N is for Neurosis

By Amrita Kajaria


All of us have probably experienced some level of anxiety or low mood at different points in our life. A racing heartbeat, a knotted stomach, heaviness in the chest, overthinking – these are experiences we all know and understand. For some people, these experiences do not last long, and they are able to carry on with life without significant disturbance.

But what happens when these occurrences become a pattern? What happens when the worry does not go away? What happens when these symptoms cause significant distress and begin to disrupt daily functioning?

Psychologists in the 18th century refer to these patterns as manifestations of ‘neurosis’ (plural neuroses), a term initially coined by Scottish doctor William Cullen to categorise symptoms that were believed to have a neurological origin. Over time the prefix ‘psycho’ was added to indicate the presence of mental and emotional factors that contributed to the condition.

Neuroses or psychoneuroses (used interchangeably) are mental health conditions characterised by anxiety, depression and/or distress that impact a person’s functioning in any area of their life.

While the degree of distress can hinder day-to-day tasks, it does not incapacitate the individual since the person is able to “reality check” themselves. In other words, the individual does not lose their sense of reality or language.

Today, however, the term neurosis or psychoneurosis is not used to refer to a stand-alone mental condition. In fact, the term was taken down from the Diagnostic and Statistical Manual of Mental Disorders in its 3rd edition because it was considered to be too loosely defined, and did not provide the precision required for psychological diagnosis. It is now used as an umbrella term to refer to anxiety and depressive disorders.

So then, why is it important for us to understand neuroses?

First and foremost, in many ways, each of us has a certain level of neurosis. Think about it - haven’t we all grappled with some level of anxiety or irrational fears? This is not to say that each of us has a diagnosable condition, but to indicate that neurosis is common. While the triggers and severity vary from person to person, an understanding of neurosis can foster greater sensitivity towards others and ourselves.

The other question to consider is - what causes neuroses?

While no single cause has been established yet, prominent figures in the field have tried to postulate theories on the causes of neurosis. Sigmund Freud, the father of psychoanalysis viewed neurosis as a condition that develops due to an overdependence on certain defence mechanisms. He believed that neuroses are likely to occur when certain repressed or ‘hidden’ thoughts, emotions and behaviours from the past enter a person’s conscious awareness and cause a disturbance in the present. His theory would explain an adult phobia of dogs or spiders as being rooted in an unresolved unpleasant childhood experience.

Carl Jung, the founder of analytic psychology had a rather interesting take on the development of neuroses. Given that most psychologists at the time believed neurosis to be maladaptive, Jung was one of the first to propose that neurosis is an attempt to ‘self-cure.’ While he agreed with Freud’s theory, he also added that working through the symptoms of neuroses would help a person become aware of their limitations and strengths. It is when limits exceed potential or when the potential is underutilized or not realized that neurosis occurs.

Karen Horney often considered as the flagbearer of feminist psychology had a slightly different take on the development of neuroses. She believed that neuroses develop as a result of overusing coping skills to deal with one’s external environment. The kind of love and care a child does or does not receive from their parental figures can result in the formation of needs to either move away, towards or against people resulting in emotional and behavioural difficulties.

Over the years, several other theories have proposed that neuroses are often developed through learning. Simply put, learning theories propose that thoughts and behaviours underlying the neuroses are learnt by either observing significant others or through a pattern of reinforcement by important figures in one’s life. For example, an anxiety-provoking thought of not being competent may have first been internalised or ‘learnt’ upon receiving critical feedback at school. Growing up, the individual may not have engaged in important tasks due to the same fear, which eventually might have resulted in possibly more critical feedback and a stronger belief in not being competent. Over time, reliance on thinking patterns such as overgeneralization or jumping to conclusions could lead to the individual experiencing overwhelming emotions such as anxiety, sadness or hopelessness.

What are the different types of neuroses?

There are some mental health conditions that are reflective of psychoneuroses and usually benefit from professional help. These most commonly include but are not limited to psychological vulnerabilities such as generalized anxiety, obsessive-compulsive tendencies, major depression, phobias and post-traumatic stress. With an overall prevalence rate of over 20% in India prior to the pandemic, it is likely that challenges associated with the COVID-19 pandemic could result in a surge of mental health conditions requiring professional help and support.

So, what can one do to cope with these conditions?

Some self-help strategies that can help navigate the challenges posed by neuroses include, but are not limited to

  1. Being curious about your emotions: Rather than labelling the anxiety, sadness or frustration as negative and bad, notice what the emotion is trying to seek from you. Emotions have a protective value. Understanding our emotions’ potential and limits is what Jung believed to be curative in and of itself.

  2. Reframing your thoughts: Are the thoughts that cause anxiety or sadness based in fact or opinion? If your friend has not responded to your text in over an hour does that really mean you have lost a friend? Simply put - do not treat every thought that occurs to you as the absolute truth.

  3. Befriending yourself: While you may think that showing yourself some tough love will do the trick, it seldom does. Treating yourself compassionately, acknowledging that times are tough and that you are doing your best in the moment can create a sense of internal support.

  4. Communicating with safe people: Reach out to people you feel comfortable with, be it friends or family members. While this can feel scary at first, closing avenues of support by withdrawing contact can actually be counterproductive.

  5. Seeking professional help: Sometimes riding through the waves all by yourself can feel quite overwhelming. Engaging in psychotherapy and seeking professional support can equip you with the tools required to stay afloat in challenging situations. Learning how to surf can make the waves seem less scary, right?

All in all, neuroses vary in the level of distress they cause, but with the right kind of internal and external support, they can be managed. Seeking out this support, or encouraging yourself to build self-care tactics, is an act of courage. It can be a powerful preventative step in the right direction.

About the author

Amrita Kajaria is a mental health counsellor and psychotherapist, She holds a Master of Education in Mental Health Counselling and Masters of Art in Counselling Psychology from Columbia University, New York. She also holds an MA in Clinical Psychology from SNDT University, Mumbai. She practices using a trauma informed model and incorporates psychodynamic, cognitive, behavioural and mindfulness-based modalities in her work. Follow her on Instagram at @newdimensionscounselling.

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