Neurosis: symptoms and treatment. Pathogenetic concept of neuroses Pathogenesis of neurotic symptoms in psychoanalytic theory

The theory and technique of psychoanalysis are based mainly on clinical data obtained from the study of neuroses. Although in recent years there has been a tendency to expand the scope of psychoanalytic research to include normal psychology, psychosis, sociological and historical problems, our knowledge in these areas has not progressed as far as our understanding of the neuroses (A. Freud, 1954; Stone, 1954). Clinical data on neuroses still provide us with the most reliable material for formulating psychoanalytic theory. In order to understand the theory of psychoanalytic technique, the reader needs to have some knowledge of the psychoanalytic theory of neurosis. Freud's Introduction Lectures (1916-17) and the works of Nunberg (1932), Fenichel (1945), and Wilder (1960) are excellent sources for this. Here I will only outline the main points that I consider the most important theoretical premises for understanding technology.

Psychoanalysis claims that psychoneuroses are based on neurotic conflict. Conflict leads to obstruction/discharge of instinctual impulses, which ends in a state of “damn me.” The ego becomes increasingly unable to cope with increasing tensions and is eventually overwhelmed. Involuntary discharges in the clinic manifest themselves as symptoms of psychoneurosis. The term "neurotic conflict" is used in the singular, although there is always more than one important conflict. Habit and convention force us to talk about a single conflict (Colby, 1951).

Neurotic conflict is an unconscious conflict between the drive of the id, which seeks release, and the defense of the ego, which averts direct release or access to consciousness.

At times, clinical material shows a conflict between two instinctual needs, for example, heterosexual activity can be used to prevent homosexual desires. The analysis will show what can be used in such a case as heterosexual activity for defensive purposes in order to avoid painful feelings of guilt and shame. Heterosexuality, in this example, fulfills the demands of the Ego and is in opposition to the forbidden instinctual urge, homosexuality. Consequently, the formulation that a neurotic conflict is a neurotic conflict between the Ego and the Id is still valid.

The outside world also plays important role in the formation of neurosis, but here too the conflict must be defined as an internal conflict between the Ego and the Id, the result of which is a neurotic conflict. The outside world can cause instinctive temptations and situations that, apparently, should be avoided, because... they carry with them the danger of some kind of punishment. As a result, we will be dealing with neurotic conflict if instinctive temptations or dangers are blocked from consciousness. The conflict with external reality thus becomes a conflict between the Id and the Ego.

The superego plays a more complex role in neurotic conflict. He may come into conflict on the side of the Ego or the Id, or on the side of both. The superego is the authority that makes instinctive impulses forbidden to the Ego. It is the Superego that makes the Ego feel guilty even for symbolic and distorted discharge; therefore, consciously it is felt very painfully. The superego can also enter into neurotic conflict, becoming regressively reinstinctualized, resulting in a tendency to reproach itself. The patient, overwhelmed by guilt, may then be driven into situations that again and again end in pain. All parts of the mental apparatus are involved in the formation of a neurotic symptom (cM. Fenichel, 1941, Chapter II; 1945, Chapter VII, VIII; Waelder, 1960 and additional references).

The id is constantly striving for discharge; it will try to obtain some partial satisfaction through the use of derivative and regressive outputs. The ego, in order to indulge the demands of the superego, must distort even these instinctual derivatives so that they appear in a disguised form, scarcely recognizable as instinctive. However, the Superego makes the Ego feel guilty, and distorted instinctual activity causes pain in various ways. It feels like punishment, but not satisfaction.

