The Neurotic Turn

The place of neurosis today is unique. It still remains within the discourse of everyday life. Already it is permeated with different meanings to describe how someone is unexplainably nervous or agitated. Perhaps, as a blanket term, “neurosis” still provides a usefulness for some as they attempt to get to grips with their own feelings, doubt and anxiety. What was once upon a time a principle topic of debate in the twentieth century has now been consigned to the history books with such phenomena as hysteria and obsessional neurosis. How did this happen and why?

Following the attempt by the neo-Kraepelinist movement of the 1960s and 1970s to radically change the approach of psychiatry - from a predominantly traditional psychoanalytically informed practice in favour of a behavioural and biologically informed practice - psychiatry was already facing a battle at this time. There were growing numbers of psychiatric patients becoming institutionalized along with unsuccessful treatments, and this led to greater scrutiny of the profession. Psychoanalysis itself was in crisis. There was public criticism following several events which led to the revamp of the Diagnostic and Statistical Manual of Mental Disorders II (or DSMII); the “anti-psychiatry” movement formed in the 1960’s, supported by Thomas Szasz, a psychiatrist who authored The Myth of Mental Illness (1961), and the Gay Liberation movement, which had been campaigning for the removal of “homosexuality” as a diagnosis of mental illness. In 1973, the Stanford psychologist D.L. Rosenhan published an article entitled On Being Sane In Insane Places, providing a study in support of the ideas of Szasz, which the general public also shared in order to promote anti-psychiatric tendencies within the public domain (Hoeschen 2014: 4).

In the change from the DSM-II to the nosography of the post-DSM-II era, neurosis was taken off the standard nomenclature of diseases. This dramatic change in the history of science had made neurosis obsolete and yet the language still remains today. It is almost as if the use of the word encapsulates what the present nomenclature does not. This paper will look at the origin of neurosis as a concept and its place in the world. This will be discussed from the point of view of theorists such as Foucault, Freud, Marc de Kesel and Jacques Lacan.

The term “neurosis” seems to have originated with the Scottish doctor William Cullen in his 1777 treatise, First Line of the Practice of Physic, the second part of which is titled “Neurosis or Nervous Diseases”, in which he describes neuroses as

preternatural affections of sense and motion which are without pyrexia, as 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, and of those powers of the system upon which sense and motion more especially depend. (Cullen 1777: 302)

Cullen’s work on neurosis not only deals with mental illnesses, but also with dyspepsia, cardiac palpitations, colic, hypochondria and hysteria. We should note that at this time medical science had been making considerable advancements in establishing itself. Many authors during this time were creating the nosography of nervous diseases. Laplanche and Pontalis point out the direction of this nosographical extension of neurosis in the nineteenth century: “The term covers troubles which would now come under one of the following three headings: neurosis (hysteria for example), psychosomatic conditions (neurasthenia, digestive troubles) and neurological affections (epilepsy, Parkinson’s disease)” (Laplanche and Pontalis 1973: 267). While the reason for this direction is unclear, it seems that at this time, as more unique mental illnesses were being catalogued, it may have resulted in the differentiation into the localization of possible lesions in the human organism.

How should we look at this petit-insanity that is neurosis? Since the time of the great confinement throughout Europe, the insane has played its part in this mass policing of persons on the grounds of health. The spread of Judeo-Christian values had permeated the way in which civilization dealt with its citizens. Shame had become part of this function of confinement. It had become a way in which families could avoid attaching shame to them by having a family member confined to prevent scandal. There were two types of patient: the madman, and the patient with some faculty for rational decision-making. Foucault called these “the unreasoned”. Foucault highlights this point by describing places such as the Narrtürmer in Germany, where the mad were on display for passers-by to see. A zoo-like culture developed in the main European cities, and people would often pay to view madness personified. Madness differed in this way from unreason. While the unreasoned remained hidden within the confinement, madness became a pure spectacle, quite like that depicted in David Lynch’s film The Elephant Man (1980).

