What is Neurosis? What does it mean to be neurotic?

 What is Neurosis?  Neurotic? Basic Psychoanalytic Ideas

What is neurosis?  Am I neurotic?  Isn’t that better than being psychotic?  Well, Freud’s answer to the latter question is yes – neurosis is a sign of greater psychological development – and presumably that means health – than psychosis.  This distinction, as arbitrary as it will turn out to be, is important in Freud’s early developmental theories.

The Id, or the unconscious, is, for Freud, what we are born with; a demanding, needy self that simply wants stuff from the environment.  But we have a trick that we can use.  We can give the id what it needs (food), but we can also give it an image of what it needs (a picture of food – we can dream of ice cream), and this will satisfy it, up to a point.  We can hallucinate (as in a dream – and in psychosis) the needed thing, and this will get us through bad spots of desire when there is no possibility of acquiring the thing we really need.

Of course hallucinated food is not as nourishing as real food – and it is the ego, the part of our self that is run by the reality principle, that develops out of the id to figure out how to find real objects in the real world rather than simply crying out that we are hungry and waiting for someone to provide – or fail to provide – for that need. 

In order accomplish its goals, the ego needs to restrain the id – sometimes by providing hallucinated substitutes for what it wants – sometimes by what Freud call repressing it, though I think we can talk about that as suppressing (and using a host of other defenses as well) to manage the urges of the id.

And this is part of Freud’s genius.  He figured out how to build a model of the mind that included two separate centers of operation that could be in conflict with each other.  And neurosis is the description of that condition.  It is the felt conflict between one part of our mind and another. 

When one part of ourselves that wants to be “good” and is in conflict with a part of ourselves that is intent on more selfish or pleasurable ends, we are experiencing a neurotic conflict.  One of my crazy fantasies about my own psychoanalysis is that it would deliver me to some post neurotic state in which I would “know” and “do” one and the same “right” action (I would become a sort of Yoda-like being).  Would that life were like that and we could achieve a post neurotic nirvana. 

In fact, most people who don’t apparently experience conflict are not functioning at a neurotic level – but at a more primitive level.  Yes, it is a somewhat problematic characteristic in this schema that people who are psychotic function with relatively little conflict, but we have come up with a term to indicate that some people intermittently function at a non-neurotic level – and this term is borderline ego functioning – a term that has been repurposed to be a much narrower diagnostic term.  But in its original sense it indicated a consistent pattern of inconsistent functioning somewhere in the borderland between "pure" neurotic and "pure" psychotic functioning where the power of the id’s needs intermittently overwhelmed the ego’s ability to constrain it, and the person would act with apparent unity of purpose towards shortsighted, selfish and ultimately self-defeating goals.

So, neurosis is a frustrating state of conflict between parts of the self that result in a compromise form of behavior that allows the person to meet more long term goals at the cost of foregoing short-term desires.

But I ran – completely by accident – into a new definition of neurosis this week that seemed to address another aspect of how we use the term.  As part of my ongoing psychoanalytic research, we were rating defenses that a patient used in a recorded psychoanalysis.  A new member had joined the team.  She is a first year graduate student interested in the psychoanalytic approach to therapy.  She (correctly) rated each of the segments that five other people rated (including me) as demonstrating a variety of lowere level defenses as examples of neurotic level defense – the highest level of defense on the scale that we use. 

I think she was right – and I think we were, too.  She, in her brilliance and naivete, was noting, correctly, that the patient was observing her defensive functioning and reporting it to her analyst.  From this perspective, this person was not simply defending against her impulses, but noting the functioning of her mind.  This is the second definition of neurosis that analysts refer to.  The rest of the members of the research were rating the actual functioning of the patient's mind – the functioning that she was (neurotically) observing and reporting.

From this perspective, neurosis is the capacity to observe, report, and reflect on the functioning of the mind, not just to act on it.  Neurosis is, then, the ability to use the ego as an observing instrument and to trust that the relationship with a competent other can help us get a better handle on the things that we do that perplex us – to realize that there are conflicts and to ask for help in figuring out how to resolve them in a more adaptive way.

This capacity is what analysts look for – and help foster – in patients so that they can become partners with the analyst in analyzing their own minds.  We want neurotic – meaning in this case self-observant – patients with whom to work on analyzing – that is understanding – the conflicts they are experiencing – their sources but also how to resolve them. 

Would that we all could be a little bit more neurotic.    

  

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