Alfred Adler Institutes of San Francisco and Northwestern Washington

The Collected Clinical Works of Alfred Adler: Volume 9

Chapter XXVI

The Structure of Neurosis1


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The structure of neurosis presents one of the most difficult problems in psychology. We often observe fear in people without considering it a manifestation of neurosis. We also frequently find a certain rigidity of thinking in people who are not neurotic, for instance in individuals who lay great stress on rules and formulas. But we cannot take this as a characteristic of neurosis. The same applies to other neurotic symptoms. The symptom of fatigue occurs in the neurasthenic as well as in so-called normal people. The symptoms found in functional neurosis may also be found outside of a neurosis. Every human being under certain psychic tensions will react according to his individual make-up. In one suffering from fear, we may notice various reactions such as heart palpitation, breathing difficulties, etc. Normal people may have these symptoms. For them, a feeling of insecurity may bring on contractions of the throat. Under the stress of fear, other individuals will react with stomach symptoms, or intestinal disorders, or bladder irregularities. For many individuals, fear manifests itself through the sexual organ. In one special type, fear creates sexual excitement. Individuals of this type consider such a reaction normal, and even go so far as to construct theories about it. Let us remember then, that no neurosis contains any phenomenon outside the range of “normal,” human psychic life and its manifestations.

In order to bring out the full significance of what follows, I shall touch briefly here on the fundamental views of Individual Psychology, especially those related to its concept of mind and soul. In considering this subject, we clearly move to a transphenomenal level. By refusing to do this, Watson and his school ignore the existence and meaning of the soul. Other schools take a purely mechanistic viewpoint on these matters, thus eliminating the mind and psychic life. In the true sense, this is impossible because the word, “psychology,” means science of the soul. Many call themselves psychologists who in fact are physiologists, and according to the structure of their scientific training, eliminate the concept of the soul or think of it in a mechanistic way. The psychologist, however, takes for granted that a basic conception of psychic life includes the various manifestations of the personality. While he arranges these manifestations in definite order and direction, he needs speculative insight to understand the context of data which may lead beyond the province of experience. But even here, in the sphere outside immediate or tangible experience, no evidence precludes the assumption of psychic life or disproves the existence of it. Let us assume, therefore, that the soul is a part of life.

The most important characteristic of life is movement. That does not mean that living things cannot be in a state of immobility, but that the capacity for motion is present as long as life exists, and that all psychic life can be interpreted in terms of movement. Hence, all phenomena which pertain to the psychic life can be seen in space-time relationships. We observe these movements and see them as if in a congealed statue’s form in repose, so to speak. Once we see psychic expression as movement, we approach an understanding of the problem; for the chief characteristic of a movement is that it must have direction and therefore, a goal. Moreover, this direction toward which every psychic movement proceeds could not exist if the entire psychic life did not have a goal, which is in the case of every individual, determinable and capable of formulation, even though the individual himself cannot articulate it. In relation to this, we may note that we have in our consciousness many impressions which are not clearly defined concepts and which, under certain circumstances, we can formulate. In this connection, some erroneously conclude that if we clothe the non-understood in words, we have moved it from the realm of the unconscious to the conscious, which is certainly not the case.

I have said that every movement has a goal. “Drives” and “natural tendencies,” such as sexual drives, for instance, have no direction. These abstract concepts cannot, therefore, be well utilized in the understanding of psychic occurrences. The direction we seem to observe in these drives is merely the direction imparted to them by the movement of the individual-as-a-unity toward his goal. The movement toward a goal shows a unified pattern. This goal makes the whole psychic life a unity. As a result, every part of the psychic movement contains the striving toward this goal; therefore, the goal becomes a part of the unity. We must conclude, then, that we understand a part of the psychic life only when we conceive it as part of a unity, proceeding along the same course toward the same goal with other characteristics of the individual. In the practical application of Individual Psychology, this viewpoint is of the greatest importance. Hence, understanding the psychic life requires an explanation of how the goal originates.

