Under neurosis (literally as "neural disease" , from ancient Greek νεῦρον neuron "fiber, tendon, nerve" and -ose for disease) is since William Cullen (1776) a nervous understood related purely functional disorder (i. E. Without evidence of organic lesion ). So one spoke z. B. of cardiac neuroses . Since the time of Sigmund Freud , this was understood to be a mental disorder caused by an inner- psychological or interpersonal conflict . At that time neuroses were contrasted with psychoses as the more severe mental disorders.
In the meantime, the term neurosis has largely been abandoned in favor of a more differentiated breakdown into different groups of disorders. The main reasons for this are that it was possible to do justice to the various disorders grouped under “neuroses” and that the theoretical assumptions associated with the term on psychological and physical causation could not be maintained in this form.
Concept of neurosis today
The term is largely avoided in the current US diagnostic system (the DSM-5 ). Instead, the DSM speaks of mental disorders in a purely descriptive sense ( cross-sectional image = current state). Also in the International Classification of Mental Disorders ( ICD-10 ), Chapter V, fifth chapter , the term no longer appears as a nosological unit, but the neuroses are found, together with stress disorders and somatoform disorders, in section F40-F48 under the heading Neurotic, stressful - and somatoform disorders. The previous classification can be found via the index as neurosis: anankastic (F42), character (F60.9), depressive (F34.1), cardiac (F45.30), hypochondriac (F45.2), gastric ( F45.31), psychasthenic (F48.8), pension (F68.0), social (F 40.1), traumatic (F43.1) and obsessive-compulsive disorder (F42). In addition, the unspecified (F 48.9) and other neurotic disorders are also mentioned there.
Psychodynamically oriented authors see the term z. B. from a psychogenetic point of view (longitudinal section = point of view of development ) continues to be necessary. Hoffmann and Hochapfel define neuroses as predominantly environmental diseases that cause a psychological, physical or personality disorder .
In the cognitive-behavioral approaches, the neuroses, like other mental disorders, are described in terms of misadapted and learned behavior and attitude patterns that arise on the basis of vulnerability and stress.
Theories and systems
Traditional term neurosis
According to the view, which is partly no longer represented today (see above), the neurosis is a general psychological behavior disorder of long duration. Certain war traumas (as shown by the so-called war tremors) were understood as neuroses (war neuroses). It is characterized by the fact that it was created in the course of development. To confirm such diagnoses, organic disorders must be excluded as the cause of the malfunction. The neurotic is unable to control his characteristic behavioral disorders, but he is aware of his suffering and in himself able to fathom its causes. According to Freud's theory, this spiritual striving leads to the first therapeutic results, especially when using dream analysis . The psychotic tends to be incapable of doing this, because he no longer has a connection to reality. The transitions to neurosis are fluid, however. For example, the dreams of healthy people (“normal” neurotics) according to Freud represent “psychotic” processes in the broadest sense, as a result of the momentarily weakened ego ability to distinguish the reality experienced in the dream from the reality surrounding the dreamer.
Obsessive-compulsive disorders (e.g. " compulsive washing"), hysteria , hypochondria , phobias (e.g. social phobia ), anxiety disorders , schizoid and paranoid disorders were counted among the neuroses. A differential diagnostic criterion for differentiation from psychoses was that neurotics are able to recognize their problems as inherent in themselves, while those affected by psychosis suffer in acute cases from the inability to understand their inner situation ('hearing voices' etc.) . Ä.) To differentiate from the surrounding reality.
There are different degrees of tendency towards “neurotic” experience and behavior that do not always require treatment, but can also manifest themselves as “healthy” forms of coping with fear and conflicting in a typical form. A description of the different types beyond a disorder with disease value can be found in Fritz Riemann . The widespread prevalence of a certain type of neurosis in the respective affected culture has a subjective effect of relieving it, which thereby becomes the social norm . This weakens the feeling of social exclusion or inferiority (see above).
Newer classification systems
The ICD-10 and DSM-5 classification systems replaced the term neurosis , which is based exclusively on the theories of psychoanalysis, with neutral, atheoretical terms. In the official nomenclature of these systems, only the adjective neurotic occurs. Reasons for the plan to largely avoid the term neurosis are
- the inadequate delimitation from psychosis, as this is important according to the standards of the WHO and for differential diagnosis;
- the impossible sharp demarcation between neurotic and healthy behavior and
- the theory-bound nature of the term.
