Neurosis

   In his First Lines of the Practice of Physic, the first volume in the English translation of which was published in 1777, William Cullen introduced the term "neuroses" to mean diseases of the nervous system in which there was no obvious physical lesion. Mental illnesses (the "Vesaniae") were a subcategory of neuroses. Of the "neuroses" he wrote, "I propose to comprehend . . . all those preternatural affections of sense or motion which are without pyrexia [fever] as a part of the primary disease; and all those which do not depend upon a topical affection of the organs, but upon a more general affection of the nervous system" (p. 122 of vol. III of the 1799 edition). Thus launched, the term "neurosis" was taken up by a number of authors, notably Vienna’s Ernst von Feuchtersleben (1806–1849), who in a series of lectures on psychiatry in 1845 (see Psychosis: Emergence), distinguished between "psychosis" and "neurosis": "Every psychosis [disorder of the psyche] is at the same time a neurosis [disorder of the brain], because without the mediation of the nervous system no mental change is able to become manifest; but every neurosis is not simultaneously a psychosis" (p. 265).

   Yet, subsequent authors would reverse the meaning of the two terms, making psychosis the major form of psychiatric illness and neurosis a lesser disturbance. In his 1872 Textbook of Psychiatry (Lehrbuch der Psychiatrie), Richard von Krafft-Ebing distinguished between "psychoneuroses," meaning "mental illnesses that affect individuals with normal brains," and "psychic degeneration." "For those mental disorders that affect individuals with healthy brains let us use the designation psychoneuroses; for those that arise on the basis of predisposition the expression psychic degeneration will serve" (2nd ed., 1879, vol. II, p. 3).

   For Sigmund Freud, psychoneurosis meant symptoms arising from unconscious conflict as opposed to current life issues (which latter category he called "actual neuroses"). The first time he used the term "psychoneurosis" was in his essay on "Sexuality in the Etiology of the Neuroses," published in the Vienna Clinical Review (Wiener Klinische Rundschau) in 1898: "The significant differentiation, one that in each case may be made through careful evaluation of the symptoms, is whether the case has the character of a neurasthenia or a psychoneurosis (hysteria, obsessive thoughts)" (Gessammelte Werke, I, p. 496). The term "neurosis" as such, however, had long entered medical discourse, and Freud employed it from the very beginning to mean "disorder." See, for his example, his essay on the distinction between neurasthenia and "anxiety neurosis" (Angstneurose) in 1895 in the Central Journal of Neurology (Neurologisches Zentralblatt). (See ANXIETY: Freud differentiates . . . [1895].) The Freudian psychoneuroses embraced much of the range of psychopathology. In 1913, in an essay on "The Disposition to Obsessive Neurosis" ("Die Disposition zur Zwangsneurose") in the International Journal of Medical Psychoanalysis (Internationale Zeitschrift für ärztliche Psychoanalyse), Freud argued that, "The order in which the psychoneuroses are conventionally discussed—hysteria, obsessive neurosis, paranoia, dementia praecox—corresponds to (if not exactly) the order in which they appear in life. Hysterical forms of illness may be observed as early as infancy; obsessive neurosis reveals its first symptoms in the second stage of childhood (from 6 to 8 years old); the two other psychoneuroses, which I have brought together under the term ‘paraphrenia,’ manifest themselves only after puberty and in young adulthood" (Gesammelte Werke, VIII, pp. 443–444).

   After Freud, the term "neurosis" remained largely in the domain of psychoanalytic speculation, although it retained some currency in neurology as a synonym for "functional," or symptoms without lesions. As London neurologist Samuel Alexander Kinnier Wilson (1874–1937) pointed out in his posthumous textbook Neurology (1940), "Current neurological opinion takes the word [neurosis] to signify a disorder of nervous function for which as yet no underlying basis has been found" (p. 1626). "Neurosis" was banned from psychiatry officially by DSM-IV in 1994 (the two previous editions, DSM-III [1980] and DSM-III-R [1987] having used it in parentheses as a synonym for disorder).