Sunday, April 10, 2011

Different Ways of Defining and Describing 'Neurosis'

Updated...Feb. 18th, 2012...dgb


The term 'neurosis' stems back at least to the beginning of Freud's work in Psychoanalysis in the early 1890s, back to the point where the science of neurology first started to overlap with the art and science of psychiatry, clinical psychology, and psychotherapy.

Perhaps the easiest and quickest association between the name 'neurosis' and what it it is/was used to define/describe is the idea and experience of  'nervousness' and/or 'bad nerves'. This is particularly relevant in what Freud referred to as 'anxiety neurosis'.

For the longest while -- many years -- Freud equated anxiety neurosis with the idea of 'blocked sexual excitement and energy' (or 'libido'). It wasn't until very late in his career that Freud finally relented this position and more appropriately defined anxiety as that feeling/emotion that can best be equated with the perception of danger. This doesn't totally reject Freud's previous postion of 'blocked sexual excitement' because who doesn't often/usually feel at least partly 'nervous' or 'anxious' when their mind-body is 'filling up with sexual excitement' particularly in the close proximity to a 'perceived sexual object/person'.


Here are some internet definitions/descriptions of 'neurosis'.
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Neurosis

1. A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety) but not usually a severe loss of touch with reality. Contrast with psychosis which does involve a more severe loss of touch with reality.



2. (in nontechnical use) Excessive and irrational anxiety or obsession.
 
3. Neurosis is a term generally used to describe a nonpsychotic mental illness which triggers feelings of distress and anxiety and impairs functioning.


4. Wikipedia....Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms.[1] It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic. The term essentially describes an "invisible injury" and the resulting condition, and is no longer in official use by the scientific, medical, and psychiatric communities.



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Since most of my work here is Freudian and/or Psychoanalytically based, and Freud used the term extensively, and broke it up into sub-categories, I will do the same although my sub-categories will be partly different. I still think it is a useful term although the term 'disorder' generally replaces it today. 

 Three broad 'mental health disorders' that are commonly differentiated from each other are: 1. 'Bi-Polar Disorder' (which usually means 'Manic-Depression Disorder'); 2. 'Obsessive-Compulsive Disorder' (which usually refers to what Freud would have classified  as 'Anal' Obsessive-Compulsive Disorders; in contrast, the 'Oral' Obsessive-Compulsions are usually classified as 'Addictions' -- more on this distinction later); 3. 'Borderline Personality Disorder' which based on my understanding of this diagnostic category refers to a person who 'borders' between 'neurosis' and 'psychosis' and the only way that he or she can 'keep it together' is by subscribing to 'tight, anal-retentive, often obsessive-compulsive, defense mechanisms' that are designed to ward off 'extreme feelings of internal anxiety/panic'. High stress levels such as the loss of a job and/or the loss of a loved one are often likely to push this type of person 'over the top', resulting in the possibility of  a 'nervous (psychotic) breakdown', and perhaps even hospitalization. Of course, if the intensity of 'stressor(s)' is strong enough, we don't necessarily need to be diagnosed as a 'borderline personality' for something of this order to happen. It is just that borderline personality 'neurotics' tend to be more prone to these types of breakdowns....

  

Another way of defining and describing 'neurosis' is by using the principle of 'homeostatic (or dialectic) balance'.  This can be applied either 'culturally' or 'politically' or 'legally' or 'religiously' (which gets us into the problem of 'ethical relativism') or it can be applied 'trans-culturally' in terms of 'individual and social/civil needs and rights'.

Using the 'trans-cultural' -- in this case 'biological-medical' approach -- if a person has 'the flu', it doesn't matter what country or culture they live in; they still have 'the flu'. The 'bio-medical model or paradigm' works 'across different countries and cultures'.

In the case of 'psychological disorders', the 'bio-medical' approach doesn't always work as neatly and precisely. Schizophrenia is still schizophrenia but oftentimes -- indeed, almost always -- social, political, family, cultural, political, legal, economic, religious and/or philosophical factors all have to be taken into account in order to fully and properly understand this form of 'psychotic' illness as well as other forms of  non-psychotic illness  -- i.e., 'a non-psychotic, neurotic disorder' -- that we are dealing with.  Psychotic illnesses may involve genetics, drugs, brain-neurological dysfunction -- as well as social and internal psychological stressors.


