Neuroses

a group of diseases caused by psychic trauma; they are characterized by functional, as a rule reversible, nervous and mental disorders in which the patient maintains a critical attitude to the disease as well as the capacity to control his behavior.

The term “neurosis” was first used in 1776 by the Scottish physician W. Cullen. Initially, various diseases of uncertain origin, such as epilepsy, multiple sclerosis, and tetanus, were classed as neuroses. Later, any functional disorders of the nervous system were called neuroses. In contemporary usage, neuroses include only psychogenic disorders—that is, disorders arising from psychic traumas and prolonged nervous tension. The predisposing factors are bodily constitution and trauma, intoxication, infection, and other debilitating diseases. Neurosis may be caused by an overpowering acute psychic trauma, such as the sudden loss of a loved one. Less serious, but persistent psychic traumas, especially if they give rise to internal conflicts, such as one between duty and desire, may also result in neurosis.

In his experiments with animals, I. P. Pavlov demonstrated the possibility of developing a neurosis under the influence of weak stimuli. Experimental neuroses in animals arose when the processes of excitation or inhibition were overstrained or the responsiveness of these processes impaired. Animals that most frequently became ill were those with a weak or strong unbalanced type of higher nervous activity.

Experimental neuroses in animals, although not identical with neuroses in man, have provided valuable information for the understanding of human neuroses. Thus, it has been demonstrated that overstrain of the nervous system is also the basis for neuroses in man and that these are more likely to occur in persons whose nervous systems are weak, imbalanced, or insufficiently responsive. Neuroses also occur in persons with disorders in the relation between the first signaling system [the Pavlovian cortical system in man and animal associated with the sense organs that respond to external stimuli] and the second signaling system [the Pavlovian cortical system in man associated with thinking and speaking]. Neuroses are especially common in psychopathic personalities. They may also arise in a person with a strong nervous system, when there is very intense or prolonged psychic trauma. The severity of the psychic trauma depends on the character of the individual and his attitudes toward events. The abilities to evaluate critically one’s immediate environment, to make firm decisions, and to overcome difficulties are highly important for the prevention of neuroses.

Clinical manifestations of neuroses comprise somatic and nervous and mental disorders. The most common symptoms are undue fatigability, easy excitability, rapid exhaustion, disturbed sleep habits, sweating, and unpleasant sensations in the chest near the heart. Sometimes, as with hysteria, seizures of various types, paralyses, deaf-mutism, hysteric pregnancy, vomiting, and amnesia may occur.

The principal forms of neuroses are neurasthenia, obsessional neuroses, and hysteria. In addition, distinction is made between neuroses involving expectation, fear, and anxiety; motor neuroses (tics, stuttering); and neuroses of organs. Thus, expectation neuroses are characterized by disruption of some function (stuttering, insomnia) caused by fear of possible failure. Anxiety neuroses are characterized by seizures of terror or states of alarm that are not connected with a real threat. Neuroses of organs (heart, stomach), or systemic neuroses, are manifested by functional disorders of a certain system of the body (cardiovascular, respiratory, sexual), which are caused by a disruption of nervous regulation without organic changes in the internal organ. Neuroses of organs were earlier called vegetative neuroses, but inasmuch as the vegetative nervous system is only an intermediate link between the internal organs and the central nervous system, neurosis of an organ is now considered a clinical variant of general neurosis (neurasthenia, hysteria, or obsessional neurosis).

States similar to neurosis (neurasthenic syndrome, obsessions, hysteriform reactions) that are found in various—usually severe or prolonged—mental or somatic illnesses (schizophrenia, manic-depressive psychosis, atherosclerosis of the cerebral blood vessels) are distinguished from true neuroses.

Treatment of neuroses include psychotherapy directed toward removing the source of trauma or changing the patient’s attitude toward it (treatment by persuasion, including rational psychotherapy, suggestion, hypnosis, autogenic training); normalization of the patient’s work and rest routines; medicinal treatment (bromine preparations, valerian drops, vitamins, and tranquilizers that decrease emotional tension—Librium, meprobamate, Valium); treatment at sanatoriums and health resorts; and physiotherapy. In a few cases, inpatient treatment and temporary freedom from work are indicated. The prognosis is favorable.