exposure training is the practicing of important existing skills in a stressful and distracting environment to develop the ability to perform them reliably in spite of the circumstances.
There are a number of occupations where a potentially ...
was developed to reduce anxiety in doctors during times of intense stress by American doctor
Donald Meichenbaum
Donald H. Meichenbaum (born June 10, 1940) is an American psychologist and Distinguished Professor Emeritus of Psychology at the University of Waterloo, Ontario. He is a research director of the Melissa Institute for Violence Prevention and Tre ...
in 1985.
![Edna Foa David Shankbone 2010](https://upload.wikimedia.org/wikipedia/commons/8/8a/Edna_Foa_David_Shankbone_2010.jpg)
In 1986, "emotional processing theory" was first presented by psychologists
Edna Foa (Israeli-American) and Michael J Kozak
(American).
This led to their development of
prolonged exposure therapy Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal expo ...
for PTSD. It is characterized by two main treatment procedures. "Imaginal exposure" is repeated purposeful retelling of the trauma memory. "In vivo exposure" is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous (despite being objectively safe).
The first
selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
SSRIs increase the extracell ...
(SSRI) medication went on the market in Belgium in 1986. They became available in the United States in 1988, and in other places around this time. This class of drugs largely replaced MOAIs and TCAs, as they were much safer. In the United States, these drugs are most commonly known as Prozac, Zoloft, Paxil, Luvox, Celexa and Lexapro. (The first SSRI was developed by chemists including the Scottish-American
Bryan Molloy
Bryan Barnet Molloy (30 March 1939 – 20 May 2004) was a Scottish chemist, known notably for helping to invent the antidepressant ''Prozac'', a name for fluoxetine. ''Prozac'' was introduced in 1988, and has been the world's leading antidepressan ...
and Chinese-American
David T Wong.) The SSRIs were soon supplemented with the similar
SNRI class, which includes Effexor.
Antidepressant discontinuation syndrome
Antidepressant discontinuation syndrome, also called antidepressant withdrawal syndrome, is a condition that can occur following the interruption, reduction, or discontinuation of antidepressant medication following its continuous use of at leas ...
is a significant issue with the use of both classes.
Azapirone
Azapirones are a class of drugs used as anxiolytics, antidepressants, and antipsychotics. They are commonly used as add-ons to other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).
Medical uses
Azapirones have shown ...
s are a group of drugs that work at the
5‐HT1A serotonin receptor, and are used to reduce anxiety. The first available azapirone
buspirone
Buspirone, sold under the brand name Buspar, among others, is a medication primarily used to treat anxiety disorders, particularly generalized anxiety disorder. Benefits support its short-term use. It is taken by mouth, and it may take up to fo ...
(Buspar), was approved in the United States in 1986. (It was invented by a team at
Mead Johnson
Mead Johnson & Company, LLC is an American company that is a leading manufacturer of infant formula, both domestically and globally, with its flagship product Enfamil. It operates as an independent subsidiary of Reckitt.
The company dates back t ...
in the US in 1968). The only other drug in this class that is widely used in
tandospirone
Tandospirone (brand name Sediel) is an anxiolytic and antidepressant drug used in China and Japan, where it is marketed by Dainippon Sumitomo Pharma. It is a member of the azapirone class of drugs and is closely related to other azapirones l ...
(Sediel), which is available in some Asian countries.
Eye movement desensitization and reprocessing
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress di ...
(EMDR) is a form of
exposure therapy
Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thou ...
devised by American psychologist
Francine Shapiro
Francine Shapiro (February 18, 1948 – June 16, 2019) was an American psychologist and educator who originated and developed eye movement desensitization and reprocessing (EMDR), a form of psychotherapy for resolving the symptoms of traumati ...
from 1987, with the first papers on it published in 1989. It involves focusing on traumatic memories while engaging in side-to-side eye movements or other similar distractions. (The technique became more broadly known after the release of Shapiro's book ''Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures'' in 2001.)
Cognitive processing therapy
Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the ...
(CPT) was developed by American psychologist
Patricia Resick
Patricia A. Resick is an American researcher in the field of post traumatic stress disorder. She is known for developing cognitive processing therapy.
