 Neurotic problems that are usually reported in the clinics and primarily as you saw in our last lecture that there was a stark difference between the neurotic and the psychotic patterns of behavior. Today, we would come across interesting pattern of human abraded behavior what is popularly called as neurotic disorders. The first one anxiety which is primarily a state of free floating anxiety which is usually punctuated by acute attacks. When you look at the DSM criteria where you have the whole description of anxiety disorders you will find even know different type of anxiety being talked about. But remember one thing this is one of the most common type of what you call issued at majority of the people would tell you that they had suffered it at certain time in their life. For example, if somebody has to know board a train and you realize that the train which comes to a particular station where you are waiting to board it it is fully crowded. This could instigate a sense of anxiety within you because you know that you would have to struggle a lot in terms of finding out a seat for yourself. Say similarly, if you are planning to take a flight and you are told that the flight has been rescheduled. So, whole lot of situations will come throughout life most of the days where you would realize that things would not move the way you had actually thought of it. You are told that know there will be a quiz you are anxious now what is actually going to happen to you. You are told that there would not be any quiz and you are still worried I do not know what is going to happen to our scoring system. So, all these types of know situations where you think that know things are not the way you expect them to be the outcome somehow troubles you within such situations can lead to certain degree of anxiety. But the type of anxiety that we are talking about here is the free floating anxiety. Free floating anxiety would be that irrespective of what type of situation you are encountering you just feel anxious. Unlike the examples that we do if you have to board a train and the train is all jam packed it is really a cause of concern because know with the two bags that you are carrying it will find difficult to know find a place for yourself. Finding out a seat for yourself would be difficult even somebody who would be know occupying your seat you will have to struggle to make the seat available for yourself. So, there is a genuine problem that you anticipate and all these things make you anxious which is genuine here. But in the case of free floating anxiety you just feel anxious irrespective of the varying situations you have to come to the class at it this is a source of anxiety for you 8.30 onwards there is a source of anxiety that fine I have to go to some other room now I had to I did not take my breakfast I have to know do this I have to do that several several things it is more like say searching for reasons that can really make you anxious. The problem comes when you have situations which are actually know punctuated by acute type of anxiety and acute anxiety will have its own know manifestation when for a certain small period of time you find yourself know completely at the mercy of the symptoms that you are experiencing. Then another set of common neurotic problem is the phobic reaction. Now fear we have talked about know when we were going through goal congruent in congruent emotions and the pressure process how it influences adjustment at that time we had talked about the basic emotions and fear happens to be one of the basic emotion. But fear and phobia are know two different from each other a phobic situation would ensure that the fear that you are experiencing the fear symptom is actually irrational whereas in the case of fear you have a justification why is it that when there is announced quiz everybody turns up there is a rational fear and the rational fear is that if I miss it I will be missing on certain percentage in terms of the grade that I will finally get. So it is the sense of know loss of grade which is actually a real threat which makes you know scared and therefore you ensure that you are present there. But phobia would be a scary reaction a reaction which is full of fear but then the fear that you are holding is actually completely completely completely baseless. For example say whenever you go out cross the road and you see this huge ground in front of you you feel scared why because the ground where you are you realize that it is vast know it is quite open from all the side. So I do not know what might come from what side this could be one set of fear the other set of fear could be at the moment you know close the two doors you have a cluster phobic tendency know everything from all the sides it is wall. So if something happens how will I run away they are just demetrically opposite type of fear but it happens. If you see the whole list of phobic reactions you will realize that we have more than 120 types of phobias. Somebody is phobic towards something else somebody else is phobic towards something else. The most common ones you would find is cluster phobia where you are extremely scared of closed spaces and it is very common you will find in people who are otherwise pretty normal except this type of phobic reactions that they show hematophobia very common. You see an accident that has taken place you see the blood coming out of the wound and you faint I am sure you must have seen many people like this know they faint when they see blood this is hematophobia you know you are phobic to blood. I know two people who are here know very somehow closely related to me who would never take the lift and remember know I sit on the sixth floor and from there even if they have to come to some office twice or thrice a day they will now take