Mental health issues need to be place in a 'socio-economic-political-legal context' in order to be understood properly. Sometimes it may be the particular 'society' or 'culture' or 'religion' or 'political-legal landscape' that is more 'neurotic' than a thousand or a million particular individuals within this socio-economic-political-legal context that are trying to adapt in 'dysfunctional' ways to a 'dysfunctional environment' -- and that includes particularly more than any othe relevant factor the context of the 'nuclear family' which is the source of the main 'cogntive-emotional templates' that we develop as we are 'evolving' and/or 'de-volving' as children.


On a cultural-historical level, in Freud's Victorian time, you have to factor in 'the different types of individual neurosis' with what might be called the 'Victorian culture's distorted and/or overly-restrictive, views on human sexuality' that created what might be called a 'Socio-Cultural Pathology of Sexual Normalcy' in this cultural and family environment.
More specifically, in Freud's time, there was a whole network of  'neurotic socio-cultural fears and negative socio-cultural judgments and defenses' -- some reflected by Freud himself -- concerning the phenomenon of masturbation. You had a whole set of negative perceptions, interpretations, judgments, values, and directives around this alleged 'social problem' of 'masturbation'.
We laugh at this now but back then, 'the negative perception regarding the dangers of masturbation' caused a whole host of negative 'individual and social neurotic problems'. If a mom caught her little boy 'playing with himself', she might say, 'Quit playing with yourself or your dad will cut it off!'  This, I would speculate, must have been something that Freud actually experienced and feared in his early childhood -- theoretically generalized many years later in his professional career under the concept and theory of 'castration anxiety'.  

The concept of castration anxiety doesn't work too well for me as a theorist today -- except perhaps in a metaphorical sense -- but similar, associated concepts like '(sexual) peformance anxiety'  (fear of not being able to sexually perform properly)  -- particularly relevent now amongst an 'aging masculine (and feminine) baby boomer population' -- i.e., fear of loss of one's masculine and/or feminine prowess and capabilities and a resulting loss of 'masculine or feminine self-esteem' connected often to an 'internal raging against aging'...) -- all of these 'inter-connected, neurotic anxieties' connected in turn to 'loss of self-identity' and/or 'loss of (sexual) self-esteem' do seem to be very relevant today...in partly similar, partly different ways, for both men and women....

Alfred Adler's abandoned concept of 'The Masculine Protest' (the perceived social and internalized self need and demand for a man to perceive and evaluate himself as  a 'real man') is still highly relevant today, and my extrapolation and extension of the above concept into 'The Feminine Protest' (the perceived social and internalized self need and demand for a woman to feel like a 'real woman') would seem to me to be equally just as currently relevant -- and a potential source of high level stress, distress, anxiety, rage, and/or depression...

Similarily, a seemingly outdated Freudian concept (that feminists have loved to hate) of 'penis envy' could/can be updated as well and fit into the syndrome of 'masculine and feminine protest neuroses'. Both men and women have 'sexually specific assets' that can be the 'lust' of the opposite (and/or same) sex. But 'lust' is not the same concept and phenomenon as 'envy'. 'Sexual envy' is more likely to be a 'same sex phenomenon, less so an opposite sex phenomenon'. Thus, a woman is more likely to 'lust' a penis, and 'envy' another woman's 'body shape', or 'breasts', or 'popularity among men'....It is actually more likely to be a man who is more prone to 'envy' another man's 'penis' or 'youth' or 'body shape' or 'popularity among women'....Thus, the 'long rejected Freudian concept and theory of women having 'penis envy' Freud equated mainly with the wrong sex...It is more likely to be a 'man's issue' rather than a woman's.  

Freud distinguished between the 'psycho-neuroses' (childhood neuroses) and the 'actual neuroses' (present-day, adult neuroses).  This distinction is still relevant today although I use different terminology -- 'the transference ('childhood' or 'there and then') neuroses vs. 'the existential ('here-and-now') neuroses. In most actual cases, transference neuroses and existential neuroses converge and join together into the 'same overall neurotic complex' -- in Freud's words, most neuroses (or neurotic complexes) are 'overdetermined'.


Freud's supposed 1896 'dilemma' regarding his 'conflict' between '(sexual and/or romantic traumacy' and 'instinct-fantasy' theory basically amount to 'opposite sides of the same coin' -- or the mythological image of 'Janus' -- one side looking back to the past, while the other side looks to the present and future. 'Sexual fantasies' are often 'narcissistic fixations/fetishes' and/or 'narcissistic-defensive compensations' against 'childhood ego-traumacies'.....

