Psychoneurosis is Not An Illness

Psychoneurosis Is Not An Illness was published in 1972 by Gryf Publications

Reviewed by Emma Nicholson

This work of Dabrowski's is one of the jewels in the crown – the reason his whole theory was was so revolutionary and wonderful. It is an affirming view that psychological tension was not necessarily poor mental health, but a sign of positive disintegration.

It is by no means an easy read, but on the other hand it is not War and Peace either. While some of the language is technical, the book is set out in bite-sized chunks, and points are illustrated through case studies and regular examples.

The opening sentence of this book really sums up what it is all about…

“In this small book I wish to show that so-called nervousness and psychoneuroses are, in most cases, positive developmental phenomena.”

 

Below is a summary of the contents of the book (following the actual contents table):

    1. Psychoneuroses from the perspective of positive disintegration – In the opening part, Dabrowski covers an introduction to what he believes psychoneurosis is, and how it impacts developmental potential. He talks about how it assists us in determining our own values, by forcing us to feel uncomfortable with the way things are, and move towards how they ought to be.
    2. Five cases – He then goes on to compare five case studies of psychoneurotic people. Each case is analysed individually, looking at the psychoneurotic characteristics each. The section then concludes with a comparison of the cases, showing where each sits within unilevel of multilevel disintegration.
    3. Neuroses and Psychoneurosis – This short section gives a comparison between neurosis and disorders, and psychoneurosis, and how it can be classified as different.
    4. Psychosomatic correlation – Here, Dabrowski describes how psychoneurosis can manifest in the body. Everything from nervous tics and habits, through to hormone and thyroid imbalances.
    5. Disintegration and psychoneuroses in personality development – a look at the various psychoneurotic traits (e.g. overexcitability, tendency towards internal conflict, and need for solitude and quiet) and how they affect growth.
    6. Psychoneurotic syndromes according to the theory of positive disintegration – This section starts with a look at how overexcitability can be expressed according to a person's level of developmental potential, and then uses more cases studies. Dabrowski also goes into a general discussion and description of some of the syndromes from the standpoint of positive disintegration (this includes things like psychoneurotic depression, psychosomatic disorders, and even sexual psychoneurosis)
    7. Inner psychic milieu in psychoneurosis – We get a description of how an inner psychic milieu is developed, and it's role in shaping us into our personality ideal. Dabrowski also outlines his difference in opinion, stating that psychoneurotic symptoms were an expression of positive human development, and maps them across his levels of positive disintegration (and back to his case studies). Again, he talks about the symptoms such as psychoneurotic depression and anxiety, and the role they play in development. But he also goes on to talk about the protective role, or ‘prophylactic' role of certain symptoms – i.e. when we use psychoneurotic symptoms as a safety measure, or form of positive maladjustment, to maintain our sanity.
    8. Psychoneurotic obsessions – Dabrowski talks about certain types of obsessions and whether or not they represent mental growth, or an inability to push through positive disintegration. He then looks at this case studies, and shows how the various types of obsession could not be explained by other theories. There is also a transcript of a dialogue between himself and a patient who was obsessing over death. 
    9. Psychoneuroses and mental disorders – Dabrowski compares psychoneurosis to things like psychopathy, paranoia, and being schizophrenic, and then brings out some more case studies to talk about the differences.
    10. Psychoneuroses and outstanding individuals – He defines personality, and how it is only attained through positive disintegration. We then get a look at several famous individuals, and how they exhibit psychoneurotic and creative traits, and experience development. The section then concludes with a look at how psychoneurosis connects with creativity.
    11. Superior abilities and psychoneuroses in children and young people – Research and Case Studies and Analysis, Oh My! A study of gifted and creative children and a look at their psychoneurotic traits.
    12. Theories of neurosis and theories of development – Dabrowski compares his theory with the theories of others, including Freud and Jung.
    13. Psychotherapy and psychoneuroses – Dabrowski talks to the clinician on how to work with patients showing psychoneurotic symptoms. There are more cases studies, and transcripts here.
    14. The book wraps up with a cracker of a glossary.

    If you're wanting to know about the essence of positive disintegration, then this book is a really good place to start.

    While it's not a hard-core exploration of the levels, by looking at psychoneurotic symptoms, it shows us what that development can look like in practice. It has a comparison between the theory of positive disintegration and other theories. It talks about overexcitabilities. More to the point, it carries some of the most important sentiments underpinning the theory.

    Reading this book, one thing that jumped out at me, was how ahead of its time it is. There are many concepts which we are just starting to come to grips with today. It's neurodivergent affirming, in it's loving acceptance of overexcitability as a different way of being. It recognises that there are types of depression which are perfectly OK, and a normal response to the world. The book recognises the need for solitude and quiet, in order to create and process – yes, you heard right, it recognises the needs of the introvert! It even (and hold on to you hats here) draws a connection between neurodivergence and multi-gender attraction.

    Importantly it does a lot for de-stigmatizing emotions which would commonly be considered poor mental health. By reframing these as a path to growth (not just as things which are perfectly fine, but in fact a key ingredient in development) it flips the attitude towards things like depression completely on its head.

    Not only was this thinking a wild sentiment when the book was published in 1972, but it is still an uncommon approach. Depression and anxiety are seen today as ‘nothing to be ashamed of', but they are still seen as something which should be mitigated. Certainly no one is talking about how they lead to personality development. Dabrowski's approach to psychoneurosis is one that provides an alternative to the common sentiment, which see these things as something to be ‘fixed'.

    “In contrast to this writer's view that psychoneurosis usually represents a phase of accelerated, authentic development, is the opinion, widely held not only by laymen, but also by physicians, psychologists and educators, that psychoneurosis constitutes an illness.”

    However, Dabrowski does not stop there. He maintains that psychoneurosis in small doses gives a person an ‘immunity' to poor mental health. He talks about the role that these symptoms have in keeping us ‘positively maladjusted' to the world, and maintaining our sanity. In essence, it means that by having these emotional reactions to a crazy world, we recognise its insanity, and in the process, stop ourselves from going insane.

    “We may even go so far as to affirm that in most cases the milder psychoneuroses, and these are by far the more numerous, comprise basic prophylactic elements which guard a person against sustaining serious mental illness.”