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For psychoanalysts, neuroses are mental disorders that have no discernible underlying anatomical causes and whose symptomatology arises from intrapsychic conflict between unconscious fantasies bound up with the Oedipus complex and the defenses that these fantasies arouse. Neuroses may be defined in several ways. From a topographical standpoint, they may be defined in terms of a specific differentiation of the ego. From a dynamic standpoint, they may be defined by the ego's embrace (under the influence of the superego) of the reality principle, to the detriment of the pleasure principle and the id's instinctual demands, and this leads to the emergence of castration anxiety. From an economic standpoint, they may be defined by a prevalent but partly ineffective mobilization of the mechanisms of repression against the id's instinctual demands. Finally, from a developmental (or genetic) standpoint, they may be defined by the achievement of a symbolization of intrapsychic conflicts in accord with the oedipal model. This basic neurotic structure is variously associated, in the adult as in the child, with different sets of symptoms (hysterical, phobic, or obsessional).

Nineteenth-century medicine used the terms neurosis and psychasthenia interchangeably to denote nervous conditions of "functional" origin. It was accepted that the impact of such conditions on the various bodily systems (digestive, cardiopulmonary, urogenital, etc.) was unrelated to any underlying clinical or anatomical factors, and furthermore that there was no major degradation of the subject's relation to reality. This kind of exclusive diagnosis, purely behavioral and "pre-psychoanalytical," was revived in the 1990s by some present-day nosologies, among them the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the tenth edition of the World Health Organization's International Classification of Diseases (ICD-10).

As early as 1894 Freud drew a distinction between two classes of psychopathological phenomena: on the one hand, the so-called "actual" neuroses, which, in accordance with classical medical theories, he related to a sexual dysfunction contemporaneous with the mental condition (frustration in the case of "anxiety neurosis," masturbation in the case of "neurasthenia"), and on the other hand, the psychoneuroses of defense, whose cause, he set out to show, was to be found in an intrapsychic conflict of infantile origin.

Only the psychoneuroses, which for a time Freud called "transference neuroses," correspond to genuine neuroses as Freud definitively described them in 1924: anxiety hysteria (or phobic neurosis), conversion hysteria, and compulsive (or obsessive) neurosis. This clear distinction between the two types of neuroses, though Freud acknowledged that it was sometimes arbitrary, remained essential to his theory. The hypothesis that the origin of the psychoneuroses lies in intrapsychic childhood conflict constitutes, along with dream theory, the theoretical bedrock of psychoanalysis.

The topographical, dynamic, and economic viewpoints, as presented briefly above, have not undergone any serious revision since Freud's work of 1924. A handful of details aside, all psychoanalytic authors would probably concur with the following formulation from "Neurosis and psychosis": "The ego has come into conflict with the id in the service of the super-ego and of reality; and this is the state of affairs in every transference neurosis" (1924b [1923], p. 150). In contrast, the "genetic" or developmental standpoint still continues into the twenty-first century to spark endless controversy.

In his rereading of Freud's case of the "Wolf Man" (1918b [1914]), Jacques Lacan (1988) drew a clear distinction between what he called "foreclosure" (Verwerfung) and the concept of repression (Verdrängung). Evoking the feminine position assumed by the subject in the oedipal scenario (a position that prohibits the subject, under the threat of castration, from accepting genital reality), Lacan noted, "The Verwerfung thus cuts off short any manifestation of the symbolic order" (1988, p. 38). For Lacan, this inability to access the symbolic order differentiates psychosis from neurosis, where there is access to the symbolic order. In his terms, neurotics seek, in a more or less elaborate way, "to introduce into the demand whatever the object of their desire is" and, symmetrically, "to satisfy the demand of the Other by conforming their desire to it." Because the "Wolf Man" could not place himself within this oedipal interplay by means of a "deferred" interpretation of the initial scene of seduction, visited upon him at a very early age by his elder sister, he was partially barred from the "chain of signifiers." In contrast, the phobia of "little Hans" (Freud, 1909b) gave him access to the symbolic order and allowed him to structure his infantile neurosis.