Biography
After earning her doctorate from the University of Georgia in 1976, Resick served as A ...
from 1988. The primary focus of the treatment is to help the client understand and reconceptualize their traumatic event in a way that reduces its ongoing negative effects on their current life. Decreasing avoidance of the trauma is crucial to this, since it is necessary for the client to examine and evaluate their
meta-emotions Meta-emotion is "an organized and structured set of emotions and cognitions about the emotions, both one's own emotions and the emotions of others". This broad definition of meta-emotion sparked psychologists' interest in the topic, particularly reg ...
and beliefs generated by the trauma.
In 1988, the First European Conference on Traumatic Stress Studies was held in
Lincoln
Lincoln most commonly refers to:
* Abraham Lincoln (1809–1865), the sixteenth president of the United States
* Lincoln, England, cathedral city and county town of Lincolnshire, England
* Lincoln, Nebraska, the capital of Nebraska, U.S.
* Lincoln ...
, with the participation of the STSS. The European Trauma Network was formed at this time. This became the European Society for Traumatic Stress Studies (ESTSS) in 1993.
The
conservation of resources
Nature conservation is the moral philosophy and conservation movement focused on protecting species from extinction, maintaining and restoring habitat (ecology), habitats, enhancing ecosystem services, and protecting biological diversity. A ra ...
(COR) theory of stress was proposed by American psychologist Stevan Hobfoll in 1989. It is a heavily cited theory that describes the motivation that drives humans to both maintain their current resources and to pursue new resources.
The world's main psychoanalysis bodies decided to admit people who weren't medical doctors in 1989, after a major lawsuit was made against them.
''The Anxiety and Phobia Workbook'' was first released in August 1990. It has since sold over a million copies, and had seven editions. It was written by American philosopher and behavioural scientist
Edmund J. Bourne
Edmund J. Bourne is an American self-help author and researcher on anxiety, anxiety disorders and the treatment of anxiety disorders. He was the director of The Anxiety and Treatment Center in San Jose, California, San Jose and Santa Rosa, Calif ...
.
The International Karen Horney Society was founded in 1991.
After decades of development, the American psychologist
Marsha M. Linehan
Marsha M. Linehan (born May 5, 1943) is an American psychologist and author. She is the creator of dialectical behavior therapy (DBT), a type of psychotherapy that combines cognitive restructuring with acceptance, mindfulness, and shaping.
Line ...
published a defining paper for a new treatment for borderline personality disorder, called
dialectical behavior therapy (DBT) in December 1991. This has come to be used to treat emotional dysregulation more broadly.
The
World Association of Psychoanalysis
The World Association of Psychoanalysis (WAP) was launched at the initiative of Jacques-Alain Miller in Buenos Aires on 3 January 1992. It was declared in Paris, four days later, on 7 January. Its statutes are modelled on Jacques Lacan's "Founding ...
was founded in January 1992, and became the largest organisation devoted to the psychotherapy of
Jacques Lacan
Jacques Marie Émile Lacan (, , ; 13 April 1901 – 9 September 1981) was a French psychoanalyst and psychiatrist. Described as "the most controversial psycho-analyst since Freud", Lacan gave yearly seminars in Paris from 1953 to 1981, and pu ...
.
The first World Conference on Traumatic Stress was held in
Amsterdam
Amsterdam ( , , , lit. ''The Dam on the River Amstel'') is the Capital of the Netherlands, capital and Municipalities of the Netherlands, most populous city of the Netherlands, with The Hague being the seat of government. It has a population ...
in June 1992, organised by the ISTSS.
DSM-IV (1994-2013)
The conditions
acute stress reaction and
acute stress disorder were added to the ''
DSM-IV
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' (1994), describing what had previously been considered some types of
adjustment disorder
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
. Acute stress reaction referred to the symptoms experienced immediately to 48 hours after exposure to a traumatic event. Acute stress disorder was defined by symptoms experienced 48 hours to one month following the event. Symptoms experienced for longer than one month were considered to be
PTSD
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
.
The Anxiety Disorders Association of Victoria was established in
Melbourne
Melbourne ( ; Boonwurrung/Woiwurrung: ''Narrm'' or ''Naarm'') is the capital and most populous city of the Australian state of Victoria, and the second-most populous city in both Australia and Oceania. Its name generally refers to a met ...
in 1994.
Trauma-focused cognitive-behavioral therapy (TF-CBT) was developed by American psychiatrists Anthony Mannarino, Judith Cohen, and Esther Deblinger in the mid-1990s to help children and adolescents with PTSD. There are 3 treatment phases: stabilization, trauma narration and processing, and integration and consolidation.
