Neurosis

“ The term neurosis is now generally used synonymously with psychoneurosis, although it has been applied to certain disorders in which, while the symptoms are both mental and physical, the primary cause is thought to be essentially physical. In most instances, however, both psychogenic and physical causes are operative and we can assign only a relative weight to the one or the other. ”

“ The fact that they are exaggerated and put into the foreground in neurosis is a consequence of the stored-up energy or libido. The psychological trouble in neurosis, and neurosis itself, can be considered as an act of adaptation that has failed. ”

“ The neurosis has become a psychosis. The physical condition has become a mental discomfort. Normally this ensuing mind state should be in accordance with the extent of the injury to the nerve-cells and fibers. But under long-continued discipline, or influenced by emotion, the conscious mind may not recognize the neurosis; whereas, in the hypersuggestible, consciousness will translate it into entirely disproportionate suffering.
A great problem of nervous education is what the mind will do with discomfort or pain. ”

“ To the direct question—How does the objective neurosis become conscious as a subjective psychosis?—while freely admitting that I do not know, I enter the protest that it is philosophically an illegitimate question; for an answer is impossible without transcending consciousness. ”

“ In both these cases the organism takes the simple course of attempting to reimpose the state of suppression in a form more or less complete, by means of which the instinctive tendency has previously been held in check. In the successful attempt the neurosis, perhaps only present in an incipient form, disappears, while in the other case a definite form of neurosis develops, the special characters of which are determined in large measure by the process which is put into action in the attempt to solve the conflict. ”

“ According to materialism, psychosis is a product of neurosis; but according to monism, neither is psychosis a product of neurosis, nor is neurosis a product of psychosis, but neurosis is psychosis. They are identical. What an external observer might perceive as a neurosis of my brain, I should at the same moment be feeling as a [466] psychosis. The neurosis is the outer or objective aspect; the psychosis is the inner or subjective aspect.
It is almost impossible to illustrate this assumption by any physical analogies. ”

“ The special form of the psycho-neurosis depends partly on the nature of the failure and the processes by which it has come about, partly on the nature of the restorative processes which come into activity, and partly on the degree of their success. The psycho-neuroses may be regarded as attempts, successful or unsuccessful, to restore the balance between instinctive and controlling forces, attempts to solve the conflict between these warring elements. ”

“ If we turn to the sufferers from neurosis we find some who have lost their powers of speech or of vision; some, like the blacksmith we saw in Coué's clinic, who have lost the use of their limbs; others suffering from a functional disturbance of one of the vital organs. The cause in each case is nothing more tangible than an idea which has become realised in the Unconscious mind. ”

“ Given that plasticity, which is the psychological presupposition of all acquisition, then learning by experience is a possible development from such a primitive stage.
But though every psychosis have its concomitant neurosis, it is uncertain how far the converse holds good. The action of the heart, for example, depends upon neuroses of which we have now no direct consciousness. ”

“ In applying psychoanalysis we must grant the regressive phantasies of the patient, for psychoanalysis has a much broader outlook, as regards the valuation of symptoms, than have the above psychotherapeutic methods. These all emanate from the assertion that a neurosis is an absolute morbid formation.
The reigning school of neurology has never thought of considering neurosis as a healing process also, and of attributing to the neurotic formations a quite special teleological meaning. Neurosis, like every other disease, is a compromise between the morbid tendencies, and the normal function. ”

“ The affect is a rapidly passing state, the neurosis is chronic because the exogenous excitement acts like a stroke happening but once, while the endogenous acts like a constant force. The nervous system reacts in the neurosis against an inner source of excitement just as it does in the corresponding affect against an analogous external one.
152 IV. The Relations to Other Neuroses. A few observations still remain to be mentioned on the relations of the anxiety neurosis to the other neuroses in reference to occurrence and inner relationship. ”

“ Whoever has had a pronounced case of neurosis in his immediate environment, knows all that can be "effected" by a neurosis. In fact, there is altogether no better means of tyrannising over a [390] whole household than by a striking neurosis. Heart attacks, choking fits, convulsions of all kinds achieve enormous effects, that can hardly be surpassed. ”

“ Past associations plus fear have so welded together idea and bodily manifestation that one follows the other as a matter of course, long after the real cause is removed. In such ways innumerable nervous symptoms arise. The same laws which form healthy complexes, and, indeed, which make all education possible, may thus be responsible for the unhealthy mal-adaptive association-habits which lie back of a neurosis. ”

“ It is sufficient for our purpose to show the bearing of the facts of localization of function upon the problem of psychogenesis. The first proposition derived from these facts is, that psychosis and neurosis are phenomena having common space-relations. ”

“ Capitalizing an Illness. Then, too, a neurosis provides a way of escape from all sorts of disagreeable duties. It can be capitalized in innumerable ways,—ways that would horrify the invalid if he realized the truth. Much of the resentment manifested against the suggestion that the neurosis is psychic in origin is simply a resistance against giving up the unconsciously enjoyed advantages of the illness. An honest desire to get well is a long step toward cure. ”

“ It is time that the medical and teaching profession should realize that functional neurosis is not congenital, not inborn, not hereditary, but is the result of a defective, fear-inspiring education in early child life. ”

“ We can not conceal from ourselves what we were wont to disavow to the patient, namely, that the significance of a grave neurosis for the individual subjected to it is not less than any cachexia or any of the generally feared maladies. ”

“ We may be predisposed to neurosis by the very nature of complexity, delicacy, and sensitivity inherent in the structure of a highly organized nervous system, and still we may remain healthy and strong all our life long, provided we know how to keep away from noxious agencies. The creed of the inevitable fatality of neurosis is as much of a superstition as the Oriental belief in the fatalism of infectious diseases, plagues, and accidents of all kinds. ”

