Obsessive Neurosis (Compulsive Neurosis) | Psychoanalysis

The term  obsessive neurosis  (or  compulsive neurosis ) indicates a condition in which the patient’s mind is invaded (against his will) by images, ideas or words. The patient’s consciousness, however, remains clear and his reasoning power remains intact. These uncontrollable obsessions are experienced as morbid insofar as they temporarily deprive the individual of freedom of thought and action. Defenses can sometimes eliminate anxiety and symptoms, but at the price of shifting characteristics of primitive obsession (uncontrollability, compulsions) to defense mechanisms .

Sigmund Freud’s perspective on obsessional neurosis appeared as early as 1894. In ‘ The Defense Neuropsychoses ‘ (1894a), he broke with the concepts of classical psychiatry and stipulated that the cause of obsessional neurosis lies in the existence of an intrapsychic conflict of  origin sexual mobilizing and blocks all energy flows. Thus, he opposed the classic theory of degeneration and the idea of ​​innate ego weakness that Pierre Janet used as the basis for his description of psychastenia. Freud proposed a traumatic etiology for obsessional neurosis. An early sexual event occurs before puberty; however, in contrast to what happens in hysteria, this event is a source of pleasure for the child. The individual experiences strong feelings of guilt and is oppressed by self-censorship. These feelings are repressed and then replaced by a primary system of symptoms and traits: scruples, shame, self-doubt. The success of these defenses allows the individual to go through an apparently healthy period. But, eventually, these defenses are exhausted and there is a return of the repressed memories with the outbreak of the disease and its concomitant symptoms.

In “ The disposition to Obsessive Neurosis: A Contribution to the problem of choosing neurosis ” (1913i), Freud defended the idea that the choice of this neurosis is linked to inhibitions of development, and emphasized the role of fixation and regression to the analgesic phase. sadistic. He suggested that a “chronological overcoming of libidinal development by ego development should be included in the  provision obsessive neurosis. Such precociousness would make it necessary to choose an object under the influence of ego instincts, at a time when sexual instincts have not yet taken their final form, and a fixation on the stage of pre-genital sexual organization would thus be abandoned. ” (p. 325). Thus, in the object relationship, hatred will precede love and “obsessive neurotics have to develop a super morality to protect their object – the love of hostility that lurks behind it” (p. 325). This opposition between love and hate for the object was underlined by Freud in the case of ” Homem dos Ratos “, related in “Notes on a case of obsessional neurosis” (1909d). He saw this as the source of the doubts, compulsions and ambivalences that are characteristic of obsessive functioning.

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In “Inhibition, symptom and anguish”, Freud described the two main defense mechanisms in obsessional neurosis that replace repression : undoing what has been done and isolation. The first, undoing (  Ungeschehenmachen  ), means making something that has already been done “undone” through a symbolic motor action; it is also found in magical practices, folk customs and religious rituals. The second, isolation, involves the motor sphere and consists of the fact that, after an unpleasant event, there is a pause during which nothing else can happen, no perception is possible, and no action can take place. Motor isolation functions to ensure an interruption in the connection of thoughts.

In the same way that the obsessive patient decrees the taboo against touching (because he fears that contact with the object will force him to face his unconsolidated ambivalence between love and hate), the isolation of an impression or an activity, through of a rupture in the chain of thoughts, symbolically indicates that he does not want to allow the thoughts related to it to “contaminate” other thoughts. This mechanism is present in normal people in their daily mental activities that involve concentration.

The fundamental rule of free association   involves asking the ego to give up this defense. The patient suffering from obsessional neurosis finds this rule particularly difficult to follow. That is why, paradoxically, psychoanalysis is both the most suitable treatment for these patients and, at the same time, the most difficult to implement.

Like Freud, the psychoanalysts who came after him always emphasized the obsessive structure, rather than symptoms. This poses terminology problems. The term  obsessional neurosis  is not the exact equivalent of the German  Zwangsneurosis :  Zwang  refers not only to compulsive thoughts or obsessions ( Zwangsvorstellungen ), but also to compulsive acts ( Zwangshandlungen ) and compulsive affects ( Zwangsaffekte ). Certain French authors therefore prefer to use the term neurosis of contrainte , and some American authors prefer the term  compulsive neurosis ( compulsive neurosis) . F obsessive Operation is the preferred term for the set of defense processes and mechanisms that characterize obsessional neurosis, but which are also present, to a lesser extent, in other patients, in the form of obsessive personality traits or a defense system that presents itself as a alternative to a more expensive mode of psychic functioning, psychotic functioning.

In this regard, we will note that, because organized obsessional neuroses are sometimes extremely debilitating, the categorization of this pathology has been questioned and it has been compared with psychoses. Several factors present in the former are lacking in the latter: self-recrimination by the ego, adherence to insistent concerns, and the implementation of elaborate defenses. In the obsessive patient, affective isolation allows the ego to isolate itself from desire, while in psychosis the ego is out of reality.

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