Neurosis is a group of non-organic mental disorders that manifest mainly as distress due to various physical or mental discomforts, or intense internal conflicts, or unpleasant emotional experiences. The term neurosis was first introduced by W. Cullen in 1769 as sensory and motor abnormalities due to dysfunction, and in the late 19th century D. Jeanne divided neurosis into two categories: hysteria and neurasthenia. The 1968 reprint of the American Diagnostic and Statistical Manual of Mental Disorders (DSM-II) considered anxiety to be an important feature of neurosis. The new DSM-III-R (1987) classifies neuroses as affective disorders, anxiety disorders, artificial disorders, somatic disorders, and dissociative disorders, and de-emphasizes the use of the name “neurosis”. The Chinese Classification and Diagnostic Criteria of Mental Disorders, Second Edition (CCMD-2) (1989) classifies neurosis into: neurasthenia, anxiety neurosis, obsessive-compulsive neurosis, phobic neurosis, hypochondriac neurosis, depressive neurosis, dysthymic neurosis, etc. The common features are: (1) often the disease is caused by the combination of unsound personality and psychological and social factors; (2) it can manifest as mental and somatic symptoms, but the examination cannot reveal organic pathological morphological changes; (3) except for some hysterical patients, the consciousness is generally clear and the patient has not lost contact with the outside world; (4) the patient has self-awareness of the disease state and demands treatment, the personality is generally not impaired, and does not put (4) Patients are self-aware of their disease state and require treatment, and their personality is generally not impaired, nor do they confuse their own morbid subjective experience and imagination with external reality. This group of disorders can be acute or chronic, with a variety of symptoms and persistent or recurrent pathological experiences. The illness often has varying degrees of impact on work, school, life, and social life.
The clinical manifestations of neurosis are complex and its pathogenesis has not yet been universally explained. However, psychological research on the pathogenesis of neurosis has a long history, and the following are different explanations from different schools of psychology.
1. Psychoanalytic explanation
The psychoanalytic school, represented by Freud, believes that anxiety is the key to understanding all neuroses. When the ego’s erotic drive conflicts with the aggressive drive and the superego’s drive to control and regulate such drives, the ego, if it cannot use rational mechanisms to regulate their conflict and alleviate the anxiety caused by the conflict, has to use some psychological defense mechanisms to avoid anxiety, such as repression, projection, reverse formation, fixation, etc. If these defense mechanisms are not sufficient to resist or prevent the anxiety, the ego will have to use them. If these defense mechanisms are not sufficient to resist or alleviate these anxieties, neurotic conflict arises in order to replace the instinctual desire impulses. Since the instinctual impulses whose expression the ego is seeking are in the subconscious realm, it becomes difficult for the ego to become aware of the real object of its conflict, and therefore it experiences inexplicable fear and anxiety. Therefore, anxiety is considered by psychoanalytic theory to be the most basic core symptom of neurosis. When anxiety is transformed into a somatic symptom, it manifests as a transformative symptom of hysteria; when anxiety is separated from consciousness, it manifests as a dissociative symptom of hysteria; when anxiety is turned to an object in the external world, it manifests as a phobia; when anxiety is isolated, it manifests as an obsessive-compulsive disorder; if anxiety is experienced directly, it manifests as anxiety. These symptoms can be understood as the result of “compromise formation” or ego attempts to integrate the ego drive, the superego and reality.
In the psychoanalytic view, there are two types of conditions that are most likely to trigger neurosis from the above theoretical assumptions: Oedipal complexes and psychosexual developmental fixations. The following is a psychoanalytic explanation of the neuroses triggered by psychosexual developmental fixations. These neuroses usually appear as fixations or regressions at some early stage of their psychosexual development. These disorders may be triggered by the patient’s encounter with a real-life situation corresponding to a traumatic experience in early life. Subconscious fantasies and emotions are activated, reviving the original conflicting conflicts. As a corollary, it is possible that due to this fixation, individuals maintain perfectionistic and ritualistic behaviors into adulthood, such as those suffering from obsessive-compulsive neurosis who are thought to be fixated at the level of anal desire.
