This article will help you to differentiate between Neuroses and Psychoses.
Neuroses also known as Psychoneuroses refer to minor mental disorders. They are characterised by inner struggles and certain mental and physical disturbances. Psychoneuroses include the milder abnormalities of the cognitive, conative and motor processes precipitated by conflicts, frustrations and other emotional stresses. These partially incapacitate the individual to meet the demands of life property and effectively.
Clinically, psychoneuroses implies a bodily disturbance without any structural or organic defect. These symptoms in-fact are the functions of certain mental disturbances the origin of which the patient is unable to understand; but nevertheless, he realizes that something is wrong with him.
Psychoses are major personality disorders marked by gross emotional and mental disruptions. These diseases make the individual incapable of adequate self management and adjustment to society. While neuroses refer to mild mental disorder, Psychoses refer to insanity or madness.
The distinction between psychotics and neurotics in general are symptomatic, psychopathological and therapeutic :
1. Psychoses involve a change in the whole personality of the person in whom it appears, while in psychoneuroses only a part of the personality is affected. With the development of psychoneuroses, there is often no marked outer change of personality of any kind. As Meyer puts it, a psychoneuroses is a part reaction, while a psychoses is a total one.
2. In a psychoses, contact with reality is totally lost or changed. The reality contact practically remains intact in a psychoneurotic, though its value may be quantitatively changed. In-fact insight and reality have the same meaning for them as the rest of the community.
3. The changes in the reality values of the psychotic, psycho- pathologically is partly expressed through projection, for example, the strong belief that one is being constantly watched. Projection of this sort often based on a sense of guilt, subjective but unconscious, does not occur in the psychoneuroses.
4. Language, which is a means of communication, is the symbolizing function for social adaptation. In the psychoneuroses language as such is never disturbed, whereas in the psychoses language often undergoes gross distortion.
5. Some psychoses are primarily organic. Even in the functional psychoses organic factors enter into the aetiology. The psychoneuroses on the other hand are predominantly socially conditioned. Horney has therefore remarked “Psychoneurotic is the individual who deviates in his behaviour from the norms accepted by his culture because of anxiety and who feels lonely and inferior because of this deviation.”
6. In psychoanalytic theory the psychoses may be differentiated from the psychoneuroses in terms of the amount of ego and libido regression and in terms of the topographical location of the conflict. In psychoses therefore the libidinal regression goes as deep as the early anal period i.e., beyond the level of reality testing.
Psychoses may therefore be considered dynamically as a disorder in which the ego looses much of its contact with reality and is more concerned with the forces of the id.
The psychoneurotic on the contrary, suffers libidinal regression only to the phallic or late anal period as his conflict may be considered as a struggle between the forces of the id and the ego, in which the ego maintains its contact with expressed reality. The regression is only to the level of reality testing and so the neurotic retains insight and does not deny reality.
7. As regards aetiology Page says that in psychoneuroses the psychogenic factors and heredity are of considerable importance, where as neurophysiological and chemical factors are insignificant. On the other hand, in psychoses, heredity, toxic and neurological factors are the determining agents. Psychogenic factors as such may or may not be important.
8. So far as general behaviour is concerned, in the neurotic the speech and thought processes are coherent and logical. There are little or no delusions, hallucinations and confusion in case of psychoneurotic. On the contrary, in case of the psychotics speech and thought processes are incoherent, disorganized, bizarre and irrational. There is constant confusion. Delusion and hallucination are marked symptoms.
9. Neurotics are capable of self management, partial or completely self supporting, are rarely suicidal. They do not need hospitalization on the other hand; psychotics are incapable of self management. They often attempt to commit suicide and need hospitalization or equivalent home care.
10. The personality of the neurotic undergoes little or no change from normal self. A neurotic has good insight. In case of a psychotic, on the other hand, there is radical change in personality, insight is partially or completely lost.
11. The psychotics and psychoneurotic also differ in treatment procedure.
Psychoneurotic respond favourably to psychotherapy, such as suggestion, psychoanalysis aid other forms of psychotherapy while the psychotics do not effectively respond to psychotherapy and treatment is mainly chemical and physiological.
12. As regards prognosis, the symptoms of psychoneurotic are transitory and outcome of treatment is usually favourable. The deterioration and mortality rate is quite less. On the other hand, in psychotics, the symptoms are relatively constant from day to day, outcome less favourable and cure temporary and death rate is high.
In-spite of these differences, the psychotics and neurotics cannot be separated by watertight compartments and there is no sharp break between behaviour which is to be called psychotic and the behaviour which is to be called neurotic.
In fact, there are many cases of mental illness where it is quite difficult to assess definitely whether it belongs to the psychotic or psychoneuroses group. In such cases the problem of border line psychotics and border line neurotics arise.
In-spite of everything, between a well developed psychoses on the one hand and a full-fledged psychoneuroses on the other hand there is a world of difference from the descriptive as well as from the therapeutic respect. Transitions also occur, so that a patient who reacts psycho-neurotically at one time may react psycho-neurotically at another.
Wishner (1961) believed that behavioural efficiency will be taken as a predictable correlate of psychopathology, with lower efficiency in severe pathologies. Being un-dimensional, the measure of efficiency places neuroses and psychoses on the same continuum.
But Lewis firmly established the point that they have little in common each being an independent entity with a different origin and outcome. Follow up studies indicate that only 4 to 1% of neurotics develop psychoses in later life.
However Henderson cites an example of case history of a patient who began with psychoneurotic anxiety symptoms and later on developed into a paranoid schizophrenic psychoses. But such transitions are the exceptions and not the rule.