We find striving toward a goal or objective everywhere in life. Everything grows “as if” it were striving to overcome all imperfections and achieve perfection. This urge toward perfection we call the “goal of overcoming,” that is, the striving to overcome. Language is inadequate to express the full range of interpretation of what “overcoming” means. The interpretation varies with each individual because the goal of each individual differs. If we say that such a striving is for “power” or “force,” or a “running away from reality,” we have made typical generalizations which do not give a clear insight into a particular, individual case. But we have gained one point. We have illuminated the field under consideration, and must then narrow down the meaning so that we can perceive the particular direction of movement of the individual in question. For this we need experience, alertness, and a closely critical, objective, unbiased examination of each individual case.

The phenomena to which we allude imply the existence of a minus and plus situation simultaneously in the same individual, that is, an inferiority feeling and at the same time a striving to overcome this inferiority. The inferiority feeling can show itself in a thousand ways, for instance, as a striving for superiority. The question then arises as to how the fictitious goal or guiding fiction is established.

We concede that every child is born with capacities different from those of any other child. We object to the teachings of the “hereditarians” and every other tendency to overstress the significance of constitutional disposition because what matters is not what we are born with, but what we make of that equipment. Still we must ask ourselves, “Who uses it?” As to the influence of the environment, who can say that the same environmental influences are apprehended, worked over, digested, and responded to by any two individuals in the same way? To understand this fact we must assume the existence of still another force: the creative power of the individual. We have been impelled to attribute to a child creative power, which translates all the influences on him and all his capacities into movement toward overcoming an obstacle. The child feels this power as an impulse that gives his striving a certain direction. All phenomena in the psychic life of a child aim toward overcoming his inferior position; consequently, the views of those who believe in the “causative” influence of “heredity” on the one hand, or “environment” on the other, as complete explanations of his personality, are made untenable by the assumption of this creative power of the child. The drive in the child lacks direction as long as it has not been incorporated into the movement toward the goal which he creates in response to his environment. This response is not simply a passive reaction, but a manifestation of creative activity on the part of an individual. Attempting to establish psychology on the basis of drives alone is futile, without taking into consideration the creative power of the child which directs the drive, gives it form, and supplies it with a meaningful goal.

Nonetheless, certain factors do affect the child, leading him to mold his life in a certain direction. These factors are not primarily causative agents, but rather enticing, stimulating phenomena. The attitude toward these factors varies widely in different individuals. No mathematical rule could teach us how to make the proper use of anything we possess. However, unprejudiced research observes not the disposition or constitution that individuals possess, but the “use” they make of what they possess. As I have indicated, these factors appear as enticing or stimulating opportunities to the individual. We would be wrong to assume that they act as causes, for with deepened understanding, we see that different individuals make different use of the same stimuli. Therefore, we are justified in assuming that on a merely statistical basis, they will probably evoke in an individual certain typical uses of them. So much we may understand. Any assertion beyond that we may regard as a bit unscientific. In other words, the creative factor comes into play here, which we have to train ourselves to understand better.

As a result of our experience, we know that a child with inferior organs will feel inadequate for the tasks of life and will feel the minus situation more intensely than the average child. This is significant because our experience confirms that when a child feels especially insecure in a minus situation, the results are striking and show a greater striving toward a plus situation. These observations apply to children born with inferior sense organs, brain structure, or endocrine glands. The organic weakness does not necessarily function as a “minus” situation, but the child experiences the weakness of his organic equipment for average social tasks, and feels impelled to reorganize it accordingly.

Rooted in an experience of organ inferiority, the striving to overcome the sense of inadequacy takes many forms. Some individuals seek to eliminate problems; some act to avoid them. By the avoidance of problems, some feel relieved and thus more secure. Others wrestle and struggle with their problem, for instance, left-handedness, and accommodate themselves more courageously to outside influences. The outcome depends on the creative power of the individual which expands outwardly according to no rule except this: that the determining goal is always “success.” What constitutes success for him depends on the individual's own interpretation of his position. During the first three or four years of life, the child forms his life pattern. He has then shaped his concrete goal, determining the way in which he overcomes his problems. From then on, we can perceive in his attitude the result of this process of creative goal-formation. These goals have a million variations. They differ from each other, metaphorically speaking, in color, shape, rhythm, and intensity.