A key factor in understanding the pathogenic outlet of neurotic conflict is the need for the ego to constantly expend energy in attempts to prevent dangerous tendencies in consciousness and motor activity. Ultimately, this leads to a relative insufficiency of the ego, and derivatives of the original neurotic conflict overwhelm the depleted ego and break through into consciousness and behavior. From this point of view, psychoneurosis can be understood as a traumatic neurosis (Fenichel, 1945). A relatively innocuous stimulus may arouse some id drive, which may be connected to the instinctual reservoir of "damn me." An exhausted Ego is unable to fulfill its protective functions; it is overfilled to such an extent that it is forced to give some release to instinctive impulses, and such a release will be disguised and distorted in its manifestation. These disguised, distorted involuntary discharges appear in the clinic as symptoms of psychoneurosis. Let me illustrate this with a relatively simple clinical example.

Several years ago a young woman, Mrs. A., came for treatment, accompanied by her husband. She complained that she was unable to leave the house alone and felt safe only with her husband.

In addition, she complained of fear of fainting, fear of dizziness, and fear of incontinence. These symptoms appeared out of the blue almost six months ago while she was in a beauty salon.

The analysis, which lasted several years, showed that the actual trigger for the sudden onset of phobias in the patient was the fact that a male beautician was doing her hair. Eventually we were able to discover the fact that at that moment she remembered how her father combed her hair when she was little. That day she went to the hairdresser in pleasant anticipation of a meeting with her father, who was going to pay the newlyweds their first visit after their wedding. He was going to stay at their house, and she was filled with delight, she was aware of that. Unconsciously, she felt guilty for her love for her father and the prevailing unconscious hostility towards her husband.

Apparently something as innocuous as combing one's hair aroused old strong incestuous urges, hostility, guilt, and anxiety. In short, Mrs. A had to be accompanied by her husband to ensure that he was not killed by her death wishes. In addition, his presence protects her from the sexuality that rushes out.

Fears of fainting, dizziness, incontinence were symbolic representatives of loss of moral balance, loss of self-control, i.e. fear of tarnishing one’s good character, of humiliating oneself, of losing one’s high position. The young woman's symptoms are associated with pleasant bodily sensations as clearly as with infantile fantasies of punishment. I believe that the events can be formulated as follows: combing the hair aroused the repressed impulses of the id, which brought it into conflict with the ego and superego. Although there were no obvious neurotic symptoms preceding the sudden onset of phobias, there were signs that her ego was already relatively depleted and her id was in need of adequate release. Mrs. A. had suffered from insomnia, nightmares, and sexual dysfunction for years.

As a result, the fantasies evoked by combing the hair increased the tension of the id to such an extent that it broke through the infantile defenses of the ego, and involuntary discharges appeared, which led to the formation of an acute symptom.

Two additional points should be noted at once, although further consideration will be deferred. The ego attempts to cope with the forbidden or dangerous impulses of the id by resorting to the various defense mechanisms at its disposal. Defenses can be successful if periodic release of instinctive tensions is ensured. They become pathogenic if a large number of libidinal or aggressive impulses are excluded from contact with the rest of the personality (A. Freud, 1965). Ultimately, what is repressed takes the form of symptoms

The neurosis of an adult is built around a core from his childhood. Mrs. A's case shows that her sexual feelings were fixed on the childhood image of her father, and sexuality is as taboo now as it was in childhood. Although Mrs. A. has overcome her childhood neurosis sufficient to function effectively in many areas of life, she remains neurotically regressed in everything that concerns genital sexuality. Her childhood phobias and anxieties about her body returned in her adult neurosis. (The only neurosis that does not have a basis in childhood is true traumatic neurosis, which is extremely rare. It often merges with psychoneurosis.) (Fenichel, 1945).

The purpose of the training course is an in-depth study of the fundamental classical and modern works and approaches to the psychoanalytic theory of neuroses in a historical perspective and within the framework of various psychoanalytic schools and directions.

Disclosure of the essence of the most important concepts, hypotheses and concepts discovered by Freud and developed by modern psychoanalysts on this topic is carried out in the context of a conceptual understanding of the principle postulated by Freud about the “inextricable connection” of theory and practice with the development of psychoanalytic thinking in students.

