Fear neurosis

Every mental symptom that reflects an imperfect, poor adaptation of a person to his social environment can be called a manifestation of such a condition as neurosis, provided that organic causes such as psychosis and psychopathy have been carefully excluded. There is no need to exclude depression, since the symptoms of neurosis should facilitate the rapid diagnosis of depression as the basis for the development of neurosis. When planning treatment, decide for yourself what is more important in a particular case - fear or depression.

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Causes of fear

• Stress (excessive fatigue or lack of work, unfavorable environment, such as loud noise, endless quarrels in the family).
• Stressful moments in life (a child starts school; a person changes jobs or gets a job for the first time, leaves a familiar environment, home, gets married, retires; a child appears in the family; a loved one suffers from a fatal illness).
• According to intrapsychic theories (for example, the feeling of fear is an excess of psychic energy and a manifestation of suppressed hostility or conflicting impulses). According to this theory, neurotic behavior is considered a way of getting rid of excess psychic energy, and according to psychoanalytic theory, it most often occurs if the given personality has not passed normally through the oral, anal and genital stages of development.

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The connection between neuroses and crime

From a clinical point of view, the most common neurotic conditions among people who have committed crimes are anxiety and neurotic depression. The least common are phobic and compulsive conditions.

High levels of neurotic symptoms in criminals do not necessarily imply a causal relationship between the symptoms and crime. Criminal behavior and neurotic symptoms are related to the same social and personal circumstances, so they may occur in the same person without necessarily interacting. Studies of neurotic symptoms among prisoners show significantly elevated levels of neurotic symptoms among persons with personality disorders. Significant levels of substance abuse are associated with neurotic symptoms and personality disorder. Given the interaction of these disorders, it is extremely difficult to isolate the precise contribution of neurotic disorders to crime.

Neuroses and murder

Reactive neuroses (depression and/or anxiety) can be so severe that the accompanying stress can lead to an emotional outburst resulting in murder, even in the absence of a personality disorder. Courts accept chronic reactive depression and moderate depression as grounds for applying the defense of diminished responsibility.

Neurosis can have a significant effect in combination with personality disorders, such as the neurotic depressive reaction in a person with an explosive or antisocial personality. It can disinhibit the subject in a tense situation, with a subsequent outburst leading to murder - either to destroy the source of frustration or to transfer the tension to an innocent person.

Neuroses and theft

Thefts may be clearly related to neurotic depressive states (as shown by the example of shoplifting), if they are committed, presumably, with the aim of drawing attention to the subject's unfavorable state or with the aim of calming down. Such motivation is also seen in thefts committed by unhappy and restless children. The tension associated with the neurotic state may lead to theft as a psychologically destructive act. The subject may show a picture of prolonged depression, although in some cases the accompanying behavioral disorder may be so pronounced that it distracts attention from the underlying mental disorder.

Neuroses and arson

The connection between neurosis and arson is well established. This is especially true for states of tension. Fire can act as a way to relieve tension, alleviate feelings of depression, and symbolically destroy the source of pain. In cases of arson, the well-known comorbidity of neurotic disorder with substance abuse and personality disorder may be especially significant.

Neuroses and crimes related to alcohol consumption

Alcohol can cause states of melancholy. Crime can also be preceded by depression or anxiety - in sensitive individuals, as well as binge drinking. This combination can lead to the commission of a crime; alcohol acts as a disinhibitor.

Neuroses and imprisonment

Imprisonment, either pre-trial or in relation to a prison sentence, can cause neurotic symptoms such as anxiety and depression in offenders. It is therefore important to distinguish symptoms arising after arrest from pre-existing distress relevant to the offending. Imprisonment is a fearful experience which involves loss of autonomy, separation from family and friends, and exposure to the immediate stress of imprisonment. An Office for National Statistics study found that the four most common neurotic symptoms associated with imprisonment among prisoners were anxiety, fatigue, depression and irritability. Prisoners were significantly more likely to seek medical advice than the general population.

There is one particularly distinguished syndrome, Ganser syndrome, which is described as a reaction to confinement and is classified in ICD-10 as a form of dissociative disorder (F44.8).

Ganser in 1897 described three prisoners with the following mental disorder characteristics:

• inability to answer simple questions correctly, even if their answers indicated some degree of understanding of the question (V.: “How many legs does a horse have?” - A.: “Three”; V.: “And what about an elephant?” - A.: “Five”);
• some clouding of consciousness (disoriented in place and time, distracted, confused, slow reaction and a feeling of their “absence”, as if they are somewhere in a dream);
• hysterical conversion syndromes (for example, loss of pain sensitivity throughout the body or in areas of increased pain sensitivity);
• hallucinations (visual and/or auditory);
• a temporary sudden cessation of the disorder with the disappearance of all symptoms and a return to a state of complete clarity of consciousness, followed by deep depression and a resumption of symptoms.

