What is Neurotics Anonymous?

Introduction

Neurotics Anonymous (N/A), founded in 1964, is a twelve-step programme for recovery from mental and emotional illness.

To avoid confusion with Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.

Refer to Neuroticism and Neurosis.

Brief History

The conception of Neurotics Anonymous began with Alcoholics Anonymous (AA) co-founder Bill W. After achieving sobriety Bill continued to suffer from neurosis, specifically depression. In letters to other AA members he wrote about his personal experience with neurosis, its prevalence in AA, and how he and others learned to cope with it. Bill expressed that as he learned to let go of his dependence on people and situations for emotional security and replaced that dependence with “showing outgoing love as best as he could,” his depression began to subside. In correspondence with another AA member about neurosis and psychoanalyst Karen Horney Bill suggested how a Neurotics Anonymous fellowship might operate.

You interest me very much when you talk of Karen Horney. I have the highest admiration of her. That gal’s insights have been most helpful to me. Also for the benefit of screwballs like ourselves, it may be that someday we shall devise some common denominator of psychiatry — of course, throwing away their much abused terminology — common denominators which neurotics could use on each other. The idea would be to extend the moral inventory of AA to a deeper level, making it an inventory of psychic damages, reliving in conversation episodes, etc. I suppose someday a Neurotics Anonymous will be formed and will actually do all this. Bill W., Letter to Ollie in California, 04 January 1956.

In a subsequent letter to Ollie in June 1956, Bill suggested the inventory of psychic damages include inferiority, shame, guilt and anger. He added that the effectiveness of the inventory would come from reliving the experiences and sharing them with other people.

Neurotics Anonymous was created eight years later, 03 February 1964 in Washington, D.C. by Grover Boydston (16 August 1924 to 17 December 1996). Grover was an AA member, recovering alcoholic, psychologist, and Ed.M. Grover had attempted suicide five times before the age of 21 and, like Bill W., was neurotic. Grover believed members of twelve-step programmes shared the same underlying neuroses caused by self-centeredness, a view expressed in other twelve-step programmes. Grover went as far as to say, “All of us are, indeed, brothers, and the variations in detail are no more than if one of us likes chocolate ice cream, and the other likes vanilla.”

While in AA, Grover discovered working the Twelve Steps helped remove the neuroses underlying his alcoholism. As an experiment Grover instructed a woman who suffered from neurosis, but not alcoholism, to work the Twelve Steps. He discovered that they aided her recovery from neurosis as well. He wrote Alcoholics Anonymous World Services for permission to use their Twelve Steps with the word “alcohol” in the First Step replaced with “our emotions.” Permission was granted. Grover placed an ad in a Washington, D.C. newspaper for Neurotics Anonymous, and organised the first meeting from those who responded to it. N/A grew modestly until an article was published on it in Parade magazine. The Associated Press and United Press International republished the story, and N/A groups began forming internationally.

By 1974 the Diagnostic and Statistical Manual of Mental Disorders, at the time in second edition (DSM-II), was undergoing revision. The framework developed for the third edition (DSM-III) was no longer based on psychoanalytic principles such as neurosis. The connotation of neurosis in common language also began to change. “Neurosis” was being used, increasingly, in a facetious or pejorative sense, rather than a diagnostic sense. These combined factors could make it difficult to take an organization known as Neurotics Anonymous seriously. In current Neurotics Anonymous literature, there is not a scientific definition ascribed to neurosis. As used in N/A, a neurotic is defined as any person who accepts that he or she has emotional problems.

Demographics

Grover Boydston conducted the first demographic study of Neurotics Anonymous in 1974. Such studies are rare and samples sizes are usually small as any group following the Twelve Traditions is required to protect the anonymity of their members. While researching such groups is still ethically possible, it is more difficult given this constraint.

