Pathogenesis of neurotic symptoms in psychoanalytic theory. Causes of neurosis from the point of view of psychoanalysis

And connected with the name of Sigmund Freud. Before Freud, the cause of neuroses was seen as a disease of the nerves. Today, as at the beginning of the twentieth century, the theory of neuroses, their symptoms and treatment are most fully explored within the framework of psychoanalysis.

From the point of view of psychoanalysis neurosis is the result of a conflict between unconscious desires, often of an aggressive and sexual nature, and a mental structure that evaluates the fulfillment of these desires as potentially dangerous. This definition is an adaptation of the formulation given by Sigmund Freud regarding the difference between neurosis and psychosis, which states that: neurosis is the result of a conflict between ego and id, while psychosis is a conflict in the relationship between ego and the external world.

In other words, in neurosis, a person does not want to know anything about his inner reality - about his fantasies and desires, while in psychosis testing of external reality is violated.

Thus, neurosis is a less severe psychopathological condition than psychosis. However, the degree of suffering caused by neurosis and its impact on the quality of life is impressive.

The description of mental states, which later became known as neurotic, began to appear at the end of the nineteenth century. But the ultimate recognition and exploration of neuroses came about through psychoanalysis.

Today, approaches to neuroses are different. International classification diseases of the tenth revision (ICD-10) includes a heading of neurotic disorders. Within the framework of domestic psychiatry, disorders of the neurotic level are considered. Whereas in the American Manual of Diagnostics and Statistics mental disorders(DSM-5) there is no category for neuroses, but a number of disorders of a neurotic nature are provided.

2. In psychoanalysis, neuroses include:

Obsessions are aimed at preventing a certain event or the commission of a certain action. These events and actions are of an aggressive or sexual nature. In obsessive-compulsive disorder there is always a conflict of love and hate. In obsessive rituals, the realization of a love or aggressive desire and a ban on the realization of this desire are expressed. That is, the first action is canceled by the second, this is called the destruction of what has been done.

The result is that it is as if there was not a single action, when in reality there were both. Freud compared such magical thinking or animism to the rituals of primitive peoples trying to propitiate spirits. In the rituals of a person suffering from obsessive-compulsive disorder, the same tendency can be traced, when, for example, he performs a certain ritual action so that nothing happens to his relatives or to him. Such a person has an unconscious motive of hatred for a loved one and at the same time love for him. The stronger both, the stronger the obsessive symptoms.

Aggression in the symptoms of obsession is manifested in the desire to control not only oneself, but other people, forcing them to participate in the performance of their rituals.

The expectation of bad events, as well as the fear of injuring oneself, committing suicide, are associated with a sense of guilt for one's own hatred, which is not realized.

Contradictions in the mental life in obsessive-compulsive disorder are particularly pronounced. The world seems to be divided into good and evil. In compulsive rituals, there is a tendency to avoid "bad things" and deal only with "good" ones. Moreover, it can be difficult to understand the logic by which things are divided into good and bad.

People who suffer from obsessions are usually very energetic by nature, but the constant internal struggle leads them to indecision, doubt, lack of strength.

At their core, these are very conscientious people, as in all neuroses, in obsessive-compulsive disorder, guilt plays a large role. But there were events in their early history that prevented them from being in touch with their feelings, emotions, and desires. As a rule, these are psycho-traumatic events or circumstances that occurred at an age when the child did not have the mental resources to cope with them. This causes excitement in the psyche, which is transformed into aggressive and sexual desires that overwhelm a person, and obsessions arise as a defense against a breakthrough of these impulses.

Obsessive symptoms act as a barrier to forbidden impulses, which is why there is great anxiety if you try to stop the symptoms by volitional effort. A person seems to be deprived of restraining mechanisms and is left alone with his frightening desires.

Psychoanalysis makes it possible to investigate the cause and significance of the symptoms of obsessive-compulsive disorder. Reconstruction of the past and its connection with the present helps the patient understand himself, reduce the need for obsessive symptoms, and develop more adaptive mechanisms for coping with the onslaught of unbridled desires. When a person understands the meaning of his symptoms, he becomes able to find harmony with his inner world.

The meaning of the most intricate obsessive rituals can be understood if we trace how their appearance is connected in time with the patient's experiences, determine when the symptoms appeared and what events they are associated with.