the staircase and once I asked him why do you take a staircase when you know that he had come know right from the account section to the top and again he told me sir I will take this file and go downstairs. So I told him take a lift why do you know climb staircase so much and of course he is slim trim know. So he does not need to worry that much about the weight and he gave me justification justification was determinates for physical fitness. But I know that that man for last 20 years has never used the lift reason phobia and it is irrational you see people getting in you see people getting out. But the moment the know door of the lift closes you are scared know it is all closed I do not know what is going to happen to me these are irrational fears zoo phobic people know people who are very very scared of animals know people who are know extremely scared of a contamination every time they feel as if they have touched it know some contamination has taken place a whole long list of phobic reactions you would realize it reminds me of a very interesting case long long back. I knew somebody who happened to be a doctor who had completed his MBBS was doing his MD he was married had a small baby and most of the places you would find that there are know hostels for married students know. So this man had room in the married doctor's hostel so once when I visited him he had a very cute very young little daughter. So I asked know do you know what your father does and she said yes and when I asked what and she told me know he repeatedly takes bath. So I was actually inquiring about the profession of the father and the girl told me that father know is just into bathing nothing else and then the mother gave the justification when the child wakes up in the morning that is the time when the father has to go to the hospital for getting ready father has to go to the bathroom and he know takes bath the first impression that the child has papa is taking bath once he comes back from the hospital he would remove all his clothes once again take bath because there is a possible perception of contamination he will take bath daughter sees that also that is the time when the daughter will once again eat something and sleep. When she wakes up at around 4 or 5 the father has to go for visit to the ward before going to the ward again he takes bath and when he comes back at around 7 30 or 8 again he takes bath and that is the time when the child once again has dinner and she sleeps. So during her wake up duration all she sees is that father goes comes back before and after and there is a process of bathing all the time know I am not saying that this is good or bad I am not saying that this was phobic reaction in a potential doctor all I am saying is that you will find lot many people who are into such type of behavior who have know fear of things which usually you do not find a large number of people being scared of. And primarily what happens in phobic reaction is that because you have an irrational fear therefore you would try your best to avoid that situation the situation that makes you scared you tend not to fall in that situation. So if you are claustrophobic you will ensure that you never get into a closed space this is something that you always ensure. Then we come to another interesting type of neurotic reaction that is obsessive compulsive disorder you will find it written OCD sometimes sometimes written OCN basically means one and the same know obsessive compulsive disorder will be OCD and if it is obsession compulsion neurosis obsessive compulsive neurosis then it is OCN. Now this has a very interesting dynamics it has two elements know one is the element of obsession and the second one is the element of compulsion. Obsession has to do with the thought process compulsion has to do with the action. So if a thought perseverates in your mind for long duration then it is a obsessive thought and if an action gets repeated multiple times then it is a compulsive act am I clear. So there has to be a cycle of thought or action if it is a cycle of thought then it is obsession if it is a cycle of action then it is compulsion. But what is interesting is that compulsion is always preceded by obsession. So the act the cyclic act that you perform is always followed by sorry it is always preceded by a thought that keeps on keeps on perseverating in your mind and therefore it is called a neurotic thought. But I must tell you that there is a need to draw a very clear line of distinction I will give you some examples do not feel scary know when I give these examples. You are coming from the city you went to a mall to get something and you saw a beautiful girl or you saw a very handsome boy I am assuming that you have a heterosexual preference and then while you return back know that beautiful girl or handsome boy that image repeatedly comes to your mind you found that boy or girl to be really charming matched the boy or the girl of your dream and therefore you constantly have that image coming to you all of you have experienced it anybody who says no thankfully nobody otherwise I would have to think of the other type of a problem know. So you saw somebody you found a momentary sense of infatuation and that makes that image repeatedly come to you this has happened to everybody now is it an obsessive thought the answer is no although there is a reputation in the thought it is not followed by a compulsive act and therefore it does not qualify to be a neurotic problem it is a legitimate genuine type of what you call human reaction you saw somebody you found her to be charming you found him to be handsome and therefore you just know that beautiful appearance or that know handsome appearance flashes back repeatedly to you which is absolutely fine you wake up early in the morning