Neurosis structure
The term neurosis structure , coined by Harald Schultz-Hencke , describes in psychodynamic theory a personality variant that has arisen due to unconscious biographical factors and has an increased risk of developing a neurotic disorder. However, a neurotic structure is not itself a neurotic disease, so it does not have any symptoms that require treatment and no psychological stress that requires treatment. In order for a person with a neurotic structure to develop a manifest neurosis, additional current factors must be added.
Earlier type theories
Antiquity
Ancient medicine was shaped by humoral pathology, which attributed illness to an imbalance in body fluids. Later the theory of temperament developed from this, which also connected the human personality with the juices.
Ernst Kretschmer
In the first half of the 20th century, the neurologist Ernst Kretschmer described three body types
- Leptosomes with a schizothymic character and a tendency to schizophrenic diseases
- Pyknics with a cyclothymic character and a tendency to manic-depressive illnesses
- Athlete with a viscous character and a tendency to epileptic diseases
- Dysplastic as a mixed form with different characteristics.
Kurt Schneider
Another psychiatric classification goes back to Kurt Schneider . Schneider divided people whose personality does not meet the usual standards of normality into ten types. He made a difference
- hyperthyme
- depressed
- insecure
- fanatical
- validity
- mood-unstable
- explosible
- uncomfortable
- willless and
- asthenic psychopaths .
Schneider saw these personality types as innate.
Harald Schultz-Hencke
The neo-psychoanalyst Harald Schultz-Hencke did not want to be satisfied with such a static, purely phenomenological-descriptive view, because it showed no possibilities for change. He was interested in the extent to which both the innate ( genotypic ) and acquired ( peristatic ) factors play a role in the structure. In agreement with Schneider, he recognized the asthenic personality as essentially innate. According to Schultz-Hencke, genotypic factors also predominate in hyperthyroidism, depression and dysphoria . But with self-insecure (fearful), explosive and even more with self- assertive (propulsive), fanatical ( paranoid ) and willless psychopathies, he saw clear peristatic-psychodynamic influences and thus possibilities of therapeutic influence.
Development of the personality structure
According to Schultz-Hencke, the personality structure develops in the first five years of life from innate characteristics. The innate disposition or constitution of the child is differentiated into an individual personality structure by the special environmental influences. Problematic innate factors such as high sensitivity , hypermotor skills , hypersexuality , debility or organ inferiority can, under unfavorable environmental influences, develop into a structure that is predisposed to a later neurotic disease. Schultz-Hencke called such a disposing structure “neurotic structure”.
According to Schultz-Hencke, hardship or pampering (as well as the unpredictable change in parenting behavior between hardship and pampering) have a particularly unfavorable effect on the personality development of a child. Hardship can also result from adverse external circumstances such as economic hardship, serious illness of a parent or a sibling, and a failure of the parental relationship. The main consequence of unfavorable framework conditions is that the child's natural basic drives cannot develop in a health-promoting manner. Schultz-Hencke made a difference
- an "intentional" drive experience in the sense of attention, greed and turning to the world
- an "oral-captive" drive experience in the sense of accessing, taking, absorbing the world
- a "retentive anal" drive experience in the sense of not wanting to give away (all pleasure wants eternity)
- an "aggressive, ambitious" drive experience in the sense of expansive "aggredi", approach, search for attention, confirmation and approval (hatred, as soon as the environment offers resistance)
- a "urethral" drive experience in the sense of letting go, impulsiveness, exuding yourself in a high arc and devotion
- "Loving-sexual" drive experience in the sense of affirmative affection and tender search for contact.
Drive experience
The drive experience can be reduced to three basic tendencies: striving for possession, striving for validity, sexual striving. According to Schultz-Hencke, neurotics are characterized by an unusually strong degree of inhibition of one or more of these driving forces. The inhibition of the drive experience is, within certain limits, a necessary adaptation of the child's self-control to the demands of the environment and to the living conditions that it finds. The inhibitions, adaptations and defense mechanisms with which the child reacts to the mostly chronically effective conditions of his young life, condense and solidify over time into characteristic and lasting patterns of experience and behavior. We call the entirety of these patterns or schemes that become habitual "personality", "personality structure" or also "character" or "character structure". If we want to emphasize with Schultz-Hencke that this is a disposition that is particularly susceptible to a neurotic disorder, we speak of "neurotic structure".
The structures of the neuroses in detail
The structure of the neuroses is, so to speak, the result of the subjectively experienced and internalized earlier reality, including the deficits and conflicts of this time, some of which have become unconscious, as well as the associated compromise attempts at adaptation and solutions. For Schultz-Hencke, every person has neurotic components. For him, the difference between manifest personality disorder and "normal" personality is not a qualitative one, but a quantitative one. The neurotic is more inhibited and more deforming than the mentally healthy. As a result of his inhibition, he is often particularly comfortable and at the same time has exaggerated demands on himself, his environment and life. Schultz-Hencke defined four main neurotic dispositions, each of which is characterized by a preferred inhibition of a specific drive experience. He distinguished between a depressive, an obsessive-compulsive, a schizoid and a hysterical structure.
According to Schultz-Hencke, the depressive structure is characterized by the inhibition of oral and aggressive impulses. People with a depressive structure have huge latent claims and a murderous hatred of failing relationships. Oral and aggressive impulses are so threatening that they must be completely antagonized by fear and guilt. As a result of the complete defense, the depressively structured appears defenseless in situations of temptation and frustration. He can neither represent nor defend his needs. He feels the demands of the environment as a burden, they overwhelm him. Pent-up aggressive energy finds no other way than - in the form of suicidal impulses - against one's own self.