Obsessive repetition

The symptoms of obsessive-compulsive disorder are very diverse and are described within the framework of various approaches, but the following manifestation of obsession has been studied mainly or even exclusively in psychoanalysis. It's about compulsive repetition. This is an inevitable hit of a person in the same circumstances. Certain life difficulties, tragic events can seem to haunt you through life. Moreover, the person himself feels such repetitions as bad luck or the disfavor of fate. One's own contribution to the formation of obsessive situations is often not recognized. However, there is always an unconscious motive to constantly experience the same situation.

An example is a series of relationships that miraculously develop and end according to the same scenario. It can be love relationships, friendships, situations with colleagues at work, and so on. It is as if the same circumstances find a person, or, more correctly, unconsciously he finds them, as if deliberately choosing exactly the path where "the same rake" lurked.

The treatment of neurosis with psychoanalysis helps to see the connection between the patient's past and his current life, which makes it possible to get out of the vicious circle of the same situations.

6) Emotional lability

Instability in the emotional sphere is another characteristic feature of neurosis.

The cause of emotional states and reactions often remains unclear both to those around him and to the neurotic individual himself. This is because the repressed desires and ideas, although not realized, continue to evoke feelings associated with them.

Among the feelings that are rooted in unconscious fantasies and desires, one can name: shame, guilt, anger, resentment, despondency, envy, jealousy, fear.

One of the basic feelings in a neurosis, and even forming a neurosis, is guilt. The repressed sexual and aggressive desires associated with the Oedipus complex, although not realized, continue to be condemned by their own morality. The feeling of guilt is the most difficult to endure, it torments a person, but without the ability to understand its origins and cope with it.

Dissatisfaction, despair to achieve love, internal conflicts, hatred, the causes of which remain in the unconscious, lead to aggressiveness, outbursts of indignation. If aggression is redirected to oneself, there is a depressed mood, despondency and depression.

Self-pity, low spirits, depression, and low self-esteem often accompany neurosis. A negative emotional background and underestimation of oneself lead to isolation, lack of initiative, and the loss of various opportunities. But addiction to these experiences can also arise, when the need for someone to feel sorry, sympathetic or feel guilty leads to fantasies about this or open demonstration of one's suffering. This, in turn, can form features masochism, in which pain and suffering begin to bring pleasure. As a result, a person unconsciously always seeks to turn his cheek where there is an opportunity to get hit on it.

Hot temper and irritability, becoming traits of character, can bring their owner a hidden or not so hidden pleasure, a feeling of triumph over the victims. This behavior is a manifestation sadism. But at the same time, it complicates relationships both with relatives and in professional and other areas. A person may feel like a hostage to his own explosive temperament or bad character. Behind such manifestations are unconscious motives, the understanding of which in the process of undergoing psychoanalysis helps to curb one's own temper.

Suspicion and suspiciousness can become a character trait that complicates a person's life when one's own aggressive impulses are projected outside and attributed to others. As a result, other people are perceived as bad and persecuting. This is an unconscious mechanism that allows you to keep feeling good, but violates the objective perception of other people.

Feeling special attitude towards yourself, condemnation from others, even if it strangers on the street, arises under the influence of guilt.

Love heals many diseases. But in the context of the topic under discussion, questions arise: what is love and can it save from a mental disorder?

Passion, lust, addiction, habit can be mistaken for love, but the ability to experience a mature feeling is not available to everyone. Neurosis impairs a person's ability to enter into close, truly deep relationships.

One of the concepts mental development, neurosis is associated with the undermining in early childhood of faith in unconditional love on the part of the closest. The capacity for deep attachment suffers from this. A person insures himself from experiencing disappointment associated with a possible break in relations, guided by the principle that he can only rely on himself. Such defense against attachments leads to loneliness, emotional closeness, lack of reciprocity and trust in relationships.

The ability to empathize and sympathize, to understand one's own emotions and the feelings of others, can be significantly limited as a result of neurosis. But the longing for close relationships remains.

Hysteria is associated with the need to attract attention to oneself by any means, hence the pretense in behavior, drama, theatricality, demonstrativeness. A person with such traits may, however, feel lonely and misunderstood, despite the increased interest in himself. This is due to the fact that the relationship remains superficial.

