Neurosis and Neurotic Conflict
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Karen Horney (1937) defined neurosis as a “psychic disturbance brought about by fears and defenses against these fears, and by attempts to find compromise solutions for conflicting tendencies” (p. 26).Neurotic conflicts stem from childhood experiences where parental figures did not provide a loving, safe, and consistent environment. As a result, the child internalizes core feelings and beliefs of unworthiness, shame, and defectiveness. In an attempt to distance from these feelings, the individual develops compromise solutions to create a homeostatic self-regulating system to keep painful feelings at bay.
Karen Horney (1885–1952) was one of the most original psychoanalytic thinkers to emerge from the Berlin Psychoanalytic Institute, a renowned center of psychoanalytic learning since the early part of the twentieth century. Her originality became clear early on as she began her cultural critique of Sigmund Freud’s classical instinct theory focused on libido theory, psychosexual stages of development, and oedipal rivalries as the basis of adult psychopathology.
Following Horney’s move to the United States in 1932, her convictions grew that the descriptions of classical theory were not only gender biased but philosophically rooted in outmoded nineteenth century ideas of objective distance, scientific detachment, and linear causation. In 1939 she published New Ways in Psychoanalysis, in 1945 Our Inner Conflicts: A Constructive Theory of Neurosis, and in 1950 Neurosis and Human Growth: The Struggle Toward Self-Realization. Through these books Horney created a new basis for understanding and treating neurosis and neurotic conflict: that the characterological present could not be ignored and that in terms of treatment progress the colliding forces of character dynamics were the ground zero of neurotic conflict. Although Reich (1949), Ferenczi (1952, 1955), and Ferenczi and Rank (1925) all challenged Freud on his unwarranted assumptions, only Horney actually offered a comprehensive new theory of neurosis and its treatment.
Clinical Details of Horney’s Strategic Paradigm Shift in Psychoanalysis
Let us describe the clinical details of Horney’s strategic paradigm shift in psychoanalysis. She developed a dynamic integration of intrapsychic, interpersonal/relational, and systemic aspects of the self. Rather than rooted in instinctual forces, conflict was seen as a product of compulsive trends in character structure operating in the moment-to-moment present. It compels the analyst to attend to the raw subjectivity of the patient: the tumult, terror, and humiliation that can potentially exist in all of us.
Conceptual changes began to develop that are much more attuned to process rather than to content. Danielian and Gianotti (2012) describe this as a metapsychological shift that “casts a long shadow: shame becomes more relevant than guilt, dissociation more relevant than repression, and the characterological present more relevant than the instinctual past” (p. 4). Addressing the moment-to-moment balance of forces in a patient brings us much closer to appreciating the ever-present conflict between the obstructive and constructive forces within the personality, what Horney called the psychic conflict between the real self, the self-hating self, and the idealizing self (Horney 1950).
It is relevant to point out that with the introduction of the psychic forces at work, Horney began to enlarge the concept of neurotic conflict itself. In her earlier works, when Horney (1939, 1945) described neurotic conflict, she meant characterological conflict occurring between compulsive trends each of which being fueled by self-hate and self-idealizations. But in Neurosis and Human Growth, Horney (1950) expanded the definition to include “central inner conflict” (p. 112 and p. 368). To be sure the central inner conflict is not very apparent in the early stages of analysis but gradually comes more into view as the patient begins to develop authenticity and self-realization. Its power is derived from “the fact that at the very core of our being, our real self with its capacity for growth, is fighting for its life” (p. 113).
The fight between the constructive forces that are in battle with the obstructive forces within the personality is present in all stages of therapy. However, as treatment progresses and the constructive forces get stronger, the patient is at a crossroads, where “pseudo-solutions” must be modified or relinquished in order for further integration of the real self to occur. This presents both an unconscious and conscious dilemma because at the heart of the neurotic construction is an attempt to create a sense of safety, equilibrium, and/or connection.
From a relational perspective, the creation of the pseudo-solution is a child’s early adaptive attempt to preserve the tenuous connection to parental figures, figures who were often inconsistent, disorganized, or unavailable to meet the child’s basic needs. Directly or indirectly, parental demands that the child remain “loyal” to the status quo meant not challenging parental authority. This dilemma often meant the relinquishment of the real self in order to preserve the precarious attachment or going against the status quo and suffering the experience of isolation, annihilation, or abandonment. From a relational perspective, this no-win false solution is at the heart of the central inner conflict.
In sum, Horney describes the central inner conflict as “the most comprehensive conflict of all – that between his pride system and his real self, between his drive to perfect his idealized self and his desire to develop his given potentials as a human being” (p. 356). Horney states that this is often the most turbulent period of analysis, requiring the patient to examine core questions of this conflict, such as, “does the patient want to keep whatever is left of the grandeur and glamor of his illusions, his claims, and his false pride or can he accept himself as a human being with all the general limitations this implies, and with his special difficulties but also with the possibility of his growth” (p. 356–7). Inevitably, resolving the central inner conflict requires a progressive grieving and a letting go of the grandiose wish for invincibility and the grandiose need to be perfect, allowing the individual to accept the innate humanness and goodness of who he is.
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