The course “Psychoanalytic theory of neuroses” allows you to show in detail and consistently the development of the psychoanalytic ideas of Freud and his followers from the psychoanalysis of individual clinical cases before the formation and transformation of the psychoanalytic theory of neuroses and the theory of therapy of neuroses.

The course is intended for 2nd year students of the Faculty of Clinical Psychoanalysis as theoretical and practical preparation for qualification

The objectives of the training course include:

• systematic and detailed study of the proposed material on the psychoanalytic theory of neuroses in a historical perspective, in the context of the development of the theory and practice of psychoanalysis

• formation of positive motivation in students for research activity within the framework of independent reading of texts (compare, contrast, draw conclusions, look for reasons)

• awakening interest in beginnings practical work. Training in applying theoretical knowledge acquired in the course to the practice of conducting a mock clinical interview with another person.

• awakening interest in research and knowledge of the hidden sides of one’s personality

• awakening interest in the application of the psychoanalytic research method in interdisciplinary fields (literature and art, philosophy, sociology, medicine, ethics, etc.)

• developing skills to recognize the developmental aspects and limitations of psychoanalytic science

The knowledge gained as a result of mastering this course will allow students to:

• basic psychoanalytic concepts, hypotheses, concepts within the course “Psychoanalytic theory of neuroses” from the point of view of theoretical, technical and content-therapeutic approaches

• apply the acquired knowledge for the purpose of diagnosis and differential diagnosis of various neurotic, psychotic and borderline levels of personality organization.

• compare and navigate the body of various theories, trends and schools of psychoanalytic theory of neuroses.

• skills of recognition in the presented texts and on individual trial clinical material: anxieties and frustrations, symptoms, conflicts, phantasmatic activity, drives and defenses

• skills in establishing connections between current psychopathology and etiological aspects.

• skills to determine the location of a symptom on mental level, at the behavioral and somatic levels.

• practical skills in studying psychoanalytic literature

• skills in recognizing transfer-countertransfer interaction

A distinctive feature of this course is the understanding of the fundamental role of identifying a class of neuroses in the formation of a psychoanalytic method of research and therapy and the formation of psychoanalytic thought on this basis.

Systematic and analytical reading of original author’s texts on the psychoanalytic theory of neuroses, practical use clinical material, including the use of psychoanalytic literature unpublished in Russia, ensures the most complete mastery of the course material. The course program is formed in the context of international teaching and learning practices.

The author's concept is based on many years of clinical experience, training experience within the International Psychoanalytic Association, as well as teaching experience. The established methodology involves a detailed and regular study of the works of Freud and modern psychoanalysts belonging to various directions and psychoanalytic schools as part of the course. The concept is based on a systematic study of literary and clinical material and combines the principles of research and generalization of both theoretical and practical experience.

Topic 1. Historical background for the creation of the psychoanalytic theory of neuroses

The mystery of hysteria since ancient times. Understanding hysteria as a phenomenon at the intersection of medicine, social issues and culture

• Freud's identification of hysteria in the field of medicine

• Current professional context as a starting point for this discovery

• Influence of J.M. Charcot, P. Janet, I. Bernheim, E. Kraepelin on understanding the nature and essence of hysteria.

Collaboration with J. Breuer

• Freud as a scientist capable of processing and using the works, materials, data of his predecessors and creating his own innovative knowledge
• Hysteria as the first neurosis studied by Freud, and the key to his further research and development of the psychoanalytic understanding of neuroses

Topic 2. Psychiatric understanding of neuroses

Psychiatric understanding of neuroses:

• Phenomenology. Symptoms and syndromes
• Basic forms of neuroses
• Etiology and pathogenesis
• Diagnosis and differential diagnosis
• Treatment and prevention

Medical understanding of neuroses in Freud's time and in modern psychiatry.

