The dichotomies: psychosis/neurosis and functional/organic: a historical perspective

Abstract

Psychosis and neurosis have formed one of the crucial dichotomies in psychiatric classification. This has not always been the case, and indeed the distinction is again being blurred (Cooper 1989). This article will show how the dichotomy arose and how it was strengthened during the first fifty years after the introduction of the term psychosis. The relationship between psychosis and neurosis has not been examined historically, except briefly by Berrios (1987). Lopez Piñero (1983) has dealt with the origins of the concept of neurosis, but his study does not address later issues. The term psychosis was coined in 1845 (Feuchtersleben 1845) to denote 'mental disorder which affected the personality as a whole' and was a subcategory of the then much wider category of the neuroses. The latter were described by Cullen (1784) in the late eighteenth century to denote all the diseases of the nerves and muscles. In 1800, therefore, the neuroses were seen as diseases with a physical cause. The insanities, by contrast, were viewed as diseases of the mind and not generally of physical origin. By about 1900 this situation had been reversed. Most psychiatrists believed that the insanities were of organic aetiology, while the neuroses were of psychological origin, although at that time some psychiatrists and neurologists still believed that the neuroses were caused by organic changes, albeit ones which were not detectable by currently available means, and ones which were therefore referred to as 'functional disorders'. The historical contrast between the so-called functional and the organic disorders will be addressed in this article, as will its relationship to historical and contemporary issues regarding the psychosis-neurosis dichotomy.

Historical sketches of the beginnings of the academic "Mental and Nervous Diseases" in Brazil, and European influences

“…At the beginning of the twentieth century, Sigmund Freud (1856-1939) promoted the theory of psychoanalysis and helped to define the modern concept of neurosis 2 . By this time, most psychiatrists already believed that the insanities were of organic etiology, while the neuroses were of psychological origin -exactly the opposite of what was believed at the beginning of the nineteenth century 3 . However, some psychiatrists and neurologists still believed that the neuroses were caused by organic changes 2,3 .…”

“…By this time, most psychiatrists already believed that the insanities were of organic etiology, while the neuroses were of psychological origin -exactly the opposite of what was believed at the beginning of the nineteenth century 3 . However, some psychiatrists and neurologists still believed that the neuroses were caused by organic changes 2,3 . Regarding (1784) presented by William Cullen (1710-1790) to refer to "disorders of sense and motion" caused by a "general affection of the nervous system".…”

“…This stream gave a heritage to the most influential Forerunner School of Psychiatry and considering research and scientific teaching, the accomplishment was poor. Conversely, the influent School lead by Wilhelm Griesinger (1817-1868) carried out research based on anatomoclinical method [2][3][4][5] . Moreover, another group guided by Benedict-Augustin Morel (1809-1873) combined anatomoclinical (not obvious anatomical lesion) and philosophical methods to propose a degenerative theory for mental disorders 1,3 .…”

“…Conversely, the influent School lead by Wilhelm Griesinger (1817-1868) carried out research based on anatomoclinical method [2][3][4][5] . Moreover, another group guided by Benedict-Augustin Morel (1809-1873) combined anatomoclinical (not obvious anatomical lesion) and philosophical methods to propose a degenerative theory for mental disorders 1,3 . The proximity of neurologists and modern psychiatrists led to the emergence of "neuropsychiatrists" from the nineteenth century until at least two-thirds of the twentieth century 1 .…”

Misunderstanding Psychopathology as Medical Semiology: An Epistemological Enquiry

“…– The concepts of ‘hysteria’ [39] and ‘neurosis’ [40] were abandoned due to the lack of stability in their meaning and the confusion they gave rise to.…”