Michel Foucault criticises the general view of “the age of reason” which dominates the discourse on what is considered reasonable and what is alienated from reason — namely madness. Madness, something that had been interpreted from the position of “moral reason” in the post-Renaissance era, was believed to be closely related to the role of passion in the individual. The folies were deemed as vices and were thus stigmatized and seen as contrary to reason. In this way passion and madness were linked. It was also the period where the body and soul were both united and demarcated by the passions. Foucault describes it as the “meeting ground”, a “geometrical centre” and a “locus of their communication” (Foucault 1965: 86). In addition, he suggests that passion is “no longer simply one of the causes of madness, rather it forms the basis for its very possibility” (Foucault 1965: 88). What he seems to suggest by this is that passion appears as this remainder which makes it possible for madness to take over.

Foucault notes an important distinction between unreason and madness at the beginning of the nineteenth century: “If, in the case of unreason, the chief intention was to avoid scandal, in the case of madness that attention was to organize it” (Foucault 1965: 70). The unreasonable were starting to be differentiated from those who were mad. The mad were free from moral unreason but appeared as beasts who needed restraint from a violent animalism. Asylums were slowly developing the reputation for caging mad beasts. Their outbursts of rage were perceived to be a social danger. All forms of liberty were inevitably suppressed through this form of discipline. Foucault, based on his investigations, believed that “madness threatens modern man only with that return to the bleak world of beasts and things, to their fettered freedom” (Foucault 1965: 88). He states that

We no longer understand unreason today, except in its epithetic form: the Unreasonable, a sign attached to conduct or speech, and betraying to the layman’s eyes the presence of madness and all its pathological train; for us the unreasonable is only one of madness’s modes of appearance. On the contrary, unreason, for classicism, had a nominal value; it constituted a kind of substantial function. It was in relation to unreason and to it alone that madness could be understood. Unreason was its support; or let us say that unreason defined the locus of madness’s possibility. (Foucault 1965: 83)

This was the place unreason operated from in the classical period, a place in which everything was questioned and nothing was absolute.

As characteristic of the eighteenth century, in which physiologists attempted to define in precise form the nervous system by way of functions, their main focus was upon an organ that suffers. Foucault notes the particularity in which an organ suffers: “in a fashion all its own, a general attack (it is the sensibility particular to the organ which assures this nonetheless discontinuous communication), and the idea of a propagation in the organism of a single disorder that can attack it in each of its parts (it is the mobility of the fibre which is responsible for this continuity, despite the diverse forms it assumes in the organs)” (Foucault 1965: 155). Irritability was key in the perpetual harassment of the body. The neuroses had been stuck in the place of unreason. From the seventeenth and throughout the nineteenth century, it could only be observed, conjectured, and resulted in inaccurate explanations of animalism, vapour excretion and organ irritation.

The emergence of what was known as the “nervous diseases” stemmed from the research of melancholia delirium and its relation to mania. The use of the humours was still prevalent at this time, and so the movement of black bile within the organism was attributed to the cause of melancholia. It was described by Hermann Boerhaave as a “long persistent delirium without fever, during which the sufferer is obsessed by only one thought” (quoted in Foucault 1965: 118). Dufour later on characterized it as a “love of solitude” which “makes them more attached to the object of their delirium or to their dominant passion, whatever it may be, while they seem indifferent to anything else” (quoted in Foucault 1965: 118). Dufour and Boerhaave seem to accurately point out some of the parallels between what was considered to be an aspect of madness and what was later described as a neurotic trait by describing it in psychological terms (or of object relations). The seventeenth century still placed the cause of such illnesses on the movement, temperature, moisture and quality of the humours. In turn, psychiatry could provide a causal basis for the pathology of an idea or fear which occupied the mind of a sufferer. It was only by the end of the eighteenth century that melancholia became the classification for “all forms of madness without delirium, but characterized by inertia, by despair, by a sort of dull stupor” (Foucault 1965: 124). What was proving to be difficult for psychiatrists was the exact definition of what was going on in the patient — because they were not suffering from delirium and were considered to be above normal intelligence, melancholia was still considered to be a form of madness due to the moral dilemma of withdrawal from the world around them. The eighteenth century also saw the emergence of nerve metres and tension. Foucault describes the new explanation for melancholia during this time: “the melancholic can no longer enter into a resonance with the external world, because his fibers are relaxed or because they have been immobilized by too great a tension” (Foucault 1965: 126).