Isolating the concept of hysteria from the psychiatric nosography of its time

Topic 3. Stages of formation of the psychoanalytic concept of neuroses

Joint work with J. Breuer and its result: “Study of Hysteria”, 1895

• Fundamental principle: hysteria as the prototype of all psychoneuroses. "The symptoms make sense"
• First hypothesis of the origin and treatment of hysteria
• The fundamental importance of mental trauma in the etiology of hysteria
• Hypothesis about the splitting of the content of consciousness
• The first statement about the specifically sexual nature of the trauma
• Sexuality as a factor motivating repression
• The transition from the cathartic method of treatment of J. Breuer to the method of free associations of S. Freud
• “Study of Hysteria”, 1895, “New Notes on Psychoneuroses of Defense”, 1896, “Etiology of Hysteria” 1896

The second stage of the formation of the psychoanalytic concept of neuroses. 1897-1909

• Phantasmatic life in connection with psychic bisexuality
• Symptoms, fantasies and dreams as symbolic embodiment of unconscious desire. Infantile sexuality
• Symptom of transformation as condensation of embodied phantasms
• Features of hysterical identifications
• The fundamental role of mental conflict
• Psychoneuroses as a negative perversion
• Psychoneuroses of defense
• - “Sexuality in the etiology of neuroses”, 1898, “Interpretation of dreams”, 1900, “Fragment of the analysis of one case of hysteria (Dora)”, 1905, “Three essays on the theory of sexuality”, 1905, “Hysterical phantasms and their relation to bisexuality”, 1909

The third stage in the formation of the psychoanalytic concept of neuroses. Hysteria in the service of metapsychology. 1909 – 1918

• Differences and similarities between various neuroses
• Conditions for entering neurosis
• Symptom formation
• Difference mental mechanisms for hysteria, hysteria of fear and neurosis obsessive states
• Rationale for the similarity of all defense psychoneuroses. Their difference from narcissistic neuroses
• The role of suppression and the transformation of libido into anxiety in hysteria of fear
• - Analysis of the phobia of one five-year-old boy (Little Hans), 1909, “From the history of an infantile neurosis” (Wolf Man), 1918, “Notes on a case of obsessive neurosis” (Rat Man), 1909, “Metapsychology”, 1915, “Inclinations” and their fates", 1915, "Mourning and Melancholy", 1917, "Introduction to Psychoanalysis", 1916, "Lectures on Introduction to Psychoanalysis", 1916-17

The fourth stage in the formation of the psychoanalytic concept of neuroses.

• Revaluation of neuroses. Second structural theory
• Problems of female sexuality. Questions of the pre-Oedipal phase of development.
• - “I and “It”, 1923, “Beyond the Pleasure Principle”, 1920, “Neuroses and Psychoses”, 1924, “Suppression, Symptoms, Anxiety”, 1926, Female Sexuality, 1933, “New Lectures on Introduction to Psychoanalysis ",1933

Topic 4. Problems of metapsychology

Topological (structural) approach

• First topic. Differentiation of the mental apparatus into the Unconscious-Preconscious-Conscious
• The second structural theory is “It-Ego-Super-Ego”. “Super-ego” as the heir of the Oedipus complex.
• Concept of ideal self

Economic approach

• Loading and anti-loading problems
• The relationship between the principles of pleasure and reality and primary and secondary processes

Dynamic approach

• Concept of conflict
• Drive theory. First and second
• Protection problems
• The first and second theories of fear/anxiety
• Affect theory
• Problems of aggressiveness, sadism, masochism

Topic 5. Genetic approach

• Genetic approach from the point of view of drive-structure theory and from the point of view of object relations
• Psychosexual development and the development of object relations.
• Sources, goals and object of attraction

The concept of orality. K. Abraham. Influence of M. Klein and her school (U. Billon)

• Orality and incorporation
• Primary identifications
• Specific oral fears and fantasies
• Oral conflict - the first conflict of ambivalence
• Schizoparanoid and depressive positions
• Early Oedipus complex

The concept of anality. Influence of K. Abraham, D. Winnicott

• Sources, goals, object of attraction
• Second conflict of ambivalence
• Typical fears and defenses of the anal phase
• Formation of oppositional pairs – activity/passivity
• The meeting of narcissistic and object libido
• Narcissistic enhancement of feelings of omnipotence

The concept of phallicity. Contribution of S. Ferenczi, O. Fenichel.

