Neurosis () is a term mainly used today by followers of Freudian psychoanalytic theory to describe mental disorders caused by past anxiety, often anxieties that have undergone repression. In recent history, the term has been used to refer to anxiety-related conditions more generally.
The term "neurosis" is no longer used in psychological disorder names or categories by the World Health Organization's International Classification of Diseases (ICD) or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the American Heritage Medical Dictionary of 2007, the term is "no longer used in psychiatric diagnosis".
Neurosis is distinguished from psychosis, which refers to a loss of touch with reality. Its descendant term, neuroticism, refers to a personality trait 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. A similar concept is included in the ICD-11 as the condition "negative affectivity".
History
A broad condition (1769–1879)
The term neurosis was coined by Scottish doctor William Cullen to refer to "disorders of sense and motion" caused by a "general affection of the nervous system". The term is derived from the Greek word neuron (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. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex 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, mania, dementia, and idiotism.
Morphine was first isolated from opium in 1805, by German chemist Friedrich Sertürner. 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."
German psychologist Johann Friedrich Herbart used the term repression in 1824, in a discussion of unconscious ideas competing to get into consciousness.xxii Introduction to Studies on Hysteria
The tranquilising properties of potassium bromide were noted publicly by British doctor Charles Locock 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.
American doctor Weir Mitchell first published an account of his rest cure for non-psychotic mental disorders in 1875. His 1877 book "Fat and Blood: and how to make them" gave a fuller explanation. The cure originally involved women being isolated in bed, only communicating with a nurse trained to talk about unchallenging topics, a fattening diet of milk, plus massage and the application of electricity. Eventually, the cure advocated by the Mitchell family had less strict isolation and diet, and was followed by men as well as women. "Fat and Blood" was revised and reprinted for many decades.
Breuer, Freud and contemporaries (1880-1939)
Austrian psychiatrist Josef Breuer first used psychoanalysis to treat hysteria in 1880–1882. Bertha Pappenheim 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. 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.The details of her illness are taken from the case history published by Freud and Breuer in , as well as from her medical records found by Albrecht Hirschmüller in the papers of Bellevue Sanatorium and published in his 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 did not 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, tuberculous meningitis, and encephalitis. 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 for his 1883 book Clinical Lectures on Mental Diseases. He describes a condition that covers what is today considered the schizophrenia and autism spectrums (a combination of symptoms that would soon become better known as dementia praecox).
French neurologist Jean-Martin Charcot came to believe that psychological trauma was a cause of some cases of hysteria. 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 and Walton in America, principally as it occurs after injuries, and especially after railway accidents. They have recognised, like Mr. Page, 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 was a student of Charcot in 1885–6. In 1893 Freud credited Charcot with being the source of "all the modern advances made in the understanding and knowledge of hysteria."
French psychiatrist Pierre Janet released his book L'automatisme psychologique (Psychological automatism) in 1889, its third chapter detailing his understanding of hypnosis and the unconscious. At this time, he claimed that the main aspect of psychological trauma is dissociation (a disconnection of the conscious mind from reality). (Freud would later claim Janet as a major influence.)
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: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 (given the pseudonym "Anna O."). This book established the field of psychoanalysis.
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, neurasthenia, exophthalmic goitre, epilepsy, migraine, Sydenham's chorea, Parkinson's disease and tetany.
The fifth edition of German psychiatrist Emil Kraepelin'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 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 hysterias and psychasthenias. 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 and executive functions.
Janet founded the French "Société de psychologie" in 1901. This later became the "Société française de psychologie", and continues today as France's main psychology body.