you leave your bed and walk in the corridor and suddenly you start know humming a song and you kept keep on keep on humming that is the same song throughout the day has it happened to you is it compulsion the answer is once again no just it happened there is no obsessive thought that is guiding you had it been preceded by an obsessive thought then it would have been no a case of a neurotic problem otherwise you realize that although there is a reputation it does not qualify to be a neurotic problem remember that it is very important to draw lines know when something starts becoming neurotic although it is a reputation in both the examples that we took here it is there is a situation of reputation but then up to certain limit it does not become a neurotic act beyond certain limit yes but think of other situations you feel as if know your hand has not been washed properly and therefore know you take some soap and know rub it and then wash your hand once twice thrice four five ten fifteen multiple times a day each episode of cleaning the hand is far more know higher in frequency compared to what other people would do in the same situation now this is a repetitive act but such repetitive act qualifies for obsessive compulsive neurosis for the reason that this act is preceded by an obsessive thought of the fact that you still need to be clean why you still need to be clean is again a big question know what is it that makes you feel that you are unclean many many many many things we would not go into the details of it and therefore you would realize that usually people who are know prone to such type of a thing or who have been reflecting O C N for example washing hand you would realize they washed their hand to the extent that they have wounds on their skin so because of excessive cleanliness this part of the skin starts peeling off know so you have all uneven surface here on the palm you might have cracks in the pores of the finger simply because you have applied too much of soap and too much of water simply and you have kept on kept on kept on rubbing it it goes to that extent you are told that there is a great dearth of water do not waste it for rest of the things you ensure that water is not wasted but as far as cleaning is concerned you do not compromise on that these are interesting examples of obsessive compulsive disorders. Hysteric reactions also you find it being reported to the clinic and usually you would have a hysteric reactions of two type know the somatopharm hysteric reactions where the symptoms would be more and more represented in the bodily symptoms and dissociative type of hysteric reactions where you deal ink yourself situations where in a given type of a situation you suddenly faint now fainting is usually seen in epileptic episodes somebody who really suffers from epilepsy and therefore has such type of epileptic attack or one of the prominent symptom of epileptic attack is that you shake and then you faint for some time again you regain your consciousness but interestingly there is a very clear distinction between epileptic seizures and hysteric know convulsive type of a thing. In epileptic convulsions you have certain know changes taking place in the brain that makes you undergo the convulsive attack. So, you suddenly you have this tremor and then you fall down you keep shaking your body I do not know if you have seen epileptic cases and then after some time know you regain your consciousness this is what happens in epileptic seizures but in hysteric attacks you would realize that one would show this such type of convulsive attacks in the front of near and dear ones. Epileptic seizure is irrespective of who is around you it could take place anywhere anywhere the worst of epileptic seizure at a public place that I have seen was somebody getting out of the train and dot on the gate of the train suddenly that person know start shaking falls down and he was fortunate not to fall outside know fortunately he was still inside otherwise you would have know just fallen on the track the gap between the platform and the train allows you to fall know there is little bit of cleft there fortunately he did not fall there. So, that was the worst but all I am trying to say is that epileptic seizures are basically know neurologically driven and therefore, you do not know take into account who is near you who is looking at you convulsive hysteric attacks will always first filter know are there people know whom I want to show that see I also have this type of an attack and therefore, you should take care of me you should be concerned about me. So, there is some secondary benefit that you are somewhere contemplating and therefore, you show those type of convulsive attacks know that is the form of the hysteric attacks that you see there. So, that is the part of somatopharm hysteria dissociative hysteria is you know another interesting part of it where you deliberately delete certain part of your memory and you turn amnesiac I do not know I do not know where I was last evening you select a part of it and you remove it there is an associated concept in psychology called motivated forgetting motivated forgetting is similar type of situation where you are desperate enough to delete something from your content conscious content of your memory and the worst of hysteric attack in the dissociative form could be where you go for multiple personality where I am say Ram Prasad right now and then after certain period of time in my life I suddenly become Lakshmi Narayan when I become Lakshmi Narayan Lakshmi Narayan does not remember Ram Prasad after 2 years of being Lakshmi Narayan I again become Ram Prasad and then the second phase of Ram Prasad does not remember that for 2 years I was Lakshmi Narayan such type of no situations although I have