“ For the other chief form of functional nervous disorder no more appropriate term can be found than that which I have used in this report. The meaning of anxiety-neurosis is also at once apparent. It indicates in direct fashion that anxiety is both the main factor in causation and at the same time one of the leading symptoms. ”

“ Suggestion rises at some spot in the throbbing cerebral tissues, or from without, and is snatched up by the cortex to be delivered back as ultimate gospel to the whole human establishment: great balance of the brain and all the instincts in it, spinal cord, nerves, organs and muscles. These, then, like a converted Christian, are compelled by one fallible new layer of the organism to adjust to the command. When the whole man cannot, the cortex founders in neurosis or psychosis. ”

“ In connection with all such neurotic affections we find invariably present a feeling of unrest, hesitation, doubt, conflict, discord, uneasiness, a feeling of anxiety, conscious or subconscious, feeling of some impending evil. In all such affections we find the brooding spirit of the most powerful of all animal instincts,—the fear instinct. Neurosis is a disease of self-preservation and fear. ”

“ The other factor, the infantile and altogether repressed and unconscious one, which, according to psycho-analysis, is also essential to the production of a neurosis, has not been systematically sought for, though I have found it in the few cases of which I have been able to make a full study. Its presence or absence is a matter of greater theoretical importance than might perhaps appear, even though its practical importance may often not be great. ”

“ We thus see that the most fundamental of psychological principles—the association of ideas—is merely an obverse expression of the most fundamental neurological principles—reflex action. But here we have an important qualification to take into account. All reflex action, or neurosis, is not attended with ideation, or psychosis. In our own organization, for instance, it is only cerebral reflexes which are so attended; and even among cerebral reflexes there is good reason to believe that the greater number of them are not accompanied by conscious ideation ”

“ All Mental Process Accompanied by Neural Process.—Whatever the ultimate decision of psychologists may be regarding the relation of mind to the sensory and nervous mechanism of man it is certain that there is so close an association between them that the least alteration in the mechanism means a parallel effect in the mind, or in the words of Huxley, “every psychosis is definitely correlated with a neurosis.” The rind or cortex of gray matter which constitutes the surface of the large cerebral hemispheres of the [Pg 196] human brain is regarded as the seat of consciousness. ”

“ It is principally because a displacement of this sort can be Transference and the cure of neuroses much more easily produced in certain kinds of neurosis than in others, that neuroses differ from one another markedly in their amenability to treatment ”

“ As in every scheme of a pathological kind we can distinguish between the conditions or causes of the morbid process and the mechanisms by which these conditions produce the manifestations or symptoms of disease. In the heat engendered by differences of opinion concerning the conditions of psycho-neurosis, the pathological mechanisms had been neglected and had aroused little interest, a neglect which is readily intelligible, for few will find it worth while to study the details of a structure resting on foundations they reject. ”

“ The weakling and the neurotic attached to his neurosis are not anxious to turn such a powerful searchlight upon the dark corners of their psychology. ”

“ For a complete understanding of the psychogenesis of any given psychoneurosis, such as a phobia, we must know all the antecedent experiences which formed the setting and gave meaning to the dominating ideas and determined the instincts which have become incorporated with them to form sentiments. ”

“ Neurosis has an absolute genius for malingering. There is no illness which it cannot counterfeit perfectly. ”

“ The neurologist to whom a psychological training is truly invaluable, finds himself ill at ease when in his investigations he strikes a problem which has to be studied mainly from a psychological point of view. A piece of tissue, a lump of protoplasm, a nerve cell with its dendrons and axons can be stained, mounted, observed, and experimented upon, but who can get hold of a fact of consciousness, of an elementary psychic state, of a sensation, of a feeling, of an idea, stain them, put them under the microscope for scientific investigation? ”

“ It is to physiology rather than to sociology that we should look for the clue to the nature of the process by which a person is guarded from such elements of his unconscious experience as might disturb the harmony of his existence.
It is now generally admitted that the nervous system, in so far as function is concerned, is arranged in a number of levels, one above another, forming a hierarchy in which each level controls those beneath it and is itself controlled by those above. ”

“ The unbridged gulf between sensation and the changes produced in effector organs necessitates a separate handling of the functions of the nervous system according as their office under consideration is sensation or material effect. This holds especially in the case of the brain, and for the following reasons.
Psychosis and the Fore-Brain.—Hippocrates wrote, “It is through the brain that we become mad, that delirium seizes us, that fears and terrors assail us.” “We know that pleasure and joy on the one hand and pain and grief on the other are referable to the brain. ”

“ How, then, do we explain those morbid phenomena which have their origin in misplaced affection, in disappointed ambition, in hatred, or in anger, and which culminate either in serious chronic maladies, or in death or suicide? They all seem to start from an impairment of the cerebro-spinal centres. The continual excitation of these by everpresent emotions determines a paralysis of the central nerve-substance, and thus affects its connections with the nerves extending out to the various organs. These nerves next degenerate by degrees, and soon the great functions are compromised. ”

“ But what should we say of a man who directed his ill usage of his body to that part of our system which is most closely connected with the brain; who were purposely to impair his nervous system, and subject himself to those delusions and diseased views of things which are the well-known result of any disorder there? Yet this is precisely what they do who seek to mortify and lower their understanding. ”

“ The censor of the sick brain is stupefied by toxins, shock, or exhaustion, and the citadel he is supposed to guard is thronged with besiegers from every side. The strongest—i. e., those equipped with most associations pertinent to the emotional status at the time—win out, occupy the brain by force, and demand recognition and expression from all the senses, deluding them by their guise of the reality of external matter.
We find consciousness, then, determined by all past experience, by an external world, and by its organ of expression—the brain. ”