Neurosis
Paul T. P. Wong Ph.D. C.Psych
Tyndale University College
Toronto, Ontario

Introduction

1. Please note that the term neurosis has been replaced by mental or personality disorder in APA’s Diagnostic Statistics Manual
2. Existential-analytical logotherapy or existential analysis refers to the therapeutic process of logotherapy
3. Logotherapy can complement the goal of psychotherapy
4. Logotherapy focuses on the discovery of responsibility and existential meaning, while psychotherapy tends to focuses more narrowly on removing symptoms
5. General existential analysis addresses the human concerns about the meaning of life and the meaning of death
6. Special existential analysis addresses the existential needs underlying neurosis, depression and psychosis.
7. Frankl makes it clear that Logotherapy is not a general purpose treatment for every disorder.
8. Meaning-centered counselling and therapy covers all three areas: (1) the general quest for meaning, (2) various mental disorders, and (3) noogenic or existentially based disorders.

Etiology of neuroses

1. Neurosis may result from four sources: Physical, psychological, societal and existential
2. Suffering and existential vacuum can lead to neuroses
3. The tragic triad: pain, guilt and death (grief)
4. The neurotic triad: depression, aggression and addiction
5. Existential triad: boredom, despair, and meaninglessness
6. Any of the above three triads can lead to suicide and criminal behavior
7. Logotherapy is a special therapy for existential or noogenic neuroses

Classification of Neurosis according to Etiology

1. Somatogenic neurosis - caused by biological conditions such as dysfunctioning of endocrine glands or autonomous nervous systems
2. Psychogenic neurosis - caused by psychological factors, such as attitudes and societal conditions
3. Psycho-somatic neurosis - physical illness triggered (but not caused) by psychological factors, such as asthma
4. Reactive neurosis - arising from fight for or flight from something; over-reacting to symptoms of a somatic or psychological disturbance
5. Noogenic neurosis - arising from spiritual or existential causes, such as a crisis of conscience or existential vacuum

Collective Neurosis

Certain widespread attitudes in our society may lead to personality disorders, such as antisocial, borderline, obsessive-compulsive; dependent tendencies). These attitudes are:

1. Fatalism - Everything is pre-determined and controlled by outside factors; becoming cynical and pessimistic
2. Fanaticism - Taking one’s idealized value to an extreme and absolute approach; intolerant and ignoring the views and personhood of others
3. Provisory attitude - Drifting aimlessly; lack of goals and commitment; only interested in the present with no concern for the future
4. Collectivistic thinking - Conforming to the group, abrogating one’s individuality and personal responsibility

These attitudes may reflect and be related to the rise of the Nazi movement.

Treatment of Collective Neurosis

1. Rediscover their own areas of freedom and responsibility
2. Rediscover their values and purpose
3. Understand their own uniqueness
4. Pursue their personal goals
5. Socratic dialogue and re-education of attitudes are helpful
6. In Socratic dialogue, the therapist draws out what is already inside the client
7. Re-education involves confronting and modifying harmful attitudes

Individual neurotic patterns

Excessive avoidance

1. Anticipatory anxiety can result in a self-sustaining vicious cycle
2. Anxiety about anxiety may increase anxiety
3. Avoidance or flight from fear may reinforce symptoms of fear and anxiety
4. May lead to anxiety disorders, such as panic attack and phobias

Excessive fighting against something

1. Fighting against obsessions and compulsions only make them stronger, because of the vicious cycle of pressure and counter pressure

Hyper-intention

1. Neurotic pursuit of happiness, status or power as a terminal value
2. Giving up relationships and other meaningful activities in their pre-occupation with misguided pursuits
3. Could lead to addiction

Hyper-reflection

1. Pre-occupation with self-monitoring or navel-gazing
2. Tendency to catastrophize minor failures and obstacles
3. Hyper-intention coupled with hyper-reflection could result in a feedback system that increases the problem, such as insomnia or erectile dysfunction


Anxiety Neurosis

1. Existential anxiety may express itself in hypochondria
2. For example, fear of death centers on a single organ or a particular fatal disease
3. A general anxiety about life may result in anxiety neurosis (The case of a depressed woman)
4. The task of the logotherapy is to reshape a crisis into a spiritual rebirth
5. The task of the logotherapist is to be a midwife in Socratic dialogue
6. The challenge is to lead the patient to independent responsibility
7. The symptoms of depression and anxiety will vanish once the patient discover her unique and singular task of her life
8. Vanity and pride often prevent people from discovering their unique life tasks in their concrete situations

Treatment of Individual Neuroses

1. Focus not on delving into the roots of the disorder, but on breaking the vicious circle
2. Paradoxical intention makes use of the uniquely human capacity for self-distancing to break the vicious cycle of anticipatory anxiety or the tendency to flee from something.
3. Self-distancing enables us to step away from ourselves and laugh at ourselves
4. De-reflection makes use of the unique human capacity for self-transcendence to counteract obsessive-compulsive disorder of hyper-reflection
5. Self-transcendence means the human tendency to turn to something or some one bigger than themselves

Obsessional Neurosis

Characteristics

1. It has a constitutional or physiological basis
2. Today, this neurosis is called obsessive-compulsive disorder (OCD)
3. The patient has lost his instinctive certainty about things so obvious (2 plus 2 equal 4)
4. The patient compensates by seeking 100% certainty to overcome his skeptic thinking
5. He wants too much; therefore, he can never attain what he is striving for - perfect security in cognition and emotion
6. He gets trapped in a vicious loop - his unrealistic quest for certainty only makes him more anxious about his uncertainty which creates greater need for certainty
7. Worry about this problem results in hyper-reflection and intensifies his anxiety

Logotherapeutic treatment

1. Generally, the logotherapist is not concerned with treating the symptom or the disease; rather, he should set out to transform the client’s attitude towards neurosis.
2. Logotherapy should aim at relaxing the patient and relieve the anxiety toward OCD.
3. Remove patients’ unfounded fear that they may become psychotic.
4. Learn to accept the core of his suffering as his fate or as “the will of God”.
5. The patient is not responsible for his obsessive ideas, but responsible for his attitude towards these ideas.
6. One task of the therapy is to rediscover the instinctive certainty which has been buried by deep emotional layers of the personality.
7. This may be accomplished through re-education and cognitive therapy.

Treating the skeptic worldview

1. The neurotic’s skeptic worldview demands proof of 100% certainty and obviousness.
2. The ultimate quest for 100% certainty is regarding the meaning of existence.
3. Patients need to learn to accept the limits of rationality. The datum “I doubt everything” actually means “everything thing except this particular datum.”
4. Need to challenge patient’s exaggerated rationalism which underlines skepticism (p.197).
5. They not only doubt the logical validity of their thinking and memory; they also doubt the moral validity of their own action - therefore, they are often tormented as to what they ought to do in various situations.
6. The therapist makes use of the patient’s capacity for freedom to choose not to be too conscientious or skeptical.

The ABCD of Meaning-Centered Conselling
(To be used together with the PURE model)

1. Acceptance - Accepting the symptoms and problems; accepting one’s limitations and fate; accepting one’s responsibility in areas where one still has freedom; accept the existential givens, including one’s mortality.
2. Belief - Believe and affirm that healing is possible and wholeness is attainable; believe that meaning and hope can be discovered in every situation right up to the last minute of one’s life; believe that a better future is achievable through meaning-seeking and meaning-making.
3. Commitment - Commit oneself to some future goals. Pursue meaningful goals and projects. Have the courage to take responsible actions and make the right choices in every situation.
4. Discovery - Discover the meaning and purpose in life; discover the freedom from symptoms and the joy of living.