Experience depression is a difficult state of mind that cannot be compared with a bad mood. The psyche is trying to get out of this state, resorting to desperate attempts. There is inspiration, reaching to mania, when a person is overwhelmed with positive emotions, an indefatigable thirst for activity, he is like the sea knee-deep. But these states occur spontaneously without any reason, their character is artificial and superficial. The desire to take on everything at the same time does not allow you to productively focus on one thing. Such outbursts of irrepressible fun are abruptly replaced by low spirits, depressed mood, and a depressive phase begins.

Emotional swings can manifest themselves in different situations and relationships. For example, in the form of an unpredictable change of anger to mercy and back in relationships with loved ones, with children, in social contacts. The treacherous onslaught of feelings can negatively affect personal life and professional activities.

Mood lability, emotional instability are integral companions of neurosis, which psychoanalysis is designed to overcome. Awareness of the motives of arising feelings contributes to finding peace of mind.

7) Sexual disorders

Sexuality is one of the fundamental components of life. Surprisingly, such a fundamental instinct becomes very fragile under the influence of neurotic disorders. Sexual function, one way or another, is affected by any mental disorders.

For example, with depression, along with the general tone, sexual desire is also suppressed. Inadequate mental states hinder the development and maintenance of relationships, respectively, limit the possibility of a normal intimate life.

Mature sexuality is not limited to sexual intercourse. Mutual support, care for offspring, genuine intimacy in the broadest sense - these are the components associated with the manifestation of libido. Violations of interpersonal relationships, the inability to sincere intimacy undermine openness and trust in a couple. As a result, serious difficulties arise in intimate life and personal life in general, which not everyone succeeds in solving, as they say, amicably.

Mental conflicts, unconscious inhibitions, fantasies that are felt to be unacceptable and repressed, all underlie sexual disorders.

These include: impotence, which in most cases has a psychogenic nature; in men, premature ejaculation or difficulty reaching orgasm; among women frigidity, sexual coldness, inability to achieve orgasm, vaginismus - contraction of the muscles of the vagina before intercourse, which makes it impossible to penetrate the penis; aversion to sex; psychogenic pain and discomfort from sexual intercourse without somatic reasons; neurotic experiences that interfere with the enjoyment of sexual life, such as: fear, anxiety, paralyzing shame, guilt, latent homosexuality turns sexual relations of heterosexual partners into a kind of formal process.

A man who is afraid that he will not be patent enough, courageous, will disappoint the other half, really loses potency from these experiences, which instills even more uncertainty and forms a vicious circle.

A woman may worry about whether she is attractive to a man, how much she will be accepted by him, whether she will lose control if she gives herself to sexual pleasure. If such experiences are too intense, it prevents a woman from reaching orgasm or even enjoying sex.

It happens that the female gender identity is violated by disappointment, which was broadcast to the girl in childhood by her parents, who openly or covertly show dissatisfaction with her gender. Rudeness or coldness on the part of one or both parents, a ban on sexuality as such - all this prevents you from accepting femininity in yourself and undermines sexual sensuality in the future.

Men have the so-called division of the female image into “Madonna and prostitute”. It manifests itself in the fact that a man is able to sexually liberate himself and experience satisfaction only with a woman for whom he does not have tender feelings, while with one for whom he feels reverent love, sexual satisfaction is impossible.

In each case, their unconscious causes of sexual disorders.

Some of these disorders can be overcome as a result of the emergence of trust in the couple.

If both partners are aimed at gaining each other's trust, demonstrate acceptance, openness, sensitivity, in the end they achieve harmony in intimate life.

However, the neurotic foundations of sexual disorders are quite deep, behind them there may be: unconscious hatred, fear, undermining basic trust, envy, violated sexual identity. When it comes to the violation of interpersonal relationships in general, this is reflected in the sexual sphere.

In this case, psychoanalysis will help the patient to establish contact with his inner world and with other people. Problems in the intimate sphere will be solved as a person begins to realize their hidden causes.

