What Is a Neurosis and What Does it Mean to Be Neurotic?

Neurosis, like depression, is a word whose misuse exasperates therapists and analysts. Time and again people will refer to a friend as a “neurotic mess,” or a “bundle of neuroses” without really understanding what that means. Neuroses are in fact complex, and they come in many forms.


The term “neurosis” originally meant a disease of the nerves, implying that the nerves could somehow malfunction or become infected, like one’s tonsils or appendix. “Neurosis” first appears in a medical treatise of 1777, titled First Lines of the Practise of Physic. The author, a Scottish physician named William Cullen, included the physical symptoms of neurosis, such as indigestion and heart palpitations, under the subheading “Neurosis or Nervous Disease.”

By the nineteenth century, “neurosis” referred not to an actual disease but to a functional disturbance of the nervous system. But neuroses were also believed to have a localised origin in the body. So, for example, the terms “cardiac neurosis” and “digestive neurosis” were still routinely used. It also covered illnesses like Parkinson’s and epilepsy, which were placed under the heading “neurological affections.”

Freud and Hysteria

Freud’s great discovery was that one of the neuroses, hysteria, resulted from a disturbance of the personality rather than the nerves. Since Freud, neurosis has been used to distinguish mental disorders which are not diseases of the nervous system.

Freud was a neurologist, living in late 19th century Vienna. Many of his, and his colleague’s, patients were suffering from hysteria, which was believed to afflict mainly women. An “hysterical woman” suffered from inexplicable physical symptoms. In other words, she experienced physical symptoms with no obvious physical cause. So, for example, her neck might stiffen, or she may lose her sight in one eye, and yet when she visits her doctor, he can find nothing wrong. Later, the symptom disappears, and then reappears, and so on. Today, this is known as “conversion hysteria.” The other form, “anxiety-hysteria” is now known as phobia.

In 1882, Josef Breuer, a physician, told Freud about a young woman he was treating named Anna who suffered various complaints, including a squint and a paralyzed arm, that had no physical explanation. Anna had recently nursed her father through cancer, which she found traumatic. Together, she and Breuer traced her symptoms back to specific incidents in her life. For example, she recalled wanting to cry as she nursed her father but resisting the urge for fear of upsetting him. This, she realised, was when the squint began. When she recalled the origin of such symptoms, they disappeared.

Freud pondered this, and cases like it, and together with Breuer published Studies In Hysteria, in which they argued that hysterics suffer mainly from reminiscences. The hysteric undergoes a trauma, and memories of the trauma are pathogenic (meaning they create disease). Freud was arguing that purely mental processes create physical symptoms.

Next, it was argued that these memories persist; they do not wear away as the years pass. Instead, they are repressed into the unconscious where they influence thought and behavior. Since the memories cannot be expressed, the emotions they arouse (the “affect,” as psychoanalysts call them) fester and build. These strangled emotions need an outlet or release, which they find in the symptoms of hysteria. If the patient can recall these memories and release the pent-up emotion, she may find relief from the symptoms.

Neurosis Today

The general public use the word “neurotic” to refer to people who are generally anxious, tense or over-sensitive. Indeed, you may have overheard someone turn on a friend and exclaim “don’t be so neurotic about it,” as if neurosis were something people consciously choose to develop. In fact, psychoanalysts separate them into several different kinds.

The “psychoneuroses” are perhaps the best known. These can be explained only by reference to the individual’s personality and past experiences. The psychoneuroses themselves subdivide into “conversion hysteria,” “anxiety hysteria,” (more commonly known as phobia) and “obsessional neurosis.”

In conversion hysteria, the symptoms are physical. Interestingly, however, they often correspond not to how the body actually works (as they obviously would, should the body break down) but to how the patient believes their body works, regardless of anatomy and physiology. Anna, described above, was suffering from conversion hysteria. Her psychological suffering had been ‘converted’ into physical symptoms. Anxiety hysteria, on the other hand, is more commonly known as phobia.

An obsessional neurotic suffers from obsessive thoughts and compulsive behavior. And these thoughts seem to break into his consciousness from elsewhere – as if invading his mind. They are also resented for their repetitive and distracting nature. The content of these thoughts, which tend to be obscene, upsetting, or simply absurd, may also be resented. The patient feels equally helpless about his behavior, which also tends to be repetitive and absurd. Freud even drew a parallel between obsessional neurosis and religious ritual.