• The problem of gender differentiation
• Psychosexual development and object relations in the phallic stage
• The unification of partial drives under the primacy of genitality
• The main fears and fantasies of the phallic stage in boys and girls. Child masturbation.
• Children's sex theories
• Primary scene. Identification.
• Sexual or narcissistic meaning in the development of symbolization
• Two functions of the development of the ideal of self and self: 1) as a replacement for lost narcissistic omnipotence and 2) a product of identification with parental figures
• Latency. Period of suppression and amnesia
• Puberty. Identity crisis in girls and boys.
• Object relation and object choice

Topic 6. Theory of the pediatric clinic

• - “Transactional spiral” in the family
• - Object relations
• - Identity and identification
• - Fantasies and phantasm
• - Children's fears and defenses
• Fixation, regression and traumatization
• Metapsychology childhood(topological, dynamic, economic point of view)
• Narcissism and body image
• Aggression and action
• Mentalization
• Neurotic types of mental organization
• Childhood hysteria and hysteria of fear
• Obsessive mental organization
• Psychotherapy in children

Topic 7. Neurotic structures

• The concept of neurosis. Classifications. Neurotic level of personality development
• Individual neurosis according to the first and second topics of S. Freud
• Unconscious neurosis
• Symbolic and incestuous formations
• Modern concept neurosis - family neurosis
• Typical symbolic incestuous relationships
• Mutual dependence and omnipotent control
• Implicit prohibitions. Language compromise
• The meaning of the symbolic role of the father
• Typological Oedipal core
• oedipal identifications
• oedipal castration
• Oedipal choice of object
• Pseudo-neurotic forms of psychopathology: fear neurosis, neurotic depression, phobic neuroses, character neurosis
• Clinic
• Manifestations
• personality and character neurosis (hyperactivity, rigidity, total sterilization)
• types of decompensation
• Connection with the threat of losing an object
• Authentic neuroses: conversion hysteria, hysteria of fear, obsessive-compulsive neurosis, psychoneuroses of defense

Topic 8. Conversion hysteria

• Economic structure
• Main conflicts
• Libido, fear concepts
• Hysterical relationships
• Hysteria and repression
• Hysteria and gender differentiation
• Hysteria and femininity
• Desire unsatisfied desire
• Masochism hysteria
• Hysterical identifications, mental contagion
• Bisexuality and homosexuality
• Hysteria and transfer

Topic 9. Hysteria of fear

• Fear Hysteria Clinic
• The Case of Little Hans
• Counterphobic object
• Economic structure
• Phobic bias
• A New Theory of Neurotic Fear: The Product of the Self and the Signaling Function of Fear
• Threat of castration

Topic 10. Obsessive neurosis

Clinic of obsessive neurosis:

• symptom of affect isolation
• distancing from any affective intimacy
• obsessive omnipotent control
• obsessive character
• obsessive rituals

Concept of ambivalence

Thinking like a screen

Regression to the anal level

Sadomasochistic context. Identification with the aggressor

Economic structure

Obsessive bias

Fear of castration, fear of loss of control

Oedipal conflict expressed in pregenital language

Sexual and narcissistic. Narcissistic depression.

Differential diagnosis with borderline conditions

The Case of the Rat Man

Topic 11. Neurotic depression - as a sign of narcissistic ego weakness

The main method of neurotic decompensation is the result of devaluation of the narcissistic self-image.

Manifestations: rumination, masked forms, neuroses of fate, failure, abandonment, disorders of a functional nature.

Connection with neuroses. Differences in the mechanisms and manifestations of neurotic depression in hysterical and obsessive neurosis

The possibility and ability of mental processing of depressive pain as a sign of the neurotic nature of depression (as opposed to melancholic depression).