2. The neo-psychoanalytic explanation
The neo-psychoanalytic doctrine criticizes the psychoanalytic view represented by Freud. Jung saw the behavior of neurosis as the result of an intricate conflict between the unconscious emotions of the individual and the collective unconscious. The collective unconscious is the accumulated intelligence and motivation of all human beings. Adler saw neurosis as a widespread debilitating “inferiority complex”, the result of a person’s unsuccessful attempts to gain mastery over his environment and life. Erikson proposed that anxiety is the result of a failure in the psychosocial development of children. He asserts that every child has to go through several developmental stages in order to learn self-control, aggressiveness and trust, and especially in order to determine their own identity. If a child is not nurtured by caring parents, but is neglected, abandoned, hostile and psychologically ambivalent, these feelings cause anxiety in the face of the normal emergencies of life, and the child grows up distrusting others, the environment and, above all, his or her own abilities, and if parents arbitrarily set absolute and detailed rules or rigid requirements, one of two reactions will result: rebellion or anxiety caused by hostility and aggression, which the child outwardly submits to but actually feels inside. The child’s inability to tolerate these anxieties may result in inhibited tension reactions that prevent the child from engaging in ordinary daily activities. The child loses those satisfactions and the next very likely step is the development of anxiety abnormalities. Such individuals cannot clearly identify with their own personality, feel constant anxiety, and develop neurotic psychological defense symptoms to help them cope with the world as they see it.
3. Behaviorist explanation
Behaviorist psychology believes that not only is the normal way humans behave the result of stimulus-reflexes, pathological behavioral responses have been formed through conditioned reflexes, as may be the case with the production of neurosis.
The classical model of conditioned reflexes views phobias as learned fear responses. Watson did an experiment with a young boy named Albert who was nine months old, healthy and unafraid of the world. They took advantage of Albert’s inattention to suddenly ring a gong, the sudden loud sound finally scared little Albert cried; not only that, with the gong stimulation, they also made Albert learn to have a fear response to the previously unafraid mice; after three months of repeated experiments, this fear response even further generalized to dogs, rabbits and other animals or fur clothing, etc..
The idea of operational conditioning is that behaviors that are reinforced are then easily retained. This is seen most clearly in obsessive-compulsive neurosis: a compulsive ritual is often a behavior that alleviates fear-filled obsessive thinking, so no matter how silly or irrational the behavior is, it continues. For example, patients with obsessive-compulsive verification symptoms constantly check that they have locked their doors, folded their clothes, turned off the lights, etc. Roper has done research on this subject to understand the subject’s checking response. When subjects were measured before and after their ritual actions, a significant increase in anxiety was found before verification and a decrease in anxiety after verification. This suggests that their compulsive verification behaviors were being reinforced. The neurotic behaviors acquired through reinforcement may “make sense” or may be the result of chance. It was found that pilots with dysthymic symptoms such as diplopia appeared to have a symptom directly linked to the source of anxiety; in contrast, many compulsive symptoms were simply the result of variable and unexpected events.
The social learning argument extends the concept of reinforcement by suggesting that neurotic behaviors may elicit many different and subtle benefits. Neurotic behaviors may “benefit” them because the symptoms evoke sympathy, attention, and other social solidarity. Some individuals may unconsciously organize their environment in such a way that only maladaptive behaviors and pathological self-perceptions are reinforced. They are rejected and made to feel uncomfortable and anxious, and they may interact with others in this way. They interact with people in a way that is annoying and causes normal people to avoid them. As a result, they receive little social reinforcement for developing kindness and positive responses, and their behavior is only reinforced when they gain the sympathy of others for depression, anxiety, and other symptoms.
Just as children learn language, table manners, and even subtle personality traits by imitating their parents, neurotic behaviors can be learned in the same way. Many types of neuroses seem to run in families. Because there is insufficient evidence that neurotic behaviors are inherited, a possible explanation is that children imitate or mimic their parents’ forms of neurosis. These poor observations and imitations can enter the child’s life and become the basis for the child’s anxiety. Children may respond emotionally with anxiety in the absence of specific anxiety stimuli.
Researchers of the behaviorist school of psychology also argue that since pathological behavioral responses are formed through acquired acquisition and reinforcement, it is also possible to replace pathological behaviors by establishing new stimuli with new conditioned reflexes. Since then, Wolpe’s doctrine of cross-inhibition and systematic desensitization therapy, Skinner’s theory of operant conditioning and aversion therapy, positive reinforcement method, etc. have been developed and established from the basic theories of behaviorist psychology.
4.Humanistic explanation
Humanistic psychology, represented by Rogers and others, believes that everyone is born with the ability of self-actualization and self-improvement, but it is only due to the invisible and intentional interference and hindrance of environmental factors that these potentials are not reasonably brought into play, and the formation of personal character and cognitive patterns are distorted and distorted. The neuroses seen in clinical practice are all growth deficits, and their origin is the external manifestation of the suppressed and distorted potential for self-improvement. Each person needs to realize himself or herself, to manifest his or her own abilities. When there is an incompatible conflict between one’s self-concept and external values, it causes inner anxiety. In order to cope with the anxiety, people have to resort to mental defense mechanisms, especially rationalization, degradation and avoidance. These measures limit the individual’s free expression of his or her thoughts and feelings, weakening self-actualization and thus affecting the person’s psychological development, the extreme of this state being psychosis.
