Psychoneuroses

PSYCHONEUROSES, a term that has had different meanings at different times. In older psychiatric literature (in the manuals of Schüle, Krafft-Ebing, and others), the term psychoneuroses united mental diseases "without obvious pathoanatomical changes"—"functional psychoses," which were classified as including melancholy, mania, primary curable dementia, and hallucinatory confusion. These "psychoneuroses" afflict individuals with a normal brain, thus being as it were accidental disorders, in contrast to "psychic degenerations." Briquet and later Charcot advanced a different understanding of psychoneuroses: with them, the concept of psychoneurosis almost coincides in its content with the concept of neurosis and embraces that group of functional disorders of the central and autonomic nervous systems in which the intervention of the psyche plays a predominant role. This understanding of psychoneuroses became especially widespread during the period of active study of hypnotic phenomena, when the possibility of psychogenesis ("ideogenesis") was proved experimentally. The popularity of the term psychoneurosis was greatly promoted by the psychotherapist Dubois, whose entire system was based on taking into account and systematically eliminating the psychogenic components of a number of nervous and neuro-somatic diseases. The group of psychoneuroses usually includes hysteria, neurasthenia, and obsessive-compulsive neurosis (psychasthenia). In psychoanalytic literature, only hysteria and obsessive-compulsive neurosis, arising according to Freud's teaching in a psychogenic way, are classified under psychoneuroses, whereas neurasthenia and "anxiety neurosis" are singled out into a special group of "actual neuroses" as developing on the basis of somatic exhaustion or certain anomalies of sexual activity. A. I. Yushchenko, dividing neuroses into reactive neuroses, true neuroses (neurosis vera), and psychoneuroses, assigns to the latter only those forms where the nervous symptoms are entirely rooted in the characterological features of the subject and are fixed thanks to the teleological attitudes of the psychopathic personality and its "will to illness." Instead of the concept of psychogenesis, V. P. Osipov introduced the term affectogenesis, believing that this defines the origin of the disease more closely and accurately and at the same time establishes a connection with the state of the autonomic nervous system. In view of the predominant origin of psychoneuroses from a social situation, Osipov considers it possible to include the latter factor in their characterization as well, since, according to Osipov, psychoneuroses represent "socio-affectogenic diseases." This complex characterization, however, can be presented in a simpler form, namely as an understanding of psychoneuroses primarily as reactive diseases (even more broadly, psychogenic ones), which is confirmed especially by those cases where, with the disappearance of the cause that provoked the psychoneurosis, all phenomena rapidly smooth out. However, even here, more severe forms of psychoneuroses require constitutional factors for their appearance, in the absence of which psychotraumatic situations exert only an insignificant effect on the personality, never causing severe hysteria and especially obsessive-compulsive neurosis, the purely functional character of which is subject to great doubt. Lately, the term psychoneurosis has been gradually falling out of use. Designations such as situational neurosis, psychogenic reactions, psychogenic overlays, etc., are used more frequently.

10. Kannabikh.