Perspectives On The Treatment of Neurosis

Neurosis is a term of art in the psychological profession that, unlike psychosis, has not survived in the official literature. The reasons for its disappearence are related to the line taken by the editors of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe visible behaviour instead of the inner workings of mental perturbation.

Neurosis arises in early life as a set of strategies developed by a child whose needs have been poorly met. Instead of facing the world with the confidence and competence gained by his peers during early life, the neurotic dedicates most of his resources to the maintenance of or or more (contradicting) strategies that appeared to work early in life. The energy required to maintain a rigid, inflexible, protective sense of self precludes the development of most of the child's potential. The result is an exiguous, impoverished existence; but existence nonetheless, in the face of a world considered to be too threatening for the resourceless child to successfully navigate.

The result is a chronic sense of depression, anxiety, and exhaustion. At the negative end of the spectrum, the neurosis descends further into what the psychological profession calls a 'personality disorder' i.e. where the early conditions of life were severe enough that the 'self' is little more than an emergency executive committee employing a small range of primitive defense mechanisms to deal with the world.

There are many psychological factors that explain neurosis:

• The experience of trauma, especially in early life
• The individual's own propensity for melancholy and anxiety
• The occurrence of misfortunes, sometimes of a catastrophic nature

All these factors will shape experience, and especially in the case of trauma suffered during early life, prime the nervous system with an increased sensitivity for negative emotion. The spiral becomes clear: the traumatised individual relives his trauma, reinforces it, and reproduces it by inflicting suffering upon others borne out of their own inability to resolve the conflicts that threaten to shatter his mind if vigilance is not carefully maintained.

And yet, some psychological schools of thought maintain that feeling bad is a very natural state of affairs. The forces that have set the cycle in motion may have shaped brains and shaped the neurotic flow of life. No force is infinite, however, and momentum must be maintained; the momentum of neurosis is maintained by a constantly reinforced decision to remain divided, to desire life ardently but also being terrified of it.

Strategies emerge to maintain an uneasy equilibrium. The mind struggles under the increasing load of disappointments and personal (if not social) tragedies, the pain intensifies, and a conviction emerges that the strategy must be maintained, with the intensity of someone who has paid for a lifetime subscription for a rather useless service and now feels compelled to use it. After all, life is thrifty and flexible; if the amount of pain was secondary to survival, the mechanisms that allow neurosis to emerge would have long been selected out.

Other systems in our minds are ready to be of service to the neurotic strategy: the force of habit, forged by conditioning; the force of memory; the force of all the learning systems that have made an economical decision such as 'no one can be trusted'. To ensure that the individual does not fall into the trap of ever making that mistake again, those systems invade conscious space with hot and furious emotion, while also modulating unconscious systems to maintain that state going as long as the threat is present. And, for the neurotic, the threat is ever present.

Shōma Morita (1874 - 1938) was a Japanese psychiatrist and contemporary of Sigmund Freud who developed a very different approach to the latter's psychoanalytic school. While Freud was interested in digging into the neurotic's unconscious mind for the psychological roots of unease, Morita thought that the neurotic should sweat, instead.

Morita's answer may sound like it comes out of a koan, that is because it seems paradoxical. Morita took much inspiration from Japanese Zen, known for being comfortable with paradox.

That said, what is the Moritist prescription for unease?

• Acceptance: if bad feelings are a storm, then experiential avoidance is like the energy present in the warm tropical seas. Morita advocates for acceptance in the sense of welcoming the negative emotions and thoughts in our minds.
• Purpose: Thought, emotion, and action are certainly interlinked, but action is the easiest component of the system to activate i.e. one can act despite the prevalance of negative thoughts and emotions. Morita likened thought to weather patterns, and poignantly compared the mind to the changeable Japanese sky.
• Purpose: Thought, emotion, and behaviour are certainly interlinked, but the latter is the domain of existence over which we exert the most control. Thought and emotion are likened to weather patterns: they are complex, hard to modify, and can be as unpredictable as the Japanese sky. The question is simple: "what needs doing now?"
• Action: One can feel heartbreak while writing an essay, or angry while tending to one's garden, but we would not write or garden if there we hadn't a valuable end in mind.

Approaches like Morita's resonate with the one taken by Alfred Adler or Karen Horney, who were also contemporaries. Adler spoke of social interest as the lodestar of personality development, based on the fact that a well-developed personality integrates with the social world cooperatively, in order to achieve the society's ends.

For the neurotic, there is a private logic that aims to justify and reinforce the maladaptive behaviour. This logic is often contrary to social interest i.e. action oriented towards the benefit of the social body.

According to Karen Horney, the child whose needs were neglected developed a fundamental anxiety which, in turn, led to the emergence of neurotic strategies to deal with life. Neurosis and Ego Integrity exist on a spectrum.

The basic strategies are:

• Moving towards others: this is the strategy of the people-pleaser, the clingy and needy individual whose sense of self-worth is entirely defined by being accepted and loved by other people. Security can be achieved by acquiring other people's love. The problem with this strategy is that the focus is exclusively on maintaining one's own sense of safety (which is felt to be lacking) through the acquisition of affection, which means there is a lack of grace and abundance. For this player, love is something to be exchanged transactionally.
• Moving against others: this is the strategy of the highly aggressive individual who believes that security can be achieved by being in a position of dominance. This is the strategy of the narcissist, of the manipulator, of the individual who sees life as a zero-sum game. This player will see himself as a leader, a commander, a ruthless businessman who adopts a 'take no prisoners' approach.
• Moving away from others: this is the strategy of the avoidant person, the individual that truly believes that security can only be achieved by making onself as self-reliant and isolated as possible. This player may see himself as a man of great sanctity or insight, a philosopher or mystic for whom mixing with the common man would be nothing but a distraction and a form of debasement.

Other thinkers, such as Dabrowski, see the maladaptation of the individual to their society and the conflicts emerging thereby as an opportunity for great growth.

All individuals must undergo challenges and crises that lead to psychological disintegration. For Dabrowski, the neurotic who suffers is inherently motivated to find an equilibrium again; to achieve this equilibrium and depending on the factors modulating his personality, he may either achieve a form of peace by integrating with the way society thinks or he may face a series of disturbing conflicts between choices.

First, the individual will face conflicts between choices that exist on the same horizontal level of values. Nonetheless, for an individual with sufficient potential (and sufficient neurosis) the choices must eventually be between a lower course of action and a higher, nobler path.

If the individual is able to choose the nobler path consistently, this will reinforce those choices and help him develop moral insight and steadfastness. At this point, the individual is integrated - if not with society, then with a deeply rooted sense of identity. For Dabrowski, personality is a platonic construct and secondary integration is the union of the changeable matter with the form of personality - or, paraphrasing Nietzsche, to become who you are.