8) Daydreaming

Not only thoughts can be intrusive, but also fantasies, or, as Freud called them, daydreams. When a person would like to change the external reality, but it is impossible to achieve immediate changes, he consoles himself with fantasy, where he can imagine himself as a hero, a winner, a desired object of love, a successful person, embody revenge for the wrongs inflicted in his dreams, or assert himself. Such comforting daydreams are a common component of mental life, but in the case of a neurosis they seem to enslave the consciousness.

Neurosis is different in that it does not have enough mental strength to try to change the real state of affairs. Instead, satisfaction occurs in fantasies. When a person plunges into the world of dreams, he becomes divorced from the real world, which further deprives him of the opportunity to set goals and achieve them. This position is akin to masturbation, which in neurosis can completely crowd out attempts to build relationships with other people.

With neurosis, mental pain or unbearable excitement arising from various experiences, memories or vivid impressions, like anesthesia, requires immersion in the comforting world of an alternative fantasy reality.

Addiction to the world of dreams can lead to pathological states of dependence, such as: gambling, alcohol, drug addiction, this also includes: extreme hobbies leading to injury and death, promiscuity or promiscuity, passion for everything that is associated with risk and excitement . Adventurism can become second nature to a person.

There are many manifestations of addiction, one of the leading feelings in them is the emerging excitement, detachment from reality and severe anxiety, if it is impossible to indulge in hobbies to which addiction has developed.

Psychoanalytic treatment aims to help the patient understand what is in their history that has prevented them from developing more mature ways of coping with reality. This research helps to understand the origins of social failures and learn how to adequately overcome difficulties. Gradually, a tolerance for anxiety develops, which previously could only be fought by escaping into the world of dreams.

5. Treatment of neurosis by psychoanalysis

Treatment of neurosis by psychoanalysis aims to help the patient understand the unconscious causes of his experiences and even certain life circumstances, come to terms with repressed fantasies and desires, see the impact of childhood history and relationships with loved ones on today's life, and develop more mature and adaptive ways to cope with various difficulties.

The fact is that the development of neurosis is associated with the so-called secondary benefit from the disease, which is not only responsible for the occurrence of the disorder, but also interferes with coping with it. The motives for the disease of neurosis consist in achieving a certain goal, the understanding of which is often not available to the sick person in the first place.

However, neurosis is not at all a voluntary choice of a person. Freud gives a metaphor, comparing neurosis with the instinctive impulse of an animal, replacing one difficult circumstance with another.

Imagine a traveler who rides a camel along a narrow path along a steep cliff, a lion appears from behind the turn. There is nowhere to go. But the camel finds a solution, he escapes from the lion by rushing down with the rider. Symptoms of neurosis best way out, it's more automatic action, lack of adaptive mechanisms since childhood. Such a choice does not allow us to cope with the situation, the solution is no better than the difficulty itself. But this is the only maneuver that the psyche of a person with a neurosis is capable of.

An ordinary conversation, no matter how confidential and warm it may be, is not able to reveal the deep unconscious motives for the emergence of a neurosis, and, consequently, to cope with it. The secondary benefit from the restrictions imposed by neurosis allows you to avoid certain circumstances, or with the help of the symptoms of neurosis to influence loved ones, to achieve a certain attitude towards yourself. All this makes nervoz a valuable acquisition, to get rid of which turns out to be unprofitable for mental economy. However, this way of solving problems is not mature, along with benefits, often imaginary, neurosis brings severe mental suffering.

Difficulties arise in interpersonal relationships, adaptation to the environment is disrupted, a person loses the ability to adequately perceive his psychological needs and be in harmony with himself.

The psychoanalyst is able not only to treat with sympathy the experiences of the patient, but he also tactfully explores the questions: what do the symptoms of a neurosis mean, why and for what did the patient fall ill?

The emergence of neurosis is associated with psychological trauma received in childhood and reactivated by a similar traumatic event in adulthood. Here the expression is suitable: "Where it is thin, it breaks there." Often these topics are associated with severe mental pain, which does not allow you to directly approach them.

Anything that prevents a person from understanding his inner world and to overcome neurosis in psychoanalysis is called resistance. To demonstrate to the patient the work of resistance and to help him overcome it is one of the main tasks of the psychoanalyst. It helps to achieve it by creating trusting and reliable relationships based on unconditional acceptance, empathy and the opportunity to discuss any topic. At the same time, confidentiality and respect for the patient's personality are guaranteed.

