The History Of Neurosis And The Neurosis Of History

IGAP Paper: The History of Neurosis. Dec. 15, 2006. Luisetta Mudie Spirits and magic are almost the sole causes of illness among primitives. The autonomous contents are projected by the primitive upon these supernatural beings. Our world, on the other hand, is freed of demons to the last trace, but the autonomous contents and their demands have remained. They express themselves partly in religion, but he more the religion is rationalized and watered down...the more intricate and mysterious become the ways by which the contents of the unconscious contrive to reach us. One of the commonest ways is neurosis.i Jung, CW8.712

The neurosis of history The term 'neurosis' can be seen as a response to a complex of psychological, somatic and cultural phenomena which first began to be described among patients in a postEnlightenment, rapidly industrialising Europe. Advances in medicine and technology had produced a deepening of the divide between subject and object. Mind, if separated from matter through repeatable and verifiable experiment, could achieve great things, including social reform, the eradication of major diseases, and a new culture of Industry and Progress. It could even objectify, and therefore study, itself. The term 'neurosis' was coined by a Scottish doctor, William Cullen, in 1769 to refer to "disorders of sense and motion" caused by a "general affection of the nervous system". Cullen needed a term that would describe problems which had no physiological cause.ii The non-biological basis of neurosis was maintained with Sigmund Freud and the beginning of the psychoanalytic movement. It moved away from attempts to describe the somatised experiences of patients in terms of putative organic disorders, for example, the 'wandering womb', and opened up the field of psychology as a legitimate object of enquiry for the scientifically minded, while at the same time differentiating it from medicine. The Enlightenment shift also moved away from the holistic approach to mind, body and soul characterised by Renaissance thinkers, for whom the gods and astrology were still a proper part of scientific enquiry. It is that attitude which Jung develops and revives in a form appropriate to his time and social milieu: analytical psychology. By the mid-19th century, across Europe, intellectuals were deserting the old systems of meaning, once the preserve of the Church. Ernest Renan's secular appraisal of Christ, La Vie de Jesus, was emblematic of the positivist rush to believe in the power of human reason. And while the newly-empowered rationality redefined itself against the backdrop of an increasingly watered-down religious life, the irrational, troublesome and fascinating parts of the psyche not adequately addressed by post-Enlightenment thinking were thrown into sharp relief: both in individuals seeking help for neurotic suffering; and collectively, in mass movements and war.

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Early approaches Henri Ellenberger dates the beginnings of what he terms 'dynamic psychiatry' from 1775, when the physician Franz Anton Mesmer superseded the work of the highly respected exorcist Gassner.iii Mesmer's theory of animal magnetism was based on the concept of an energetic fluid, and his philosophy—which his disciple Puységur later summarised as believe and wantiv—fully recognized the effects of clinical intent on his patients. The late 18th century and entire 19th centuries were dominated by a psychiatric focus on the 'magnetic diseases'. Most common in the care of such practitioners were patients suffering from spontaneous somnambulism, lethargy, catalepsy, multiple personality, and, later, hysteria. Theories of invisible fluids began to be replaced by notions of psychic energy1, an heuristic concept which informed much of Jung's psychological theoryv. The chief clinical technique throughout much of this time was hypnotism, which had its roots in the Renaissance concept of imaginatio, which placed a great emphasis on the power of suggestion. Such techniques were used to great theatrical effect by the Paris-based neurologist JeanMartin Charcot (1825-93) during his tenure as clinical professor of the nervous system at the Pitié-Salpêtrière hospital. Nicknamed "the Napoleon of the neuroses", Charcot was most famous for staging demonstrations of technique and symptoms using his most prominent and interesting hysterical patients. But the mainstay of Charcot's work was his concern with a diagnostic classification of key neurological disorders; his 'nosography'. Charcot's work has proved fertile ground for later critiques of the phenomena of hysteria as owing more to gender politics and the socioeconomic circumstances of the day than to classifiable and treatable illness.vi One of Charcot's students, Pierre Janet (1859-1947), was to influence Jung's work profoundly. A summary of Janet's theory of psychic energy is included as an end-note to this paper.vii Haunted minds: Jung's roots While the practice of hypnosis gained momentum throughout the 19th century, it wasn't taken up by medically trained practitioners until the 1880s. By then, the plethora of minds turning their attention to the hypnotic method had begun to show up its weaknesses, which included the difficulty of knowing whether people were truly 1