Why is this dichotomy of melancholia-mania important? Because of the implications it has for the actual neuroses and psycho-neuroses that Freud goes on later to develop. Already we can begin to see the lead up to what Freud begins to describe in his Project for a Scientific Psychology (1895).

Foucault asks two important questions concerning hypochondria and hysteria: (1) Is it legitimate to treat them as a mental disease? (2) Are we entitled to treat them together? As with melancholia, hysteria was proving to be difficult for psychiatrists to define. The imaginary came into psychiatric discourse in its description of hysteria. Willis even acknowledged the ignorance of the doctor in determining the cause of the illness: “The idea of hysteria is a catchall for the fantasies, not of the person who believes himself ill, but of the ignorant doctor who pretends to know why” (quoted in Foucault 1965: 138). At this stage, the causes were now being localized to the organs of the body. In particular, the intestines, the stomach, the intercostal nerve and the womb. The prevalence of the theory of a nervous condition was growing throughout the eighteenth century and was starting to use terms such as “irritation” and “irritability”. These terms are what we use now to describe the behaviour of a neurotic.

What had caused science to detach itself from the philosophical tradition started to return to philosophical musing as a result of the inexplicable phenomenon that was hysteria. Thomas Syndham notes that hysterical affection is attributed to “some sorrow” and the “incoercible agitation of desires in those who had neither the possibility of satisfying them nor the strength to master them” (quoted in Foucault 1965: 150). Foucault describes hypochondria and hysteria as diseases of the nervous type, which were “idiopathic diseases of the general agency of all the sympathies” (Foucault 1965: 151). The localization of hysteria focused on using the metaphor of a faculty — an agency of some sort to direct the movement from one organ to another within the organism. In addition, it promotes the faculty of feeling and sympathy. This agency of sympathy “permits the organs to communicate with each other and to suffer together, to react to a stimulus, however distant” (Foucault 1965: 152). Hysteria is now going down the same path as passion, in which it becomes similar due to its eluding character. Not only this, but hysteria was now placing the person as perpetrator of its own illness as opposed to victim. The body of the person was now protesting the compromises the person has to make in its engagement in reality by way of attack. This irritation stemmed from the “abuse of things that were not natural, the sedentary life of cities, novel reading, theatre-going, immoderate thirst for knowledge, too fierce a passion for sex, or that other criminal habit, as morally reprehensible as it is criminally harmful” (Foucault 1965: 157). For the pathologists of the eighteenth and nineteenth century, this represented an ethic of desire where the body took revenge for the abuse of non-natural appetites. Again, the language was beginning to change and Foucault sees this. Reason — or more precisely unreason — determined the logic of madness: “What had been [called] blindness would become unconsciousness, what had been error would become fault, and everything in madness that designated the paradoxical manifestation of non-being would become the natural punishment of a moral evil” (Foucault 1965: 158).

This new concept, that the body acts on a moral principle, would become a point of debate for years to come and is still being discussed today. This is the position from which Freud operated when he was only beginning to formulate what was later to be called psychoanalysis. Perhaps the task of trying to define neurosis cannot be possible without it being a psychoanalytic one. One of the descriptions of neurosis is that it is a form of compromise. If we are to understand the workings of a neurosis we must understand that humans must pay a price in order to live harmoniously with one another and avoid chaos. I would argue that as beings-in-language we all must be neurotic (at our most functioning level). Some would argue that in order to be successful, that is, what is culturally seen as successful, one must be a psychotic. One example is Bret Easton Ellis’s novel American Psycho, where everyone seems to answer to no one but themselves and creates a new ideal universe within the confines of the actual universe where no ostensible intolerable frustration exists. Freud’s structural position explains that it does not take much for someone to fall into a psychosis. Again, we find the “possibility” of madness as it once was described. However, neurosis might also be considered the anchoring point which prevents one from floating away into the abyss of psychosis.