At the dawn of psychoanalysis, when the method was just being formed, Freud achieved success in the treatment of neuroses by helping patients remember scenes that led them to psychological trauma and subsequently repressed from consciousness. However, it soon became clear that memories do not always eliminate the symptoms of neurosis, or the result is not stable. In addition, in some cases, patients remember sad events and even realize their connection with the current state, but this does not help to cope with mental suffering.

Just remembering an event that the psyche preferred to forget means making an unhappy person out of a neurotic sufferer. That is, to return him to the moment when he acquired his neurosis. Actually, a neurosis would not have developed if a person would be able to cope with life's difficulties. Therefore, Freud came to the conclusion that in the treatment of neurosis by psychoanalysis, in addition to the memories of traumatic events, it is necessary to work out their consequences. The goal of working through is to make the patient mentally more mature, to help him overcome mental suffering, to strengthen his ability to withstand emotional stress and to use more adequate means for solving life problems than those that the neurosis forced him to resort to.

In conclusion, I would like to say about such an advantage of psychoanalysis as high standards of qualification. In psychoanalysis, a prerequisite for professional development is the passage of personal analysis. In order to be able to provide psychological help Patients need to take care of themselves. The professional community monitors the observance of the ethical principles of psychoanalytic work. Psychoanalysis is the most developed and researched method of depth psychotherapy, which has many directions. Entire institutes specialize in the study of psychoanalysis.

If you need psychological help, there are experiences that you would like to deal with, relationships do not add up, difficult life circumstances arise - contact me, I will be happy to help!

Reception lead in Moscow.

Martynov Yu.S.

Psychoanalysis arose within the framework of medicine and is the brainchild of the physician. However, the fact that psychoanalysis was originally presented as a clinical theory, and the vast baggage of psychoanalytic observations, knowledge and interpretation algorithms was intended to comprehend the causality and essence of "mental illness", is dictated by other theoretical and practical motives.

We must not forget that Freud, by abandoning the approach to observation practiced in the framework of somatic medicine, made a revolutionary revolution. According to Freud, certain symptoms, character traits and behaviors, the totality of which is usually called "neuroses", are not "diseases" caused by somatic pathological processes, but are the result of a special psychological processing of intrapsychic conflicts.

The psychodynamics underlying neurotic symptoms, as well as the corresponding defense mechanisms, are to a certain extent also characteristic of a "normal" person under ordinary conditions. It is impossible to draw a clear demarcation line between "normal" and "pathological" states, since the idea of ​​their polarity is nothing more than a convention. Thanks to psychoanalytic discoveries, the superficial pedantic description of the external manifestations of the disease was replaced by an analysis of a much more significant mental dynamics.

At the end of the 19th century, when hysteria was still considered neurological disease, monumental monographs were created, countless chapters of which were devoted to the description of individual forms of the disease (in accordance with the defeat of one or another part of the body, the little finger, respiratory organs or vision caused by this "neurological affectation"). Meanwhile, already in 1895, Freud managed in a much more compact article to characterize the essence of the “disorder” underlying all these varieties of illness.

However, neither the improvement and successful application of psychoanalytic theory in practice in the field of medicine and in many other areas of human activity, nor the decisive reorientation of the theory, taking into account the psychodynamic nature of mental and psychosomatic diseases, could create conditions for the abolition of the nosological concept of illness, and this is explained not only by the desire to preserve fidelity to tradition.
The sensational discoveries in the field of the psychogenesis of the so-called neuroses and the replenishment of the baggage of medical and other knowledge at the expense of new information obtained by the psychoanalytic method did not serve as proof that a systematic typology is superfluous. Despite significant difficulties, attempts to create a systematic psychoanalytic clinical theory are being undertaken with the same vigor. In the course of the controversy over the “specificity” of individual conflicts or character structure (that is, their belonging to a certain symptomatology, a certain psychosomatic syndrome), which subsequently flared up within the framework of psychoanalytic psychosomatics, it turned out that even with the classification of exclusively mental diseases (psychoneurosis, psychoses, equally as well as intermediate disorders) it is quite difficult to solve this problem.

