Negative and Positive Diagnosis of Neuroses: Myasishchev's Concept of Neuroses

There is positive and negative diagnosis of neuroses: Positive – identifying signs characteristic specifically of this disorder – identifying the psychological causes of the illness; Negative – excluding an organic basis – if there are no organic disorders, yet an organ hurts, it follows that this is a neurosis, based on medical methods of examination. Myasishchev's model (concept of neurosis) Positive diagnosis of neuroses assumes that there is a specific category. Negative diagnosis is the justification of the diagnosis by negative results. 1) Psychogeny is connected with the personality of the patient, with the traumatic situation. 2) The emergence and course of neuroses are connected with the pathogenic situation and the personality's experience. There is a corresponding relationship between changes in the state and psychotherapy. 3) The clinical manifestations of neurosis are connected in their content with the traumatic situation and the personality's experiences. It represents an affective reaction, a pathological fixation of certain experiences. 4) A high effectiveness of psychotherapeutic methods is noted in comparison with biological interventions. Myasishchev believed that neuroses are based on contradictions between the personality and significant surrounding reality. Not every psychological trauma leads to neurosis. Personality is a hierarchical set of a system of relations.

From V. N. Myasishchev's point of view, neurosis is an experimental model that life creates for studying the characteristics of a person's relations. «Nowhere, as in neurosis, is a person's personality revealed to researchers with such fullness and prominence; nowhere does the pathogenic and beneficial role of human relations manifest so convincingly; nowhere does the disfiguring and healing power of influence appear so clearly, nor is the role of circumstances created by people expressed with such distinctness» (Alexandrov A. A., 2009).

Neurosis is often a consequence of the influence of external pathogenic events, which frequently place contradictory demands on the individual. In such conditions one may speak of an external conflict situation in which a person finds themselves, but, from V. N. Myasishchev's point of view, pathogenic events bearing the character of a conflict can become both a source of a person's psychological growth and a source of the onset of neurotic illness. The second variant arises when the traumatic situation coincides in significance with an intrapersonal conflict, which makes the external situation, the external conflict, subjectively unresolvable. This is an important, but not the only, condition for the onset of the illness. The second condition is the involvement in the conflict of especially significant relations of the personality, occupying a high rank in the individual's system of relations and possessing rich emotional and motivational components.

«Neurosis is, above all, an illness of the personality because it is caused by circumstances of significance within the personality's system of relations» (Alexandrov A. A., 2009). Although, from the point of view of an outside observer, in neurosis only separate, local spheres of relations are affected, the individual becomes entirely drawn into this situation owing to the significance of the disturbed sphere of relations. The subjective unresolvability of the intrapersonal conflict is projected outward and further complicates the resolution of the difficult situation, so the individual becomes stuck in it. Therefore, when a psychotherapist, in the course of taking the case history, notes such problematic situations in the patient's past, they assume that these may reflect an intrapsychic conflict already existing in the patient. Comparing them with the current traumatic situation allows the therapist to better understand the content and essence of the main intrapsychic conflict. Working through this conflict, clarifying its content and its mechanisms (how and by what it is sustained, and how, if the mechanisms of consolidation of the intrapsychic conflict were not engaged, it would resolve spontaneously, as indeed happens in some cases), and its constructive resolution is the main goal of pathogenetic psychotherapy.

Thus, in pathogenetic therapy the intrapsychic conflict is the main target of therapy. The presence of an unresolvable traumatic situation, of an intrapsychic conflict, leads to a state of chronic psycho-emotional overstrain and, at a certain stage, to the emergence of general neurotic symptoms, above all of the asthenic and vegetative kind.