Australia's "National Centre for War-Related PTSD" was founded in 1995. In 2000 it broadened its focus to include all post-traumatic mental health, and become "Phoenix Australia – Centre for Posttraumatic Mental Health" in 2015.
The popular book ''Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society'' was edited by Dutch-American psychiatrist
Bessel van der Kolk
Bessel van der Kolk (born 1943) is a psychiatrist, author, researcher and educator based in Boston, United States. Since the 1970s his research has been in the area of post-traumatic stress. He is the author of ''The New York Times'' best selle ...
, Australian psychiatrist Alexander C. McFarlane and Norwegian psychiatrist
Lars Weisaeth. It was released in 1996.
The World Association for Person Centered & Experiential Psychotherapy & Counseling (WAPCEPC) was established in July 1996, furthering the work of
Carl Rogers
Carl Ransom Rogers (January 8, 1902 – February 4, 1987) was an American psychologist and among the founders of the humanistic approach (and client-centered approach) in psychology. Rogers is widely considered one of the founding fathers of ps ...
.
The Deutschsprachige Gesellschaft für Psychotraumatologie (German-speaking Society for Psychotraumatology) was established in 1998. It was co-founded by German psychologist
Andreas Maercker Andreas Maercker (born 26 April 1960) is a German clinical psychologist and international expert in traumatic stress-related mental disorders who works in Switzerland. He also contributed to lifespan and sociocultural aspects of trauma sequelae, e.g ...
.
Bestselling book ''Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness'' was released by American doctor
Daniel G. Amen in December 1998.
Anxiety Canada was established in 1999.
In 2000, ''A cognitive model of posttraumatic stress disorder'' was published by psychologists
Anke Ehlers (German-British) and
David M. Clark
David Millar Clark, (born 20 August 1954) is a British psychologist.
Career
Clark was born in Darlington and studied experimental psychology at Oxford University. He trained as a clinical psychologist at the Institute of Psychiatry. He then retu ...
(British). They and others followed this with a publishing of a treatment method based on this model in 2005.
The three components of this are to: modify negative appraisals of the trauma; reduce re-experiencing symptoms by discussing trauma memories and learning how to differentiate between types of trauma triggers; and reduce behaviors and thoughts that contribute to the maintenance of the "sense of current threat".
The highly cited paper "Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity" was published by German psychologist Axel Perkonigg, American sociologist
Ronald C. Kessler, S. Storz and German psychologist
Hans-Ulrich Wittchen
Hans-Ulrich Wittchen (born 6 July 1951 in Bad Salzuflen) is a clinical psychologist, psychotherapist and epidemiologist. He has been a head of the Institute of Clinical Psychology and Psychotherapy and the Center of Clinical Epidemiology and Long ...
in December 2001.
Another highly cited paper, titled "Post-Traumatic Stress Disorder," was published by American psychiatrist
Rachel Yehuda in January 2002.
''The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms'' by American social worker Mary Beth Williams and Finnish psychologist Soili Poijula in March 2002. It has been widely used.
In 2005, the
Swedish Board of Health and Welfare
The Swedish National Board of Health and Welfare ( sv, Socialstyrelsen) is a Swedish government agency. The agency was the result of a merger between the National Swedish Board of Health and the Swedish Royal Board of Social Affairs in 1968. ...
adopted into that country's variation of the ICD a refined conceptualisation of severe burnout it described as "
exhaustion disorder
Exhaustion disorder or stress-induced exhaustion disorder (ED or SED, sv, Utmattningssyndrom) is a diagnosis used in Health care in Sweden, Swedish healthcare to indicate a maladaptive stress disorder more severe than adjustment disorder. Common ...
."
The PTSD Association of Canada was founded in 2006.
"Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies" was a February 2011 paper that was highly cited. Its lead author was British psychiatrist Alex J Mitchell.
''Monkey Mind: A Memoir of Anxiety'' was a popular book released by American journalist
Daniel B Smith in July 2012.
DSM-5 (2013-current)
The Freudian etiological meaning of neurosis is conveyed through the
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
(2013) category "Trauma and Stress-Related Disorders". This includes:
*
Reactive attachment disorder
Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children, although these issues do occasionally persist into adulthood.DSM-IV-TR (2000) American Psychiatric Ass ...
*
Disinhibited social engagement disorder
Disinhibited Social Engagement Disorder (DSED), or Disinhibited Attachment Disorder, is an attachment disorder in which a child has little to no fear of unfamiliar adults and may actively approach them. It can significantly impair young children's ...