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In classical psychoanalysis, several types of neuroses are distinguished. Psychoneurosis is due to past causes and can only be explained in terms of personality and life history. Freud identified three types of psychoneurosis: hysterical conversion, hysterical fear (phobia) and obsessive-compulsive disorder. The symptoms of these neuroses can be interpreted as a conflict between the ego and the id. It is psychoneuroses, from Freud's point of view, that are caused by neurotic conflict, that is, an unconscious conflict between the impulse of the "Id", which strives for discharge, and the protection of the "Ego", which prevents direct discharge or access to consciousness. Thus, a conflict is hysterical only if one of its sides is unconscious and if it is resolved by the application of defense mechanisms other than sublimation. In this case, the symptom is considered as a compromise between the suppressed desire and the requirements of the overwhelming factor. The occurrence of the symptom is due to symbolization, which Freud characterized as "an ancient but obsolete way of expression." The super-ego plays a complex role in neurotic conflict. It is the "Super-ego" that makes the "Ego" feel guilty (which is consciously felt very painfully) even for the symbolic and distorted discharge that manifests itself as a symptom of psychoneurosis. Thus, all parts of the mental apparatus participate in the formation of a neurotic symptom. The actual neurosis is due to present causes and can be explained in terms of the patient's sexual behavior. It is a physiological consequence of disorders in sexual functioning. Freud distinguished two forms of actual neurosis: neurasthenia as a result of sexual excesses and anxiety neurosis as a result of the lack of discharge of sexual excitation. Narcissistic neurosis is associated with the patient's inability to form a transference. Character neurosis is expressed in symptoms that are essentially character traits. Traumatic neurosis is caused by shocks. Transference neurosis develops in the course of psychoanalysis and is characterized by the patient's obsessive interest in the psychoanalyst. Organ neurosis refers to a psychosomatic disease, but this term is used quite rarely. Childhood neurosis manifests itself in childhood, while classical psychoanalysis proceeds from the fact that neuroses in adults are always preceded by childhood neuroses. A neurosis of fear (anxiety) means either any neurosis in which anxiety is the main symptom, or one of the types of actual neurosis.

From Freud's point of view, the essence of neurosis is the conflict between the unconscious and consciousness: "From the very beginning, we notice that a person falls ill because of the conflict that arises between the demands of instinct and the internal resistance that arises inside against this instinct." The conscious component is the norms, rules, prohibitions, requirements that exist in society and are elements of the "Super-ego", the unconscious component is the primary, instinctive needs and drives that make up the content of the "Id". Displaced into the unconscious, they do not lose their energy potential, but, on the contrary, retain and even strengthen it and then manifest themselves either in socially acceptable forms of behavior (due to sublimation), or - if this is not possible or insufficient - in the form of neurotic symptoms. Thus, neurosis is a consequence of the conflict between the conscious and the unconscious, which form primary, biological needs and desires, primarily sexual and aggressive, repressed under the influence of moral norms, rules, prohibitions, requirements.

However, it should be noted that different representatives of psychoanalysis unequally understand the content of the unconscious and, consequently, the content side of the neurotic conflict. For Freud, these are sexual and aggressive impulses and their conflict with consciousness. A. Adler saw the essence of neurosis in the conflict between the feeling of inferiority and the desire for self-affirmation, the thirst for power. He saw in the neurotic state an experience of weakness and helplessness, which he described as an "inferiority complex." To overcome the feeling of inferiority and satisfy the need for self-affirmation, a person resorts to the mechanisms of compensation and hypercompensation. The neurotic symptom is seen as an expression of a struggle aimed at overcoming the feeling of insufficiency. A neurotic symptom is the result of an unsuccessful compensation, a fictitious way to enhance one's own dignity. The development of neurotic symptoms is considered "flight into illness", "desire, power", "male protest". The first and third symptoms are a way of drawing attention to oneself (with the help of a symptom, a person can get it even more than a healthy one), while the desire for power - the second - comes into conflict with a feeling of closeness with other people. Adler defined neurosis as an existential crisis affecting the entire personality. He saw the main phenomenon of mental disorders not in resistance to impulses, but in a neurotic character, an inadequate attitude towards life.

