The several types and reactions of the
psychoneuroses are the following:
The anxiety reaction:
In this type of emotional illness there
are attacks of an unsettled state of mind with apprehension, nervous
tension, physical and mental fatigue, and panic. There may be
nightmares. The attack is often accompanied by vomiting,
diarrhea, and urinary urgency. There may be an overpowering
dread of some imminent disaster. The attack can last a few
minutes or for longer periods. Usually the problem relates to
some intolerable situation in the patient's experience, past or
The dissociative reaction:
This is similar to the anxiety reaction
but more intense. The individual actually loses control of
certain mental functions so that he experiences stupor or loses his
memory or conducts himself automatically, unaware of his reactions.
He may resort to aimless running.
The conversion reaction (Hysteria):
In this reaction the individual
subconsciously converts energy pent up as a result of intense anxiety
or frustration into abnormal behavior or supposed illness which tends
to protect the individual from the unbearable situation. This is
an unhealthy solution to life's problems. The conversion
reaction imitates many symptoms of disease, such as paralysis,
anesthesia, blindness, or loss of consciousness. Often the
physician's skill is taxed to tell the difference between the
conversion reaction and actual disease.
The phobic reaction (phobias):
In the phobic reaction the person
manifests an unreasonable, unjustified anxiety regarding some
situation. Consciously he recognizes that no actual danger is
involved, but he finds himself unable to control his intense fear.
Phobias may be directed toward high places, closed spaces, elevators,
dirt, danger of contamination, cancer, or certain animals.
Phobias represent a carry-over of some unresolved conflict. It
is assumed that the phobia becomes symbolic of this conflict to the
extent that he puts the true conflict our of consciousness by focusing
on the phobia.
The depressive reaction:
In this psychoneurosis the person
becomes downcast, pessimistic, unhappy. He feels he is
inadequate. He lacks energy and loses interest in activities
about him. Crying for insufficient cause is a cardinal evidence
of depression. The depressive reaction may be accompanied by
loss of appetite, constipation, headache, and sleeplessness.
There is often anxiety. The discouragement may become so
profound that the victim contemplates suicide and may attempt it.
Proper precautions should be taken so that the patient is not left
The obsessive-compulsive reaction:
An obsession is an almost uncontrollable
urge to follow the same line of thought over and over. Often the
thought is unwelcome, but the person finds it nearly impossible to
banish it from his thinking. A compulsion is an unreasonable
urge to perform some act, even though the act is unnecessary and may
be foolish. A person may become obsessed with the thought that
he is carrying a germ which could infect other members of his family
and even cause their death. As a result he washes his hands
frequently, before eating, after shaking hands, or perhaps at
fifteen-minute intervals. Mild degrees of the
obsessive-compulsive reaction may occur in persons who live normally.
This tendency may show itself in the immaculate housekeeper or in the
meticulous accountant. A person may develop the obsession that
he is changing in appearance, and this prompts the compulsion to look
in the mirror repeatedly for evidences of such change. A person
with an obsession may be constantly troubled by obscene thoughts out
of harmony with his standards of conduct. A religious person may
be obsessed by doubts regarding the foundation of his beliefs. A
person may develop the compulsion that he must remove his clothes in a
certain routine. This may become so troublesome that if anything
interferes with the routine, he will have to put his clothes on again
and start the routine all over. A compulsive person may feel he
is forced to touch all power poles as he passes them on the sidewalk.
The obsessive-compulsive reaction is supposed to be a subconscious
form of penance associated with guilt and self-condemnation. The
individual who develops these obsessions and compulsions is not
consciously aware of the background of his reactions.
Treatment of the Psychoneuroses:
Frequently the psychoneurotic will
benefit by a series of conversations with a psychiatrist intended to
help him recognize the relationship between his present symptoms and
the unsolved problems which lie at their foundation. The
patterns of thinking and acting are usually so firmly established that
a mere explanation of the cause of the symptoms will not enable the
person to overcome them. He must have time to reorient his
thinking to accept the facts of his unfavorable circumstances and plan
ways of being realistic rather than hide behind excuses or dodge the
The physician can often aid the patient
during his period of reorientation by prescribing one of the modern
tranquilizers to relieve anxiety or by using one of the antidepressant
drugs to help the patient rise above his periods of depression.