Neuroses and Other Minor Disorders

Abstract

The ways in which international comparisons can contribute to our understanding of the minor mental disorders differ considerably from those in which they contribute to the major ones. With the latter we have been dealing with fairly distinct syndromes and fairly uniform methods of identifying them in a population, even though these methods do not operate everywhere and though some ambiguity remains. Much could therefore be done in the way of comparing incidence rates or considering cultural variations in the characteristics of those who display the core syndrome, both in historical sequence and across contemporary societies. With the neuroses and other minor disorders there has been no such agreement either past or present. Prior to 1900 the term neurosis carried mainly the neurological connotation given it by its inventor, Cullen, in 1784, so that one found it embracing not just hysteria and the neurasthenias but Parkinsonism and chorea; and even the classic term hysteria was not applied in any uniform fashion, for instance being used for males by some writers but not by others. Today Cullen’s organic concept of neurosis persists in some Pavlovian schools, but even if one ignores the latter and considers the term to apply only to conditions in which there is no evidence of a relevant organic disorder, i.e., psychoneuroses, one finds that there are markedly different ways in which it is employed, so that different interpretations need to be applied to reports which, if they had dealt with the psychoses, could probably have been given a uniform interpretation. If this were merely a problem of nosology, i.e., a problem of deciding which clinical pictures to include under each heading, we might be able to circumvent it by focusing on precise syndromes, but it was one of the early discoveries of psychoanalysis that when one syndrome was “cured” — for instance by hypnosis — a different one would appear. Viewing superficially different syndromes as distinct entities thus becomes of doubtful value, and it seems much better that we should attempt to compare whole classes or categories of syndromes, perhaps only between those societies in which a uniform nosology reigns. However, although the latter is sound in principle, one is still liable to find that the criteria whereby this nosology is applied vary considerably both within and between these societies.