A 'childhood rejection and/or abandoment by a woman' might lead to the 'rejected child' -- as an adult -- becoming an 'abandoning philander' to 'internally prove to himself' -- symbolically speaking -- that his childhood rejector was wrong in rejecting him, and that he isn't/wasn't 'worthy of being rejected'....But then, this same 'rejected child syndrome' can lead to the phenomenon of 'identification with the childhood rejector' in which case the 'rejected child who was rejected by an adult woman (his mother or someone else)' becomes in the here-and-now a 'rejecting male adult who seduces women 'serially' -- and then promptly abandons them after he has seduced them'.... 

'Neurasthenia' was an interesting diagnostic category back in Freud's early, pre-1900 work. (He may have even used this category after 1900.) It can be equated with the idea of 'psychic lethargy and/or depression -- no energy, no libido, a lack of enthusiasm for life'...a technical word for a common human problem...

I think that the diagnostic category is still useful and can be sub-divided into 'transference neurasthenia' and 'existential neurasthenia'. The first is a 'carry-over' from our childhood life; the second is connected to 'here-and-now' factors such as: loss of love, loss of job, aging, health issues, 'lack of meaning in life', etc...

Freud had an interesting association between neurasthenia and sexual factors --  'too much masturbation', according to Freud, will leave a person 'burnt out and energy-deprived, lethargic' (but happy -- sorry, I couldn't resist). That's like the more recent question of whether or not an athlete should have sex before an athletic performance...If the athlete is 'exhausted' after the sexual performance -- and it's just before the game -- probably not. But if he is 'up and still full of energy' -- a 'pre-game warmup' so to speak -- then, why not? No over-riding 'generalization' seems appropriate...except perhaps...'whatever works'... 

Alternatively, a more logical and likely associative connection between neurasthenia and sexual factors ('sexual neurasthenia') would seem to me to be -- neurasthenia (lethargy, depression...) is more likely to be prevalent in situations where a person's life is 'sexless', i.e., not enough sensual and sexual touch...When the blood circulation is flowing properly, depression, apathy, lethargy, lifelessness -- neurasthenia -- generally is not likely to be an issue...unless the particular issues go deeper than simply a lack of 'touch' and 'hedonistic pleasure'... There may be underlying 'romantic' and/or 'spirituality' and/or 'more general self-esteem/self-identity, transference and/or existential issues'....

All neuroses -- like all medical disorders -- can generally be classified into either or both of these two types: 'too much of something'....and/or....'not enough of something'... the neuroses of 'toxic overload' and/or the neuroses of 'nutritional deficiency'...

This is based on our principle of 'homeostatic/dialectic balance and imbalance'...

Too much impulse or not enough impulse...too much restraint or not enough restraint...too much 'Apollonianism' or too much 'Dionysianism'....too much 'approval-seeking' or too much 'narcissism'...too much 'righteousness' or too much 'rebelliousness/anarchy'... Too much 'anal-retentiveness' or too much 'anal-explosiveness'...Too much 'oral receptiveness' or not enough 'oral receptiveness'...Too much protection of 'self-boundaries' or not enough protection of 'self-boundaries'... Too much living 'from the neck up'...or too much living 'from the neck down'... Too much 'giving'...or too much 'getting'....Too much 'anxiety and 'phobia' and/or too much'obsessive-compulsion' and/or 'avoiding'...
Too much 'agressiveness'...or not enough 'assertiveness'...Too much 'social sensitivity and empathy' or not enough 'social sensitivity and empathy'....Too much talking and not enough listening...or too much listening and not enough talking...Too much 'thinking' and not enough 'doing'...or too much 'doing' and not enough 'thinking'... Too much 'thinking' and not enough 'feeling' or too much 'feeling' and not enough 'thinking'... Too much 'eating' and not enough 'exercising' or too much 'exercising' and not enough 'eating'...

Another two distinctions can be made between the 'anxiety-avoidance' neuroses and the 'narcissistic' (social transgression) neuroses....as well as between the 'distancing' neuroses and the 'hanging on' and/or 'stalking' neuroses...

