For most of the 20th century, neurosis was the official diagnosis for the condition that we now call anxiety. The first two editions of the DSM grouped phobias, obsessions, hysteria, and free-floating dread together under “neuroses,” assuming, à la Freud, that all of them were the result of unconscious conflicts. In 1980 when the DSM-III arrived, the American Psychiatric Association replaced “neurosis” with a family of disorders: generalized anxiety disorder, panic disorder, phobic disorder, and OCD—all under the heading of anxiety. The new lexicon changed the coding more than it changed the patients. Neurosis is the engine and anxiety is the squeaky brake. I know that many of us suffer from anxiety, but let’s examine how some major theorists conceived of the reasons why we are neurotic.

  1. According to Sigmund Freud, whatever we refuse to face head-on does not disappear, but simply gets repressed from consciousness while remaining fully active underneath, later resurfacing as sundry symptoms or seemingly irrational behavior that apparently comes from nowhere. Specifically, trauma that is not consciously processed gets re-enacted rather than remembered. We do not recall the original wound so much as unconsciously re-create its conditions, often with new partners cast unwittingly in the roles of the original offenders, which explains why so many people seem unable to break relationship patterns and keep attracting (supposedly) similar partners.
  2. According to Carl Jung, the qualities we can’t tolerate in ourselves get split off into our “shadows” and then projected onto other people, which is why the traits that irritate us most about other people may be traits that we disavow or fear or refuse to recognize in ourselves. Anxiety is the bubbling up of our shadow selves.
  3. According to Jacques Lacan, we are a split subject. The moment we entered language (used words), a gap exists between the “I” who speaks and the being that the I claims to express. This may seem obtuse and difficult to comprehend, but according to Lacan we are alienated from ourselves by language. Every subsequent attempt to explain who we really are only widens that gap since the explaining happens in the very medium that alienated us in the first place. This is why “aha” moments are visceral and not purely intellectual.
  4. According to D.W. Winnicott, we create false selves early in our lives to survive conditions where our emotions were not embraced by others. Our false selves earned us love and affection but only conditionally and the very success of these facades now keeps us from being embraced for who we believe to be our authentic selves. (This is the primary theme upon which I based my first book, “How To Survive Your Childhood Now That You’re An Adult: A Path to Authenticity and Awakening”.)
  5. According to Karen Horney, neurosis develops when a child’s environment feels quietly hostile rather than safe, which produces what she called basic anxiety. Children then typically adopt one of three enduring strategies to cope with it: 1) moving toward people through excessive compliance, 2) moving against people through aggression and control, or 3) moving away from people through detachment and self-sufficiency. But essentially we are anxious because we feel that something could go wrong at any moment.
  6. According to Wilfred Bion, an infant who lacks a caregiver capable of receiving and detoxifying overwhelming raw emotion is left holding unprocessed terror, hunger, and pain that—similar to Freud—is repressed. Left unprocessed, adult life becomes a series of eruptions or evacuations rather than a comprehensible experience.
  7. According to John Bowlby, the internal working model we formed in infancy, our baseline expectation of whether we are securely attached to others, was fixed before we had language to understand it; now this attachment dynamic runs silently underneath every adult relationship regardless of how our actual partners behave and causes us to be anxious about (most of) those relationships.
  8. According to Aaron Beck, much of our distress is the result of automatic, distorted thinking, catastrophizing, mind-reading, and all-or-nothing conclusions, which means the stress can be entirely real while the beliefs generating it are inaccurate.
  9. According to Irvin Yalom, our death anxiety correlates to how fully we are living. The risks we have not taken and the truths we have not spoken accumulate as an unlived remainder and that remainder is what shows up as anxiety.
  10. According to James Hillman, we arrived carrying a specific calling that existed before any parent or culture got to us and every year spent building a life that ignores that calling produces a persistent sense of falseness no matter how externally successful we become.

I can hear a chorus of WhatAboutists yelping, “What about IFS, ACT, EMDR (and several other acronyms that are currently in vogue) as well as Somatic Experiencing, Polyvagal Theory, etc.?” Listen, I’m guilty of trying to update Freud and Lacan to apply to contemporary issues but when there’s an acronym involved, you should know that it’s a money-grab: all of the above acronyms are derivative rehashings of previous theories cloaked in new branding. Brands have one goal: to attract paying customers. Don’t be fooled by a sleek acronym, especially by any of the ignoramuses who claim to be neuropsychologists yet wouldn’t recognize a neuron if it gave them a colonoscopy without anesthesia. As Nassim Taleb says, “Studying neurobiology to understand humans is like studying ink to understand literature.” Contemporary heirs such as IFS, ACT, Somatic Experiencing, and Polyvagal Theory have refined clinical techniques, but the underlying diagnoses they’re treating were named many decades ago.

20th-century psychiatrists and psychologists disagreed with each other about many things, but I think they would concur that neurosis is not a personal failing, it’s a part of the human condition—the price of admission for living in civilization and having minds that are meaning-making-machines.

Which brings me to three words uttered by Yuval Noah Harari: “It’s all story.”

We can be players fretting upon someone else’s stage.

Or we can be the authors and poets of our lives.