The paradox of neurotic depression. Possibility of negative and positive forecasts.

Topic 12. Narcissistic dimension of the Oedipal configuration

• The myth of Oedipus as a metaphor in a metapsychological concept. Familial narcissistic neurosis.
• The influence of deception and family secrets on tragic fate Oedipa
• Turning the unspoken into a negative message. And the predetermination/inevitability of a reaction in reality as a result.
• Barking as a metaphor for the narcissistic father
• Prohibition on knowledge

Topic 13. Oedipal situation and depressive position. M. Klein and her school

• Early stages of the Oedipal conflict according to M. Klein.
• The phantasm of the primal scene as a fundamental component of the Oedipus complex
• Hatred of knowledge, inhibition of the epistimophilic impulse due to a threat to the subject's safety
• The theme of loss as fundamental for the development of a depressive position and acceptance/rejection of the reality of the Oedipal couple
• Integration of the depressive position and development of the ability to symbolize

Topic 14. Economic approach to hysteria based on the concept of injury

Hypothesis of two traumatic nuclei in hysteria

• Associated energies and symptoms
• Free energies, repetitive actions

Differences between the pleasure principle and the principle repetition compulsion

• The pleasure principle as symbolic satisfaction in symptoms
• The principle of repetition compulsion as a reproduction of a traumatic scenario

The relationship between sexual trauma and object loss trauma

The structuring role of the fantasy scenario

Tendency to recreate infantile painful events in transference, regardless of the pleasure principle

The painful experience of “inadequacy”, “absence” in the unconscious takes shape through fantasies of seduction.

Topic 15. Transference neurosis

• - Modern concept of the triad: infantile neurosis – adult neurosis – transference neurosis
• Concepts of transference and countertransference
• Features of the neurotic type of development: preservation of a phantasmatic internal object and the ability to transfer, creation of a symbolic object.
• Transference neurosis in hysterical and obsessive patients
• Narcissistic distortion of transference neurosis
• Interpretation as the introduction of a symbolic "third"
• Initial interview. Clinical talk
• Diagnosis and differential diagnosis. Difference between neurotic structures and borderline and psychotic ones.
• The function of a psychotherapist when working with neurotic patients: creating conditions for the development of transference neurosis: maintenance and resolution
• The need to work through mourning for separation from the object to resolve the Oedipal conflict and transference neurosis

Psychoanalysis considers as the causes of neurosis or factors contributing to its development: frustration, fixation on any experience, a tendency to conflict, psychological trauma, instinctive danger and others.

In most specific cases of neurosis there is no single cause, there is an individual combination of them, that is, several factors must coincide.

Freud, in his early works, put forward the idea that only highly emotional experiences can lead to neurotic illness. This emotional experience was considered a trauma, and it, becoming fixed, made the personality neurotic.

It was later shown that this kind of traumatic experience does not make every person neurotic. Only by overlapping others personal characteristics they lead to neurosis.

In psychoanalysis it is believed that neurotic disorder includes specific reactions of the ego to certain instinctive demands (primarily of a sexual nature). Those aspirations that cannot be realized, the ego tries to reflect. If the ego is helpless and unable to cope with danger, then as the tension of the instinctual need increases, a traumatic situation arises in which the instinctual impulse threatens the ego.

In this case, anxiety, or rather the instinctive threat hidden behind it, is driving force psychological protection.

Psychological trauma occurs when a stimulus releases so much large number energy that the ego cannot handle within a normal period of time.

U different people there is varying ability of the ego to withstand the tension caused by unmet needs. This individual feature explains why, under similar circumstances, some people develop neurosis and others do not.

Psychoanalysis, at least classical, sees the cause of most neuroses in infantile trauma. It is assumed that even in early childhood the future neurotic was somehow drawn into a situation of a sexual nature. The experiences were suppressed, but nevertheless they continue to influence the rest of his life.

