Psychoneurosis

Most often this illness is seen as a state of anxiety or tension, an undefined sense of worry and apprehension, often accompanied by such physical signs as trembling, sleeplessness, headache, and upset stomach. In some degree every one of us has known such symptoms. It is only when they persist into a regular and unbroken pattern that a diagnosis of an "anxiety state" can fairly be made.

Since anxiety is the most intolerable of all sensations, some mentally ill persons develop physical impairments in its place. Such persons are said to suffer from hysteria. This means a loss or change in physical function without any physical explanation. Such hysterical disease may present itself as a paralysis or loss of feeling in an arm or leg, a sudden loss of consciousness or awareness of one's surroundings, a loss of one of the special senses, such as sight or hearing, feeling, or smell. When the doctor speaks of "conversion hysteria," he means that the patient has found his fears unbearable and has converted them into a physical disability.

Another kind of ordinary mental reaction is depression. Almost everyone has experienced the normal kind of depression that grief produces. But when it becomes a prolonged sense of the lack of any worth in living, it is designated by the diagnostic term "depressive reaction." Another variety is a sense of chronic fatigue and weakness, of not being quite up to the demands of dai^ly life. An older term called this "neurasthenia." We now call it "asthenic reaction."

There are also persons in whom minor mental illness takes the form of specific obsessive fears (phobias), such as fears of closed spaces, high places, crossing the street, certain animals, and crowds. Or they may develop certain special habits that they persist in—such as the child avoiding stepping on the cracks in the sidewalk, or the man who must go back several times into his house before he leaves it to be sure the stove has been turned off, or the woman who is excessively tidy in her housekeeping. These are called compulsions.

This group of the mentally ill is usually diagnosed as suffering from what is known as an "obsessive-compulsive" sickness. All of these individuals—the anxious, the hysterical, the depressed, the tired, the obsessive—fall into the category of neurosis, or, as the physician will ordinarily call it, psychoneurosis.