Perspectives in the study of neuroses in contemporary psychiatric practice

Although DSM III has removed the category of neurosis, the implied fragmentation of the generic concept has been regretted by some investigators. Since its introduction in 1769, when the term was used to denote conditions which had a hysterical and hypochondriacal character, the technical use of the term has undergone revisions and reinterpretations which at one extreme have been embedded in psychoanalytic theory, and at the other have resulted in the replacement of the single concept by a proliferation of operationally defined syndromes. The present paper discusses some of the nosological problems implicit in recent trends. Whereas depression appears in 10 ICD9 categories does the psychiatric/neurotic dichotomy in relation to depression still have meaning in the absence of the generic term 'neurotic'? The hierarchical principle is widely accepted as a basis for classification, and yet the hierarchically minor syndromes may be a source of major distress. The paper reviews epidemiological studies of prognosis and follow-up of neuroses, and shows a significant excess of mortality, which is both behavioural and organic in origin. One important difficulty with the loss of the generic term is the potential loss of generic research where, for example, evaluation of treatment of panic disorder is considered distinct from other types of anxiety and phobia. The paper argues for the practical and theoretical benefits of retaining an umbrella term such as 'neuroses'.