From a quite different perspective, Melanie Klein (beginning in 1930) took up Freud's metapsychological hypothesis concerning the death instinct. Theorizing that infantile anxiety was directed not against the libido but against the destructive instincts, she developed the notions of the schizophrenic and depressive positions, which created a need to revise the theory of the neuroses. For Klein (1975), the possibility of arriving at the depressive position by acknowledging the presence of the destructive instincts within the personality enabled the subject to access the triangular relations of the Oedipus complex and hence to neurotically organize a personality capable of tolerating loneliness. Working in the same Kleinian theoretical tradition, Hanna Segal (1957) described the transition from symbolic equation (an inability to distinguish between symbols and the objects symbolized) to authentic symbolization. Later Segal (1991) extended the theory still further by considering the conditions of artistic creation and revisiting Freud's thoughts on sublimation.

Freud proposed the term "narcissistic neurosis" as a designation for manic-depressive psychosis. This suggestion was not adopted by others, but it draws attention to the need to distinguish between manic-depressive psychosis and the other psychoses, in which the nature of the intrapsychic conflict is clearly very different. Jean Bergeret has described as "false neuroses" a number of clinical conditions mentioned by a variety of authors ("failure neurosis," "abandonment neurosis," "character neurosis," "organ neurosis," and so on) and has proposed a more neutral nomenclature ("failure-prone behavior," "anaclitic relationship," and so on). It is true that, in contrast to hysterical neurosis and obsessional-compulsive neurosis, such conditions are not clearly related to the concept of a neurotic structure. Among such false neuroses, the "traumatic" or "war neuroses" occupy a special place in Freud's metapsychology, for they serve as a point of departure in his development of the hypothesis of a death instinct lying "beyond the 'pleasure principle' " (1920g). Finally, it should be noted that the classification transference neurosis has come to have a different meaning from what Freud originally assigned to it; it refers to certain phenomena manifesting themselves in the analysand's relationship with the analyst (transference psychosis is also used in this way).

The notion of neurosis is also related, of course, to the ideas of neuroticization and infantile neurosis as mental processes that give access to symbolization. It is in fact such a powerful organizing concept that it has sometimes been taken for an "overall vision of the human being." However, we would do well to remind ourselves of Freud's consistent and deeply negative attitude toward all such overarching visions and the mysticism that invariably accompanies them.

FRANCIS DROSSART

See also: Abandonment; ; Acutal neurosis/defense neurosis; Amplification (analytical psychology); "Analysis of a Phobia in a Five-year-old Boy (little Hans )"; Basic Neurosis, The—Oral regression and psychic masochism; Borderline conditions; Character neurosis; Choice of neurosis; "Claims of Psycho-Analysis to Scientific Interest"; Complex (analytical psychology); Conflict; Developmental disorders; "Dostoyevsky and Parricide"; Failure neurosis; Fate neurosis; Flight into illness; Frustration; Future of an Illusion, The; "Heredity and the Aetiology of the Neuroses"; Hysteria; Indications and contraindications for psychoanalysis for an adult; Infantile amnesia; Infantile neurosis; Inferiority, feeling of (individual psychology); Introductory Lectures on Psychoanalysis; "Introjection and Transference"; Narcissistic neurosis; Neurasthenia; "Neurasthenia and 'Anxiety Neurosis"'; Neurotica; Neurotic defenses; Nuclear complex; "Splitting of the Ego in the Process of Defence, The"; Obsessional neurosis; Object a; Perversion; Phobic neurosis; Phylogenetic Fantasy, A: Overview of the Transference Neuroses; Primal scene; Psychoanalytic nosography; Psychosexual development; Psychotic/neurotic; "Repression"; Self psychology; "Seventeenth-Century Demonological Neurosis, A"; Subject of the unconscious; Symptom-formation; ; Transference neurosis; Traumatic neurosis; War neurosis.