According to Ellenberger, one of the earliest theories put forward by the mesmerists was that there existed a universal 'fluid'. Illness could be caused by disturbances in the fluid, by faulty fluid, or by insufficient fluid. Puységur's emphasis on will, an essentially psychological explanation, ran concurrently with fluidic theory throughout the 19th century. In the second half of the century, the two ideas appeared to find some synthesis in increasing references among academic physicians to a deficiency of 'nervous energy' as a cause for illness. One of these was George Beard, known for his description of neurasthenia in the United States. Beard said some people were 'millionaires of nervous force', while a neurasthenic had overdrawn his nervous force to the point of 'nervous bankruptcy'. Pierre Janet's theories of psychic energies drew both on Beard's, and on the experiences of the earlier magnetisers. William James' work, The Energies of Man, was also influential at that time.

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hypnotised or simply pretending to be in order to maintain social acceptability. In the language of the age, it became difficult to separate the phenomena of the hypnotic movement into observable facts free of the influence of the social contexts in which they occurred. Related phenomena that began to emerge in the drawing rooms of mediums and spiritualistic practitioners were later to inspire Jung's doctoral thesis, in which he also noted their inseparability from social and psychological contexts. Jung's interest in such phenomena as a member of the medical profession, which via psychiatry was already beginning to emphasise organic and physical causes for mental disorders, is remarkable. It can be seen as a significant step towards reintegration of the subject-object split, so necessary for scientific enquiry, and towards a fuller experience of the neurosis of history which resulted from it. Jung's deep conviction that what the insane said or experienced was not separable from human experience, that is, that meaning was inherent in the fantasies of even his most psychotic patients at the Burghölzli hospital, led him to delve more deeply into the contexts in which such phenomena as spiritualism, hysteria, hypnosis and madness were embedded. Using a philological analogy which took the fantasies of the insane as texts in an unknown language, Jung found parallels for these fantasies in little-known theological texts, alchemical manuscripts and folk tales, myth and legend. His development of the concept of the collective unconscious sprang from a profound experience both of his own neurosis, and of that of the age in which he lived. Freud and repression Since I could not alter the psychic state of most of my patients at my wish, I directed my efforts to working with them in their normal state. This seems at first sight to be a particularly senseless and aimless undertaking. The problem was this: to find out something from the patient that the doctor did not know and the patient himself did not know.viii

Hypnotism had enjoyed a brief honeymoon period of intense interest from the medical profession before lapsing into relative obscurity. One of its legacies, which it had inherited from mesmerists, Gassner, and even the ancients, was a practice which placed strong emphasis on precipitating a crisis, or 'bringing out' the symptom, in order that it might be cured, a principle Freud redefined as the cathartic method, although he was soon to reject hypnosis. This way of working arose at about the same time as the idea that psychic energy or contents might be 'located' somewhere not immediately obvious, creating a distinction between the apparent state of the patient and their latent, unseen energies or symptoms. From here, it was a short step to the distinction between conscious and unconscious psychic activity, which began increasingly to be made and became the hallmark of the psychoanalytic movement. These foundations were laid, of course, by Freud.

