Aetiology of Neuroses | Mental Illness

After reading this article you will learn about the aetiology of neuroses.

During the last century serious attempts were made to find out the aetiology of neuroses. In the 19th century, particularly in France several psychopathologists attempted to explain its causes. While commenting on the aetiology of neuroses Page (1947) states that in psychoneuroses, the psychogenic factors and heredity are of considerable importance while the neurophysical and chemical factors are insignificant.

Several theories have been advanced to explain the causes of neu­roses:

Dissociation theory of Janet:

Janet was of opinion that neuroses like hysteria are due to dissociation of personality. When one part of a person’s mental life becomes completely differentiated from the other part he develops neurotic tendencies. This splitting up of consciousness and disintegration of personality is due to reduced physical and mental energy because of conflict.

Association and conditioning theory of Mortan Prince:

Mortan Prince viewed that as a result of repression and inhibition, a definite tendency for disintegration is observed. He has further emphasized the importance of association and conditioning in the aetiology of neuroses.

The central idea is that emotions, impulses, sensation experienced under certain conditions may become so strongly associated that the chance occurrence in the future of some element of the original situation will reinstable the original reaction. Thus, a person who suffered from nausia and headache etc., following a train accident may experience the same symptoms when he rides a train.

Supporting this view strongly, Hollingworth has remarked “To be neurotic is not merely to have established an unserviceable habit adjustment. To be neurotic is above all, to be the kind of person who is always forming such unserviceable or un-sagacious habits even under that circumstances or in a world where other people form useful ones.”

Libido theory of Freud:

Freud from his clinical experience found that in every cases of neurotic patients there was some trouble in sex life. Married or single, male or female having some difficulties and problems in sex life happened to be neurotics. From various case histories, of his patient Freud concluded that unsatisfactory discharge of libido or prolonged sexual obstinence, causes neuroses.

In other words Freud held that in the sexual life, the libido accumulates in the body and gives sex consciousness. But if the libido is not discharged, if the sexual urge is not satisfied or released, it will lead to neuroses. Thus, according to this theory people who have no scope for sexual gratification accumulate the libidinal urges and develop neuroses.

This view of Freud gave rise to a great deal of misunderstanding and controversy. People started thinking that Freud views that everybody should indulge in sex relation to express libidinal energy. But Freud nevertheless meant this only to a limit. Jung and Adler differed from Freud in this respect and developed their own theories to explain the causes of neuroses.

Energy theory of Jung:

Jung tried to explain the causes of neuroses by the theory of introversion, extroversion and collective unconscious. He pointed out that the libido is an energy which is not particularly sexual while Freud equated libido to sex energy.

It is an energy which can be utilized for sex or for some other activities, just as electricity can be used for any activity. Jung has emphasised the subtle interaction of the child and parent and regression as an important neurotic craving.

As Coleman puts it “Jung believed that the achievement of maturity and selfhood requires great courage and resolution but that failure to develop one or more essential components of the personality or the attempt to dirty the deep unconscious instead of relating to it, dooms the individual to a one sided and unfulfilling life and often to neuroses and other mental disorders.”

Aggressive theory of Adler:

Adler (1943) advocated that every individual is driven by the desire for power and dominance on other persons due to his sense of inferiority developed during the childhood helpless period. Because of physical and mental weakness, inevitably every child develops a sense of inferiority.

To overcome this sense of inferiority he develops a sense of superiority and tries to dominate on others. To satisfy this sense of superiority every individual develops a life style and to fulfil this life style sometimes takes recourse to socially disapproved channels. The greater is the inferiority, the higher is compensation and channelization.

According to Adler, the neurotic is one, who is fearful to enter into normal competitive activities as the others, but compensates or over compensates his inferiority by the use of unhealthy defences to safe guard him to achieve the feeling of superiority.

Coleman (1981) holds that in a highly competitive society of today it is a major contribution to understand the causes of neuroses.

Adler thus holds that neuroses are caused for adopting socially disapproved channels to excessive sense of inferiority. Adler’s theory of inferiority is helpful to explain neuroses in children, but it is not very effective in explaining the neuroses of adults.

Aetiology of neuroses advanced by neo-Freudians:

Neo-Freudians like Karen Horney, Erric Fromm, Sullivan and Kardinar etc. view that culture plays a very important role in the personality make up of both normal and abnormal and the cultural factors are of tremendous significance in the causation of neuroses.

The Neo-Freudians while advancing these views on the causes of neuroses hold that Freud’s approach to the aetiology of neuroses is purely biological and he has completely ignored the social and cultural factors in the causation of neuroses.

It is an observed fact that cultures and societies imposing restriction on the expression of the biological urge like sex, produce large number of neurotics and psychotics. In the modern complex and civilized societies due to restrained sex activity high degree of abnormality is found.

The Neo-Freudians point out that disturbed interpersonal and social relationship arising out of restricted cultures are the most important causes of neuroses. Karen Horney (1950) reported that excessive need for affection results in neuroses.

Lack of love and affection in the complicated culture of modern world leads to the development of a great sense of insecurity. The need for security makes the organism dependent for his existence, when this need for security is disturbed by cultural factors, it leads to personality maladjustment and finally neuroses.

Sullivan (1953) has mentioned that disturbed interpersonal relationship leads to fixity and rigidity and hence neurotic symptoms. Thus, the Neo-Freudians have attempted to explain the causes of neuroses in terms of disturbed interpersonal relationship arising out of complexity of culture.

Predisposing and precipitating factors:

The aetiology of neuroses can also be explained through predisposing and precipitating causes.

(i) Predisposing causes:

The predisposing causes of neuroses are traced back to the childhood. They are usually unconscious and are internal causes of conflict. It is held that some kind of frustration lies at the root of neuroses. Frustration leads to conflicts. Conflicts create anxiety which leads to symptom formation.

Especially frustration and disappointment during the psychosexual development period can be called to be the predisposing causes of neuroses. Freud also holds that disturbed psychosexual development leads to abnormality. Therefore it has been said that no adult neuroses is possible without infantile neuroses.

It is also viewed that unsuccessful repression during the earlier stage leads to neuroses. Thus, by and large, unfavourable early environmental factors and training play a vital role in producing neuroses.

Precipitating causes:

Individuals who in late life become psychoneurotic are often tense, fearful, and anxious as children and failures serve as precipitating causes of neuroses. This is the last load on the camel’s back.

A person who is predisposed to neuroses, certain environment factors in the puberty, such as engagement, marriage, child birth, death in the family or success or failure in some stage serve precipitating causes of neuroses. Thus, some kind of frustration always lies at the root of neuroses.

Consequent of the present disappointment, failure or frustration the previous conflict is culminated and neuroses occurs. The predisposing cause is that where the nucleus of neuroses lies and the precipitating cause only helps in the final onset of the disease.

Biological factors:

The significance of constitutional factors and inherited dispositions cannot be overruled. Studies show that the occurrence of psychoneuroses in the family history of the neurotic is much higher than that for the general population.

The investigation of Slater and Woodside (1957) points out that assertive mating might lead to a disturbed family environment which would perpetuate patterns from generation to generation. Further studies by Ehrenwald (1960), Fisher et al. (1959) also indicate that the family structure set by the neurotic parents tends to foster neurotic development in children.

Heredity and unfavourable early environment and training play a major role in producing neuroses. Heredity and unfavourable early environment and training play a major role in producing neuroses.

Studies reported by Gillespie indicate that approximately 20 per cent of the parents of 890 of psychoneurotic patients share common home environment. Intra-familial resemblance with respect to psychoneurotic traits are partly due to heredity factors and partly to imitation and learning.

The role of sex, age and other glandular functions in the causation of neuroses has also been studied. Results indicate that the interaction of biological and psychological factors play a prominent role in the causation of neuroses.

Besides amentia, fatigue, irritability, poor appetite caused by continuous emotional tension lower the tolerance of the general level of biological and psychological resistance. Due to various psychological stresses sometimes, the balance between the excitatory and inhibitory processes is impaired.

As Coleman puts it, “Cattell and Scheier (1961) refer to those end results of chronic emotional mobilization as low adaptation energy and neurotic debility, it is important to remember that they are results of neurotic reaction, not the primary cause of it.”

Thus prolonged psychological conflict provides the essential basis for a chronic psychoneurotic reaction. Cattell and Scheier (1961) have viewed that dispositional timidity increases anxiety in relation to both inner and outer threats.

Coleman finally concludes that “on the basis of the research findings so far, it is apparent that the role of constitutional factors in neurotic disorders is neither very simple nor obvious.”

Psychological factors:

A number of psychological theories of psychoneuroses have been advanced which are particularly pertinent to our present discussion. The dynamic explanation of mental illness offered by Freud was unique and more acceptable in contrast to the more static description of symptoms given by early psychologists like Kraeplin and Charcot.

Freud’s effort was welcomed by a few contemporary giants like Baludar and Adolf Meyer (1948).

Adler has also emphasized the important feeling of inferiority in the causation of neuroses. In the neurotic inferiority feeling leads to inferiority complex. Feeling of inferiority is overcompensated by dominating on others. He also tries to avoid competition and comparison by getting sick. Adler’s approach contributes to the understanding of many neurotics in highly competitive society.

The psychological factors of neuroses can be mentioned as follows:

1. Learned maladaptive behaviour

2. Stress and decompensating

3. Immaturity and guilt.

(1) Learned maladaptive behaviour:

Some investigators view that all neurotic reactions constitute un-adoptive responses learned according to the usual principles of reinforcement. According to them, once a simple fear or anxiety reaction is established by conditioning, it may then be elicited by a wide range of situations through the process of stimulus generalization.

For instance, fear for a rat due to conditioning may turn to be a phobic reaction and an anxiety reaction may be found in relation to life stresses.

Gradually these reactions are generalized and expressed on many occasions. Similarly, obsessive compulsive reactions are considered as learned ways of coping with anxiety generating situations. As Coleman has viewed “it is thought that these neurotic reaction patterns usually arise out of early conditioning experiences although they may also be learned during later life periods.

In many cases these maladaptive responses leading to phobia, anxiety neuroses and obsession compulsion neuroses are extinguished in later life due to lack of reinforcement or subsequent deconditioning experiences.

But in many cases these reactions continue in-spite of lack of repetition of traumatic experiences. Eysenck (1963) has tried to explain this by saying that the phobia is reinforced because it does reduce anxiety and tension. For example, each time a lady saw a rat, she became anxious and ran away. Since this response reduces her anxiety and fear, it reinforces for phobic reaction.

The behaviouristic approach of Eysenck (1960, 1963) to explain the causes of neuroses has emphasized the role of ease of conditioning in neurotic disorders. According to Eysenck, due to greater automatic reactivity, introverts probably form quick and strong conditioned reactions and hence are prone to surplus conditioned reactions involving fears and anxieties which leave them vulnerable to diverse environmental stresses.

Extroverts on the contrary are deficient in the capacity to form conditioned reactions, fail to acquire many needed adaptive responses and are deficient in socialization, weak in conscience development and unwilling to take responsibility.

On the basis of these findings Eysenck and Claridge (1962) have concluded that anxiety reactions, phobic reactions, obsessive compulsive reactions and reactive depressions are introverted neuroses while hysteria is found in extroverts.

But Cattell and Scheier (1961) did not find hysterics to be extroverted and weaker in conscience development. Sweetbaum (1963) similarly found anxiety but not introversion extroversion to be related to ease of conditioning.

However, it is a fact that neurotic reactions are not inherited but learnt by the individual while trying to adjust with various situations and circumstances of life. Ease of conditioning and introverted extroverted tendencies are definitely important causes of neuroses.

If we accept neuroses as a conditioned mal-adoptive behaviour as held by Eysenck (1963), we have to ignore the relevance and utility of neurotic symptoms in meeting certain current needs and problems of the patient.

It has been very often found that neurotic reactions arc developed due to exaggerations of ego defensive techniques to cope with the threatening situation. Bandura (1962) has held that through imitation and parental techniques, people learn these techniques. It is also agreed that once accepted, the neurotic reactions may be continuously maintained and reinforced.

Finally, Coleman has held that neurotic reactions reflect immaturities and faulty assumptions and evaluations and stem primarily from desperate attempts to deal with seemingly insurmountable problems.

(2) Stress and de-compensation:

(a) Failure to fulfil the unrealistic aspirations with feelings of self devaluations and inferiority.

(b) Unacceptable desires and wishes arising from early trauma.

(c) Impossible choices and decisions.

(d) Dissonant cognition in relation to one’s self structure.

(e) A frustrating life situation which makes life meaningless and hopeless.

(a) Failure to fulfil the unrealistic aspirations with feelings of self devaluation and inferiority:

Personality theorists like Adolf Meyer (1948) emphasised unrealistic level of aspiration, lack of self acceptance as the cause of neuroses.

He emphasised unrealistic levels of aspiration and lack of self-acceptance in his approach to the neuroses. He opines that many people face difficulty because they are unable to “accept their own nature and the world as it is and to shape their aims according to their asserts. Rather they seem to suffer from a false sense of competition, which does not allow the human being to take himself as he is.”

When these individuals fail to achieve their unrealistic goals, they develop feelings of inferiority, apprehensions and various other faulty emotional attitudes which finally lead to a break of compensation and to the use of unsuccessful defence mechanisms.

When the individual observes a significant discrepancy between his real and idealized self image, he faces stress situation and experiences neurotic anxiety. To save himself from the devaluation created by this conflicting self image, he takes recourse to pathological defensive reactions.

(b) Unsuccessful desires and weak spots:

The psychoanalytic psychologists have emphasized the role of conflicts between dangerous desires and childhood trauma in causing neuroses. To add to this, analytically oriented psychologists Fenichel (1944) and Horney (1945, 1950) have put stress on childhood emotional experiences leading to faulty environmental evaluation and severe conflict which centre around the ego.

Horney has put stress on childhood emotional experiences as the nucleus of neuroses which lead to weak spots and faulty self and environmental evaluations. Fenichel feels that situational stress which tends to reactive childhood conflicts and threats are particularly important in the production of neurotic reactions in psychologically predisposed individuals.

For example, an adult when was criticised in childhood by his father reacted with intense feelings of insecurity and hostility. He adjusted satisfactorily in adult life until he had a very critical supervisor who he felt was not satisfied with him. He reactivated his old fears of rejection and precipitated neuroses.

Horney was the first to publish in a comprehensive form her views about neuroses in “The Neurotic Personality our Time” (1932). She first presented an extensive cultural interpretation of neuroses (1945, 50). She has specifically emphasised the human child’s hostile reaction towards rejecting parents as a basic cause for later neuroses which the child learns to repress because of socialisation.

Ultimately it creates tension, conflict, anxiety, emotion and finally leads to neurotic breakdown. Such neurotic individuals usually reveal an underlying lack of self acceptance and a tendency to identify with and strive towards an immature and unrealistic ego ideal. Coleman comments.

(c) Impossible choices and decisions:

Insoluble conflicts arising out of day to day situation, lead to neuroses as suggested by Combs and Snygg (1959).

“Conflicts between incompatible drives have also been emphasised by Dolland and Miller (1950). The desire to marry the beloved and the fear of being disowned by the parents and society is an example of conflict between incompatible drives leading to terrible anxiety and tension. In our day to day life we face many such comparable conflicts.

If these conflicts are not solved successfully, it becomes the starting point of neurotic reactions.

“The importance of intra-psychic conflict between various sub-selves in a poorly differentiated and poorly integrated individual leading to neuroses has been emphasised by Shapiro (1962).”

Coleman (1981) explains intra-psychic conflict through the following example. “The individual may try to be the self his mother expects, the self his father expects, the self other people expect, the real self he thinks he is and the ideal self he thinks he should be.

Conflict among these sub-selves may make choices and decisions both difficult and anxiety arousing and lead to vacillation in decision and various neurotic manifestations.”

(d)  Dissonant Cognition:

Carl Rogers (1961) points out that those experiences which threaten the self concept and attack the worth of the ego are often conducive to neurotic personality. Increasing opposition between self and reality leads to anxiety and tension. Consequently, the individual takes recourse to the application of various neurotic defences and maintains a balance somehow for the time being.

(e) Lack of meaning and hope:

A life without hope and meaning is quite frustrating and full of stresses and strains. Sullivan (1953) has thus pointed out the importance of disturbed interpersonal relations. He holds that unsuccessful and problematic interpersonal relations creates anxiety and leads to breakdown of the individual system of self defences.

Anxiety according to Sullivan (1953) is a patent force in the formation of the self, but it is restrictive because in most cases anxiety leads to neuroses. Coleman further comments “with the depersonalization characteristic of our urban society an increased burden is placed on all the interpersonal relationships which are available to the individual.

Erich Fromm (1955, 1962), has therefore viewed that man gets into neurotic difficulties as a result of the new needs created in him by his culture as well as because of deprivations and frustrations of his potentialities formed upon him by it.

Since the Society has been impersonal, dehumanization has increased terribly leading to loss of memory, self identity and involvement. Ferry (1963) has therefore rightly remarked “The danger to say is not so much that machines will learn to think and feel, but that men will cease to do so.” Coleman concludes “Thus both individual situational factors and the broader sociological setting may contribute to neurotic behaviour.”

Becker (1962) insists that a person has two main tasks in difficult stress situations:

(a) To maintain the continuity of his own self identity.

(b) To continue to try to cope with the situation when the individual looses hope and meaning in life.

The ego is unable to perform the above two tasks and breakdown of personality occurs.

(3) Immaturity and guilt:

Contrary to Freudian point of view, Mowrer (1950, 1960) is of opinion that neuroses is not due to deep repressed libidinal and hostile impulses, but it is rather due to immature conscience development based on under learning. According to Coleman “To protect himself from the resulting self devaluation and anxiety he tries to repress his conscience.”

Mowrer believes that in his effort to evade social responsibilities and to defend himself against guilt and anxiety, the neurotic thus becomes the victim of his exaggerated ego defences.

According to Ottorank, the neurotic is the one with his difficulties. He cannot positively identify with the group nor can he stand alone. This produces a feeling of inferiority and guilt.

According to Adler, the neurotic is afraid to face the competitive world due to his inferiority developed during early childhood. However, he compensates and over compensates his inferiority feeling by the use of unhealthy defences and hence becomes a neurotic.

As pointed out earlier, Jung tried to explain the causes of neuroses as lack of proper interaction during childhood and personality immaturity. Thus Jung, describes “………. there appears upon the psychological stage a man living regressively, seeking his childhood and his mother fleeing from a cold and cruel world which denies him understanding.

Often a mother appears besides him who apparently has no slightest concern that her little son should become a man, but who with tireless and self immolating effort, neglects nothing which might hinder him from growing up and marrying. One sees the hidden conspiracy between mother and son, and how the one assists the other to betray life.”

An analysis of the opinion of different psychologists to explain the causes of neuroses indicates that in-spite of different points of view all these psychologists by and large appear to agree on the following:

1. The crucial importance of early childhood development in predisposing the individual to later healthy and neurotic behaviour.

2. The importance of various stresses which affect the weak spots in personality structure and function as precipitating factors in the neuroses.

3. The tendency of neurotic reactions to maintain or enhance rather than solve the patient’s problems.

It is by now a well established fact that children subjected to parental over protection, excessively high standard, and neurotic parents are emotionally handicapped. They may be over sensitized to life’s threats and dangers and come to view the world as a terrifying place.

The neurotic does not feel that his security lies within himself. Therefore neurotic disorders are said to be based primarily as internal conflicts rather as external stresses.

The particular conflicts which serve to precipitate the neurotic reaction may involve failure, sex, hostility, competition, guilt and other problems which may be classified into:

1. Conflicts centring around the individuals failure to live up-to aspirations, with resulting feelings of inferiority and self devaluation.

2. Conflicts centring around dangerous desires which are in danger breaking through ego defences into overt behaviour.

3. Conflicts centring around frustrating and unpleasant situations.

Sociological variables:

Neurotic reactions are observed among all people who are otherwise considered quite successful and lead normal life in society. Types of neurotic reactions however vary widely with the variation in culture and social structure.

For instance, obsessive compulsive and anxiety reactions are more common among the higher socioeconomic groups, while conversely hysteria is more prevalent among the primitive and lower S.E.S. groups. Coleman reports that during second world war, hysteria was more commonly found among non-commissioned men and anxiety reactions were more common among officials.

A study conducted by Freedman and Hollingshead (1957) indicate that:

1. Upper class neurotics are characterised by subjective symptoms of discomfort, anxiety, unhappiness and dissatisfaction with themselves.

2. Lower class neurotics reveal friction with the people and relatively more somatic symptoms.

3. Middle class neurotics showed symptoms of both the classes and showed a tendency of less efficiency in their works.

Perkins (1946) noted that while deficit of affective response and a type of emotional immaturity were common among many hill people, the incidence of neurotic traits, psychosomatic disorders were less.

In a similar study on coalminers, Wiesel and Amy (1952) found that a miner’s syndrome is found in coal miners who passed 40 years age.

Pasamanick (1963) has reported that neurotic disorders may be twice as among the whites as the non whites.

Hunt found the relative incidence of psychoneuroses among Negroes in the U.S.A. than among the white population. Similarly Wechsler found that psychoneuroses was more marked among a group of better educated, more intelligent and socially superior British West Indian Negroes than among a less privileged American group.

Tsungyilin (1953) noted low incidence of psychoneurotic disorders and obsessive compulsive neuroses in the island of Formosa. It is probably because the inhabitants of Formosa get support from the close knit family system and large number of rituals present in their social structure.

The lower incidence of obsessive compulsive reactions observed among Kenya Africans has been attributed to an absence of shame and guilt feeling about sex by Carchers (1953, 1957). He has further tried to explain this by saying that due to the rigidly structured social organization there, the African for any decision or action has to depend upon the strength and stability of the group.

Consequently, he does not bear any individual responsibility for his action and hence does not develop the tension and anxiety that is aroused with individual responsibility.

Interestingly, as reported by Wortis (1961) neurasthenia is the most common type of psychoneurotic disorder in the Soviet Union.

Thus, with the variation in the family setting, socio cultural differences and cultural deprivations, the incidence of neuroses varies from culture to culture. The degree of adjustment to life is determined by the above factors. To sum up, the occurrence increases specially with complex and conflicting interpersonal relationship.