Ganser was sure that this condition was not a simulation, but a real illness of a hysterical nature. He notes that in the cases he described there was a previous illness (typhus and in two cases - head trauma). Since then, there have been disputes about the true nature of this condition. This syndrome rarely manifests itself in a full-blown form and is observed not only in prisoners, and individual symptoms can manifest themselves in a variety of mental disorders. Various points of view on this syndrome have been expressed: that it is a real transient psychosis or even simulation, but perhaps the most common opinion is that it is a hysterical reaction as a result of depression. It should be distinguished from simulation, pseudo-dementia, schizophrenia and drug-induced conditions.

Symptoms of anxiety neurosis (fear)

Trembling, feeling of faintness, chills with goose bumps, feeling of butterflies in the stomach, hyperventilation syndrome (for example, accompanied by noise and ringing in the ears, a tendency to intermittent convulsions, pain in the chest), headaches, increased sweating, a feeling of palpitations, poor appetite, nausea, a feeling of a lump in the throat even without trying to swallow (globus hystericus), difficulty falling asleep, anxiety, excessive attention to one's own body functions and the physical health of others, obsessive thoughts, compulsive (uncontrollable) motor activity. In children, this is manifested by thumb sucking, nail biting, bedwetting at night, perverted appetite and stuttering.

Prevalence of crimes in neuroses

Prevalence figures are unknown. A study of shoplifters found that 10% of the group were neurotic, but there was no control study. The Office for National Statistics reports that 59% of remand prisoners, 40% of male prisoners serving sentences, 76% of female remand prisoners and 40% of female prisoners serving sentences have neurosis. These figures are much higher than in the general population. People with neurosis also often have comorbidity with personality disorder and substance abuse. Post-traumatic stress disorder is found in 5% of male remand prisoners, 3% of male prisoners serving sentences, 9% of female remand prisoners and 5% of female prisoners serving sentences.

Treatment of anxiety and fear neurosis

An effective way to reduce anxiety is to simply listen carefully to the patient. One of the goals of psychotherapeutic treatment of such patients is to teach them to manage the symptoms of neurosis or to be more tolerant of them if they cannot be managed. In addition, it is necessary to improve the patient's relationships with other people and help in resolving the most distressing problems for the patient. It is necessary to seek help from social workers. In some cases, anxiolytics may be indicated, which will make the psychotherapist's work with the patient more effective.

Approximate doses: diazepam - 5 mg every 8 hours orally for up to 6 weeks. Problems associated with treatment with benzodiazepines. As follows from the text, their usefulness is very limited.

Progressive relaxation training

The patient is taught to tense and relax muscle groups in a certain order - for example, starting with the toes and gradually involving all the muscles of the body in the process in an ascending manner. In this case, the patient's attention is concentrated on performing the above exercises, and the feeling of anxiety (as well as muscle tone) is reduced. Deep breathing movements have a similar effect. The patient must perform the above exercises quite often in order to achieve improvement. Patients can purchase appropriate cassettes with a recording of the process of learning the above exercises and use them again.

Hypnosis

This is another powerful method of treating patients with anxiety and fear neurosis. First, the psychotherapist induces a progressive trance state, using a technique that his imagination suggests, and concentrating the patient's attention on various body sensations, such as breathing. Then the patients themselves learn to induce these trance states (the state of outpatient automatism in hypnosis).

Medical and legal aspects of neurosis

If the underlying cause of the crime is clearly neurosis, not complicated by any antisocial personality disorder, the courts may consider recommending psychiatric treatment. This also applies to the most serious crimes, such as a young man with depression being accused of murdering his wife. If the subject's neurotic condition is complicated by a psychopathic disorder, the court's concern for public safety or lack of empathy for the subject may lead to prison sentences in serious cases. In cases where society is not at risk (e.g. shoplifting by a depressed person) and inpatient treatment is not required, probation with an outpatient treatment condition is usually used.

Dissociative phenomena (including dissociative phenomena associated with post-traumatic stress disorder) may be grounds for the application of the defense of automatism. The legal criteria for the application of the defense of automatism are very strict, and dissociative states usually involve partial awareness and partial memory, making the defense of automatism difficult to apply. Post-traumatic stress disorder may, in the context of repeated traumas, most notably battered women syndrome, sensitize the victim to such an extent that a relatively weak provocation may lead to violence, with the traumatized person responding to weak environmental cues that had previously indicated a threat of violence. In the United States in particular, the application of such syndromic evidence has resulted in the application of the defense of provocation, including in cases of homicide, as "self-defense."