The current term neurosis comes from Sigmund Freud's psychoanalysis and has since been discussed critically within psychoanalysis, including the associated distinction between neurotic and healthy behavior and experience, which is viewed as relative. A systematic presentation can be found in Stavros Mentzos , taking into account more recent clinical perspectives, the discussion of classificatory problems and the classic and newer models. Instead of the term neurosis, the term “ mode of conflict processing” appears . This classification counteracts the inadequate demarcation from psychosis by distinguishing between structural deficiencies, which include psychoses, borderline disorders and narcissistic disorders in the narrower sense, and more mature, non-psychotic, narcissistic modes. He counts among the non-psychotic, but nevertheless narcissistic modes. a. the depressive and the hypochondriac mode. In contrast, the more mature modes include the hysterical, obsessive-compulsive, phobic and anxiety-neurotic modes.
History of theory
In 1776, the Scottish doctor William Cullen , based on the neurophysiology of the time, which was characterized by the concepts of sensitivity , irritability and “nerve force”, understood all mental illnesses and non-inflammatory disorders of the nervous system under the term neurosis. This is still of current importance, since the field of psychiatry is still connected in a special way with that of neurology in the medical education system. The neurologist is also responsible for the psyche.
The term was controversial in the time of Cullen, as it is today, and, according to well-known contemporary psychiatrists, called the psychiatric care system into question where it was not received enough (Dörner 1975). The term neurosis was closely connected with the development of psychiatry and did not only come from Sigmund Freud.
Freud helped the concept of neurosis to become widespread, but was by no means solely responsible for this development. Freud began his professional career as a neurologist and was not free from the materialistic ideas of his time. He was working in a physiological laboratory when he was given the opportunity in Paris to learn about the clinical workings of Jean-Martin Charcot , who carried out suggestion treatments there. This caused a change in the direction of his previous scientific work. Freud extended his theories on the basis of sexuality e.g. T. except for the culture and social criticism. His systematic individual psychological knowledge (theory of neuroses), which he transferred to society ( criticism of ideology ), was decisive for this , see z. B. his late work " The Uneasiness in Culture ".
Freud applied the term neurosis in particular to those mental disorders in which no organic causes were suspected. The question of whether physical conditions do not always play a role in more severe mental illnesses (psychoses) has not yet been clarified beyond doubt. Without a doubt, this only applies to the so-called organic psychoses . Freud also opened up his theory of neuroses to these dubious cases of mental illnesses that were long known as endogenous psychoses . Here he spoke of narcissistic neuroses , while these forms were otherwise referred to as chronic paranoia or dementia paranoides .
In psychoanalysis, neurotic symptom formation is the expression of an unconscious conflict. In the classical psychoneuroses, it corresponds to an unresolved early childhood conflict. In contrast, actual neuroses are triggered by a conflict in the immediate experience. Through the analysis, this conflict is made aware and healing is made possible. According to psychoanalytic theory, neuroses are a.o. a. triggered by disorders in certain child development phases. A personality disorder (character neurosis), which is mostly ego-syntonic , is triggered by an early disorder in development.
Especially in the classical psychoanalysis and psychiatry of the Freudian school and its successors it is assumed that a neurosis is caused by an internal, unconscious conflict. Freud developed a structural model of the psyche to illustrate the dynamics of disease . Freud spoke of a psychic apparatus that consists of three entities, the ego , the id and the superego . In the case of the unconscious conflict, the ego fails to adapt as a mediator between the inner world and outer reality. This lack of adaptation of the ego to everyday external stresses is attributed to inadequately controllable, because unconscious, influences of the id or the superego. The id represents the instinctual pole of the psyche, the super-ego the role of a censor or judge. In later life, the lack of adaptation is often a vicarious consequence of an unresolved trauma in early childhood . According to psychoanalytic theory, this acute trauma or lighter, repetitive chronic traumatizations lead to an increased willingness to defend against these painful memories. From 1895 onwards, Freud used the term neurosis in a sense that is still valid today.
Carl Gustav Jung formulates that without pre-existing conscious terms, apperception is impossible, which would lead to many neurotic disorders. In the unconscious there is certain content which, due to the lack of apperceptive terms (of “grasp”, comprehendere), could not be absorbed into consciousness. Their often considerable energy shifts to normally little emphasized but conscious content and increases their intensity into the pathological . This would only give rise to seemingly unfounded phobias and obsessions (exaggerated ideas, idiosyncrasies , hypochondriacal ideas, intellectual perversions) that could express themselves socially, religiously or politically.
The primary theory of Arthur Janov explains the neurosis in a different way than the classic Freudian school. In primary theory, a child tries to resolve psychological conflicts between natural needs (id) and living conditions that conflict with these natural needs (to be understood in the broadest sense as a super-ego) by suppressing the needs from conscious experience . At the age of about six, which can vary depending on the living conditions, the child gains the fundamental knowledge that his natural needs will never be recognized. This leads to a so-called "tipping over". From this point onwards, the tendency to suppress needs is rampant and is described as neurotic in the primary therapeutic sense.
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