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...The forgotten memories were not lost. They were in the possession of the patient, ready to emerge and form associations with his other mental content, but hindered from becoming conscious, and forced to remain in the unconscious by some sort of a force. The existence of this force could be assumed with certainty, for in attempting to drag up the unconscious memories into the consciousness of the patient, in opposition to this force, one got the sensation of his own personal effort striving to overcome it. One could get an idea of this force, which maintained the pathological situation, from the resistance of the patient.ix

The theory of resistance leads Freud to the theory of repression in the very next paragraph. These same forces, which in the present situation as resistances opposed the emergence of the forgotten ideas into consciousness, must themselves have caused the forgetting, and repressed from consciousness the pathogenic experiences. I called this hypothetical process "repression" (Verdrängung), and considered that it was proved by the undeniable existence of resistance.x

Jung, writing in the early part of the 20th century, picks up on the theory of psychic energy and its implication of the existence of the unconscious psyche afresh, using it to underpin his view of neurosis. In his essay on psychic energy, he uses the laws of thermodynamics as a metaphor for his psychodynamics, and concluding that if a packet (quantum) of life energy, or libido, has disappeared as a conscious value, it is not lost. The conviction that it is no longer detectable, but yet has not been lost, presupposes an Other, hidden location, in which 'it' may now reside. Jung attributes much of the development of this principle to Freud, and the theory of repression: Nowhere can we see more clearly than in the relation of sexuality to the total psyche how the disappearance of a given quantum of libido is followed by the appearance of an equivalent value in another form...Anyone who reads Freud's works with attention will see what an important role the equivalence principle plays in the structure of his theories. This can be seen particularly clearly in his investigations of case material, where he gives an account of repressions and their substitute formations. Anyone who has had practical experience of this field knows that the equivalence principle is of great heuristic value in the treatment of neurosis.xi

But Jung, while acknowledging his debt to Freud, was soon to diverge from the path taken by the Viennese school of psychoanalysis. Neurosis is also conceived by Jung in social terms as a crisis of meaning: to borrow his shamanic metaphor, a loss of soul in modern life. At a personal level, it is 'the avoidance of legitimate suffering'; a refusal to entertain one's demons, to give them house-room. The concept of soul loss took Jung into a direct encounter, both personally and as a scholar, with what Freud labelled "the black mud tide of occultism" and into a much broader definition of libido as psychic energy, which sought expression in increasingly complex forms in human life, including religion. For the individual, Jung described libido as residing in personal complexes, which consisted of affect (strong emotion) against which neurotic behaviours often defended, but also of images which were capable of symbolising and containing the experience, which had their roots in the collective unconscious, the home of the archetypes, and of a human experience of the numinous and the sacred.

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Most importantly, meanings could be made from any or several of the archetypal metaphors inherent in humankind, and were no longer confined to infantile wish-dramas and the Oedipal myth; while Jung never denied the importance of the latter, he added to it a large array of myths and images found in his clinical practice and in his research into alchemy, Gnosticism, anthropology and folk tales. For Jung, the healing of the neurosis lay in the very images its suffering produced. This suffering would initially be experienced in the external world, he wrote, 'as Fate', but through analysis could be approached and transformed through dreams, artwork, fantasy and active imagination. But Jung's view of neurosis was also defined against the Freudian view of neurosis as the result of the repression of 'disagreeable memories and tendencies',xii or wishes that were incompatible with the neurotic's other desires.xiii Instead, Jung argued for the existence of a positive unconscious, something with its own existence independent of the ego, and not merely a dustbin for repressed ego wishes. [The] positive function of the unconscious is, in the main, merely disturbed by repressions, and this disturbance of its natural activity is perhaps the most important source of the so-called psychogenic illnesses...Like bile seeping into the blood, the repressed content infiltrates into other psychic and physiological spheres. In hysteria it is chiefly the physiological functions that are disturbed; in other neuroses, such as phobias, obsessions, and compulsion neuroses, it is chiefly the psychic functions, including dreams.

