A major part of clinical psychology is the diagnoses and treatment of mental disorders. This can often be difficult and controversial due to the fact that many of the disorders can be confused with others; there aren’t always clear guidelines in which to follow. An example of this confusion can be seen in the disorders Neurosis and Psychosis. Neither neurosis nor psychoses appear as major categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The main reason for this is that both categories were fairly broad and included a number of mental disorders with quite dissimilar symptoms. Consequently, mental health professionals did not always agree on the diagnosis for a particular patient. Neurosis is a functional (Psychogenic) disorder consisting of a symptom or symptoms caused, though usually unknown to the patient, by a mental disorder. The four commonest are Anxiety State, Reactive Depression, Hysteria and Obsessive-Compulsive Neurosis. We all know what it is to feel anxious. Anxiety becomes abnormal when it is out of all proportion to the cause, or when it continues long after the cause has been removed.
Patients with other mental illnesses often feel anxious from time to time, but the term anxiety neurosis is used to describe the illness in which anxiety is the main feature and the patient feels anxious all the time. Reactive Depression is a form of depression where the cause is known i.e. marriage break-up or bereavement. Reactive depression can be classed as a neurosis as it is an exaggeration of the normal expected response to such situations. In medical language the word Hysteria is used to mean that a symptom is beyond the patients control. If I have to take an examination tomorrow and to get out of it I ring up and say that I cannot attend because I am going to the dentist, I am malingering. I am quite deliberately telling a lie to get out of taking the examination. But if, on the morning of the examination, I wake up with a raging toothache although there is nothing wrong with my tooth, this is hysteria. There is nothing wrong, but the pain is genuine. I am quite truly incapable of sitting the examination. The symptom is out of my conscious control and has become hysterical.
Hysterical symptoms always serve to get us out of some unpleasant situation, to gain us some advantage, or to solve some conflict for us. People in whom hysterical symptoms are so pronounced that they can no longer lead a normal life are said to be suffering from hysteria. Some people will not walk under a ladder; a few would be really worried if you asked them to do so. They are obsessed by the thought that it is unlucky. Some people feel compelled to throw spilt salt over their shoulders. If a person is obsessed by a thought to such an extent, or compelled to perform certain actions so frequently that he/she is unable to lead a normal life he/she is suffering from obsessive-compulsive neurosis. The obsessions and compulsions take many different forms. The patient knows that they are unreasonable but are unable to control them. One of the most common compulsions is the need to wash time and time again another is extreme tidiness.
The one thing all of the above disorders have in common is that all arise from external factors. So a neurosis occurs when the mind is affected by factors arising in the environment. A psychosis however, differs in that it is a mental illness arising in the mind itself. The psychosis can be divided into those in which physical disease plays a major part and those in which it does not. These subdivisions are called organic psychosis and functional psychosis. Dementia and Infective-exhaustive psychosis are the main organic psychoses. The main functional psychoses are Schizophrenia and Manic-depressive psychosis. Dementia is the mental illness associated with decay or deterioration of the brain. It usually occurs in people over 60, but occasionally earlier. In old people it is called senile dementia. Most people retain their faculties quite well, but sometimes the brain ages and becomes diseased while the body remains comparatively healthy.
The symptoms of dementia are those popularly known as ‘second child-hood’. The patient forgets the immediate past but remembers his early life clearly. He doesn’t recognize people he knows well, frequently forgets where he has put things, doesn’t know where he is or what day it is. Small changes in his routine make him confused. He is unable to grasp any new ideas. Sometimes he is extremely obstinate and at others quite docile. Physical illnesses, which are accompanied by infection or exhaustion sometimes, give rise to mental symptoms. The most common is puerperal septicaemia or infection following childbirth. Others are pneumonia, influenza, tuberculosis, cancer and sometimes diseases of the nervous system. The patient is restless, sleeps little and when he does he has vivid dreams which he believes are real. He cannot think clearly and does not know what is going on. He sees and hears what is not there, may lose his memory and is often incoherent and noisy. He lives half in this world and half in a dream world. Schizophrenia is the most common of the psychosis and the most difficult to understand.
There are different types of schizophrenia and symptoms may vary from being moody and difficult to the most bizarre thoughts and actions. The patient may hear voices and see things that are not there. This is called being hallucinated. He thinks in a way that is incomprehensible to normal people. He may hold beliefs, which to ordinary people around him are quite untenable, such as that his arms are stuffed with cotton wool. Such beliefs are called delusions. He often thinks that everything that happens refers to him and that other people are conspiring against him. He is sometimes apathetic or stuporose and is given to acting suddenly, without warning. The popular term ‘split mind’, although not accurate, may have come from the way in which these patients will laugh as they describe some dreadful happening which they believe has just taken place, as if there emotions had been split off and no longer worked in harmony with their thoughts.
Manic-Depressive psychosis, a type of mental disorder which alternates between phases of excitement and phases of depression. Often there are periods between these phases of complete normality. These are just a few of the disorders covered by neurosis and psychosis. One thing that can be noticed is the fact that all of the neurosis are caused by external environmental factors whilst all the psychosis are caused by. Another difference that has been noted is that many people suffering from a neurosis are able to accept that they have a mental illness whilst with a psychosis the patient believes that they are normal and cannot separate reality and fantasy.
There are also differences in the symptoms of these disorders. Neurotic patients show exaggerated responses to events around them. These events are real and many people would react in a similar fashion just not to such an extent as the neurotic patient when in such a situation. The psychotic however, responds primarily to events that are not there, imaginary situations or hallucinations or voices. An example of this can be seen here, Normal
So Roberts got the job? Oh well, I suppose my face just didn’t fit.
It’s always the same. Jealous! That’s what they are. I should have been promoted long ago, but there just determined to see I don’t get on. They gang up against me each time.
The government knows I have the secret formula, which will split the earth in two. Their agents are following me everywhere. You’re one of them – you can’t fool me. The neurotic believes something that is possible, but not probable. The psychotic believes something that is quite impossible. The differences between these two disorders, neurosis and psychosis, may appear small but they can help in the diagnoses and treatment of patients. It can be very difficult to treat a patient when the cause of their illness is unknown or when the illness itself is difficult to understand. It is for this reason that mental health professionals need to categorise mental disorders as clearly and concisely as possible.
The DSM-III dropped the entries of neurosis and psychosis and split them down into subdivisions to try to enable better diagnosis but there is still confusion as to the differences between neurosis and psychosis. There is not only a difference between the two but also a difference in each individual case. Different things effect people in different ways and many people although share the same illness have completely different symptoms. Every case should be looked at individually and treated as such. Instead of looking for the best treatment for neurosis, it would be better to look for the best treatment for an individual.
Dean Waring 28 / 02 / 2001
Introduction to psychology – Atkinson – Hilgard – 1983
The science of mind and behaviour – Gross – 1999
The oxford companion to the mind – Gregory – 1987