Interest in the problem of neurosis

Interest in the problem of neurosis is determined primarily by the high prevalence of this suffering. According to official WHO data, the number of neuroses over the past 65 years has grown 24 times, while the number of mental illnesses is only 1.6 times. Mass epidemiological studies conducted by G. K. Ushakov et al . (1972), discovered various forms of neurotic disorders in the vast majority of people. The expansionary trends in the past, in which epilepsy, hyperkinetic syndromes, tetany, cataplexy belonged to the neurosis group, have now been completely overcome . The difficulties of the current stage are related to the differential diagnosis between neuroses, on the one hand, and neurosis-like  organic syndromes, psychopathy, and the initial forms of endogenous mental illness, on the other. To overcome these difficulties, it is necessary to develop certain criteria for the diagnosis of neurosis. The most important point is the recognition of the psychogenic genesis of neurosis, their development after mental trauma. It should be emphasized that this approach is practically key, and without a psycho-traumatic factor it is difficult to imagine the development of a neurotic state. In the history of patients with neurosis there are both relevant psychotraumas (official, family, intimate) associated with the development of the disease, and adverse living conditions during childhood. The latter include an incomplete family, improper upbringing, family conflicts, and dramatic situations. In response to an unfavorable situation of a traumatic nature, childhood neuroses ( logoneurosis , hyperkinesis, bedwetting) can develop . In a large number of children during this period, neurotic manifestations are absent. Such children remain, as it were, especially sensitive, sensitized, adverse life circumstances later, in adulthood, entail the emergence of neurosis. However, psychological trauma alone is often not enough for the development of a neurosis. There are practically no people who would not go through mental trauma . To explain the factor of the individually-selective effect of psychotraumas, attempts were made to classify them by severity. This is a very difficult task, and each person demonstrates an individual, unique to him reaction to the seemingly identical situations encountered in life.

The second important link in the genesis of neurosis is personality traits. V.N. Myasishchev (1966) defined neurosis as a disease of personality disorder. After all, a person’s personality is primarily manifested in his attitude to the environment. In order for the traumatic factor to become pathogenic, it should be given importance. Not the objective severity of psychogeny, but its importance and the difficulty of tolerance for the individual lead to the emergence of neurotic disorders. Features of a person’s personality are formed as an alloy of hereditary-constitutional traits and environmental factors, due to the conditions of life and upbringing. The main personality traits are formed in the children’s period of life, hence the role that is attached to child psycho-injuries .
The combination of a psychogenic factor and certain personality traits is a favorable condition for the formation of the main ptogenetic link – mental conflict. In this case, difficulties arise in the implementation of the correct behavior. There are several types of characteristic conflict when there is “incompatibility, a clash of conflicting personal relationships” [Myasischev V. N., 1966]. So, overstated personal claims can be combined with underestimation or complete disregard for objective real conditions; contradictory tendencies are formed between desire and duty, moral principles and personal attachments; contradictions between the real capabilities of the personality, its aspirations and excessive demands on itself. Human behavior is determined by his needs. In patients with neurosis, the presence of unmet needs (adequate social assessment, self-expression and self-affirmation, friendly communication, in the love-erotic sphere) is revealed [ Karvasarsky B. D., et al., 1976]. The formation of mental conflict entails the emergence of neurotic disorders, the most common manifestations of which are emotional, autonomic and dissominal disorders.

Thus, the following can be an adequate definition of neurosis: neurosis is a psychogenic disease that occurs against the background of personality traits, which leads to the formation of a psychological conflict and is manifested by reversible disorders in the emotional, somatic and autonomic spheres. Based on this, the criteria for the diagnosis of neurosis should be: 1) a traumatic situation; 2) features of the structure of personality; 3) the presence of psychological conflict; 4) clinical manifestations of the disease. Correctly assessing these criteria is rather difficult. A detailed and directed history, clinical and experimental-psychological examinations can provide material for assessing the role of two criteria. In connection with them, the dynamics of the disease as a whole and the dynamics of the appearance and disappearance of existing disorders in various body systems should be analyzed. The most difficult approach to identify psychological conflict. In addition to the need for special qualifications, there are objective difficulties: a lack of understanding for patients of the contradictory personality trends that they have, their formation at an unconscious level. 

In the genesis of neurosis, the factor of psychological defense must be taken into account. The protective mechanisms of the personality have long been discussed from psychoanalytic positions and boiled down to the concept of displacing psychological conflict into the unconscious sphere. Naturally, no one can now deny the meaning of the unconscious in the mental life of the individual. Interesting research is underway in this direction. D.N. Uznadze (1961) revealed the role of the system of attitudes that are available at an unconscious level, and showed that the presence of moving attitudes that are quickly adaptable to changing environmental conditions is a factor that counteracts the occurrence of neurosis. Modern research on the psychophysiology of sleep has acquired great importance , one of the purposes of which is the processing of information coming into the brain and its adaptation, its adaptation to personality settings.

The presence of quantitative and qualitative sleep disorders in neurosis is not only a consequence of emotional disorders, but also possibly reflects the lack of protective sleep function in these patients. It should be emphasized that protective psychological mechanisms take place not only in the realm of the unconscious. This and strong social attitudes in the form of relationships that develop in the family and at work.

The combination of all these factors leads to the fact that in response to a traumatic effect, either light neurotic reactions, or a certain form of neurosis, or neurotic personality development can occur. The latter are characterized by the duration of the course, low curability , polysyndromism of emotional manifestations, separation of the course of the disease from the initial psycho-traumatic effect, and the formation of disorders approaching psychopathic ones.

Clinical and physiological studies of neurosis and experimental neurosis are also underway, the beginning of which was laid by the classical works of I.P. Pavlov. At the same time, the role of not only the cortical fields, but also the deep brain structures that make up the limbicoreticular functional system is shown . A complex issue is the systematics of neurosis. The International Statistical Classification of Diseases, Injuries and Causes of Death of the 9th Revision (1975) distinguishes 10 forms: fear neurosis, hysterical neurosis, neurotic phobias, obsessive- compulsive neurosis, depressive neurosis, neurasthenia, depersonalization syndrome, hypochondriac neurosis, other unspecified neuroses neurosis.
In the domestic literature, three classical forms of neurosis are traditionally distinguished: neurasthenia, obsessive state neurosis, hysteria (hysterical neurosis). Moreover, the clinical picture of neurasthenia includes asthenic, depressive and hypochondriacal syndromes; neurosis of obsessive states consists of obsessive- phobic , obsessive- compulsive syndromes. Thus, both forms and syndromes of neurotic disorders are distinguished. Recently, quite often, undifferentiated forms of neurosis are described, in which several neurotic syndromes occur simultaneously and with approximately the same intensity.

The differentiation of neurotic and psychopathic disorders is essential. In a somewhat generalized form, the latter are diagnosed in patients with constitutional personality traits, expressed anomalies of character, difficulty in social adaptation, and frequent asocial manifestations. To this we can add the preservation of consciousness of the disease and the partiality of disorders in neurosis. However, in clinical practice, such a polar separation of these groups is often difficult. O. V. Kerbikov (1971) emphasized the well-known conventionality of separation, considering psychopathy a neurosis, prolonged for a significant part of the patient’s life. Differential diagnosis with neurosis-like syndromes is difficult enough, but necessary . The analysis of clinical manifestations is often not very promising, and only the use of the selected criteria for the diagnosis of neurosis (the role of the psychotraumatic factor, premorbid : personality traits, the formation of mental conflict), as well as the connection of clinical syndromes with organic damage to the brain or somatic sphere, allow us to come to the right conclusion. 

local_offerevent_note September 27, 2019

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