Finally, I will make the distinction between the 'impulsive neuroses' -- exploding impulses from 'The Shadow-Id Vault' up to the 'Central Ego'; vs. the 'overly-restraining, 'anal-defensive' neuroses of 'squashed impulses'...held back, or sent back, impulses from The Central Ego to the ego-defensive restraints of the 'Shadow-Id Vault'

What Charcot, Breuer, Janet, Freud, and other medical professionals called 'hysteria' back in their time -- a predominantly 'female neurosis' -- might best be viewed today as the 'cultural over-suppression of women -- and the sexuality of women' (and/or 'the masculine abuse' of the sexuality of women).  These women were often stuck in their homes, often nursing sick fathers, caught between biological and psychological sexual impulses and cultural -- predominantly 'patriarchal' -- sexual restraints, and too often sexual abuses...and often these 'transference and existential self-cultural neuroses' showed up in the form of 'strange bodily and/or medical symptoms' without any perceived 'organic medical cause'...After May 1896, Freud would come to believe that the 'primary cause' of these 'hysterical neuroses' was 'repressed childhood sexual activity, fixations, fetishes, and/or impulsive fantasy' as opposed to before May 1896 when he took the more or less opposite viewpoint -- that hysteria was primarily caused by 'repressed childhood sexual traumacy/manipulation/exploitation/assault'....There's a pretty wide gulf between the two theories -- a controversial issue that is still causing disagreement and grief, both inside and outside the psychoanalytic community today...An unresolved theoretical and therapeutic conflict issue of huge proportions that I have addressed, and continue to address, in many of my 'bi-polar, dialectic-integrative essays', yesterday, today, and tomorrow...

 Which theory was 'right'? Or were they both partly right and partly wrong? Or was one theory right in some cases; the other theory right in a different set of cases? Maybe they were both sometimes a part of the same 'neurotic complex and/or syndrome'.  All of these issues I have addressed in essays gone past, as well as new essays still coming in the future....

Freud kept fighting with his 'either/or' dilemma of 'which theory was right' and 'which theory was wrong' -- or so we are led to believe -- and my historical hindsight vision of the situation is that Freud should have integrated both 'partial theoies' into one bigger, more 'synthesized' bi-polar theory... where the 'clinical exposition of a particular case' dictated what part of the theory was most utilized; not choosing 'half a bi-polar theory' and using 'the same half' to dictate how a therapist/psychoanalyst should approach the opposite half......'Seek first to understand; then to be understood'. (This was one of Steven Covey's 7 Habits of Highly Effective People, 1989). Freud often lost his sense of seeking first to understand his clients -- especially after 1896 -- in the 'game' of trying to 'communicate, persuade, and enforce his own personal, theoretical and therapeutic understandings that had a propensity to overstate and overgeneralize the clinical facts, first in one direction (before May 1896) and then in the opposite direction (after April 1896)...

The difference between a 'learning disability' and a 'neurotic learning disorder' is that in the first case, a person has trouble making the necessary associations to constitute what we call 'learning' and/or the person has trouble 'remembering' these associations -- this may be because of a 'neurological-biochemical-brain dysfunction' (or it may be because of 'lack of interest and/or desire to make the associative connection'; in contrast, with a 'neurotic learning disorder', a person in effect 'learns too much', he or she puts together 'bad, dysfunctional, associations' or as Freud called them -- 'false connections' -- which come back to haunt and hurt the person in later situations that are deemed 'similar' or 'the same' but may be 'significantly different' in important ways that are essentially missed.  Freud was a significant, serial 'culprit' in generating his own 'associatively reductionistic and/or overly stated false connections'...

Transference 'counter-phobic', 'obsessive-compulsive' neuroses occur when we subconsciously take an adult scene that is partly similar, partly different than our 'earlier (usually childhood) traumacy scene' -- and we find ways of 'manipulating' the new scene until we have effectively turned it into a 'symbolic re-creation' of our earlier childhood scene. The 'transference goal or game' here is to 'turn this later scene into a re-creation of our earlier scene' so that we can use the present scene in an attempt to 'master' a 'surrogate adult transference figure' in a sexual and/or aggressive manner so as to attempt to 'undo the psychological message' that we keep repeating to ourselves courtesy of our childhood rejecting transference figure that we are 'weak, rejectable, helpless and/or not worthy' in the presence of our perceived more powerful, more worthy 'childhood/adult transference figure'...

With 'learning', we need a balance -- just like everything else in life -- between 'more than not enough' (of the 'right' type of learning) and 'less than too much' (of the 'wrong' type of learning).

The same goes for 'distinguishing differences' -- between 'not distinguishing enough differences' between different situations, different contexts, different people..., and 'distinguishing too many differences' between different situations, different contexts, different people...that or who may still hold a certain 'core commonality' that should be registered...relative to present and/or future interpretations, evaluations, and decisions...

That completes our little discussion about 'neurosis' today...

-- dgb, April 10th, 11th, 2011, updated Feb. 18th, 2012....

-- David Gordon Bain
  
-- Dialectic Gap-Bridging Negotiations...

-- Are Still in Process...