Alfred Adler: Problems of Neurosis

A Book of Case-Histories

Philippe Mairet

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136333804
• Edition: 1
• Topic: Medizin
• Subtopic: Gesundheitsversorgung

First Published in 1999. This is Volume XV of twenty-one of the Individual Differences Psychology series. Written in 1929, this study gathers together case histories of Adlerian psychology and the science of Individual Psychology that teaches that the recurring theme of all neurosis and conflict is a sense of discouragement and inferiority.

PROBLEMS OF NEUROSIS

Chapter I

The Concealment of the Feelings of Inferiority.—Anxiety Neurosis.—The Theory of Heredity.—Dream of Anxiety Neurotic.—The Style of Life.—Suicidal Impulse.—Organic Effects of Neurotic Tension.—A Compulsion-neurosis.—Critical Point in the Development of Neurosis.—The Dream as a Rehearsal.

THE problem of every neurosis is, for the patient, the difficult maintenance of a style of acting, thinking and perceiving which distorts and denies the demands of reality. Usually, it is not until this way of life has become difficult to the verge of breakdown that the case is brought to the physician, whose task is to find the right method for its correction. The common problem, therefore, of both patient and physician, and the basis of their co-operation, is to understand the nature of the patient’s mistakes, and this demands not only a true outline of his essential history, but a perception of the dynamic unity of that history as a continual tension towards an implied conception of superiority.

As the work of Individual Psychologists has abundantly proved, an individual goal of superiority is the determining factor in every neurosis, but the goal itself always originates in—and is strictly conditioned by—the actual experiences of inferiority, The physician’s first line of approach is to identify the real causes of the feelings of inferiority, which the patient disguises from himself in various degrees and in his individual manner. Since the feeling of inferiority is generally regarded as a sign of weakness and as some-thing shameful, there is naturally a strong tendency to conceal it. Indeed, the effort of concealment may be so great that the person himself ceases to be aware of his inferiority as such, being wholly preoccupied with the consequences of the feeling and with all the objective details that subserve its concealment. So efficiently may an individual train his whole mentality for this task that the entire current of his psychic life flowing ceaselessly from below to above—that is, from the feeling of inferiority to that of superiority—occurs automatically and escapes his own notice.

It is not surprising, therefore, that we often receive a negative reply when we ask a person whether he has a feeling of inferiority. It is better not to press the point, but to observe his mental and psychic movements, in which the attitude and individual aim can always be discerned. In this way we soon perceive a greater or lesser degree of the feeling of inferiority in everyone, together with a compensatory striving towards a goal of superiority. Such a universal feeling is not in itself indictable: its meaning and value depend entirely upon how it is used: The most important discovery of Individual Psychology is that it may be used as a stimulus to continue upon the useful side of life.

These general observations apply closely to the case of a seventeen-year-old boy, the second child in the family, who was brought to me because he suffered from anxiety, and became extremely angry when confronted with difficulties. He also had stomach trouble and diarrhœa when he went mountaineering, a sport which he sometimes shared with his comrades. His mother was intelligent, and liked him, but apparently preferred his elder brother who gave her less trouble. This elder brother was much stronger, taller and a good sportsman. The father was a capable man, and the patient esteemed him highly.

This boy was afraid of making any decisions because his feeling of inferiority was too great for him to trust himself. He was unwilling, however, to admit that this feeling was due to any cause within his control. He insisted that he was born such as he was, and his nature was no responsibility of his.

This patient’s attitude to life was one of hesitation. When confronted with problems he always made difficulties, but though he thus “slowed down” he did not stop altogether. He was a very good pupil at school, but in constant fear of losing even this advantage, and he could not decide at all what to do upon leaving the High School. He made no friends; did not like girls, and was afraid of sexual experiences. He believed some of his difficulties to be the result of masturbation and pollutions. All this shows typical indecision and lack of confidence in regard to the three problems of life—society, occupation, and love. To all three questions the answer was evaded or postponed. He disguised his sense of general inadequacy by making various causes responsible, and thus he reassured and convinced himself of worth. It is notable, however, that the patient went on in spite of difficulties. He studied well, and he climbed mountains—which latter activity, by the way, is a common device of persons who feel themselves overburdened with life, to give themselves feelings of superiority. To review and emphasise the difficulties of life from the vantage-ground of a superior feeling is the next best thing to being able to boast that one has overcome them: It was in order to escape from the consciousness of his inferiority-feeling that this patient blamed his weakness upon natural difficulties and masturbation, and especially upon inherited deficiencies.

The theory of heredity must never be emphasised in education or in the theory and practice of psychology. Except in cases of sub-normal children and congenital idiots it is proper to assume that everyone can do everything necessary. This is not, of course, to deny the differences of inherited material, but what is important is always the use which is made of it. In this way only do we see the enormous significance of education. Right education is the method of developing the individual, with all his inherited abilities and disabilities. By courage and training disabilities may be so compensated that they even become great abilities. When correctly encountered, a disability becomes the stimulus that impels towards a higher achievement. We are no longer surprised to find that those who have attained remarkable successes in life have often been handicapped in the beginning with disabilities and with great feelings of inferiority. On the other hand, we find that a person who believes himself to be the victim of inherited deficiencies and disabilities, lessens his efforts with a feeling of hopelessness, and his development is thus permanently retarded.