A second group of individuals shows a life pattern similar to that of children affected by organ inferiority: those who have been pampered in childhood. The more deeply I have delved into the problem of neurosis and searched the cases presented, the more clearly I have come to see that in every individual with a neurosis some degree of pampering can be traced. Dependence on another person for the solution of a problem or the carrying out of a task has a determining influence on an individual. But we must not think too loosely of pampering. When we speak of a pampered child, we do not mean a child who is simply loved and caressed, but rather a child whose parents always hover over him, and assume all responsibilities for him, removing from him the burden of fulfilling any of the tasks and functions he could fulfill. Under such circumstances, the child develops like a parasite and emerges as one of innumerable varieties of individuals, ranging from those disinclined to accept any suggestion or influence from others to those who always seek assistance. Thousands of differences in type and kind exist between these extremes. I would like to prevent an easy mistake, however, by emphasizing that the pampered style of life should not be understood as resulting merely from the attitude of parents or grandparents, but as the creation of the child himself. He may produce this creation even when no one has actually pampered him. The demanding attitude of the child induces the pampering.

A third group consists of children who are neglected, illegitimate, undesired, or ugly. The feeling of being neglected is, of course, relative. External circumstances can contribute to it and later in life, every pampered child will automatically find himself in situations which make him feel neglected.

The basic, underlying structure uniting all these types begins with a feeling of insecurity. This feeling of insecurity and inadequacy characterizes all failures. From the way they attempt to solve them, we may judge how well individuals in the three categories are prepared to meet problems, which are always of a social nature. All problems involve other people. For the purpose of clarification, we may classify them as problems of social, occupational, or love relationships. Their solution depends, consequently, on how well an individual is prepared to make contact with his fellow human beings. All failures -- problem children, neurotics, psychotics, drunkards, sexual perverts, suicides, criminals, etc. -- result from inadequate preparation in social feeling. As non-cooperative, solitary beings, asocial if not antisocial, they run counter to the rest of the world. This viewpoint tends to make Individual Psychology a psychology of evaluations. What does this signify? The far-reaching implication is that only the individual prepared for social cooperation can solve the social problems which life imposes. The “law of movement” of the individual must include a degree of striving for cooperation. Where it is lacking, we find “failures.” I have already shown that this inclination for cooperation and social achievement has not been properly developed in children who feel insecure. These insecure ones build a life style which shows a lack of social interest, because an insecure individual is always more concerned with himself than with others. He cannot get away from himself.

We cannot stress too much that the neurotic lacks interest in others, social interest. We must not be confused by some neurotics who seem to be benevolent and wish to reform the whole world. This wish can be merely a response to a keenly felt minus situation. Where the minus situation is strong, the striving to overcome will also be strong. We can also perceive this in the organs of the human body, for where the obstacle to be overcome is great, the tension is also great. The neurotic places the goal of his overcoming too high. Just as in the case of a normal individual, it is related to the feeling of personal value. The feeling of personal worth can be derived only from achievement, from the ability to “overcome.” A lack of social feeling prevails in the law-of-movement of the neurotic and decreases his ability to “overcome.” This lack is not as great in the neurotic as it is in the criminal. The criminal is more actively aware of his fellow creatures, but opposes them at the same time. The neurotic does not oppose them openly, but focuses his efforts on testing and utilizing, or exploiting, the social feeling of others. This is characteristic of all neurotics, so that in the structure of a neurosis we find the utilization of the social feeling of others and simultaneously the arresting of an individual's cooperative participation by a “but.” This “but” epitomizes all neurotic symptoms. It offers an alibi to the neurotic. The neurotic lives according to the formula, “yes, but,” which hinders him from going forward to achievement. His estimate of his value, therefore, depends on how much another person contributes to it, not upon his ability to overcome, or own achievements. Even in considering functional neurosis, we maintain the same viewpoint. In such cases we have to deal with an arrangement of emotions, such as anxiety, insecurity, hyper-sensitivity, rage, impatience, greediness, etc. These emotions all arise from living outside the scope of cooperation. The tension in which the neurotic lives allows him to easily work himself up into a state of heightened emotion. This tension makes itself felt at the point of “least resistance,” and the characteristic effects show up in such places as I have mentioned before, for instance, the stomach, bladder, intestines, heart, etc.