Therefore, the psychotherapy of neurosis also requires that the treatment starts from a completely equal partnership, creating a beneficial and reasonable atmosphere together with the patient, helping the patient to recover his or her true self through sincere understanding and respect, releasing the self-actualization potential, and restoring harmony and rationality to the already confused and disoriented mental activity.
5.Gestalt explanation
The Gestalt school believes that neurosis is caused by the individual’s inability to integrate his or her way of being. The patient cannot face the reality of life in the here and now and insists on practicing the stereotypes, prohibitions, expectations and completely different purposes of life brought from childhood. According to the Gestalt school, for each person to relate to others, he or she must engage with them and feel that he or she belongs to them. To achieve this, the person develops sociality. If one has a good childhood, one will be able to adapt to the environment and be competent in the future. If an individual has been in a weak state for many years due to parenting mistakes, he grows up to be anxious and temperamental and as a result develops a neurotic personality structure.
6. Explanation of cognitive psychology
Cognitive psychologists emphasize that the occurrence of emotions and behaviors must be mediated through cognition, rather than directly generated through environmental stimuli. For example, if a person meets a tiger in a mountain and feels fear, but sees a caged tiger in a zoo, he or she will not be afraid. That is, the emotional response is generated only through the understanding and evaluation of the event. Normal cognitive styles produce normal emotional responses, while abnormal cognition produces abnormal emotional responses (e.g., depression, anxiety disorders). In mood disorders, cognitive distortions are primary and mood disorders are secondary. Because neurotic patients have special individual susceptibility qualities, they often make unrealistic estimates and cognitions, resulting in unreasonable and inappropriate reactions, and when such reactions exceed a certain limit and frequency, the disease appears.
Beck, an American psychologist who founded cognitive psychotherapy, believes that some neurotic patients have many inappropriate cognitive styles, such as depressed patients who believe they are incompetent and defective, often blaming their unpleasant experiences on physical, mental or ethical and moral defects; believing that they are unwelcome, causing trouble and burdens to others, and that they should not enjoy human treatment; believing that the world is too difficult and “the earth is not They also have a negative evaluation of the future, believing that the current situation will continue, that the future is hopeless, that there is nothing to do, and that the future is full of difficulties and failures. Their cognitive style is: ① It’s either one or the other. They believe that it’s all or nothing, and that they can’t see a time when “there will be another village in the dark”. ② Catastrophizing. If something goes wrong, they think it’s the “end of the world”, and if they have even the slightest discomfort, they think they are suffering from an incurable disease. ③ Generalization. Take things that happen at one time as things that will continue to happen, or see the big picture in a small way, and take a branch or part as the whole. ④Selective. Patients tend to see only the negative side of things and ignore other evidence to the contrary; see only the dark side of things, see only shortcomings and setbacks, and recall only their failures and ignore the positive and successful experiences of things. ⑤ Preconceptions. To analyze things as a preconceived notion by jumping to a conclusion without any basis or with merely plausible evidence. ⑥Emotional reasoning. To draw conclusions based on emotions or feelings without facts, i.e. “following bad feelings”. (7) Personalization. Blaming oneself for everything that is wrong, even for things that have nothing to do with oneself. These cognitive styles are more common in people with depressive personality qualities, i.e., neurotic depression, and in people with other neurological disorders such as anxiety disorders. Therefore, cognitive psychotherapy focuses on analyzing and changing these wrong cognitive styles of patients.
7. Sociological explanation
In the view of social psychologists, neurosis is a product specific to industrialized society and middle-class lifestyle. People suffer from anxiety, obsessive-compulsive actions or phobias as a result of competition, loneliness and other mental stress. In the United States, researchers have focused on analyzing the relationship between neurosis and social class. A systematic epidemiological report showed that neuroses are 2-4 times more frequent in the middle class than in the lower class. The reason for this lies in the particular circumstances of middle-class life: they demand degrees, higher salaries, better housing conditions and other material possessions, etc. This may be a major reason for the higher incidence of neurosis.
It has also been shown that dysthymia is more common in people with less education and lower economic income, while hypochondria is more common in poorer elderly people. In older populations, there seems to be increasing attention to the body and its functions, thus predisposing many of the anxieties and mental stresses that occur with advancing age to be transformed into physical symptoms.
The above are explanations of neurosis from various schools of psychology, and it is easy to see that the views vary from school to school, so that a combination of several views is often the best explanation of neurosis.