Teachers exaggerate the maleficience of hereditary factors to excuse the inefficiency of their own methods. It is interesting to read in Einhardt’s biography of Charlemagne that this great Emperor could learn neither reading nor writing, from sheer lack of talent for such things! Now, with the development of educational method, no normal child finds these tasks beyond it. From this and many another example it appears that whenever authors, teachers or parents fail to find a method to correct errors by education they blame the inherited deficiencies. The superstition which this habit engenders is one of the greatest difficulties and the most commonly encountered in education and in handling “problem children,” not to mention the treatment of criminals, neurotics and psychotics. Yet for the treatment of these conditions the only reasonable assumption is that which is-made by Individual Psychology—that every-one is equal to his life-task. This does not mean that the results are or can be equal, for, of course, inequalities of training, method, and above all the degree of courage shown must be taken into consideration.

To return to the case in question: the ability of this boy’s father was an additional reason for his feeling that he could not make good in life. It is well known that the children of great men are very often unsuccessful: they feel incapable of ever attaining positions as high as their fathers held, and therefore do not seriously attempt anything at all. In the case of this patient, the high achievements of his elder brother also lengthened his distance from the goal of superiority in the family circle. He felt himself hopelessly surpassed. The neurosis which he developed was a protection from the painful consciousness of this inferiority. It was the adoption of an attitude which signified to him:— “If I were not anxious, if I were not ill, I should be able to do as well as the others. If my life were not full of terrible difficulties, I should be the first.” By this attitude a person is able still to feel superior, for the decision of his worth and value is placed beyond proof, in the realm of possibilities. His chief occupation in life is to look for difficulties, to find means of increasing them, or at least of increasing his own sense of their gravity. The most ordinary difficulties of life, common to everybody, are carefully collected by him and kept upon exhibition. He does this more to impress himself than others, but naturally other people take his burdens into account and do not expect so much of him. Any success he may have, moreover, is magnified by this heavily-advertised handicap, so that it becomes his most useful possession. By it he wins his way to a privileged life, judged by a more lenient standard than others. At the same time, he pays the costs of it with his neurosis.

Another case of anxiety neurosis, taking the form of agoraphobia, and accompanied by heart symptoms, occurred in a man of thirty-five. Anxiety neurosis is always symptomatic of a timid attitude towards the three problems of life, and those who suffer from it are invariably “spoiled” children.

This man dreamt, “I crossed the limit of the border between Austria and Hungary, and they wanted to imprison me.” (Such short dreams, by the way, are the best for analysis.) This dream indicated the man’s desire to come to a standstill, due to the fear that he would be defeated if he went on. Its interpretation very well confirms our understanding of anxiety neuroses. The man wanted to limit the scope of his activity in life, to “mark time” so as to gain time. He came to see me because he wished to marry, and the imminent prospect of doing so had brought him to a halt. This fact itself, that he came to consult me about his marriage, clearly indicated his attitude towards it. Similarly, the way that he would behave in marriage was mirrored in the dream, in which he commanded himself—”Do not pass the limit!” The prison in the dream also reflected the dreamer’s view of marriage. We often deceive ourselves by such images in dreams. We use them to train ourselves to tackle the problems of the near future in a manner consistent with our own style of life—but not in accordance with the logic of the situation.

The style of life is founded in the first four or five years of childhood. This period closes with the full development of the ego and the consequent fixation of its attitude to life. From this time onward the answers to the questions put by life are dictated, not by the truth of relations in themselves, but by certain automatised. attitudes, which we call the style of the individual. Thus we explain the fact that a certain mistake of adaptation—such as the desire to be the centre, to be overburdened, not to be forced, not to be curtailed, etc.—may persistently continue throughout a life-time.

A very successful man, forty years old, complained that he could not go up into a high building without having an impulse to jump out of a window. He said he had always been afraid of everything. He had been the youngest of six children, and very much spoiled by his mother. This case reveals at a glance the wish to be thought overburdened and in danger. The patient cannot avoid going upstairs, but he colours this procedure with his desire to be in a dangerous situation, clinching the danger by developing an impulse to jump.

In this case and the two previously cited, the goal of superiority is similar, as regards the motive of being over-burdened. But this man goes further. He has a desire to jump from a window, but lo! he overcomes it and still lives. He is stronger even than himself.

In support of this diagnosis I will add a recollection from the patient’s childhood. “I went to school when I was six years old. I was not very happy. The very first day a boy attacked me. I was dreadfully afraid and trembled but . . . I sprang at him and threw him down.” This fragment of memory records the two typical motives of the man’s life-style. He trembles at first, but only to overcome. And that little word “but” holds the rich meaning of his compensation for feelings of inferiority.

