Neuroses

Neurosis is a mostly outdated term that has had a number of meanings throughout the history of psychology. Its usage continues today, although more so in everyday language than in academic or clinical language. Coined in 1769 by William Cullen, a physician and professor in Scotland, the term originally referred to any disorder related to the nervous system, including [Page 619]disorders with elements of anxiety, hypochondriasis, or irritability. The word itself derives from its connection with the nervous system (Greek neuron means “nerve,” and osis indicates a disease). First listed in Cullen's diagnostic guide, System of Nosology, the category of “neuroses” consisted of a range of disorders that would now be classified as neurological and psychological, but all with an ultimate physical cause. This was a significant advance, because prior to Cullen's classification, such disorders were thought to be caused by such elusive phenomena as demons or “vapors.”

Philippe Pinel started as Cullen's translator but eventually criticized his ideas, defining neuroses as moral disorders as well as physical disorders, and suggesting that moral component warranted psychological treatment. The medical model, however, remained the dominant paradigm of mental illness until the late 1800s. The role of physical causes in mental illnesses took a back seat to psychological causes, and the word neurosis no longer signified an organic etiology.

A century after Pinel defined neurosis, Sigmund Freud and others used the word to describe mental illnesses with a psychological origin but with no characteristics of psychosis—that is, no disconnect from reality. Freud connected the concepts of psychosexual conflict, defense mechanisms, and the unconscious with neuroses. In 1896, a renowned textbook by Kraepelin explicitly divided disorders into neuroses and psychoses. The neuroses included a range of anxiety disorders, from phobias to obsessions and compulsions. Neurosis referred to milder cases, whereas psychosis referred to more serious cases more likely to have an organic cause and justify more extreme treatments. At this point, the word psychosis, and not neurosis, referred to diseases that were related to the nervous system and that had a physical origin—the original meaning of neurosis!

In the present day, the word neurosis, along with its associated adjective, neurotic, is frequently used to describe anxiety-related, dissociative, or somatoform disorders, but clinicians seldom use these terms. Since publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, neuroses have not been listed among diagnos-able psychiatric disorders. Instead, most clinicians use a more specific diagnosis, such as obsessive-compulsive disorder or generalized anxiety disorder. Today, the term communicates little clinical information but remains widely used among the general population.