A psychosis would seem to have clearly defined boundaries whereas the diagnosis of neurosis can tend to be quite subjective. A psychotic break tends to be clearly defined by the sudden onset of bizarre behavior, hallucinations, delusions, ideas of reference, and other blatant symptoms. A neurosis might be quite mild and increase in severity over time.
I stated above that a psychosis “would seem to have clearly defined boundaries.” That is because the individuals doing the diagnosing are human beings who can easily make mistakes.
In one study, a bunch of normal individuals, some of them graduate students, went into a hospital and described a single symptom that might suggest a psychosis. Every one of them was labeled schizophrenic and hospitalized. While in the hospital they acted completely normal and yet none of the professionals there recognized that they were in fact normal and not schizophrenic. It is said that we often see what we look for.
Diagnosing a neurosis is quite difficult because of its subjectivity. The symptoms vary from one person to another, although some common neuroses are defined. Also, neurotic behavior is on a continuum from barely noticeable to life-altering. Any mentally healthy individual might exhibit some signs of neuroses at various times in their life or have mild neurotic symptoms chronically.
One example of this continuum is obsessive-compulsive disorder (OCD). This was popularly displayed in the TV program “Monk.” Symptoms of OCD can include excessive cleanliness (excessive hand-washing, hyper vigilance against germs, etc.) and obsessive repetitive actions such as counting lines in the sidewalk or needing to do things in a specific order.
If most of us examine our own behavior, we may find that we have some mild symptoms of this behavior. I know one man who has to have all of his food on separate plates or must separate them on his plate so they don’t touch each other.
I will feel the need to straighten a crooked picture in someone else’s house. Sometimes I will arrange all of my bills so they are all facing the same way in my wallet.
A neurosis is an excessive focus on some aspect of one’s life. A mild neurosis can be quite harmless. A neurosis becomes a problem when it interferes with the normal functioning of daily life. Phobias are a good example of a neurosis that can be in the normal range, being afraid of snakes or spiders but not excessively so. Or a phobia can prevent someone from leaving her house.
Worry and anxiety are common to all of us. If we truly have something to be anxious about, we’re not necessarily neurotic. But when anxiety is chronic and we find ourselves being anxious about things that may never happen, we may have slipped into the neurotic range of behavior.
As mentioned above, psychosis may be a bit more subjective than most psychological professionals would like to think. When we look at it cross-culturally and across time, it is obvious that many of the practices of indigenous peoples would place them firmly in the psychotic range.
Ecstatic dancing, chanting, drumming, and the use of psychoactive drugs produced altered states of consciousness that included hallucinations, hearing voices, and even being possessed by spirits or gods.
Even today we have those who claim to communicate with the dead (and make a good living at it) and those who channel ascended masters or other spirits for the edification of their audiences. The cynic might claim that they are all fakes but for the most part they would not be identified as psychotic.
Psychosis is usually identified by a severe and dramatic change in behavior, the psychotic break. One young woman went to the dentist for surgery at age 16 and came out of the anesthetic psychotic. I knew her 16 years later and she was still in the mental health system.
Some breaks attract a lot of attention such as taking off all of your clothes in a public place. Others are more subtle like a man going on a shopping spree that ends up being way over the top. My mother was diagnosed with a nervous breakdown. This was a more polite way of talking about psychosis. Her symptoms were mostly crying all of the time and not being able to carry on with her normal life. She was given anti-psychotic drugs and shock treatment.
I have recently come to believe that she was misdiagnosed and today her symptoms would have been seen as post-partum depression. How many other women of her generation were diagnosed with a serious mental illness who were suffering from this relatively common experience?
Neuroses are fairly easily treated but the patient must have a willingness to change. Many are harmless enough and can be left alone without seriously affecting the individual’s quality of life. Most neuroses are treated with some kind of talk therapy. The outcome will be determined by the skill of the therapist but mostly by the determination of the patient.
Some mental health professionals consider a psychosis as a chronic condition, which means they don’t really believe it can be cured. Nevertheless, there is a huge industry of psychiatrists, psychologists, and other therapists and mental health workers who make their living working with this population.
The immediate treatment for the psychotic is drugs. After a first episode, some form of anti-psychotic will be prescribed. It is believed that this will dampen the symptoms and render the patient amenable to some form of talk therapy and/or group therapy.
Some victims of psychosis are able to live at home or even live on their own. When Ronald Reagan emptied the mental hospitals as governor of California, many of the mentally ill became homeless. Across the country, homelessness is still often the fate of the mentally ill. This includes many veterans with untreated post-traumatic stress disorder (PTSD).
For most of those with schizophrenia and other serious mental disorders, treatment is not successful. The pattern for many of these sufferers is to leave the hospital, go into a halfway house or go back home, and get better. But as soon as they become well enough to try being on their own, they will often have a relapse, another psychotic break, and start the process all over again.
So neurosis and psychosis are quite different in their origins and consequences. Nevertheless, a serious neurosis can be as detrimental to a normal life as a psychosis.