temporarily make made it much more longer it could be temporarily much more shorter also that is what is called as that is the whole dynamics of amnesia few multiple personality those are the symptoms of dissociative hysteria a classic example I read it in a clinical episode where during second world war I think it is a British naval ship I think so I am not getting it correctly it might be confusing the 2 countries basically it was US vessel and British vessel and one of the ship got attacked if I remember correctly it was the British ship which got attacked it was about to sink and then the US ship came there and they rescued all the personnel there and there was a man who claimed that he was a doctor and during war time you do not have time to know cross check the details. So, he told that he was a doctor and therefore he was given the responsibility of medical care on the ship later on after the war was over when the exchange had to take place that is the time when the armed forces does it very meticulously know. So, you tell your name your details your identity number they will match it with their records and then only you know they will transfer you from one country to the other. So, when he gave his details his name was no such doctor was found by these details in the central register of the armed forces there and therefore they became suspicious the case was investigated and then it was realized that this man was actually a deck cleaner. Now, if you rethink it why did a deck cleaner decide to say that I am a doctor imagine the situation you are cleaning the deck and you imagine that there would be a shot from the enemy. So, you think that you are the one who is more and more susceptible to such attacks know because you are on the deck know rest everybody is inside a metallic shield who is the safest guy I would say only two know one is the cook and the other one is a doctor because they are into their chambers which is no many metal sheets and they are inside that and perhaps that could be the reason why this man decided. So, from the most vulnerable position on the ship I go to the most safest position I experience an attack and then I decide no more deck cleaner I am a doctor most safest place in the ship and of course then they dig out the reality this man was sent for psychiatric treatment and then rest everything happened. So, this is how know the hysteric reactions you find these are know pretty common type of neurotic reactions come to the last one that is the depressive neurosis which basically know is a state of abnormally prolonged know dejection which is associated with some of the life circumstances which you consider to be extremely stressful. So, anxiety, phobia, obsession compulsion, hysteria and depression these are know the five types of neurotic disorders which you find very commonly being reported to psychiatrists to clinical psychologists. Remember that for all of these neurotic problem you need not depend on any drug, medication is not needed you just know go for behavioral interventions and with little help you can very easily come out. You can lead normal life the way you used to lead earlier you remember yesterday we were talking about this fact that in the case of neurosis one interesting feature is that most of the people who experience one or the other type of neurotic symptoms they know that they have something peculiar in them they have something peculiar in their behavior, but all they realize is that they are know somehow unable to hold it modify it contain it. And therefore, the beauty of know being aware of such type of problem is that in case you realize that you have something which might be one of these problems it good it is good to go and consult a professional know these are not know problems of grave order these are very simple type of problems you can very easily go consult an expert and with minimum effort get rid of get rid of it. If you find somebody near and dear to you who also experiences similar type of things you can know very easily ask him or are to go and meet a professional little professional help and you can very easily get out of it. So, there is no problem know saying that yes I have this type of thing or I think that perhaps I have something like this and therefore, I need professional help. Remember that these are know in terms of magnitude all these problems are much much much less problematic, but somehow the stigma is very strong. How can I take an appointment with the psychiatrist how can I visit a clinical psychologist the great degree of a stigma does not allow you to do that. So, all I am trying to say is that there is no there should not be any hesitation there is no problem going and saying that fine I think perhaps I have this. So, tell me whether it is a problem or it is just a normal pattern of behavior if it is a problem tell me how can I get rid of it. Now, we come to two interesting type of neurotic problems usually you do not find people with these two types of problems one what is called as hypochondriasis. Hypochondriasis is basically a state where one is preoccupied with bodily processes. So, I show my tendency to repeatedly touch my wrist and sense if my heartbeat is proper or not if the pulse rate is proper or not is the respiration continues normal you are too occupied with your body process something that know all this autonomic functions we hardly care about it. It goes to the extent that if you are attached sensors for your respiratory activities and if you match it with that actual template of breathing you would realize that many of us do not breathe the way we should or total inhale is less than what it should be. So, you inhale the air and you stop it intermittently and exhale it again and biofeedback you can very easily see it know that you inhale