*
Posttraumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
*
Acute stress disorder
*
Adjustment disorder
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual ...
s
* Other specified trauma- and stressor-related disorder
** Adjustment-like disorders with a late onset
**
Ataque de nervios
(, also known as "Puerto Rican syndrome"Steinberg, Marlene (1990) Transcultural issues in psychiatry: The ''Ataque'' and multiple personality disorder; Dissociation 3(1):31-33 https://scholarsbank.uoregon.edu/xmlui/handle/1794/1494) is a psychol ...
**
Dhat syndrome
Dhat syndrome (Sanskrit: धातु दोष, IAST: Dhātu doṣa) is a condition found in the cultures of South Asia (including Pakistan, India, Bangladesh, Nepal, and Sri Lanka) in which male patients report that they suffer from premature ej ...
**
Khyâl cap
** Kufungisisa
** Maladi moun
**
Nervios
(, also known as "Puerto Rican syndrome"Steinberg, Marlene (1990) Transcultural issues in psychiatry: The ''Ataque'' and multiple personality disorder; Dissociation 3(1):31-33 https://scholarsbank.uoregon.edu/xmlui/handle/1794/1494) is a psychol ...
**
Shenjing shuairuo
**
Susto
Susto (, ) is a cultural illness primarily among Latin American cultures. It is described as a condition of "chronic somatic suffering stemming from emotional trauma or from witnessing traumatic experiences lived by others".
Symptoms
Among the ...
**
Taijin kyofusho
''Taijin kyofusho'' ( ja, 対人恐怖症, TKS, for ''taijin kyofusho symptoms'') is a Japanese culture-specific syndrome. The term taijin kyofusho translates into the disorder (sho) of fear (kyofu) of interpersonal relations (taijin). Those who h ...
**
Persistent complex bereavement disorder
* Unspecified trauma- and stressor-related disorder
These conditions may lead to others, notably including
somatic symptom disorder
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...
and
dissociation
Dissociation, in the wide sense of the word, is an act of disuniting or separating a complex object into parts. Dissociation may also refer to:
* Dissociation (chemistry), general process in which molecules or ionic compounds (complexes, or salts) ...
.
The popular book ''My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind'' was released in January 2014 by American journalist
Scott Stossel
Scott Hanford Stossel (born August 7, 1969) is an American journalist and editor.
He is the national editor of ''The Atlantic'' magazine, .
In 2014, the bestselling book ''
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma'' was released by
Bessel van der Kolk
Bessel van der Kolk (born 1943) is a psychiatrist, author, researcher and educator based in Boston, United States. Since the 1970s his research has been in the area of post-traumatic stress. He is the author of ''The New York Times'' best selle ...
. It explained the author's experiences of
psychological trauma
Psychological trauma, mental trauma or psychotrauma is an emotional response to a distressing event or series of events, such as accidents, rape, or natural disasters. Reactions such as psychological shock and psychological denial are typical. ...
, and its consequent effects on mental and physical health.
''The Evil Hours: A Biography of Post-Traumatic Stress Disorder'' was a popular book released by American writer and PTSD-sufferer
David J Morris in January 2015.
Another popular book published that month was ''Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety, Panic, and Worry'' by Americans Catherine M. Pittman (psychologist) and Elizabeth M. Karle (author).
The afflicted support charity PTSD UK was established in 2015.
''Declutter Your Mind: How to Stop Worrying, Relieve Anxiety, and Eliminate Negative Thinking'' is a popular book released in August 2016 by Americans S.J. Scott (psychologist) and Barrie Davenport (coach).
The popular book ''First, We Make the Beast Beautiful: A New Story About Anxiety'' was released by Australian journalist
Sarah Wilson in February 2017.
Another popular book, ''Unfuck Your Brain: Using Science to Get Over Anxiety, Depression, Anger, Freak-Outs, and Triggers,'' was released by American councillor Faith G Harper in October 2017.
The
British Psychological Society
The British Psychological Society (BPS) is a representative body for psychologists and psychology in the United Kingdom.
History
It was founded on 24 October 1901 at University College London (UCL) as ''The Psychological Society'', the organ ...
commissioned the creation of the "Power Threat Meaning Framework"
by a committee over five years, with its first major release in January 2018. The framework aims to provide a complete understanding of psychological trauma, and the best way to treat it. Contrary to most psychological approaches, it includes a large focus on the patient's environment.
The Association Française Pierre Janet was publicly inaugurated in March 2018.