For Jung, neurotic symptoms like these were an attempt on the part of the unconscious to compensate for a one-sided attitude in the conscious mind which had not allowed them full expression in the life of the person who suffered them. The key difference between his early patients at the Burghölzli clinic and his later analysands was in the former's inability to maintain the tension of the opposites necessary to psychological development in their waking life; their ego. Here again, there are resonances with Janet*. The repressed feminine In social terms, the neurosis of history and the collective return of the repressed was often carried by women patients, themselves subjected to social repression in a male-dominated society. Feminist studies of psychoanalytic history have critiqued the role of psychiatry and psychoanalysis as a purely diagnostic and curative set of practices, highlighting instead the (unconscious) use of psychiatric labels and coercion as a political weapon in the social struggle for gender equality. For example, women whose gifts and abilities were underdeveloped because they were considered unfeminine were seen as attempting to kick back against the patriarchal system, and simply labelled 'nervous' or 'hysterical' when they continued to rebel. "During an era when patriarchal culture felt itself to be under attack by its rebellious daughters, one obvious defense was to label women campaigning for access to the universities, the professions, and the vote as mentally disturbed," writes Elaine Showalter.xiv She cites Freud and Breuer's studies in hysteria, in which they refute Janet's view of hysteria as the result of a congenital psychical weakness:

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Adolescents who later become hysterical are for the most part lively, talented and full of intellectual interests until they fall ill; they often have a remarkably energetic will. This category includes girls who get up during the night to pursue in secret some kind of study that their parents have forbidden them for fear of over-exertion.xv

In men, the repressed feminine in the form of the maternal unconscious, or in dreamlike anima representations, manifested itself in such diagnoses as neurasthenia, which was characterised by a lack of desire or motivation. Jung repeatedly linked tales of vampires which suck a man's energy to a failure to get to grips with the anima. Many others who came under the care of the psychiatric profession, male or female, saw themselves as victims of social discrimination and repression, rather than as sick. "Throughout the writings of the insane runs a wail of protest," writes Roy Porter, in Madness: A Brief History. Citing the account of Clifford Beers, Porter describes Beers' committal to a mental institution following relatively mild symptoms, which later developed into a set of paranoid beliefs about his family. Beers, looking back, concludes that his sense of persecution was relatively sane, given his arbitrary incarceration and subjection to procedures very much resembling torture.xvi In authoritarian or totalitarian states, psychology is under the aegis of a monistic government, which arrogates all meaning-making to itself or to its ideological system. Psychological appraisal, if it exists at all, is frequently used forensically, to lock up those who are crazy enough to disagree with the all-powerful State. In such extreme environments, biological causes for mental health problems tend to be disregarded by the general population, who prefer to blame the regime for sending people mad. Behaviours which in a liberal culture would be considered paranoid are the norm; only normal human feeling is pathologised.xvii Meaning, neurosis, and the body The ambiguities and questions surrounding psychiatric diagnosis have called many others to question the purpose of the psychiatric profession, the most notable of these being Thomas Szasz, who suggested that psychiatry as practised is a disguised form of social control and behaviour modification, rather than a genuine branch of medicine with knowable diseases and cures.xviii This has ramifications for the concept of neurosis, and therefore for the work done by psychotherapists working with non-psychotic disturbances. Even given the strong evidence for organic aspects to certain psychiatric disorders—for example the relationship between dopamine and behaviours grouped under the diagnosis 'schizophrenia'—mental health groups are now campaigning for the abolition of the term schizophrenia from diagnostic manuals on the grounds that it spells social and economic disaster for anyone labelled with it.xix Current diagnostic manuals have already dispensed with the term 'neurosis', leaving Jungian practitioners working with a vast spectrum of problems not acutely and floridly 6