Over time, in psychoanalysis, the traumatic theory of neurosis remained generally unchanged, but was expanded by the concept of internal trauma. This internal trauma depends on a constitutional factor, namely, on the fixation of libido, therefore, it is based on a violation of the development of instinctive impulses. Fixation and external infantile experience form complementary series etiological factors which provide a predisposition to neurosis. Fixation and external experience are interconnected. Neurosis can develop due to weak fixation, which must be supplemented by intense experience. Intense external infantile experience can cause fixation and change the structure and create a predisposition to neurosis.

An important concept in psychoanalysis is “instinctive danger.” It is part of a traumatic situation, but this is not enough to cause neurosis. Many people are able to tolerate intense stress without developing neurosis. Displeasure stems from a situation where certain sexual demands, which are perceived as dangerous, cannot be satisfied. The conditions under which anxiety arises are not always the same: each level of ego and libido development has a corresponding precondition for anxiety.

According to Freud, the symptoms of mental illness are harmful or useless acts that a person often complains of as being forced and associated with trouble or suffering. Their main harm lies in the mental costs they themselves incur and the costs necessary to overcome them. With intensive development of symptoms, costs can lead to impoverishment of the individual in terms of managing his vital energy.

The neurotic symptom is the result of a conflict arising from a new type of libidinal satisfaction. The id and ego meet in the symptom and seem to be reconciled through a compromise - the formation of symptoms. That is why the symptom is so stable - it is supported on both sides. It is known that one of the parties to the conflict is an unsatisfied libido, rejected by reality, forced to look for other ways to satisfy itself.

The question of where a symptom comes from is answered by impressions that come from the outside, were once, by necessity, conscious, and since then, thanks to forgetting, can become unconscious. The purpose of a symptom, its meaning, its tendency, is an endopsychic process that may have been conscious at first, but it is no less likely that it was never conscious and remained forever unconscious

Neurotic symptoms, like erroneous actions, like dreams, have their own meaning and, just like them, are in their own way connected with the life of the persons in whom they are found.

It is known that the ego shows some interest in the emergence and subsequent existence of neurosis. The symptom is supported by the ego because it has a side through which it satisfies the repressive tendency of the ego. In addition, resolving the conflict through the formation of a symptom is the most convenient and desirable way out of the situation. There are times when even a doctor must admit that resolving a conflict in the form of neurosis is the most harmless and socially acceptable solution. If we can say that every time a neurotic person is faced with a conflict, he flees into illness, then we must admit that this flight is completely justified, and the doctor, who understands this state of affairs, will step aside, sparing the patient. More details: http://www.gumer.info/bibliotek_Buks/Psihol/freyd/07.php

Classical psychoanalysis Freud includes a theory of the psychological origin of neuroses. He distinguishes the following types of neuroses.

Psychoneurosis is due to causes related to the past and is explainable in terms of personality and life history. There are three types of psychoneuroses: hysterical conversion, hysterical fear (phobia) and obsessive-compulsive neurosis. The symptoms of these neuroses can be interpreted as a conflict between the ego and id.

Actual neurosis is due to causes relating to the present and is explainable in terms of the patient's sexual habits. He is physiological consequence disorders in sexual functioning. Freud distinguished between two forms: neurasthenia, as a result of sexual excesses, and anxiety neurosis, as a result of the lack of relief from sexual arousal. There are differences in the symptoms of actual neuroses and psychoneuroses: in both cases, the symptoms originate from libido, but the symptoms of actual neuroses - pressure in the head, sensation of pain, irritation in any organ - are exclusively somatic processes, in the occurrence of which all complex mental mechanisms.

Narcissistic neurosis in which a person is incapable of forming a transference.

Character neurosis - in this case, the symptoms are character traits.