The United Kingdom Psychological Trauma Society (UKPTS) of psychological trauma treating professionals was formed in 2018 from the UK Trauma Group, and the British and Irish Chapter of ESTSS.
Popular book ''Welcome to the United States of Anxiety: Observations from a Reforming Neurotic'' was released by American writer
Jen Lancaster
Jennifer ("Jen") Lancaster (born November 5, 1967) is an American author whose titles have appeared on The New York Times Best Seller list.
Lancaster was an associate vice president for a technology company prior to being laid off after 9/11. B ...
in October 2020.
Another popular book, ''Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind,'' was released by American psychiatrist
Judson Brewer in March 2021.
The ICD-11 (first active in January 2022) included a substantial subset of the DSM-V conditions, and also
complex post traumatic stress disorder
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that is theorized to develop in response to exposure to a series of traumatic events in a context in which the individual perceive ...
.
Prevention
Stress inoculation training
Stress exposure training is the practicing of important existing skills in a stressful and distracting environment to develop the ability to perform them reliably in spite of the circumstances.
There are a number of occupations where a potentially ...
was developed to reduce anxiety in doctors during times of intense stress by
Donald Meichenbaum
Donald H. Meichenbaum (born June 10, 1940) is an American psychologist and Distinguished Professor Emeritus of Psychology at the University of Waterloo, Ontario. He is a research director of the Melissa Institute for Violence Prevention and Tre ...
in 1985.
It is a combination of techniques including
relaxation,
negative thought suppression, and
real-life exposure to feared situations used in PTSD treatment.
The therapy is divided into four phases and is based on the principles of
cognitive-behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
. The first phase identifies the individual's specific reaction to stressors and how they manifest into symptoms. The second phase helps teach techniques to regulate these symptoms using relaxation methods. The third phase deals with specific coping strategies and positive cognitions to work through the stressors. Finally, the fourth phase exposes the client to imagined and real-life situations related to the traumatic event. This training helps to shape the response to future triggers to diminish impairment in daily life.
Patients with acute stress disorder have been found to benefit from another type of cognitive behavioral therapy in preventing
PTSD
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a ...
, with clinically meaningful outcomes at six-month follow-up consultations. Supportive counseling was outperformed by a regimen of relaxation,
cognitive restructuring
Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions,Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Educatio ...
, imaginal exposure, and in-vivo exposure.
Programs based on mindfulness-based stress reduction also seem to be useful at managing stress.
Playing
Tetris
''Tetris'' (russian: link=no, Тетрис) is a puzzle video game created by Soviet software engineer Alexey Pajitnov in 1984. It has been published by several companies for multiple platforms, most prominently during a dispute over the approp ...
shortly after a traumatic experience prevents the development of PTSD in some cases.
The use of pharmaceuticals to mitigate the consequences of ASD has made some progress. The
Alpha-1 blocker
Alpha-1 blockers (also called alpha-adrenergic blocking agents or alpha-1 antagonists) constitute a variety of drugs that block the effect of catecholamines on alpha-1-adrenergic receptors. They are mainly used to treat benign prostatic hyperpla ...
Prazosin
Prazosin is an α1 blocker medication primarily used to treat high blood pressure, symptoms of an enlarged prostate, and nightmares related to post-traumatic stress disorder (PTSD). It is a less preferred treatment of high blood pressure. Other ...
, which controls sympathetic response, can be administered to patients to help them unwind and enable better sleep.
It is unclear how it functions in this situation. Following a traumatic experience,
hydrocortisone
Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, ...
(cortisol) has demonstrated some promise as an early prophylactic intervention, frequently slowing the onset of PTSD.
In a systematic literature review in 2014, the
(SBU) found that a number of work environment factors could affect the risk of developing
exhaustion disorder
Exhaustion disorder or stress-induced exhaustion disorder (ED or SED, sv, Utmattningssyndrom) is a diagnosis used in Health care in Sweden, Swedish healthcare to indicate a maladaptive stress disorder more severe than adjustment disorder. Common ...
or depressive symptoms:
* People who experience a work situation with little opportunity to influence, in combination with too high demands, develop more depressive symptoms.
* People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others. Those who experience bullying or conflict in their work develop more depressive symptoms than others, but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder.
* People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others. This also applies to those who experience insecurity in the employment, for example concerns that the workplace will be closed down.
* In some work environments, people have less trouble. People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others.
* Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder.
