Some ideas return after the briefest of exiles: reductionism is back in vogue. Existential questions – about who we are, about our origins and future, about what is valuable – no longer require difficult soul searching, especially when straightforward answers are expected from the neurosciences. History is being rewritten with the brain as its centrepiece; the search for great men and big ideas of the past begins again. William Cullen (1710–90), whose work on neurosis was once part of the history of psychoanalysis, is now well placed to become part of such a neuro-history. This article attempts to subvert this process, by rebuilding the original meaning of neurosis through Cullen’s physiological and medical works, in comparison with his predecessor, Robert Whytt (1714–66), and illustrating this meaning using one particular neurosis: hypochondriasis. The result is a more complicated version of neurosis which, importantly, carries significant insights into the nature and practice of medicine. Moreover, this article examines how Cullen’s standing fell in the 1820s as British physicians and surgeons turned to an idea which promised to reform medicine: pathological anatomy. When these hopes faded, Cullen became a figure obsessed with the nerves. This image has survived to the present, a blank canvas onto which any theory can be projected. It also values precisely what Cullen warned against: simplistic explanations of the body and disease, and unthinking confidence in the next big idea or silver bullet. Neurosis was not simply a nervous ailment, but it is a warning against reductionism in history making.

Objective – The aim of the study was to show, trough the calculation of the direct costs of supports and treatments actually provided by a NHS Mental Health Department, the presence of associations between four diagnostic groups (schizophrenia, affective psychosis, paranoia and neurotic disorders) and their overall and items (community care, rehabilitation facilities and in-patients services) costs. Setting – Mental Health Department and CSM “Scalo” (NHS Mental Centre), AUSL “Citta di Bologna”, Emilia-Romagna Region. Design – Yearly direct costs were calculated for a sample (n = 75) of all patients (N = 745) who during 365 days had more than four contacts with CSM and also for four randomised diagnostic groups (n = 30 per group). Main outcome measures – We calculated unit costs of 15 types of services provided by CSM, selected according to the yearly number of services provided and the time spent by each health professional, and the in patient-cost per all days spent in a public or private sector hospital for psychiatric care. Results – The statistic analysis, performed with the help of the Kruskal-Wallis test, showed significantly higher overall costs for the schizophrenic patients than the sample-group and the neurotic disorders-group; besides a significant difference in the item costs for rehabilitation facilities was found between the schizophrenic group and the paranoia, neurotic disorders groups and the sample one, whereas no significant differences in costs of inpatients services and drugs administration were tested between the groups. Conclusions – The results of our study allow to demonstrate that there are cost differences between the diagnosis (direct costs are highest for schizophrenic patients and lowest for those with neurotic disorders) and that the costs evaluation can be used to ensure appropriate provisions to Mental Health Department for support and treatment of a wide range of psychiatric disorders.

The long-term persistence of neurotic symptoms, such as anxiety, poses difficult problems for any psychological theory. An attempt is made to revive the Watson-Mowrer conditioning theory and to avoid the many criticisms directed against it in the past. It is suggested that recent research has produced changes in learning theory that can be used to render this possible. In the first place, the doctrine of equipotentiality has been shown to be wrong, and some such concept as Seligman's “preparedness” is required, that is the notion that certain CS are biologically prepared to be more readily connected with anxiety responses than others. In the second place, the law of extinction has to be amended, and the law of incubation or enhancement added, according to which the exposure of the CS-only may, under certain specified conditions, have the effect of increasing the strength of the CR, rather than reducing it. The major conditions favouring incubation are (1) Pavlovian B conditioning, that is a type of conditioning in which the CR is a drive; (2) a strong UCS, and (3) short exposure of the CS-only.