Traumatic neurosis - which is caused by shock. Freud noted that in traumatic neuroses, especially those caused by the horrors of war, there is no doubt for us the egoistic motive of the ego, striving for protection and benefit, which alone does not yet create the disease, but sanctions it and supports it if it has already begun.

With transference neurosis, which is caused during psychoanalysis, the patient shows an obsessive interest in the psychoanalyst.

According to S. Freud, the content of these neuroses is uncertain and unstable. The named forms of neurosis are sometimes found in their pure form, but more often they are mixed with each other and with a psychoneurotic disease.

And in the cause and in the mechanism of all possible forms In neuroses, the same factors are always at work, only in one case one of these factors acquires the main importance in the formation of symptoms, in the other - the other. Thus, fantasies turning into symptoms are nowhere more clearly manifested than in hysteria; Opposite or reactive formations of the ego dominate the picture of obsessive-compulsive neurosis. I present it according to: Enikeev, M.I. General and social psychology. M.: Republic, 2006. 210 - 211 p.

That., neurotic symptom is the result of a conflict arising from a new type of libido satisfaction; conflict between id and ego.

Based on the above principles, psychoanalysts try to carry out adequate diagnostics and create a “flexible” classification that allows one to outline general guidelines, but does not plunge a living person into a Procrustean bed of clinical similarity and does not assign him a specific cell on the rack of neuroses. Moreover, the expediency of such a system lies in the fact that it allows one to keep in view several dimensions at the same time, which are to a certain extent independent of each other, but under certain conditions can have mutual influence. On the basis of reflections, observations and terminological "experiments" connected with the concept of hysteria, which is now being questioned, I too have attempted to create a quick sketch of a theory of neuroses.

Considering the practice of using the concept “neurosis” as a unit of disease as an anachronism, I proposed that diagnostics should be carried out taking into account at least three dimensions.
We are talking about the nature of the key conflict, the current state of the ego/structure and the modality of processing. Using the latter terms, I tried to characterize not only obvious symptoms, but also latent psychodynamics. Firstly, these three dimensions can be varied - slightly, carefully and at the same time not entirely arbitrarily and independently of each other.

Secondly, a separate method of processing should be regarded as a “defensive strategy” (tactics of protection and compensation), which, in principle, can be applied everywhere and, under certain circumstances, be deviated or filled with new content. In my opinion, such a “flexible” diagnostic model allows not only to classify the so-called atypical neuroses, which, however, are found in clinical practice much more often than the so-called typical neuroses, but also to understand the internal psychodynamic pattern of mysterious “leaps” from one syndrome to to another.

An approach based on three-dimensional diagnostics can hardly be called an absolute innovation. It has long been practiced by many specialists who combine symptomatic diagnosis with structural. Moreover, it is obvious that the structure is a combination of the state of the ego and the nature of the conflict, while the symptom corresponds rather to the modality of processing.

I'm pointing out special attention on the fact that the processes, the development of which is recorded in these three dimensions, occur to one degree or another independently of each other, and this creates the conditions for their adequate understanding. At the same time, the proposed paradigm implies a current diagnosis, subject to constant changes, which seems to me more of an advantage than a disadvantage, since under these conditions nothing prevents further progress along the path of understanding and comprehending the essence of dynamic development within the framework of therapy. And finally, no less important, it seems to me that the analysis of significant processes occurring at the three above-mentioned levels can and should be carried out not only from the point of view of individual psychology, but also taking into account object relations.

This initiative provided the impetus for the creation of a new psychodynamic classification of psychotic and non-psychotic disorders, within which individual illness patterns and associated defense complexes are classified according to the degree of their attraction to the narcissistic pole of the self or to the pole of object relations. Thus, it is possible to place between such extreme manifestations of the disorder as autism and fusion, transitional syndromes of persecutory mania, delusions of relationships, love mania, and ecstatic state.
In accordance with this principle, it is possible to carry out a meaningful psychodynamic classification of the types of borderline personality disorder, affective-psychotic states, so-called abnormal personality types and neuropsychotic conditions.