Etiology
Historic versions of the DSM and ICD
The term "neurosis" is no longer used in a professional diagnostic sense, it having been eliminated from the DSM in 1980 with the publication of
DSM III
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
, and having the last remnants of being removed from the ICD with the enacting of the
ICD-11
The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World He ...
in 2022. (In the
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
it was used in section F48.8 to describe certain minor conditions.)
According to the "anxiety" concept of the term, there were many different neuroses, including:
*
obsessive–compulsive disorder
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
(OCD)
*
obsessive–compulsive personality disorder
Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by an excessive need for orderliness and neatness. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety o ...
*
impulse control disorder
Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature imp ...
*
anxiety disorder
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
*
histrionic personality disorder
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate ...
*
dissociative disorder
Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily. The ind ...
* a great variety of
phobia
A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
s
According to
C. George Boeree, professor emeritus at
Shippensburg University
Shippensburg University of Pennsylvania (Ship or SU) is a public university in Shippensburg, Pennsylvania. It is part of the Pennsylvania State System of Higher Education. Founded in 1871, it later became the first teachers college in Pennsylvania. ...
, the symptoms of neurosis may involve:
Psychoanalytic (Freudian) theory
According to
psychoanalytic theory
Psychoanalytic theory is the theory of personality organization and the dynamics of personality development that guides psychoanalysis, a clinical method for treating psychopathology. First laid out by Sigmund Freud in the late 19th century, psyc ...
, neuroses may be rooted in ego
defense mechanisms
In psychoanalytic theory, a defence mechanism (American English: defense mechanism), is an Unconscious mind, unconscious psychological operation that functions to protect a person from anxiety-producing thoughts and feelings related to interna ...
, though the two concepts are not synonymous. Defense mechanisms are a normal way of developing and maintaining a consistent
sense of self
In the psychology of self, one's self-concept (also called self-construction, self-identity, self-perspective or self-structure) is a collection of beliefs about oneself. Generally, self-concept embodies the answer to the question ''"Who am I? ...
(i.e., an
''ego''). However, only those thoughts and behaviors that produce difficulties in one's life should be called ''neuroses''.
A neurotic person experiences emotional distress and
unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety,
depression, OCD, a phobia, or a
personality disorder
Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
.
Freud's typology of neuroses in "Introduction to Psychoanalysis" (1923) included:
* Psychoneuroses
** Transference neuroses
***
Hysteria
Hysteria is a term used colloquially to mean ungovernable emotional excess and can refer to a temporary state of mind or emotion. In the nineteenth century, hysteria was considered a diagnosable physical illness in women. It is assumed that ...
****
Anxiety hysteria
***** Various
phobia
A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avo ...
s
****
Conversion hysteria
Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindnes ...
***
Compulsion neuroses
**
Trauma neuroses
**
Narcistic neuroses
* True neuroses
**
Neurasthenia
Neurasthenia (from the Ancient Greek νεῦρον ''neuron'' "nerve" and ἀσθενής ''asthenés'' "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the nerves and became a major diagnosis in North A ...
**
Anxiety neurosis
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
**
Hypochondria
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
**
Paraphrenia
Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) and without deterioration of intellect or personality (its negative symptom).Almeid ...
nowiki/>schizophrenia spectrum">schizophrenia_spectrum.html" ;"title="nowiki/>schizophrenia spectrum">nowiki/>schizophrenia spectrum*** Dementia praecox">schizophrenia spectrum">nowiki/>schizophrenia spectrum">schizophrenia_spectrum.html" ;"title="nowiki/>schizophrenia spectrum">nowiki/>schizophrenia spectrum*** Dementia praecox
*** Paranoia
**** Megalomaniac paranoia, Megalomania
**** Mania of persecution
**** Erotomania
**** Mania of jealousy
Jungian theory
Carl Jung
Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
found his approach particularly effective for patients who are well adjusted by social standards but are troubled by
existential questions. Jung claims to have "frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life".
[Jung, Carl G., and ]Aniela Jaffé
Aniela Jaffé (February 20, 1903 – October 30, 1991) was a Swiss analyst who for many years was a co-worker of Carl Gustav Jung. She was the recorder and editor of Jung's semi-autobiographical book '' Memories, Dreams, Reflections''.
Life
Jaffé ...
. 961
Year 961 ( CMLXI) was a common year starting on Tuesday (link will display the full calendar) of the Julian calendar.