According to Schultz-Hencke, the compulsive structure also suffers from the inhibition of the "aggredi", but more in the sense of motor development. "A lively willingness to act, in the right place, at the right time, in the right way" does not come about in the obsessively structured. In temptation or failure situations, the inhibited "urge-motor" impulses break through all the more violently and threaten the sick.
In the schizoid structure , the intentional drive experience is inhibited with the result of an extraordinarily deep contact disorder, an ambivalence and a fundamental distrust of fellow human beings, a resulting lack of commitment in relationships or even a sharp distance from the social environment.
According to Schultz-Hencke, the hysterical structure is based on the fact that there is no sufficiently rational view of the world, as it normally develops in the fourth and fifth year of life by means of a reality check. Resolute exploration of the world as it really is, including unraveling the mysteries of sexuality and the origins of children, has been inhibited in the hysterically structured. The primal productivity of early childhood imagination and intuitiveness finds no foundation for lack of orderly and planning ratio. The infantile expansiveness does not lead to adequate behavior due to a lack of structure. The irrationality is expressed in the language with which the hysterically structured "rogue" operates. "Eulenspiegelei and clowning dominate experience, expression and action." Those who are hysterically structured play the role of others haphazardly. They live "in a strange garment".
Neurotic structures are not personality disorders
Schultz-Hencke's neurotic structures have clearly influenced psychodynamic thinking, at least in Germany. The psychotherapy guidelines and the expert procedure based on them require therapists who want to carry out analytical or depth psychological psychotherapy to submit a report to the health insurance expert who is able to explain the patient's current symptoms against the background of his or her life history acquired structural characteristics. The report should contain both a symptomatic diagnosis according to the International Classification of Diagnoses ( ICD-10 , for example F32.11: moderate depressive episode with somatization) and a structural diagnosis. The psychotherapy guidelines leave open whether the structural diagnosis should be made in terms of conflict dynamics and content in the sense of Schultz-Hencke (e.g. anxious-depressive neurosis structure) and / or formally in terms of the structural levels of the OPD .
The structure names of Schultz-Hencke cannot be found directly in the ICD-10 or in the DSM-IV . The two diagnostic manuals are purely descriptive classifications and consciously refrain from any psychodynamic statements. The ICD-10 and the DSM-IV contain useful compilations and precise descriptions of clinically significant personality disorders . Schultz-Hencke's structural designations can only be found indirectly, namely as depressive, obsessive-compulsive, schizoid and histrionic (hysterical) personality disorders. In addition to the typing by Schultz-Hencke, the ICD-10 and the DSM-IV list other personality disorders, including dependent, anxious-self-insecure, paranoid, narcissistic, negativistic and emotionally unstable personality disorders.
The terms “neurotic structure” and “personality disorder” are related, but they by no means mean the same thing. Personality disorders are chronic diseases. The personality structure of personality disorders is so dysfunctional, stressful or life-impairing that it is itself the problem that needs treatment. Personality disorders are usually the result of long development. They usually do not show a clear beginning that could be correlated with a current stressful or conflict situation causing the disease. The treatment of interpersonal or intrapsychic conflicts often does not help the therapy - if the patients even get involved. The patient's introspection, transference and insight are significantly limited. An investigative psychotherapy is to be replaced by a structure-related psychotherapy. Often the social environment suffers more from the personality disorder than the patient himself. Sometimes the patient's motivation for change is so low or the burden on the therapeutic relationship is so great that no form of psychotherapy can be carried out.
In contrast to personality disorders, neurotic structures are neo-psychoanalytic constructs. They are not diseases, but only dispositions and are therefore not taken into account in the ICD-10. Symptoms that require treatment are only triggered by additional factors, for example a situation of temptation or frustration. Neurotic structures that have not become manifest neurotic diseases are, as it were, well-adapted and compensated personality disorders with no disease value of their own.
Structure and disposition of neuroses
Boessmann and Remmers propose to speak better of a (structural) neurosis disposition today instead of the old term "neurosis structure" coined by Harald Schultz-Hencke .
literature
- Gerd Rudolf, Tilman Grande, Peter Henningsen (eds.): The structure of personality. Theoretical foundations for the psychodynamic therapy of structural disorders , 2nd reprint 2010 of the 1st edition 2002, Schattauer
- Siegfried Elhardt: Depth Psychology. An introduction , 16th edition, Verlag W. Kohlhammer
- Udo Boessmann: Structure and Psychodynamics , Deutscher Psychologen Verlag, Bonn, 2006
- Udo Boessmann, Arno Remmers: Treatment focus , Deutscher Psychologen Verlag, Bonn, 2008
- Udo Boessmann, Arno Remmers: The first interview , Deutscher Psychologen Verlag, 2011
Individual evidence
- ^ Kretschmer: physique and character. Berlin 1921.
- ^ Schneider: The psychopathic personalities. In: Handbuch der Psychiatrie. Special part, 7th department, 1st part. 9th edition 1950
- ↑ Harald Schultz-Hencke: The inhibited man: draft of a textbook of neo-psychoanalysis (1940), Thieme, 6th unchanged. Edition, Stuttgart 1989, ISBN 3-13-401806-3
- ↑ Psychotherapy guidelines, pdf ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
