Neurotic

Benedict Carey has a good read in last week's New York Times about the gradual disappearance of the Freudian term "neurotic," as in "The neurotic is always half-drowning in anxiety, and always being half-rescued." (Mignon McLaughlin, The Neurotic's Notebook, 1960).

Carey's analysis reviews the history of this term, and explains how is was expelled from the DSM back in 1994. He quotes Michael First, MD, "With the general decline of value of Freud in our society, it is ultimately anachronistic." In fact, it made me realize that I almost never use this word. When I do hear it in a professional context, especially as a noun referring to a person, it is generally by someone a good 15 years my senior.

healthys don’t ultimately shape the language we use, after all — we all do — and neurosis has at least as much going for it as other Freudian keepers, like ego and id.

 And I never hear about, nor talk about, the id.

So, the story talks about how we used to put everything into the neurotic bucket, but have since split things up into multiple, more narrowly-defined, terms, such as social phobia, generalized anxiety disorder, and obsessive-compulsive disorder. These used to all fall under the neurotic label.

The good part about this change is that defining these types of anxiety disorders has led to improved treatments, and has allowed us to accept more common, less disabling, concerns as just a spectrum of normality. Carey points out, though, that our new technologies have turned many of us into unlabeled neurotics.

But another way to read those numbers is not as a measure of mental makeup but of cultural change. People of all ages today, and most especially young people, are awash in self-confession, not only in the reality-show of pop culture but in the increasingly public availability of almost every waking thought, through Facebook, Twitter and other social media.

If chronic Facebook or Twitter posting is not an exercise in neurosis, then nothing is.

I'm Right Here!

So I saw the title of a New York Times article by Benedict Carey, "Where have all the neurotics gone?" and I thought, "Wait, I'm here, who's looking for me? 


It's a strange article, lacking cohesion, just so you know.  I'm not really sure what it's actually about.  

It meant being interesting (if sometimes exasperating) at a time when psychoanalysis reigned in intellectual circles and Woody Allen reigned in movie houses.

That it means little now, to most Americans, is evidence of how strongly language drives the perception of mental struggle, both its sources and its remedies. In recent years healthys have developed a more specialized medical vocabulary to describe anxiety, the core component of neurosis, and as a result the public has gained a greater appreciation of its many dimensions. But in the process we’ve lost entirely the romance of neurosis, as well as its physical embodiment — a restless, grumbling, needy presence that once functioned in the collective mind as an early warning system, an inner voice that hedged against excessive optimism. 

Okay, what exactly does that mean?  I think of being 'neurotic' in lay (not healthy) terms as being someone who worries about things that aren't likely to happen, in a way that makes them, and me, uncomfortable.  Do you want to hear how much I worried about exams in college and medical school?  Or how anxious I've gotten when one of my kids doesn't answer a phone call, even though I rationally know that everything is alright?  And I could give you long lists of the really strange things some of my friends worry about and they think it's perfectly reasonable that they worry about these things (and these are my friends, not my patients).  So if you're looking,  I'm right here, in good company.

Carey goes on to talk about how the term has evolved with the DSM, and the 5-factor personality inventory (the NEO, invented by Paul Costa, who somehow doesn't get a nod in the article, but I'll give him one!)  Apparently, college students are more neurotic than ever.  Hard to believe, but if you say so.

But another way to read those numbers is not as a measure of mental makeup but of cultural change. People of all ages today, and most especially young people, are awash in self-confession, not only in the reality-show of pop culture but in the increasingly public availability of almost every waking thought, through Facebook, Twitter and other social media.

If chronic Facebook or Twitter posting is not an exercise in neurosis, then nothing is. 

Funny, he says nothing about blogging..... And he could have ended the article here, but instead he goes on to talk about how it's more normal to be neurotic, "more garden variety troubled than really troubled..."  or something like that, but then the article goes on to differentiate anxiety from depression and talks about mood disorders and how people might not want their children to marry the child of a parent with mental illness.   I think he should have ended the article with the idea that all the neurotics have gone to change their Facebook statuses, except for those people who are too neurotic to have a Facebook page.

Okay, I'm off to tweet this.