So we come to see that functional neurosis can be understood only when we recognize the individual as a unity. The neurotic is an individual placed in a test situation, attempting to solve his problems in the interest of his own personal ambition rather than in the interest of the common welfare. This holds true of all neuroses. They grow out of the psychic tension of an individual who is not socially well-prepared, when he faces a task which demands for its solution more social feeling than he is capable of.

The true nature of the so-called organic factors in neurosis becomes clearer when the individual finds himself in a test situation. Here the individual's interpretation of his own qualities plays a role. We do not believe that a neurotic is incapable of solving those problems before which he breaks down, but we recognize that he has not yet acquired the amount of social feeling necessary for him to make an approximately correct solution of them. He does not possess sufficient “contactability,” that is, capacity for making contact with others. He therefore develops that psychic tension which can be found in everyone who feels insecure. This tension affects the entire body and psychic life and differs with each individual. It affects those who are greatly concerned with rules, formulas, and ideas intellectually. We can observe this most clearly in compulsion neurosis and paranoia. With others, as in anxiety neuroses and phobias, the emotional sphere of psychic life is set into motion.

I also want to stress the environmental factor. Although organic and environmental factors play a part in every neurotic symptom, the true impact of the environment can be understood only when we perceive the whole individual in the expression of his life style. The therapist must put himself in the individual's place in order to see that for this particular person a certain situation seems too difficult.

Recently, a patient came to me who had previously been treated with success up to a certain point by another Individual Psychologist. Before his previous treatment, sexual stimulation was possible for him only when animals were present. Discussing why he chose animals would be interesting, but I cannot go into that part of his life style here. Anyway, due to a strong inferiority feeling, he had excluded the normal phase of a love relationship. This exclusion is characteristic of all sexual perversion. When he came to me, he was planning to get married. He said, “I want to marry, but the problem now arises of confessing to my future wife what has gone on before. If I do this, I am sure that she will refuse me.” This refusal is exactly what he was aiming at. He wanted another excuse for evading the solution of the love problem. I said to him, “You should not confess to everybody all the disagreeable events in your life for which you are not really to blame. It is unfair and not in good taste to speak of certain things. It is only the last remnant of your fearfulness which makes you think of talking about it to your fiancée. You must expect that other people are apt to misunderstand what you wish to tell.” He perceived this and understood the purpose of his determination to confess to his fiancée. I hope that his increased understanding has enabled him to rid himself of his fear of the love problem.

If we understand the law-of-movement of neurotics, we will find that in each patient the mental phase (compulsion neurosis), the emotional phase (anxiety neurosis), or the motor phase (hysteria) is predominant, although the other psychic processes, too, are always dynamically present. In the treatment of such cases, however, we must clearly and definitely determine the whole psychic process. There are no pure cases. There are only mixed cases in which we can see that at one time one aspect, at another time another aspect of the whole psychic process comes to the foreground. People who do not sufficiently understand this predominance of one aspect of life over the other frequently talk about the “unconscious.” The unconscious, however, is nothing other than that which we have been unable to formulate in clear concepts. These concepts are not hiding away in some unconscious or subconscious recesses of our minds, but are those parts of our consciousness whose significance we have not yet fully understood.