Events
By place
Byzantine Empire
* March 6 – Siege of Chandax: Byzantine forces under Nikephoros II Phokas cap ...
1989. ''Memories, Dreams, Reflections
''Memories, Dreams, Reflections'' (german: Erinnerungen, Träume, Gedanken) is a partially autobiographical book by Swiss psychologist Carl Jung and an associate, Aniela Jaffé. First published in German in 1962, an English translation appeared ...
''. New York: Vantage Books
Vantage Press was a self-publishing company based in the United States. The company was founded in 1949 and ceased operations in late 2012.
Vantage was the largest vanity press
A vanity press or vanity publisher, sometimes also subsidy publishe ...
. . Accordingly, the majority of his patients "consisted not of believers but of those who had lost their faith".
A contemporary person, according to Jung,
…is blind to the fact that, with all his rationality and efficiency, he is possessed by 'powers' that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.[Jung, Carl G., et al. 1964. '']Man and His Symbols
''Man and His Symbols'' is the last work undertaken by Carl Jung before his death in 1961. First published in 1964, it is divided into five parts, four of which were written by associates of Jung: Marie-Louise von Franz, Joseph L. Henderson, An ...
''. New York: Anchor Books
Vintage Books is a trade paperback publishing imprint of Penguin Random House originally established by Alfred A. Knopf in 1954. The company was purchased by Random House in April 1960, and a British division was set up in 1990. After Random Hous ...
: Doubleday. .
Jung found that the
unconscious
Unconscious may refer to:
Physiology
* Unconsciousness, the lack of consciousness or responsiveness to people and other environmental stimuli
Psychology
* Unconscious mind, the mind operating well outside the attention of the conscious mind a ...
finds expression primarily through an individual's inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his ''
Psychological Types''. Jung also found collective neuroses in politics: "Our world is, so to speak, dissociated like a neurotic."
Horney's theory
In her final book, ''
Neurosis and Human Growth'',
Karen Horney
Karen Horney (; ; 16 September 1885 – 4 December 1952) was a German psychoanalyst who practised in the United States during her later career. Her theories questioned some traditional Freudian views. This was particularly true of her theories of ...
lays out a complete theory of the origin and
dynamics of neurosis.
[Horney, Karen (1950). ''Neurosis and Human Growth: The Struggle Toward Self-Realization''. W.W. Norton & Company, Inc. .] In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from their early environment and that there are many ways in which this can occur:
The child's initial reality is then distorted by their parents' needs and pretenses. Growing up with neurotic caretakers, the child quickly becomes insecure and develops
basic anxiety
Basic anxiety is a term used by psychoanalytic theorist Karen Horney. She developed one of the best known theories of neurosis. Horney believed that neurosis resulted from basic anxiety caused by interpersonal relationships. Her theory proposes th ...
. To deal with this anxiety, the child's imagination creates an idealized
self-image
Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that h ...
:
Once they identify themselves with their idealized image, a number of effects follow. They will make claims on others and on life based on the prestige they feel entitled to because of their idealized self-image. They will impose a rigorous set of standards upon themselves in order to try to measure up to that image. They will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, they will despise themselves for all their limitations.
Vicious circles will operate to strengthen all of these effects.
Eventually, as they grow to adulthood, a particular "solution" to all the inner conflicts and vulnerabilities will solidify. They will be either:
* expansive, displaying symptoms of
narcissism
Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance or image and an excessive preoccupation with one's own needs, often at the expense of others.
Narcissism exists on a co ...
,
perfectionism, or vindictiveness.
*
self-effacing
Humility is the quality of being humble. Dictionary definitions accentuate humility as a low self-regard and sense of unworthiness. In a religious context humility can mean a recognition of self in relation to a deity (i.e. God), and subsequent ...
and compulsively compliant, displaying symptoms of neediness or codependence.
* resigned, displaying
schizoid
Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness ...
tendencies.
In Horney's view, mild anxiety disorders and full-blown
personality disorder
Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls ''self-realization'', a state of being in which the person responds to the world with the full depth of their spontaneous feelings, rather than with anxiety-driven compulsion. Thus, the person grows to actualize their inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.
See also
*
Individuation
The principle of individuation, or ', describes the manner in which a thing is identified as distinct from other things.
The concept appears in numerous fields and is encountered in works of Leibniz, Carl Gustav Jung, Gunther Anders, Gilbert Sim ...
*
Treatments for PTSD
PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing ne ...