less than what you should have actually done, but in the case of hypochondriasis you are always concerned know what is taking place. So, even if you sleep like this you become suspicious why is it that I am not able to hear the blood flow in the vessels perhaps I am turning anemic, but what is more fascinating about hypochondriasis is that you show extreme and extreme involvement with the bodily process and ultimately you churn out I am suffering from some disease. Usually we do not consider that normally we do not say that know normally what happens even if you have say for example, a pain in your wrist you will say that I do not know what happened yesterday I think while I slept perhaps it might have turned you know abnormally and I have a pain in the wrist. Usually we are driven by this type of a thing know that unless the pain persists for more than two days we do not visit a doctor it is not that pain occurs and the moment you have the first signal of the pain immediately you rush to the health center doctor 3.5 seconds earlier I had a pain here we are not like that know usually we will live with the pain for some time to realize it really it is stable or not in case we find that it is stable then only we approach a doctor. In fact in our country we are given a blame that we usually visit the clinic too late and when by the time the doctor diagnosis the problem already becomes little more graver. So, you say that I think know I have some pain in the stomach most of the days I have it and the doctor asks you. So, since when do you think that you had pain I think 2, 3 months, 6 months and then the doctor diagnosis finally that you have a stone in your gall bladder, but you live with your pain for quite long one of my family member had know hernia you know what hernia is. So, a part of the muscles after age certain age know it starts becoming weaker and weakening of the muscle would mean that know this abdominal area will start shrinking low. So, once it starts shrinking low if there is know an extra amount that goes you know closure to this pelvic area that is what is hernia and doctor surgeons will simply tell you that surgery needs to be performed and this part of the muscle which has slowly gone down it will be removed and that is it all they do is that the post surgery they will put a wire mesh here know and that wire mesh will actually be a hard surface which will not allow the abdominal area to further shrink down because after ageing this is a normal thing to happen. Now, when I myself had taken that family member to the doctor and the doctor asks you oh it is a full blown case of hernia. So, it must be hurting you and he said yes since when last one one and half year and the doctor was surprised even I too was surprised because that very family member never ever told know that he has been living with pain usually all I am trying to say is that we usually are accustomed of living with a symptom for little longer till we finally go and meet a consultant here is the case in hypochondriasis when you do not have a problem you deliberately make search for it you know when I blink I think now there is something here in my eye and this could be and when you think this could be you think of the highest magnitude of the problem that you can imagine of. So, this is hypochondriasis now fantastic type of a problem when you deliberately search oh I need a problem I need a problem I need a problem heart this skin blood x y z and more and more graver problem you find and more and more novel problem you find I feel yes now I have found something and then you say I do not know I have been talking to multiple doctors, but they have they are not able to diagnose my problem you never consider that you do not have a problem you think that you definitely have a problem you have been able to convey it to the doctor poor doctors they are not trained properly they cannot diagnose me I have consulted four doctors this is hypochondriasis and then comes you know neurasthenia which is a very typical type of a problem when you experience chronic fatigue weakness and complete lack of enthusiasm there was a popular drink by one of the very popular brands in our country which used to advertise I do not know if you have seen this ad it is a beautiful ad Javed Jaffrey would come like this to the office as if he would collapse any moment and then this background sound comes I can then the name of the company car and then name of the product he has one teaspoon of that product and suddenly you know interest to instead of entering to the gate hits the window the window share you know the glass breaks off and then he makes an entry rest everybody is working they are normal and he is hyperactive that is neurasthenia the previous state not the later state when you wake up in the morning to report that I do not know that mood near weakness fatigue and this is something that you live with throughout the day and that happens repeatedly primarily all type of life engagements worldly interaction will demand that you should show certain degree of enthusiasm even cleaning of the teeth for example, you cannot have something like this then is need for certain degree of energy in that. So, you take the pace you know do something there is an action and this action ensures that you have some know much more of power and passion enthusiasm involved in that irrespective of what that is it could be a small act which you perform ritualistically daily or it could be a novel act that you are performing today some degree of enthusiasm is there. But neurasthenia will finally make you completely know behave as if you are completely completely drained of your energy nothing is left within you therefore, I compared it with that very product know. So, that was all about the neurotic problems