psychotic. Given the manifold suffering reported by disempowered people as a result of the fixities of meaning and conduct applied to them by powerful practitioners, perhaps a degree of fluidity is the best guarantee we can offer our clients and the experiences they bring to the consulting room. From another point of view, however, a certain degree of firm conceptualisation can be helpful. One analysand, the client of a senior Jungian analyst, said she appreciated the effort to find a psychological explanation, rather than a biological quick fix, to recent difficulties. "A mediocre shrink would have put me back on drugs last week," she said. "A final thought on definitions and terminology...one way that they're useful to the patient is in defining what you're not. [My analyst] can say to me, no you're not bipolar, you have a complex. If he said to me, no you're not bipolar, you're just a unique individual with a unique problem, I might feel actually more trapped," she wrote in personal correspondence on the subject of neurosis. The concept of neurosis has undergone many challenges, including changing attitudes to the relationship between body and psyche. Advances in neuropsychiatry have shown that brain changes take place as a result of key emotional events, that brain development is essentially a relational processxx, and that words literally matter, in that they can affect our physiology. How the body affects the psyche, or interpenetrates it, is also beginning to be considered, as non-Western philosophies (e.g. Chinese, Ayurvedic, Tantric) become entwined in our pluralistic cultures. Such resonance – never before possible – between the nitty gritty of psychological work and the detectable activity and development (even in adult life) of the brain, has given Jung's psychology a new legitimacy, in the sense that his theory of complexes has a firm basis in observable biology. Some writers have suggested that the entire basis of brain function is essentially metaphorical: that the brain, even in rabbits, communicates with itself in terms of not-quite-closed meaning systems which reside in associative clusters to produce memory.xxi Image, and therefore even our continuity of identity, is constantly being retranscribed through metaphor, which some have described as an emergent property of matter itself. But the concept of neurosis as employed in analytical psychology—and Jung's theory of complex and archetype—may not ultimately need this legitimacy. Indeed, the enduring value of the term may be rooted in the fact that it risks—in today's high-tech world—a purely human meaning for suffering, and therefore for the psychotherapeutic work which attends it.

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References

Jung, C.G., "Analytical Psychology and 'Weltanschauung'", CW8.712 Wikipedia contributors, 2006. "Neurosis". Wikipedia, The Free Encyclopedia. Retrieved Nov. 20, 2006, from http://en.wikipedia.org/w/index.php?title=Neurosis&oldid=88850627 iii Ellenberger, H, 1970. The Discovery of the Unconscious, Basic Books, New York. p110 iv Ibid. p72 v Jung, C.G., 1948. "On Psychic Energy", CW8.26 vi Szasz, T, 1974. The Myth of Mental Illness. HarperCollins, New York. ii

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Freud, S, 1910. "The Origin and Development of Psychoanalysis", first published in American Journal of Psychology, 21, 181-218. Retrieved Nov. 1, 2006, from http://psychclassics.yorku.ca/Freud/Origin/origin2.htm ix Ibid. x Ibid. xi Jung, C.G., 1948. "On Psychic Energy", CW8.35 xii Jung, C.G., "Analytical Psychology and 'Weltanschauung'", CW8.702 xiii Freud, S, 1910. "The Origin and Development of Psychoanalysis", first published in American Journal of Psychology, 21, 181-218. Retrieved Nov. 1, 2006, from http://psychclassics.yorku.ca/Freud/Origin/origin2.htm xiv Showalter, E, 1985. The Female Malady, Virago, New York. p145 xv Freud, S and Breuer, J, 1893. Studies in Hysteria xvi Porter, R, 2002. Madness: A Brief History. OUP, Oxford. p167 xvii Bai, F and Mudie, L, 2006. "East Asia's Mental Health", Healthcare Today. Retrieved Nov. 20, 2006 from http://www.hc2d.co.uk/content.php?contentId=912 xviii Szasz, T, 1974. The Myth of Mental Illness. HarperCollins, New York. xix Bosely, S, 2006. "Call to wipe out schizophrenia as catch-all tag'. Guardian Unlimited, Oct. 10, 2006. Retrieved Nov. 18, 2006 from http://www.guardian.co.uk/medicine/story/0,,1891740,00.html#article_continue xx Carroll, R, 2001. "Interview with Allan Schore, 'the American Bowlby'". Thinkbody.co.uk. Retrieved Nov. 20, 2006 from http://www.thinkbody.co.uk/papers/interview-with-allan-s.htm xxi Modell, AH, 1996. "The interface of psychoanalysis and neurobiology". Paper given to the Boston Colloquium for Philosophy of Science, Dec. 18, 1996. Retrieved Nov. 20, 2006 from http://www.psychomedia.it/pm/science/psybyo/modell.htm