References
Bibliography
*
Angyal, Andras. 1965. ''Neurosis and Treatment: A Holistic Theory'', edited by E. Hanfmann and R. M. Jones.
*
Fenichel, Otto. 1945. ''The Psychoanalytic Theory of Neurosis.'' New York: Norton.
*
Freud, Sigmund. 1953–1974. ''
.'' (24 vols.)'','' translated by
J. Strachey. London: Hogarth.
*
Horney, Karen. 1937. ''The Collected Works.'' (2 vols.). Norton.
* —— 1945. ''Our Inner Conflicts''. Norton.
* 1950. ''Neurosis and Human Growth''. Norton.
* Horwitz, A. V. and J. C. Wakefield. 2007. ''The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder''. Oxford University Press. .
*
Jung, Carl G. 921
__NOTOC__
Year 921 ( CMXXI) was a common year starting on Monday (link will display the full calendar) of the Julian calendar.
Events
By place
Byzantine Empire
* March – Battle of Pegae: Bulgarian forces under ''kavhan'' (first ...
1971. ''
Psychological Types'', (''
The Collected Works of C. G. Jung ''The Collected Works of C. G. Jung'' (german: Gesammelte Werke) is a book series containing the first collected edition, in English translation, of the major writings of Swiss psychiatrist Carl Gustav Jung.
The twenty volumes, including a Bibliogr ...
'' 6). Princeton University Press. .
* —— 1966. ''
Two Essays on Analytical Psychology
''Two Essays on Analytical Psychology'' is volume 7 of '' The Collected Works of C. G. Jung'', presenting the core of Carl Jung's views about psychology. Known as one of the best introductions to Jung's work, the volumes includes the essays "The R ...
'', (''The Collected Works of C. G. Jung'' 7). Princeton University Press. .
* Jung, Carl G., and
Aniela Jaffé
Aniela Jaffé (February 20, 1903 – October 30, 1991) was a Swiss analyst who for many years was a co-worker of Carl Gustav Jung. She was the recorder and editor of Jung's semi-autobiographical book '' Memories, Dreams, Reflections''.
Life
Jaffé ...
.
961
Year 961 ( CMLXI) was a common year starting on Tuesday (link will display the full calendar) of the Julian calendar.
Events
By place
Byzantine Empire
* March 6 – Siege of Chandax: Byzantine forces under Nikephoros II Phokas cap ...
1989. ''
Memories, Dreams, Reflections
''Memories, Dreams, Reflections'' (german: Erinnerungen, Träume, Gedanken) is a partially autobiographical book by Swiss psychologist Carl Jung and an associate, Aniela Jaffé. First published in German in 1962, an English translation appeared ...
''. New York:
Vantage Books
Vantage Press was a self-publishing company based in the United States. The company was founded in 1949 and ceased operations in late 2012.
Vantage was the largest vanity press
A vanity press or vanity publisher, sometimes also subsidy publishe ...
.
* Jung, Carl G., et al. 1964. ''
Man and His Symbols
''Man and His Symbols'' is the last work undertaken by Carl Jung before his death in 1961. First published in 1964, it is divided into five parts, four of which were written by associates of Jung: Marie-Louise von Franz, Joseph L. Henderson, An ...
''. New York:
Anchor Books
Vintage Books is a trade paperback publishing imprint of Penguin Random House originally established by Alfred A. Knopf in 1954. The company was purchased by Random House in April 1960, and a British division was set up in 1990. After Random Hous ...
/
Doubleday. .
*Ladell, R. M., and T. H. Hargreaves. 1947.
The Extent of Neurosis"
''British Medical Journal'' 2(4526):548–49. . . .
* López-Piñero J.M. (1983) ''Historical Origins of the Concept of Neurosis'' (Translated by D. Berrios) Cambridge, Cambridge University Press
*
McWilliams, Nancy. 2011. ''Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process'' (2nd ed.). Guilford Press. .
*
Russon, John. 2003. ''Human Experience: Philosophy, Neurosis, and the Elements of Everyday Life.'' Albany: State University of New York Press.
*
Winokur, Jon
Jon Winokur (born August 5, 1947) is an American writer and editor.
Born in Detroit, the son of Martin M. and Elinor Winokur, he attended Temple University (BA, 1970) and the University of West Los Angeles
The University of West Los Angeles (UW ...
. 2005. ''Encyclopedia Neurotica.'' .
External links
*
{{Authority control
Psychoanalytic theory
Stress-related disorders
Psychopathological syndromes