Prognosis in the Neuroses

I am as one for ever out of his element

C. Day Lewis1

I am using the word “neurosis” in this article in an epidemiological sense (taken from the International Statistical Classification of Diseases, Injuries and Causes of Death2 categories 300-309). How do individuals considered neurotic interact with society, and how does their environment affect them? There is considerable overlap between neuroses and personality disorders, as well as affective disorders. Although neurosis is very common in the general population, there is a gradual increase of severity to be found from 1) neurotics in the general population to 2) patients consulting their family doctors for predominantly psychiatric symptoms to 3) psychiatric out-patients to 4) psychiatric in-patients.3 The follow-up findings of this report are mainly based on studies from Uffculme Clinic, Birmingham, U.K., in which all the one hundred forty-six patients treated for neuroses of mixed type in hospital in one year were followed-up twelve years Jater with an interview by a trained interviewer usually at the patient's home. These studies are reported elsewhere.3-10

Greer and Cawley consider that an accurate knowledge of the natural history of neurosis can only be obtained by a follow-up study, and in order to allow for the operation of the vast number of environmental and other factors affecting the course and outcome in any given individual, it is necessary to study large numbers of patients.11 At follow-up I found a mortality considerably above that expected;6 over ten percent of the previous neurotic patients were found to show established dependence on either alcohol or psychotropic drugs.7 The metamorphosis of neurosis into psychosis was found to be an unusual event, probably associated most often with initial misdiagnosis. An identical follow-up procedure to that undertaken with neurotic patients was carried out with a supposedly normal group of subjects.8 Ninety percent of the normal group were found to have a sa