A girl of twenty-seven came to consult me after five years of suffering. She said: “I have seen so many doctors that you are my last hope in life.” “No,” I answered, “not the last hope. Perhaps the last but one. There may be others who can help you too.” Her words were a challenge to me; she was daring me not to cure her, so as to make me feel bound in duty to do so. This is the type of patient who wishes to shift responsibility upon others, a common development of spoiled children. It is safe to assume that in childhood she constantly contrived to keep another person occupied with her; and we may infer that it was probably her mother. We need additional facts to verify this impression, but there are methods by which it can be done even in the first interview.

It is important, by the way, to evade such a challenge as the one I have recorded here. The patient may have worked up a high tension of feeling about the idea that the doctor is his “last hope,” but we must accept no such distinction. To do so would prepare the way for grave disappointment, or even suicide.

This girl was a second child, whose elder sister was more beautiful than herself, besides being very clever and popular; so that the patient’s life had been like a breathless race to overtake her rival. The sister married happily. The ‘patient also developed well, especially intellectually, out-doing her elder sister in school work. However, the sister was much more charming and attractive, and made friends far more readily. The life of the older sister had been smoother and pleasanter, giving her greater self-confidence. The younger, from a sense of insecurity, felt a need to assert herself against others, which repulsed their friendship. Doubtless none of these two girls’ acquaintances recognised the true nature and origin of this difference between them; but they all felt it unconsciously, and they were attracted to the one and repelled by the other.

The patient had been in love at the age of fourteen, when she was ridiculed for it, so she had ever since declined to play the part of a loving woman. When her sister married she fell in love with a married man. Such an attachment cannot, in itself, be dogmatically estimated. Nobody can be sure if such a love will turn out well or not. But we cannot ignore the fact that every girl in such a situation sees the great difficulties it involves quite as clearly as her parents or anybody else can see them. And a girl going through such an experience tells herself “This is what love is like.” Her selection of such a troublesome love is prima facie ground for suspicion that she does not wish to see love and marriage through. In this case we see the patient adopted, towards this new life-problem of love, the same hesitant, non-committal attitude she had exhibited in the past. There were reasons. She was less attractive than her sister, and she had been ridiculed in her first love-affair. A girl of such a competitive nature, bent towards the goal of superiority, is always in danger of losing courage and self-confidence by marriage. She will usually feel marriage to be a menace to her sense of superiority. The happy marriage of this girl’s sister fed these fears: so did the unhappy marriage of her parents and her mother’s inferiority.

The girl’s hesitating attitude to love and marriage came out during frank discussion with her. She said: “I am sure my husband would leave me two weeks after our marriage.” When I hinted at the deep feeling of inferiority which was the cause of her evasion of marriage she tried to retract this statement: but the mere fact that such an idea could appear at all, even in a joke, showed that her mind had been occupied with that specific problem.

Even when the man with whom she was in love wanted to kiss her she ran away from his caresses. In such ways she established her distance from the demands of love and marriage, and sacrificed everything to her neurotic goal of superiority. “If this man were not married I would marry him” was her answer to this problem of life.

“If” is usually the leit-motif of the neurotic drama. “If” is the last resort in every neurotic dilemma, and the one sure way of escape. For the will to escape there is only one reason, and that is fear of defeat, which is the hardest of all reasons to admit. At this point, therefore, we frequently find some fictitious form of anxiety, which the patient interprets to himself variously but never truly—never, that is, as the simple fear of being beaten. Agoraphobia, anxiety neurosis, and all the forms of phobia may originate at this point, but, whichever it may be, it fulfils its purpose of blocking the way to further activity. Thus what was desired is attained—namely, the ordeal is evaded without disclosing, even to its owner, the hated feeling of inferiority. All the other neurotic symptoms, such as compulsion ideas, fits, fatigue, sleeplessness, functional disturbances such as neurotic heart, headaches, migraine and so on, develop out of the severe tension of this very difficult concealment.

The organs most disturbed by this tension are those which have been made susceptible by some inherited weak-ness. Hence, we find, where a whole family is liable to a particular organic weakness, that several members suffer from organic illnesses, and others from neurotic symptoms of that same organ. In such cases we must not overlook the contributory factor of imitation. We find, however, in distinction from other psychologists, that the only symptoms imitated are those which are alignable to the neurotic goal of superiority.

This patient had held a position in an office, where she played a leading rôle and was much appreciated, but, like all people with an excessive feeling of inferiority, she was insatiable of appreciation, and always striving for more. At the age of nineteen she changed her position, and lost the admiration she had formerly enjoyed. Reviewing her case, we may note—

1. She was hopeless of competing with her sister, either in making friends or in making a successful marriage.

2. She feared to face the problems of love and marriage.

3. She had lost a favourable position in her work.

In short, all the defeats she had feared had now befallen her; her intense feeling of inferiority had been justified. She did not reason out the situation in this way, but showed, by the appropriate mood, that this was how she felt it.

We may note in passing a typical concentration upon, and exaggeration of, one point in the life-problem, namely, the fear of defeat. While occupied upon the useful side of life one has always to reckon with possibilities of defeat, which we normally minimise by regarding occasional reverses as incidental to every human enterprise. But in such a case as we are now reviewing, the possibility of defeat has become the focus of life. The patient subordinates his whole life to it, just as a person with a cleaning mania makes her life revolve around the idea of dirt and the normal and useful act of washing becomes exaggerated...