Freud’s early writings focus largely on neurosis. Like many other psychiatrists, he set out to discover the basis of the illness. He, also like other German psychiatrists, divided mental illness between neurosis and psychosis. Freud, along with Pierre Janet, believed hysteria and obsessional neurosis to lie outside of the classification of psychosis; folies and delusional states. Freud was to create his own psychoanalytic nosography based on disorders which originate in the mind. His classification divides neurosis into two subclassifications: actual neurosis and psychoneurosis. In Freud’s explanation of hysteria, he implied a connection between the soma and psyche, like many of the predecessors before him.

Following from American neurologist George Beard, Freud describes neurasthenia as a degeneracy of the nervous system. While Beard’s description of this was analogous to an electrical system, Freud’s explanation was purely sexual. His basis for this was due to the neurasthenic nervous system longing for a reduction in tension. He gave the example of excessive masturbation to elaborate his point. Rik Loose gives an interesting comment on Freud’s hypothesis:

because the nervous system must be able to tolerate a certain amount of tension, the neurasthenic becomes vulnerable to illness as he has fallen victim to the habit of trying to completely avoid any amount of accumulated tension. The neurasthenic symptomatology is based on a lack of tension and this lack (or deficiency of something) which cannot be psychically processed becomes toxic. (Loose 2002: 170)

Freud states “the mechanism of anxiety neurosis is to be looked for in a deflection of somatic sexual excitation from the psychical sphere, and in a consequent abnormal employment of that excitation” (Freud 1894: 108). What does this mean? Loose explains this further: “there is an accumulation of endogenous sexual tension (that is, the somatic sexual drive or physical libido); this reaches, but does not go beyond, a certain threshold...so, for various reasons, psychic linkage does not happen and the physical tension becomes a toxic substance (anxiety)” (Loose 2002: 172). Now the language has again changed to elaborate on nervous disorders. While tension remains, it is now partnered with toxicity. A substance that is hazardous. The “reduction in tension” forms the basis for much of psychoanalytic thinking. Its manifestations are varied and can result in numerous nervous conditions. In one of his earliest and most important texts, “Project for a Scientific Psychology”, Freud elaborates this notion on the reduction of tension in the subject though its relationship with reality, something that will be discussed further on in this essay.

How is neurosis different from psychosis? In his paper “Neurosis and Psychosis” (1924), Freud’s structuralism comes into play to establish the similarities and differences. He establishes that the most important genetic difference between a neurosis and a psychosis is that “neurosis is the result of a conflict between the ego and its id, whereas psychosis is the analogous outcome of a similar disturbance in the relations between the ego and the external world” (Freud 1924: 149). As Freud explains, the difference is a genetic one which establishes that both neurosis and psychosis is part of the same genus. The ego acts as a sort of mediator between the demands of the id versus demands of the superego (the superego acting as the moral, symbolic and authorative representative of reality). In what he describes as the “anticathexis of resistance”, Freud explains that the resistance employed by the ego on the instinctual demands of the id by way of repression is what creates the neurotic quality.