If we focus our attention on the goal, direction, and form of an individual's “movement,” which alone give us true understanding of him, we find among neurotics several different types of “movements.” First, the distance complex shows an attempt to establish distance as a safeguard. For some neurotics, then, the most striking characteristic is that they keep themselves at a significant distance from the solution of the problem that confronts them. They may create this distance by means of hysteria, fainting, indecision, a tendency to doubt, etc., but all these symptoms mean nothing more than an attempt to stand still in a world that is moving. If an individual cannot decide whether he should do this or do that, one thing is certain: he does not move. We can also clearly see this keeping oneself at a distance in anxiety neuroses. Functional neuroses are also capable of hindering a person from solving social problems. Thus, an individual may be compelled to urinate just when he is about to go to a party. Also, the compulsion neuroses are well designed to effect this “distance,” consequently causing a standstill, whenever the neurotic feels himself forced to do something.

The second form of movement manifests itself in a hesitating attitude: the neurotic advances, but hesitatingly. An example of this is stuttering. Any problem may be met with a “stuttering approach.” This hesitation may lead to postponing a solution of problems by means of insomnia. The patient with this symptom is so tired that he can solve his task only hesitatingly. Fatigue is one of the chief symptoms of neurasthenia. In agoraphobia, the neurotic obviously hesitates to solve his problem without the assistance of another person.

The third form of movement characteristic of all neurotic symptoms is the detour around the solution of a problem and the refuge in a battlefield of lesser importance. This becomes especially clear in a compulsion neurosis. The patient sets up a counter-compulsion in opposition to the compulsion of social demands. In doing this, he merely postpones the solution of his problems. As for example, in the washing compulsion.

The fourth form of movement, the most complicated and striking, I might call the “narrowed path of approach.” The person does not give himself up fully to the solution of a problem, but attempts part of it and eliminates other parts, generally those which are most pertinent. This is the case in perversions. Another phase of this same form of movement sometimes leads to great cultural achievements.

Each individual approaches the goal of “overcoming” differently. Proceeding toward a general diagnosis, we may recognize traits of unconcealed despotism aiming to make the other person a slave to the patient, as in anxiety neurosis. Such individuals have learned in their childhood to force others to come to their rescue by frightening them. Another group uses the “alibi” as the chief form of movement toward the goal of “overcoming.” Their ambitious tendency becomes obvious when we see them insisting on their point of view. For instance, they will say, “If only I could sleep, I would be the first or among the first.” But they content themselves with having this alibi. Of course, not everyone presents that alibi in such an easily understandable form; therefore, we have to take into account the whole of a patient's attitude toward his problems. In a third group, individuals create fictitious values within themselves. Such neurotics, for instance, pride themselves on how much they have attained in spite of their neurosis.

I want to stress one more thing: in psychic processes the single spheres are not as separated as some schools of psychology assume. In no area do we find only the emotional or the mental side, only action or volition. The psychic process comprises the whole of an individual. When we observe a part of it, we should feel forced to search for the rest of it. So, if an individual tells us his first childhood recollections, we may gather from them the mental, emotional, and attitudinal aspects, but only after that can we understand the unity of his personality. By virtue of our experience we can, with all due precaution, ascertain the dynamic value of mental, emotional, and attitudinal aspects as movements directed toward, or determined by a goal, that for the individual, has the meaning of securing for him what he regards as his position in life. In this way, we can understand these goal-directed movements as the individual's efforts to secure for himself what he interprets, or misinterprets, as success, or as his way of overcoming a minus situation in order to attain a plus situation.

Thus, we come to the following conception of the structure of neurosis: all neurotic symptoms are safeguards of individuals who do not feel adequately equipped or prepared for the problems of life, but instead carry within themselves merely a passive appreciation of social feeling and interest. This appreciation becomes apparent when they take into account and exploit the social feeling of others. As soon as we learn to recognize the meaning of this attitude, we realize that in any neurosis, we deal with the pampered individual, or with the individual who has not become a cooperative fellow-being because in his earliest childhood he was trained to utilize the services of others for the solution of his own problems.

1 Originally published in English in Lancet, Vol. 220, pages 136-137, 1931. Re-printed in the International Journal for Individual Psychology, Vol. 1, No. 1, pages 3-12, 1935.

Volume 9 of the Collected Clinical Works of Alfred Adler
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