  • Age: Boydston’s study found the average age of N/A members surveyed to be 43.02 years. A study six years later of self-help groups for people with serious mental illness, found the average age to be 35.3 years.
  • Attendance and Tenure: Of the N/A members surveyed Boydston found they attended, on average, six meetings per month and had spent an average of 2.37 years in N/A. N/A had existed for approximately ten years at the time of the survey.
  • Employment and socioeconomic status: Boydston categorised the occupations of N/A members into four categories.
    • Professionals: Includes people who practice a profession that is so considered by scientific, academic, business, and other people. It includes physicians, lawyers, engineers, nurses, college and university instructors. These represented 38% of the members surveyed.
    • Clerical persons: Includes people who perform office work or sales work according to the classification of “clerical.” These represented 32% of the members surveyed.
    • Homemakers: A person who takes care of a home as his or her main work. These represented 16% of the members surveyed.
    • Other: Includes students and people who do not fit into the three previous categories. These represented 32% of the members surveyed.
  • According to Boydston’s results at least 70% of N/A members were employed. This is similar to a specific study of Emotions Anonymous that found most of the members were middle class. Other studies of self-help groups for people with serious mental illness found most of the members tend to be unemployed, while others found members to be predominantly working class.
  • Ethnicity: Boydston’s study, and all similar studies in the literature have found that the majority of members in N/A and other self-help groups for people with serious mental illness in the United States are white.
  • Hospitalisation: Boydston’s study of N/A members found that 42% percent had been hospitalised for psychiatric reasons. More recent studies have shown that in self-help groups for serious mental illness approximately 60% (55-75%) of members had been hospitalised for psychiatric reasons.
  • Marital Status: In Boydston’s study of N/A members he found 25% were single, 48% were currently married, 22% were divorced and 5% were widowed. This finding has not been replicated in studies of similar groups where it was found most members had never been married.
  • Religion: Boydston’s survey included not only religious affiliation, but also included a measure of religiosity. Of the N/A members surveyed he found 24% identified as Catholic, 47% identified as Protestant, 9% identified as Jewish, and 19% did not consider themselves religious. Additionally, only 19% of members identified themselves as “very religious”, 42% identified themselves as moderately religious, and 39% identified themselves as “not very religious”.
  • Specific disorders (neuroses): Boydston’s survey contained an open-ended question asking about the “main complaints” N/A members came to the programme with. He summarized them in a list of twelve. Listed below are his results, in order from the highest to lowest percentage of members reporting them. Members often presented with more than one complaint.
    • Depression (58%).
    • Anxiety (32%).
    • Fears (23%).
    • Problems in relationships (18%).
    • Psychosomatic pains (14%).
    • Confusion (13%).
    • No desire to live (11%).
    • Inability to cope (9%).
    • Nervousness (7%).
    • Loneliness (6%).
    • Feelings of hopelessness (5%).
    • Hate (3%).
  • Sex: Boydston’s study of N/A members found approximately 36% were male, and 64% were female. This ratio, of two (or more) females for every male, has been reproduced in all other studies of self-help groups for persons with serious mental illness, as well as specific studies of Emotions Anonymous groups.

Criticism

N/A members in Comalapa (a municipality in Nicaragua) believe X-ray images (radiografías) can serve as a moral diagnostic revealing information about the intent and mores of those being examined. There is, however, no evidence that they are deliberately attempting to mislead other members. Americans had similar misunderstandings of X-ray technology when it was first introduced in the United States.

Increasing Deviant Stigma

Sociologist Edward Sagarin noted that alcoholics and addicts are considered deviants because their behaviour is socially labelled as deviant. Meaning chronic substance abuse is seen as deviant, while being sober or “clean” is normal. For an alcoholic or addict, joining groups such as AA or NA immediately reduces their deviant stigma, regardless of whether or not the alcoholic or addict believes it does. There is no similar clear cut language to label the deviance of those in N/A, in the act of joining members label themselves as deviant and take on stigma by identifying as one of those in the group afflicted with the problems of the other members. Initially joining the group may prove to be more ego damaging than ego reinforcing, regardless of whether or not the group helps them overcome their problems. Therefore, social stigma would attract alcoholics and addicts to groups like AA and NA. It would, however, become a barrier preventing people from joining groups such as N/A.