In his structural model of psychosis, Freud explains that the ego creates a new world in accordance to the id’s wishful impulses, and “that the motive of this dissociation from the external world is some very serious frustration by reality of a wish — a frustration which seems intolerable” (Freud 1924: 150). He also adds to this point of turning away from the world by his description of dreams among the neurotic and psychotic: “The close affinity of this psychosis to normal dreams is unmistakable. A precondition of dreaming, moreover, is a state of sleep, and one of the features of sleep is a complete turning away from the world” (Freud 1924: 151). With this Freud is talking about the genetic link between psychosis and normality by way of the unconscious. Normality too demands a “turning away” from the world. The world represents many things for different people. For some, it can represent the irredeemable frustration of a wish which is located in the external world. How are we to look at these prohibitions that frustrate? On the one hand, it is these prohibitions that create a desire for the wished-for object, whatever that may be. The psychic installation of acknowledgement and acceptance of this prohibition leads to a neurosis. On the other hand, we find a failure on the functioning of the ego because of an overbearing prohibition which can lead to a psychosis. Freud believed that it depended on the frustration of one of those childhood wishes which “are forever undefeated and which are so deeply rooted in our phylogenetically determined organism” (Freud 1924: 151). Is he saying here that there are childhood wishes that are inherent and cannot back down in the face of a frustration and, for the psychosis, recreate a world that is sourced from this rupture from the conflict between prohibition and unstoppable wish?

What does this “compromise” mean in psychoanalysis? Firstly, the onset of a neurosis results from the frustration of a desire. This desire might be at odds with another, which leaves the individual/subject at an impasse. In psychoanalysis, the ego, in its attempt to defend itself, uses repression against the instinctual impulse of the unwanted material. The repressed material re-emerges in a recreated form as a substitutive representation and imposes itself upon the ego. For the neurotic individual this substitutive representation is otherwise known as the symptom — as such an individual might say:

This is the compromise I have made with the world or the law which has frustrated my original desire, and now I have an accord with the world, but it has cost me what Lacan describes as ‘a pound of flesh.’

However, once I have made this compromise, I am now subject to guilt every moment I pull out of “the deal” with the world. Neurosis is the act of putting the question of “Am I making the right decision?” forward when it comes to the subject’s relation with the world.

What is this psychic apparatus that leads the subject to a neurosis or psychosis? Based on the logic of Aristotle’s Nicomachean Ethics, Freud conceives the psychic apparatus as a judgement apparatus in his treatise “A Project for a Scientific Psychology” (1895). Here the subject is working in a similarly logical, syllogistic manner to Aristotle’s belief that moral action is due to a logical process. “The only — but far reaching — difference is that here thought is considered to be an unconscious process, operating in a field of memory traces (and, thus, of representations), and operating according to its own logic” (De Kesel 2009: 75). For Freud, within the psychic apparatus, hallucination plays an important role in the decision-making of the individual. It still operates on a stimulus-response philosophy; however, the hallucination is purely unconscious for the individual. Energy in the form of tension is discharged that moves through certain pathways which he calls “facilitations”. Their aim, an effect — pleasure. This “judgement apparatus”— which Freud hypothesized — operates on an ethical principle for the subject through its relation to its field of representations (which he calls “memory traces”). De Kesel adds, “This is the way the system thinks unconsciously and regulates its relation to reality. If it could in fact live by its pleasure principle alone, it would have no need of any reality for thanks to these [unconscious] representations, it could have an exclusively hallucinated satisfaction” (De Kesel 2009: 75).

Freud extended the view of the stimulus-reaction paradigm that was prevalent in the nineteenth century that Helmholtz and Fechner had made advancements on. It looks at the psychic apparatus as a series of stimulus-response actions (the emphasis being on the influence of reality upon the human organism). In what he describes as “Not des Lebens” or the exigencies of life, Freud describes the role of reality stemming from the pleasure principle of the human organism. As a result, the Darwinian explanation of self-preservation is not the sole cause for humans reacting to reality, but the pleasure it experiences in the act of self-preservation such as feeding, sleeping or the act of sex. According to Marc De Kesel, “reality is that which acts on an organism as a field of stimuli and thereby effects a tension — an ‘energy’ — inside the organism that must be discharged or abreacted as quickly as possible. It causes unpleasure that requires removal, generating pleasure” (De Kesel 2009: 68). The constant need to ward off reality is what constitutes the reality principle. Lacan later points out that the reality principle is a type of collaboration with the subject in the operation of desire:

When Freud speaks of the reality principle, it is in order to reveal to us that from a certain point of view it is always defeated; it only manages to affirm itself as the margin. And this is so by reason of a kind of pressure that one might say, if things didn’t, in fact, go much further, Freud calls not ‘the vital needs’ — as is often said in order to emphasise the secondary process – but ‘die Not des Lebens’ in the German text. An infinitely stronger phrase. Something that wishes. ‘Need’ and not ‘needs’. Pressure, urgency. The state of Not is the state of emergency in life. (Lacan 1999: 46)

Freud’s extreme step in behind the pleasure principle suggests that, in the final analysis, the reaction principal aim is to allow all the internal energy to flow out entirely and to thus bring the organism back to its in-organic state. Being basically an inertia principle, the pleasure principle ultimately makes the drive to discharge all tension and therefore to become completely cleansed of the outside world (meaning reality). (Lacan 1999: 69)

In this way it could be said that neurosis is a sort of precursor for the drive of all of our musings and worry and doubt. What Lacan identifies in Freud is the beginnings of his formulation on the death drive; not the drive towards one’s own self-annihilation, but the drive to inorganicness. And yet the neurotic is at pains to engage with the world around them. They oscillate between a dissatisfaction of being around others and a dissatisfaction of being alone. This is what essentially characterizes the neurotic. It is not that the neurotic is an indecisive subject, but they are divided by the compromise made with the world to engage and disengage.

So why is neurosis considered to be “an ethical principle”? The judgement it makes is not necessarily good for oneself, rather it ascertains what is good based on the status of reality. Some would call this “context”.

Maybe it is possible to locate guilt based on Freud’s treatise. Perhaps it is part of the broader ethical proposal. What do I mean by this? Neurosis is part of the struggle with the law via its ability to compromise so that the law is not an obscene law. We must remember that neurosis is a choice. It is a decision, albeit an unconscious one, to continue to engage with reality despite succumbing to the original trauma by way of frustration which forces us to make such a choice. I believe there is a hidden begrudgery inherent with anyone who has had to give their “pound of flesh”. Maybe the struggle of the psychiatric community from its inception up to the 1960s and ‘70s acted in such a neurotic way in order to answer a demand. What is this demand for? It is always for something else. This is the way in which a neurosis manages its tension.

Becoming less immune to stimuli is the aim of the organism in order that it may master the tension within. Neurosis on the other hand is the absolute opposite. It almost demands more. Neurosis is the reason for never enough. This is why it is characterized by doubt, inadequacy and inefficiency. While the complaint is about not being good enough, the demand is essentially two-fold: that reality demands too much in the perception of the individual and also that the individual demands more from reality to provide an answer for such lack. Almost like a discourse of absence, if reality were to suddenly reply with better answers than the neurotic, the neurotic would only demand more while at the same time feeling guilty and beating himself up for not doing enough (even if they surpassed their peers at certain competitive tasks; school, work, etc.). Lacan highlights this point succinctly:

What is this paradox? It is that the moral conscience, as he says, shows itself to be more demanding the more refined it becomes, crueller and crueller even as we offend it less and less, more and more fastidious as we force it, by abstaining from acts, to go and seek us out at the most intimate levels of our impulses or desires. In short, the insatiable character of this moral conscience, its paradoxical cruelty, transforms it within the individual into a parasite that is fed by the satisfactions accorded it. (Lacan 1999[1959-60]: 89)

In a way the superego can be as cruel as the id the more the subject obeys the demand of reality. This is the paradox of moral conscience today. I believe neurosis is the attempt to get to grips with reality. A continual conflict of passion (id and superego). A feeling of being not quite right. Fundamentally neurosis is a symptom of ethics. It is the possibility not of passion or delirium, nor of madness and reason, but of the neccesarilly contingent framework of irreducible guilt and innocence. We cannot underestimate the enigmatic but simple statement from Lacan in this respect: “the only thing of which one can be guilty is of having given ground relative to one’s desire” (Lacan 1999[1959-60]: 319).

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