*Janet and psychic energy The psychological analysis of Pierre Janet described a system of psychic energies held in tension between hierarchies of mental activity. At the bottom of the tree, psychic energy was confined to the

expression of reflexive tendencies like attraction, repulsion, incorporation or excretion. These actions might be simple or more complex, but the energy would be used until the chain of events was complete, and therefore not available for other modes of functioning. He describes epileptic seizure as a regressive return to this level of activity. The next stage of functioning, 'perceptive-suspensive', requires the ability to suspend action during a chain of events, suggesting a basic capacity to play a game, even if that game is the game of life itself. At the social level of functioning, two channels of action become apparent; the diversion of energy towards others in the social group, and its diversion towards one's own body. Janet also observed close interactions between the two systems, and saw them as having a strong effect on the emotional life of the individual. His observations have been borne out by attachment theory and still more recent neurobiological understanding of the relational basis of brain development and affect regulation. The 'middle' functions occupied a great deal of Janet's attention, especially the level he termed 'elementary intellectual tendencies'. This staged is concerned with double signals (often of form and function) contained in things, but also in the capacity to represent things in language. The capacity both to participate and to observe is important at this stage of psychic organisation, and to switch between the two. Moreno's work on psychodrama can be seen as a journey to recover this capacity, as the tension between observatory and participatory modes gets harder to hold as mental functioning becomes 'higher'; that is, more rational and objective. The first level of Janet's higher functions describes further complexities, as the ability of language to detach itself from the world is experienced. One of the characteristics of this stage is the ability, as Tolkien would say, to say 'green sun'. Janet calls this inconsistent language. He shows how language exacerbates the difference between the individual's experience of themselves and their interaction with the world. He also describes a difference between the ease of saying something ('talk is cheap'), and the act of affirming it to oneself, or in bringing it to action in the world. This stage is called 'immediate actions and assertive beliefs' and is linked closely to the development of will and thought. It is also the point at which psychological life exists through persona roles and projections onto others, in Jungian terms. The rational-ergetic stage is the level where the human world becomes truly separate from the animal, with organisational structures and logic which are carried through often for no other reason than that they exist. Real world experience is reintegrated with the emergence of scientific enquiry at the next, 'experimental', stage, while the best a human being can be begins with the emergence of a reflective capacity. At this level, many of the themes of the earlier levels are recapitulated, like the ability to stand more than one viewpoint. Except that, this time, different levels of psychological reality are held in tension and synthesised. He describes the 'complete real' the synthesis of which requires the affirmation, through reflection, of the existence of corporeal and non-corporeal bodies. The former are endowed with material form; the latter with intentionality. In the 'almost real' mode, the individual is making use of a sensitive feedback mechanism, in a state of constant adaptation. Janet calls this process 'selfreporting'. And in the 'semi-real', abstract ideas, fantasies, recent memory and predictions for the near future are brought into play. This most complex stage of psychological development Janet called 'progressive tendencies', and linked it to the refinement of consciousness. Janet saw psychological problems in terms of the individual's ability both to draw upon a supply of psychic energy, and to maintain it at levels of ever-increasing complexity, without losing the force necessary to contain the raw energy, or without the supply being insufficient to stay at the level already achieved. He describes an evolutionary, bottom-up and adaptive process of ever-increasing complexity, which is open-ended and sensitive to its environment. Janet also emphasised the dissociative capacity of a psyche in which the supply of energy was out of keeping with the level of tension needed to give it form. Many of his themes were taken up by Jung, who developed them further throughout his long elaboration of the principle of the tension of opposites. They would be recognisable to many who work with notions of complex, emergent and ecological systems across a number of disciplines today.