This book critically examines Freud's own detailed arguments for his major explanatory and therapeutic principles, the current neorevisionist versions of psychoanalysis, and the hermeneuticists' reconstruction of Freud's theory and therapy as an alternative to what they claim was a “scientistic” misconstrual of the psychoanalytic enterprise. The clinical case for Freud's cornerstone theory of repression – the claim that psychic conflict plays a causal role in producing neuroses, dreams, and bungled actions – turns out to be ill-founded for two main reasons: (a) Even if clinical data were valid, the method of free association has failed to support the psychoanalytic theory of unconscious motivation; (b) Clinical data tend in any case to be artifacts of the analyst's self-fulfilling expectations, thus losing much of their evidential value. The hypothesis that psychoanalytic treatment is in reality a placebo poses a serious challenge to the assumption that insight is a key causal factor when therapy is successful. This challenge has yet to be met by psychoanalysts. Similar conclusions undermine the neorevisionist versions of psychoanalysis. The most influential hermeneuticists, on the other hand, are shown to have imposed an alien philosophy on psychoanalysis, partly through their reliance on gross misconceptions of the natural sciences. Karl Popper's criticism of the Freudian corpus as empirically untestable has misjudged its evidential weaknesses, which are more subtle. If there exists empirical evidence for the principal psychoanalytic doctrines, it cannot be obtained without well-designed extraclinical studies of a kind that have for the most part yet to be attempted.

This case study deals with the effect of treatment of social phobia on psychotic symptoms in a patient with a diagnosis of schizophrenia. Stress vulnerability models were used to provide a rationale for treatment. The phobia was treated using standard CBT techniques while the therapist avoided any direct treatment of the psychotic symptoms. Scores for social phobia reduced to a sub clinical level over the course of treatment and the psychotic symptoms rapidly abated. Although only a single case study and therefore impossible to generalize to a wider patient group the study would seem to suggest that treatment of comorbid anxiety disorders can effect psychotic symptoms. Some thoughts are presented as to why this might be the case.

Hospitalization rates of monozygotic (MZ) and dizygotic (DZ) twin pairs in Finland were compared for schizophrenia, neuroses, and alcoholism. Record-linkage of hospital records and death certificates for the years 1972-1979 was carried out for persons in the Finnish Twin Cohort (16,649 like-sexed twin pairs). The ratio of the number of observed vs that of expected concordant pairs and the ratio of concordance rates between MZ and DZ pairs were greater among males than females, and greater among young (40 years old or less) than among older pairs. The highest difference was found in schizophrenia and the lowest in neuroses. Pairwise concordance rates for schizophrenia (11.0% for MZ and 1.8% for DZ) seem to indicate great environmental influence (high proportion of discordant pairs) with apparent genetic liability (6.1-fold ratio in concordance between MZ and DZ pairs). In neurotic disorders, the difference of pairwise concordance rates between MZ and DZ pairs (6.8% vs 4.0%) was quite low, not strongly supporting a genetic hypothesis. Of the MZ pairs concordant for psychiatric hospitalization, 47% had lived together for their whole life time; of those discordant, 16% lived together. The corresponding figures for DZ pairs were 18% and 15%. The effect of intrapair relationships in disease-concordant pairs should be taken into account when evaluating the effect of genetic and environmental factors in psychiatric disorders.

The inheritance of General Neurotic, Obsessive, and Impulsive Hysterical personality traits has been studied in a sample of 260 female and male adult same-sexed twins. At least one of the twins in each pair had been treated for neurotic or borderline disorders. The results showed that the General neurotic and the obsessive personality factor had a significantly but moderately high hereditary component. The same was also true for more than half of the 17 separate personality scales. No personality scales emerged as highly hereditary. Therefore, each item was analyzed separately, and items classified as either distinctly hereditary or environmental were placed in each of these two groups. The items of the two groups were separately factor-analyzed, and three hereditary and three environmental main factors emerged. The hereditary factors seemed to represent a basic core in the three personality factors of the total questionnaire, whereas the environmental factors could be explained as derivatives of early representation of the basic hereditary core, influenced by familial and cultural patterns.