Whatever Happened to Neurosis? Who are we Analyzing? and How?: The Importance of Mental Organization

The concept of neurosis has virtually disappeared from modern psychoanalytic literature and conferences for multiple reasons, particularly a developmental lag in integrating the structural theory into our nosological schema. Consequently the use of diagnostic categories in determining analytic strategy is minimized. Instead we teach candidates to assess suitability for analysis or to assess mental structure to determine whether a patient should be treated with analysis or psychotherapy. But diagnostic categories based on structural distinctions can be used to choose which analytic strategies of the many available in our current pluralistic state can best help a particular patient. The diagnostic question should be what type of analysis will help this particular patient, not whether or not he or she can be treated with analysis. Analytic technique should no longer be one size fits all. Neurosis is then defined in terms of mental structure. Symptoms or character traits are neurotic if they occur within a neurotically structured mind. Four structural criteria of a neurotically organized mind are offered for heuristic purposes: self-reflective capacity, capacity for affect regulation, capacity for narcissistic regulation, and internal conflict.