C. G. Jung considered the content of the unconscious much more broadly, believing that, in addition to repressed sexual and aggressive urges, it also includes some intrapsychic material that has deeper, historical, roots - the innate experience of past generations. From Jung's point of view, the human psyche includes three levels: consciousness, personal unconscious and collective unconscious. The collective unconscious is a mental content common to all people, existing independently of a person, “the mind of our ancient ancestors”, which is a deeper and less accessible level of mental activity. The collective unconscious is presented in the form of archetypes - mental structures, primary mental images that make up the content of the collective unconscious. Archetypes are considered as prototypes, dominants, a priori forms of organization of our experience. Archetypes determine the nature of human symbolism, dreams, fairy tales, myths. They can express religious feelings and have the meaning of collective symbols. Jung gave archetypes the meaning of predisposing factors, internal determinants mental life of a person, guiding his behavior and making it possible to realize certain patterns of behavior common to most people, even in situations that the person himself has not previously encountered, which are not in his personal experience.

The personal unconscious, on the contrary, is connected with the past experience of a person and consists of impulses, memories, desires, experiences that are repressed or forgotten, but can be realized quite easily. The personal unconscious contains complexes (or is organized in the form of complexes), which are a collection of emotionally charged thoughts, tendencies, ideas, memories, desires, feelings associated with personal experience individual. Displaced into the unconscious (in particular, under the influence of a moral sense, which Jung also considered innate), these complexes have a significant impact on a person's mental activity, on his behavior. Complexes that have a high degree of affective charge and come into conflict with the conscious "I", and are the source of neurotic disorders.

K. Horney considered two basic needs as determinants of human behavior and development: the need for security and the need for satisfaction. Central to Horney's theory is the concept of basal anxiety, which she describes as "the feelings of a child, alone and defenseless in a potentially hostile world." Basal anxiety is a deep feeling of loneliness and helplessness, a feeling of insecurity. In response to the frustration of this need, the child develops certain behavioral strategies that can be fixed as protective mechanisms in relation to anxiety. Horney considers such fixed strategies as neurotic needs. Initially, Horney identified 10 basic neurotic needs, later described three personality types based on the severity and predominance of certain neurotic needs and their corresponding behavioral strategies: compliant personality (need to be near others, in recognition and love of a dominant partner - people orientation) , detached personality (need for solitude, flight from people, independence and perfection - orientation from people) and aggressive personality (need for opposition, power, prestige, admiration, success, need to subjugate others - orientation against people). A neurotic personality is characterized by the dominance of any one need or one group of needs and their corresponding behavioral strategies. Such inflexibility, the inability to direct behavior to meet other needs and change behavior in accordance with new circumstances, does not bring success, but only increases frustration and exacerbates neurotic problems.

As mentioned above, Horney identified two basic needs: the need for security and the need for satisfaction. The latter includes the satisfaction of not only physical (biological) needs, but also the need for self-esteem and self-respect, evaluation, acceptance and recognition by others, in achievements. The presence of these two needs (security and satisfaction) is a source of constant contradictions and conflicts. To satisfy the need for security, a person uses fixed strategies of behavior, that is, he forms behavior that limits the scope of his functioning (restrictive behavior) to relatively safe areas, which reduces anxiety, but hinders real achievements, that is, the need for satisfaction is frustrated. In striving for achievements, a person is forced to explore new areas, abandon fixed strategies and restrictive behavior, which leads to the frustration of the need for security. Thus, the presence of these two needs carries a contradiction, which can lead to neurosis. And in this sense, the difference between health and neurosis is only quantitative.

E. Fromm also does not see any qualitative differences between health and neurosis. From his point of view, a person is characterized by the presence of two tendencies, or two needs: the need for freedom, autonomy, one's own identity, self-expression and the need for security. Fromm believed that people, in principle, can be free and autonomous and still not lose a sense of community with other people and a sense of security. He called such freedom positive freedom, but in modern society for many it is unattainable. And these two needs are in constant conflict, for the struggle for personal freedom and autonomy leads to alienation from others, to feelings of loneliness, detachment, and to the frustration of the need for security and community with other people. Fromm saw the cause of neurosis in unconscious, compulsive activity - "escape from freedom" as a way to get rid of feelings of loneliness, hopelessness and personal responsibility. Fromm described three main mechanisms, or three strategies, for escaping from freedom: authoritarianism (sadism and masochism), destructiveism, and conformism. The conflict between the need for freedom and the need for security, as well as the mechanisms of escape from freedom, are present both in patients with neurosis and in healthy people, but with varying degrees of intensity.

