The Meaning of Neurosis According to Adler

Zivit Abramson

Abstract

This article aims to provide a clear, structured schema of the components of an

"Adlerian neurosis." In Adler's concept, a neurotic person retreats from performing
life tasks to avoid loss of self-esteem due to what the individual interprets as failure.
This threat is based on a dialectic combination of inferiority feelings and striving
for superiority. Retreating from performing life tasks can happen only with a poorly
developed social interest, which, in turn, is usually connected with having been a
pampered child. To maintain the illusion of the potential for high achievement, avoid
inferiority feelings, and protect themselves from the guilt of not acting according to
social interest, neurotics create excuses or symptoms. When all these factors exist,
Adler considered the person neurotic.
Keywords: Individual Psychology, neurosis, Adler

Seven years ago, 1took it upon myself to teach a class about the mean­
ing of neurosis according to Adler to students of "Adlerian Psychotherapy."
It was then that I discovered neither Adler nor Dreikurs described neurosis
in a structured, detailed manner suitable for teaching purposes. So I set out
to put down a structured schema of the subject for the students, with the
thought that it could also be useful for the therapist in practice: What exactly
should one look for in the neurotic patient and what should be treated?

Introduction

Adler was in the habit of borrowing professional terms from Freud and
then giving them completely different meanings. That is what happened to
the term neurosis. When Adler used it, he did not talk about childhood trau­
mas, internal conflicts, early fixations, or the Oedipal complex. He used the
term in a totally different way.
Since then, in spite of the fact that the term neurosis no longer serves
as a professional-official diagnosis, both professionals and laypeople widely
use the term, although each has a different interpretation in mind. This pa­
per discusses the term and the concept as Adler understood, described, and
treated it.

The Journal o f Individual Psychology, Vol. 71, No. 4, W inter 2015

©2015 by the University of Texas Press

Editorial office located in the College of Education at Georgia State University.

Published for the North American Society of Adlerian Psychology.
 Neurosis According to Adler 427

World View: Two Possibilities

This paper begins with a short description of two ways in which differ­
ent people perceive social life (starting in childhood and then throughout
their lives).
Lydia Sicher (1991), Adler's student and later work partner, offered an
imagery that illustrates the two principal ways in which social life can be
perceived according to Adler. She called them the Vertical Axis and the
Horizontal Axis.
The Vertical Axis is like a ladder based deep in the ground and reaching
up to heaven (where according to popular belief, God is). The Horizontal
Axis may be described as parallel to the ground
Those who maintain the Vertical view believe that all people are meta­
phorically located on a ladder, each at a different height, and on a separate
step. Each step has room for only one (one person, one couple, one family,
one community, one race, one people, one gender, etc.) so it is impossible
to be together and at the same height. This means that whoever is not you is
necessarily either higher or lower than you. Everyone is rated.
The goal, according to this view, is one: To be high, higher, highest.
Position is always relative and is determined by comparison. In compari­
son to those above, one is low; and in comparison to those below, one is
placed high.
People who uphold this outlook determined their sense of value based
on their place on the imaginary ladder. The result is that people who uphold
the Vertical outlook on life view human relationship as a competition.

Vertical view. The competitors must do the best they can to climb
as high as they can on the ladder—to reach a place "above" others to be
"higher" than them, or "highest." According to Adler, all humans strive to
overcome, to lift up from the minus to the plus. Verticalists strive to over­
come the other (or others). When they succeed, they feel valuable (although
the fear of descending always exists) and when they fail, they lose courage;
they despair and feel worthless, inferior, and with no sense of belonging.
Verticalists' sense of belonging thus depends on others. Their interpreta­
tion of "success" depends on whether they are more or less successful than
others. If the others are more successful, they are worth less. According to
Adler, to be worth less—to perceive oneself as inferior— is an unbearable
position. "The supreme law . . . is the sense of worth of the self shall not be
allowed to be diminished" (Adler, in Ansbacher & Ansbacher, 1967, p. 358).
For that reason, the experience of diminishing self-worth arouses in peo­
ple a strong urge to change the situation or at the very least to change their
own perceptions of the situation. Such a change may be obtained either
by an act of climbing— an attempt to reach a higher level—or other means
428 Zivit Abramson

of coping w ith the sense of inferiority. Either way, Verticalists— concerned

with their own value and place on the ladder— are centered on themselves.
They strive for goals that they perceive as a personal matter. They do not see
the social ramifications of their behavior; they see only the personal results
("this w ill bring me a level up and that w ill take me to a level of inferiority").
This means that those with a Vertical outlook on life have underdeveloped
social interest.

Horizontal view. Those who uphold the Horizontal outlook on life be­
lieve that all human beings are equal. Everyone, according to the analogy, is
on the same horizontal line, which can be marked parallel with the face of
the earth. Everyone walks together; there is room for everyone. The tasks of
survival, existence, and development of humankind require a contribution
from each and every one. In order to succeed in these tasks, there is a need
for cooperation.
Similar to Verticalists, the goal of those with the Horizontal outlook is
also to overcome, but in a different way. For Horizontalists, movement also
means overcoming, but not over others; rather, with others. With their help,
they strive to overcome the problems and obstacles that the universe and
social life place before them. Others are not the individual's competitors,
but rather they are partners in coping and overcoming.
Those upholding this worldview possess a sense of value that is not
dependent. No condition needs to be fulfilled for a person like this to feel
equal to others. Just like everyone else, Horizontalists strive to belong to
human society and to take their place in it. They accomplish this goal by
fulfillin g the needs of the situation, of others, and of themselves. That is, they
act in accordance with social interest. Their sense of belonging depends on
themselves alone, because the possibility of fulfilling the needs of the situa­
tion and acting in a manner that contributes is constantly open and is always
in their hands.
This stable sense of value relieves individuals upholding the Horizontal
worldview from being centered on themselves and allows them to invest
their energy in involvement in what goes on around them. They are curi­
ous and interested in life. Whether they succeed or fail, they continue with
courage to focus on dealing with life's tasks. They invest their energy in the
"useful side of life." Those who uphold a Horizontal worldview have a well-
developed social interest.
It is important to remember that this distinction between Verticalists and
Horizontalists is only a schematic model. