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Neuroses

Borderline psychiatric disorders, and neuroses make up a good deal of them, are predominant in a large group of mental illnesses. According to the World Health Organization about 10% of the population of the industrially developed countries suffer from neuroses and during the last 65 years their number has multiplied by 24 times. Neuroses, like an epidemic, are spreading universally. It is known, that from 30 to 65% of people who visit general practitioners have  expressed neurotic symptoms. There’s a sad joke among the experts studying this pathology: instead of asking whether a person is suffering from a neurosis one should ask what particular type of neuroses he or she is suffering from.

According to the definition, neurosis is a psychogenic (occurring on the nervous ground) neuro-psychic disorder, which is formed as a result of the violation of vital relations of man. In simple words it means that a neurosis is developed when a person due to various circumstances fails to find a way out of a predicament, to resolve a psychologically relevant situation or to survive a tragedy.

The symptoms of a neurotic breakdown are well known: irritability, insomnia, a feeling of inner discomfort, inactivity, apathy, lack of appetite. Phobias, outbursts of aggression may occur etc. All these symptoms may be accompanied by a general lack of energy, unpleasant bodily sensations, vegetative disorders. Manifestations of neuroses may be generally named as a resistant loss of ease of mind. The person suffering from a neurosis preserves his or her criticism, is depressed by his or her condition, but can’t do anything about it.

Along with that there are some states with the clinical picture reminding that of neuroses, but having a different mechanism of development. They are defined as neuroses-like, they occur  in the course of many somatic diseases, infections, cerebral atherosclerosis and other pathological conditions.

The term “neurosis” is firmly established in our life and is everyman’s knowledge. They single out school and retirement neuroses, achievement and isolation ones, somatogenic, environmental, children’s,“week-end” and even fate neuroses.

A special group is comprised of the so-called noogenic neuroses, connected with existential frustration or the loss of the meaning of life, conflict of values. There is data confirming that approximately every fifth neurotic case has a noogenic basis, but actually it seems that almost every neurosis has spiritual roots. But let’s tell everything in its turn.

The term “neurosis” was coined by Scot, physician William Cullen in 1776. It does not mean however, that before Cullen neuroses had not existed at all. Their emergence, as emergence of illnesses as such, happened due to the Fall of man. One can find description of neuroses already in the ancient written sources of mankind. Thus, the Kahun papyri (about 1900 B.C.) and the Ebers papyrus (about 1700 B.C.) contain data about sickliness of women, which very much resemble the clinical picture of the hysteric neurosis.

The first stage of scientific exploration of neuroses is connected with the name of a German philosopher and psychiatrist Karl Jaspers. Jaspers was talking about relation between psycho-traumatic situation and the diseased state, as well as about the fact that recovery of the patient occurs after cessation of impact of psycho-traumatic factors.

The next stage may be connected with the concept of another German psychiatrist and psychologist Ernst Kretschmer about individual-psychological types. Kretschmer pays attention to the personality of man. “The situation fits the person as the key fits the lock”, - Kretschmer used to say. Later on neurosology became dominated by psychoanalytical concepts.

Scientists opinions about neuroses became confused. Neurotic reactions which may follow heavy commotions, conflicts, somatic diseases or worries of life, are quite diversified. Their symptoms overlap with the personality of man, his or hers peculiarities of character, upbringing, social conditions – which leads to opposite viewpoint on this problem.

It is interesting to note, that at the cutting edge of scientific discussions you may see not only the issues of classification of neuroses, but even their existence as a nosological entity. The extreme point of view of some psychiatrists looks approximately like this: neurosis is a bad, persistent habit of non-adaptive behavior ( Joseph Wolpe).

The major theories of neurogenesis may be briefly summarized as follows: cerebral dysfunction; repression of an internal conflict; ultimatism of mindset and dogmatic thinking; inability to predict conflicts and get ready for them; wrong stereotypes of behavior; failure to implement self-actualization need etc. Some researchers will refer the roots of neuroses to the peculiarities of thinking, others – to the pathology of emotions, the third ones – to the violation of the process of self-cognition, the fourth ones – to psychological immaturity and infantilism. Still others prefer neuro-physiological factors. Some scientists make an accent on the rush of our life.

For example, M.M.Khananashvily was speaking about neuroses as of a disease, associated with information overload. In his book “Informational neuroses” he presents the following prove of his point of view: “… it has been calculated that in economically developed countries by the year 1970 every person made on average during one year more long distance trips, met more people, obtained more information, than an average person in 1900 during the whole of his or her life… About 25% of the global population are affected by dramatically increased information overloads…”. This explorer believes that the risk of development of the disease is connected with lasting implementation of a bulky volume of works under conditions of time pressure and a high level of motivation.

Academician P.V.Simonov, on the contrary, characterizes neuroses as a disease of shortage of information. Thus, according to this scientist, whose statements also seem to be substantiated and logical, the fury, for instance, compensates for the lack of information necessary for the organization of an adequate behavior, the fear – for the lack of information needed to organize defense, the grief occurs when there’s a heavy deficit of information about the possibilities to compensate for the loss etc.

The majority of modern explorers agree that neurosis is a personality disorder. A person becomes sick with neurosis not all of a sudden - this ailment has its period of pre-existing disease. It is possible to picture a sort of a profile of the potential neurotic, to be more precise, it is going to be a whole gallery of types, each of which is inclined to transfer potential, latent sickliness to reality. One of the distinctive features of such people is the style of thinking, characterized by ultimatism; their assessments are expressly flat, whatever is taking place – it does not have any shades and is based on the contrast: bad-good.

Neuroses more often result from inner personal processes. External initiating agents and circumstances act just as the last drop, a triggering mechanism of the development of neurotic disorders. A person predisposed to this sickliness develops a certain ability to respond to life in a nervous way. Some reasons for affective experience (conflicts, stresses) may fade away with time, become irrelevant, but soon they are substituted by others, and the sickliness repullulates. The attitude towards neurosis as a minor mental dysfunction is changing to a large extent.

The principle of functionality (easy reversibility) is not proved by the modern clinical practice. According to the published data, recovery after neuroses is registered in less than 40-50% of the patients. Often the sufferings last for years and even decades.

In the course of the disease they distinguish neurotic reaction, acute and chronic neuroses and neurotic development.  The proposed scheme makes it possible to see and analyze a possibility of transfer from one type of the clinical course to another (reaction – neurosis – development). The patients with diagnosis of “neurotic development” are practically disabled, they are often given a certain degree of disability.

It should be stressed, that the colleagues will consider any psychological school, any scientific theory accomplished only when it is substantiated and provides a new angle of viewing the problem of neuroses.

So, there are many standpoints, but no clarity. The science got tangled. Increasingly often they speak of neurosis as of a multi-casual psychic disorder, and there is a point to it. However, to my mind a good deal of the problem remained in the shadow. Neurotic pathology, apart from anything else, has a spiritual basis, which has largely been ignored and still is ignored by psychiatry to my regret.

The unrestrained growth of neuroses is generated not only by stresses and scientific/technological progress with its informational overloads, but first of all by spiritual factors and circumstances, by captivity of man’s soul to sin.

Throughout its history, mankind has survived wars, different natural disasters, floods, droughts, and tornados. And it is difficult to juxtapose, for example, to what degree our present time is more anxious and unsettled than the epoch of reign of Ivan the Terrible. Why did the problem of neuroses become so acute only in the last century? There is, it seems, only one reason – the lack of faith, the loss of a spiritual foundation of mankind, together with the true meaning of life. It turns out, that the origin of neuroses is rooted not so much in stresses and worries but in the human personality. And notably in the personality with an internal disorder.

In his letter to the author of these lines the Holiest Patriarch of Moscow and of the Whole of Russia Alexi II wrote, that “the rhythm and a widespread way of life of the modern man, regretfully, leaves very few possibilities for taking care of the condition of one’s soul, this is why often sinful inclinations, once rooted, become a source of and reason for many serious illnesses”.

Sin, as the root of all evil, brings along neurotic disturbances. Taking place in the depth of the human spirit, it arouses passions, disorganizes the will, excludes emotions and imagination from the control of the consciousness. According to St.Theophan the Recluse, “the internal world of the sinner is filled with high-handedness, disorder and destruction”. Deep neurosis is a sign of moral illness, spiritual and mental disturbance. Enumeration of symptoms of a neurosis often is simply a list of sins (irritability, fits of anger, impatience etc) and the “spiritual diagnosis” may correspond to the medical one.

The deadening power of sin consists, according to St.Theophan in “ deprivation and a sort of killing of psychic and bodily powers. Sin is called a poison: and indeed, it is a poison. As iron is eaten away by rust, the soul and body are eaten by it. It deprives the mind of alertness, agility, quick understanding, the will of its strength and tenacity, the heart of its flair and grace. The poisonous nature of sin for the body is obvious to everybody. In this respect a man captured by sin is the same as the one who is dying or is pre-mortally yearning. How sensibly it is manifested in the continuous, wretched condition of the sinner! “

A well-known Russian psychiatrist, professor D.E.Melekhov believed, that many mental disorders are rooted in the lack of humility, and in particular in arrogance. Neurosis in this sense is not an exception. It is generally accepted that this illness develops due to the conflict of personality with self (intra-psychic conflict) or with other people (inter-psychic conflict). Neurosis is a clash between the desirable and the actual. The stronger is the clash, the more acute is the illness. “The faith in essence is humility “– says st.Varsonofy the Great. Many years’ experience and observations show, that sinful passions cause numerous mental disorders, including neuroses. Neuroses are justly considered to be an inveterate form of passions (passion here is understood in the patristic sense of this word as a sinful disposition of the soul).

What are these sinful passions and how do they affect the human soul? Passions are sinful habits of the soul, which due to the long time and frequent exercise of the sin turned into a sort of natural qualities. Thus, for example, the one who is constantly irritated, ignites with wrath, the one who gets insulted even by an insignificant action or a word by his or her fellowmen, who is filled up with revenge etc – is possessed with the passion of wrath. The one who is fond of thinking and speaking rhetorically about himself or herself and meanly about others, accusing and disapproving them – is possessed by the passion of pride, the most sinister passion. So, every passion engenders a certain sin.

According to the Holy Fathers, the seed of the moral evil in man is self-love, which grows into arrogance (love of glory), love of pleasures, greed (covetousness). The Holy Fathers single out eight main passions: gluttony, lust, covetousness, wrath, sorrow, despair, vanity, pride. We must elaborate on pride separately.

Pride is the beginning of every sin. It contains all types of evil: vanity, love of fame, love of power, coldness, cruelty, indifference to the sufferings of fellow-men; pensiveness of mind, the strengthened action of imagination, demonic expression of eyes, demonic character of all shape; gloom, melancholy, despair, hatred; envy, abjection, often break-downs leading to fleshly lusts; painful internal anxiety, disobedience, fear of death or vice verse – inclination to suicide and, quite often – total madness. These are the signs of demonic spirituality. But unless they make themselves conspicuous, many people do not notice them.

The underlying basis of various neurotic symptoms is formed by impoverishment of love in human hearts, and there, where there is no love, indifference, hostility, intolerance, irritability, irascibility, envy, fear etc ripen. One patient, suffering from a prolonged neurosis confessed to me during one of his visits: “Envy is destroying me. When I see that my neighbor or acquaintance is in possession of something better than I have, I cannot sit still, as if I am burning down from within”.

Father Alexander Elchaninov wrote: “It seems to me, that nervousness and so on are just types of sin, and in particular of pride. The major neurasthenic is the devil. Can one possibly imagine a humble, kind, patient person being a neurasthenic?”

“Irritability comes from not knowing oneself, from pride, and also from not realizing the depth of our nature’s damage, and from not knowing the meek and humble Jesus”(Righteous St.John of Kronstadt).

Irascibility, irritability are always preceded by pride, self-conceit, self-praise. The Archbishop Arseni (Zhdanovsky) described the reasons of irritability and loss of ease of mind: “All of a sudden you are seized by a sort of irritability, discontent with people surrounding you, or just by prostration of spirit, melancholy, disappointment. The least thing abates your spirits. Why? Apparently, your spiritual ground was prepared for this mood previously. Irritability, discontent with people are caused by envy, hostility towards them…”

Pastors of the Church paid particular attention to keeping peace of soul under any life circumstances. “I do not wish you either wealth, nor fame, nor success, nor even health, but just  peace of mind. This is the most important thing. If you have peace – you will be happy” (Venerable Alexis of Zosima). A logical deduction follows: “the best medication for neuroses is a Christian way of life with uncomplaining bearing of one’s cross, thanking God for everything, humility.

Life of many modern people is remote from Devoutness, from Christ the Saviour and His Holy Church. And this remoteness often leads to commotion of the spirits.

Many neurotics speak of insensibility of soul, a sort of internal cold. The Venerable Seraphim of Sarov taught: “God is the fire warming and kindling the hearts and bowels. Thus, if we feel coldness in our hearts, which is from the devil, for the devil is cold, then let us beseech for the Lord, and He, upon coming, will warm up our hearts with perfect love not only to Him, but also to our fellow-men. And in the name of the warmth the coldness of the hater of good will be banished.”

Every illness has spiritual roots, but it is sometimes impossible to identify them. Neurosis is singled out from among other psycho-somatic disorders by being a moral barometer, in a way. Its connection with the spiritual sphere is apparent, and the growth of this ailment following spiritual anguish and pangs of consciences can be fast-moving. However, sin only creates spiritual ground for the occurrence of neurosis, the development of neurotic manifestations depends on the peculiarities of the personality, living conditions and upbringing, neuro-physiological preconditions, as well as various stresses and other circumstances, many of which are hard to take into account.

Not everything can be put into one scheme, life is much more sophisticated. One person may develop neurosis, while in another the reaction can be limited to a shock, but illness does not occur. The underlying essence of neuroses is a secret known only to the Lord.

It must be noted, that the clinical study of neurotic disturbances has changed drastically during the last 10-15 years. It has become more complex, confused (as, by the way, have the souls of the patients), while the length of the illness has become more prolonged. Misunderstandings are constantly growing between people, even among closest; unclocking the door of the heart and mind of the patient is becoming more and more difficult. And it is not only my observation, but also the opinion of many of my colleagues.

In conclusion, I wish to underline, that a person suffering from neurosis is neither better or worse than anyone else. His or her illness is simply a personal event of the consequence of sin. Human nature has been damaged by sin since the days of our forefathers, therefore all of us must repent and improve, hoping for the Lord’s help and mercy.

In spiritual sense the treatment of neuroses is a journey along the path of love and humility, meekness, patience leading to Christ. It is the path of struggle with sins and passions.


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