In general, all representatives of psychoanalysis are characterized by a view of neurosis as a conflict between conscious and unconscious needs and tendencies. In terms of content, these needs and trends can be understood in different ways.

According to Freud, the symptoms of mental illness are harmful or useless acts that a person often complains about as being forced and associated with trouble or suffering. Their main harm lies in the mental costs that they themselves cost, and in the costs necessary to overcome them. With the intensive formation of symptoms, the costs can lead to impoverishment of the personality in relation to the disposal of its vital energy.

The neurotic symptom is the result of a conflict arising from a new kind of libido satisfaction. The id and the 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 from two 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 the symptom comes from is answered by impressions that come from outside, were at one time necessarily conscious, and since then, through forgetting, can become unconscious. The purpose of a symptom, its meaning, its tendency, is an endopsychic process which may have been conscious at first, but it is no less likely that it was never conscious and remained forever in the unconscious.

Neurotic symptoms, like erroneous actions, like dreams, have their own meaning and, like them, are connected in their own way 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 that gives satisfaction to the repressive tendency of the ego. Moreover, the solution of the conflict by the formation of a symptom is the most convenient and desirable way out. There are times when even a doctor must admit that resolving a conflict in the form of a neurosis is the most innocuous and socially acceptable solution. If it can be said that every time in the face of conflict a neurotic flees into illness, then it must be admitted that this flight is fully justified, and the doctor who understands this state of affairs will step aside, sparing the patient. Read more: http://www.gumer.info/bibliotek_Buks/Psihol/freyd/07.php

Freud's classical psychoanalysis includes the theory of the psychological origin of neuroses. He distinguishes the following types of neuroses.

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

The actual neurosis is due to causes that are relevant to the present and can be explained in terms of the patient's sexual habits. It is a physiological consequence of disorders in sexual functioning. Freud distinguished two forms: neurasthenia as a result of sexual excesses and anxiety neurosis as a result of lack of relief from sexual arousal. There are differences in the symptoms of actual neuroses and psychoneuroses: in both cases, the symptoms originate from the 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 processes are not involved at all. mechanisms.

Narcissistic neurosis, in which a person is not capable of forming a transference.

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

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

In the transference neurosis that is evoked in the course of psychoanalysis, the patient shows an obsessive interest in the psychoanalyst.

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

The same factors always operate in the cause and mechanism of all possible forms of neuroses, only in one case one of these factors acquires the main significance in the formation of symptoms, in the other - the other. Thus, fantasies that turn into symptoms nowhere appear more clearly than in hysteria; opposite or reactive formations of the ego dominate the picture of obsessive-compulsive disorder. I state according to: Enikeev, M.I. General and social psychology. M.: Respublika, 2006. 210 - 211 p.

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

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

Considering the practice of using the concept of "neurosis" as a unit of illness as an anachronism, I suggested that diagnostics be carried out taking into account at least three dimensions.
It is about the nature of the key conflict, the current state of the ego/structure, and the modality of processing. With the help of the latter terms, he tried to characterize not only the obvious symptoms, but also the underlying psychodynamics. First, these three dimensions can be varied—slightly, cautiously, and at the same time not quite arbitrarily and independently of each other.

Secondly, a separate way 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 rejected 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 another.

The approach based on three-dimensional diagnostics can hardly be called an absolute innovation. It has long been practiced by many specialists who combine symptomatic and structural diagnostics. At the same time, 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 turning Special attention on the fact that the processes, the development of which is fixed in these three dimensions, proceed to one degree or another independently of each other, and this creates conditions for their adequate comprehension. At the same time, the proposed paradigm implies a current diagnosis that is subject to constant changes, which seems to me more an advantage than a disadvantage, since under these conditions nothing prevents further progress along the path of understanding and understanding the essence of dynamic development within the framework of therapy. And finally, it seems to me no less important 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 was the impetus for a new psychodynamic classification of psychotic and non-psychotic disorders, in which individual illness pictures and associated defense complexes are classified according to their degree of 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, transient syndromes of persecution mania, delusions of relationships, love mania, 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, the so-called abnormal personality types and neurotic states.