Next, there are the “actual neuroses,” explained by the patient’s current sexual habits rather than those in the past. Freud divided these into “neurasthenia” and “anxiety neurosis.” The first was caused by excessive sexual activity, the second by unrelieved sexual tension.

A “traumatic neurosis” is caused by some shocking incident, such as a sudden and unprovoked assault. The victim may then develop symptoms bearing no relation to the actual injuries. Later, they find themselves acting out or repeating parts of the traumatic event, often in dreams. But, unlike in other neuroses, these dreams cannot be interpreted. In other words, there is no unconscious or symbolic meaning. Analysts now believe such people are assimilating, or coming to terms with, their trauma by confronting it.

A “transference neurosis” is one in which the patient is capable of transference; in its opposite, a “narcissistic neurosis,” the patient cannot form a transference. Transference is a process by which the patient ‘displaces’ ideas and feelings relating to previous individuals (her father, for example) on to the analyst. The patient then relates to the analyst as though he were some object from the past. To give a simplistic example, a young woman who repressed her attraction to her father claims to be in love with her male analyst.

Adult and childhood neuroses are also separated, though many argue that all neuroses were preceded by one in childhood. A neurosis experienced when young is known officially as an “infantile neurosis.” And, though anxiety often plays a part in other neuroses, when it is the major symptom this is known as an “anxiety neurosis.”


The brain keeps the individual’s behavior in check and prevents the rest of the nervous system from running wild. In other words, the brain stores energy released by the body until an appropriate moment arrives to discharge it. But this creates tension. According to Freud, human beings are motivated by what he called the life and death instincts, which urge us to survive, reproduce and destroy. When tensions aroused by this desire to fight, kill, eat, have sex, etc, can find no relief in the physical, three-dimensional world, they turn inwards, and neurosis is the result.

The life and death instincts, and the energy they release (known as “libido” and “mortido”), surge up from what Freud called the “Id.” The Id is one of three parts of the personality, along with the ego (roughly one’s sense of self, or “I”) and superego (essentially one’s conscience or moral code).

A neurosis is an abnormal way of relieving the tensions aroused by libido and mortido. Since the individual cannot kill his rude and sarcastic boss, for example, or make love to his neighbor’s beautiful wife, the tension must find an outlet elsewhere.

Those are crude and simplistic examples, of course, but whatever the cause, neurotic symptoms usually fail to relieve such tensions. The energy is used up, but not in a way that satisfies the Id instincts. Indeed, neurotic behavior often backfires, making the individual more, not less, unhappy.

Often, these Id tensions date back to childhood, to our relationship with our parents and the psychosexual stages of development. And since these wishes are frequently incestuous or murderous (or both) they are repressed, and so manifest in a disguised form (hence the often bizarre nature of neurotic symptoms).

It may be comforting to learn that psychoanalysts consider everyone a little neurotic. No one instantly relieves all their Id instincts in an appropriate way. If they did, society would be a chaos of murder and rape, and civilized life would be impossible. Everyone uses some degree of neurotic behavior to relieve tension. When this behavior spirals out of control, however, you have true neurosis.

Indeed, all sorts of routine, mundane behavior can be neurotic: gambling, smoking, drinking, sexual promiscuity, even obsessing about one’s bowels! To put it another way, a neurotic symptom, according to the psychoanalyst, is both a defense and the symbolic expression of an Id wish. The neurotic, like everyone else, is forever caught between impulse and morality: primitive instinct urges a man to leap on an attractive woman, morality and conscience restrain him.

To be human is thus to be a tension-producing machine which can never be fully satisfied or truly happy. For Freud, civilization itself creates neurosis. In fact, neurosis is the price we must pay in return for civilization.

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Mark Goddard, Ph.D.

Mark Goddard, Ph.D. is a licensed psychologist and a consultant specializing in the social-personality psychology. His publications include magazine chapters, articles and self-improvement books on CBT for anxiety, stress and depression. In his spare time, he enjoys reading about political and social history.

*The views expressed by Mr. Goddard in this column are his own, are not made in any official capacity, and do not represent the opinions of his employers.

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