By David Joel Miller
Do people still get treated for being neurotic?
On my bookshelves are a whole lot of older books on mental health and mental illness. Many of them talk about neurosis. A couple even has the word Neurotic or neuroses in the title. I mentioned “Be glad you are Neurotic,” by Bisch in a previous post. With all the literature on Neuroses, where have all the neurotics gone?
Neurosis was a pretty inclusive term. In the older psychological literature, you could get three diagnoses, Neurosis, psychosis and that group that seemed to move back and forth across the line got called “Borderline” because they appeared to live at the border between Psychosis and Neurosis.
Today our understanding of the possible mental illnesses is getting much more complicated. For example, one new piece of research from the University of Buffalo seems to suggest to me that over a hundred different genes may be causing schizophrenia because of their effect on one structure in the brain. Eventually, we may diagnose and or treat dozens or even hundreds of different types of psychoses.
The word Neurosis has leaked from psychiatry into the popular vocabulary. It like so many other words mean different things to different people.
Some dictionary definitions include “relating to, involving, affected by, or characteristic of a mild psychiatric disorder characterized by depression, anxiety, or hypochondria” and “overanxious, oversensitive, or obsessive about everyday things.”
So by this definition of neurosis, most of the things that today we break out into anxiety, mood disorders, obsessive-compulsive disorder and a few other disorders would all be thrown into the category neuroses.
Neuroses have been completely dropped from modern psychiatric diagnosis, largely because neuroses were based on theories of what is going on inside the person like dreams and the unconscious. Current preference is to primarily use symptoms that are visible to others or can be described by the client, like lack of sleep, loss of pleasure or similar characteristics as the basis of diagnosis.
This older term, neurosis, also included most of the currently recognized personality disorders.
One effect of this move from the simple classifications system, you either had a psychosis or a neurosis, has been that people with many symptoms now may get a number of diagnoses.
Neurosis used to include symptoms of both depression and anxiety. Now that the two are separated and further separated into many types of anxiety disorders and mood disorders, many people qualify for both a depressive diagnosis and an anxiety diagnosis. The overlap is so large that a combined depression and anxiety disorder was considered for the new DSM-5. (It did not become a separate diagnosis but there are specifiers for this.)
All the neurotics now get to have dozens or more of new diseases and disorders that are the result of refining our system of classification rather than in any real change in human behavior or the way in which mental illnesses affect people.
So you can go on feeling you are neurotic if you chose. You can say others are acting neurotic, but the diagnoses that the clinician will give you will have one of the newer disorder names.
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