Of all the nerve! THEY want to take our neuroses away. It's unfair. How can we exist without our phobias, compulsions and obsessions which, though annoying at times, can also be strangely comforting? The very thought of obliterating those comfortable neuroses is enough to give a person (who has had a neurotic symptom or two) a major anxiety attack.
You think I'm beginning to sound like a hysterical, obsessive-compulsive paranoiac? The situation is not quite as a grave as that... yet. But, the prospect of a neuroses wipeout is definitely unsettling to one who has become possessive about her personal, private, pathological neuroses. Should those of us who have grown accustomed to our anxieties, etc., be forced to plead -- please don't take my neuroses away?
The aforementioned THEY are the members of the American Psychiatric Assn., that organization of professionals who probe people's psyches and soothe their emotional aches and pains is compiling its third Diagnostic and Statistical Manual of Mental Disorders. And, this is the news that is startling to many: Neuroses will no longer be listed as such in the association's manual.
Dropped from the newest edition of the manual, a dictionary of mental disorders designed to aid professionals in making their diagnoses, will be some of the familiar psychiatric terms such as depressive neurosis, anxiety neurosis, depersonalization neurosis and hysterical neurosis.
This news, no doubt, would have plunged Dr. Sigmund Freud, who identified several of the neuroses, into a deep depression. It may also depress those who have learned to live with their neuroses in a complex world that necessitates constant coping with stresses and strains. To survive in such a world, most people have developed some degree of neurosis: Some may be compulsive workers; others may put up emotional defenses that help them cope.
Some experts feel that many people have developed a dependency on their neuroses; there are people, as a matter of fact, who thrive on their fears and phobias, anxieties and obsessions.
Woody Allen, for one, said he loves living in New York because the anxieties that it produces in him trigger the neuroses that compel him to do his best work. His movie, "Annie Hall," has been cited as a highly effective dramatization of Allen's neurotic behavior.
Could this change in the APA's diagnostic manual be prophetic of an anti-neurotic conspiracy among psychiatrists? Dr. Robert L. Spitzer, chairman of the APA task force, assures us that it isn't so. He insists that the group is not wiping neuroses off the face of the earth. Although he didn't mention it, it's likely that if such a wholesale elimination of neuroses should occur, many analysts and psychotherapists might be out of work.
In a telephone interview, Spitzer assured us that anxious, compulsive, phobic, obsessed, hysterical, repressed and depressed people will probably always be among us. It's just that the APA task force believes that rather than using "neurotic" as an umbrella term for such problems, it is better to be more precise about the sundry psychological ailments that plague many of us.
Spitzer, who is affiliated with the New York State Psychiatric Institute, said the term "neurosis" has become imprecise. "It has been used in so many different ways that we believe it no longer has a very precise meaning," he said. "The lay public has come to use the term 'neurosis' to describe any type of emotional hangup that isn't a psychosis."
Neurosis is defined as any pattern in which unwanted and compulsive thoughts, feelings and/or actions occur without producing a major, sustained disorganization of personality or the loss of a sense of reality. Rather than being out of touch with reality, the neurotic often has a concern with reality beyond the point where it has any function.
Psychosis is a state characterized by a severely disorganized personality and the loss of a sense of reality. For instance, the inability to discriminate between subjective and objective worlds.
"What we are doing in the new manual," explained Spitzer, "is eliminating the old heading 'the Neuroses' with descriptions of such disorders as depressive neurosis. In its place will be 'Disorders,' with detailed descriptions of specific disorders, including phobias, anxiety, obessive-compulsive, hysteria, depression and depersonalization disorders."
The new disgnostic manual will include more explanation than usual, according to Spitzer. For instance, instead of listing depressive neurosis alone, the manual will classify the disorder under three categories: adjustment disorder (a mild depression that follows some type of emotional stress), and major affective disorder (episodic moods of depression) and chronic depressive disorder (mild depression that lasts for long periods).
Some psychoanalysts are a mite anxious about the upcoming changes in the manual because they view the exclusion of neuroses from the psychiatric nomenclature as a move away from Freudian theory.
"Nonsense," said Spitzer. "It's not a move away from anything. It's a move toward more specific diagnoses. We are not saying that neuroses don't exist. We simply want to be more specific about the emotional disorders we're describing instead of lumping everything under neuroses."
Don't worry about the possible loss of neuroses, said Dr. Sheppard Lellam, professor of psychiatry at the University of Chicago. "It's difficult to legislate a word out of the psychiatric lexicon," he said. "Those working on the new manual deserve credit for taking a leap forward in improving the criteria used for making a diagnosis. Their contribution goes beyond a mere change in semantics. I believe that if the majority of psychiatrists continue to use the term 'neurosis' it will be virtually impossible to eliminate it."
Three cheers for Lellam! Many would undoubtedly miss the term "neurosis" if it were to be completely phased out. The word has a nice ambiguity to it that doesn't pinpoint exactly what is upsetting a person's mentional balance. A substitution, such as "disorder," just doesn't hack it. Disorder sounds like a description of an untidy room, instead of a mind that's in disarray.
Nope. Disorder simply does not have a psychological-sounding ring to it.
Neuroses are by no means restricted to tragedy. We see emotional wrecks in comedy, too. A case in point: Neil Simon's compulsively neat Felix and his constant slob of a roommate, Oscar, in "The Odd Couple." And a Woody Allen movie without Allen in the throes of angst would be like an opera without anguish. Opera, by the way, has more than a fair share of emotionally scarred characters singing their hearts out about the miseries of life.
And think how bland fiction would be without neurotics. Brooding Heathcliff gives a dark and eerie tone to Charlotte Bronte's "Wuthering Heights." Emma Bovary in Flaubert's "Madame Bovary" is a bundle of anxieties.
Yes; we need our neurotics. We depend on those neurotics who touch us in a book or play, opera or movie because we discover that we can identify with them. Or because they show us that they have problems deeper than our own, they make us feel better about ourselves.