In contrast, those with severe mental illness may have acquired stigma through professional labels and diagnoses as well as through other behaviours associated with their mental illness defined as deviant. This stigma may not be as easily understood as alcoholism or addiction because the behaviour is more varied and can not be explained by substance use.

The objective of NA and AA is not just to help their members stop abusing drugs and alcohol. It is acknowledged in these programs that addiction is more systemic than a “bad habit” and is fundamentally caused by self-centeredness. Long term membership in Alcoholics Anonymous has been found to reform pathological narcissism, and those who are sober but retain characteristics of personality disorders associated with addiction are known in AA as “dry drunks.”

Effectiveness

Neurotics Anonymous developed the Test of Mental and Emotional Health as a tool to help members evaluate their progress. It is a fifty question test, with each answer rated on a three level Likert scale. Possible scores range from zero to one hundred. Higher scores are thought to indicate better mental and emotional health.

In Boydston’s survey of N/A members, when asked if they had received help through the program, 100% of those surveyed said “yes.” Boydston claimed N/A had similar results to AA in terms of recovery – 50% with a desire to stop drinking do so, 25% recover after one or more relapses, but most of the other 25% never successfully recover.

Literature

From 1965 to 1980 Neurotics Anonymous published a mimeographed quarterly periodical, the Journal of Mental Health. This should not be confused with the newer journal of the same name that began publishing in 1992. Early in the development of N/A they used Alcoholics Anonymous (the so-called Big Book) and the Twelve Steps and Twelve Traditions, the two fundamental books of the Alcoholics Anonymous programme. While reading out loud at meetings, members changed instances of the word “alcoholic” to “neurotic.” Passages in the book referring specifically to drinking were ignored. Eventually, N/A began creating books from articles published in the Journal of Mental Health. There were three such books published in English.

  • Neurotics Anonymous (1968). Neurotics Anonymous. Washington, D.C.: Neurotics Anonymous International Liaison, Inc.
  • Neurotics Anonymous (1970). The Laws of Mental and Emotional Illness. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTOFYS. LCCN 76102220. OCLC 104842.
  • Neurotics Anonymous (1978). The Etiology of Mental and Emotional Illness and Health. Washington, D.C.: Neurotics Anonymous International Liaison, Inc. ASIN B000FTON22. LCCN 76040759. OCLC 4500175.

The N/A organisations in Brazil and Mexico use translations of the English literature as well as literature written by groups in their area.

Parallel Organisation

A registered charity, known as Neurotics Anonymous and located in London, was created in the late 1960s by John Oliver Yates. Yates was prompted to create the groups after trauma he had suffered from a car accident that left him completely blind. Group membership was open to anyone, although it was recommended for people who had a nervous illness severe enough to require hospitalization. This charity differed from conventional twelve-step programmes in several ways. There was a nominal fee charged for membership. Meetings opened with a discussion of outside issues, such debate on social, political or cultural topics. The debate was followed by a personal problem forum where members brought their problems to Yates for initial comment followed by a presentation for group discussion.

What is Neurosis?

Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations.

The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

… anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”.[8]: 140  Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”.  A contemporary person, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive-compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from their early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by their parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealized self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once they identify themselves with their idealised image, a number of effects follow. They will make claims on others and on life based on the prestige they feel entitled to because of their idealized self-image. They will impose a rigorous set of standards upon themselves in order to try to measure up to that image. They will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, they will despise themselves for all their limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as they grow to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. They will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness.
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or co-dependence.
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of their spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualise their inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.

What is Neurosis?

Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

… anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”. Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”. Contemporary man, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from his or her early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by his or her parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealised self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once he identifies himself with his idealised image, a number of effects follow. He will make claims on others and on life based on the prestige he feels entitled to because of his idealised self-image. He will impose a rigorous set of standards upon himself in order to try to measure up to that image. He will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, he will despise himself for all his limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as he grows to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. He will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness;
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or codependence; or
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of his or her spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualize his or her inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.