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THE WORD neurosis has two connotations. In popular speech it covers the whole subject of psychological disease. It is difficult for me to know whether I am expected to deal with neurosis in a general way or whether those who planned this programme wished for a brief statement of neurosis in the more strict and restricted psychiatric sense of the term.
For the psychiatrist, neurosis refers rather specifically to the difficulties inherent in the personal life, and not on the whole to troubles arising out of faulty management. Moreover, neurosis does not include psychosis, or a latent psychosis, or a mood disorder, or a paranoid tendency, or an antisocial tendency.
Neurosis proper denotes unconscious conflict. It relates to the instinctual life of the child. Its main point of origin is at the toddler stage, before the age generally accepted for education at a school. At this stage the family setting is of maximal value.
It will be evident that the existence of true neurosis implies healthy emotional growth at the very important earlier stages in infancy, where dependence on the mother is near-absolute, and where failure of care produces psychiatric illness more serious than neurosis.
Neurotic illness takes its origin in the very severe anxiety that results from the instinctual drives of the child. By anxiety I mean the sort of affect that breaks through in the nightmare. These instinctual drives have biological backing.
Fantasy is the imaginative elaboration of physical function. In the play and in the conscious and unconscious fantasy of the small child we find all that is to be found in the lives of adults, except the full capacity for instinctual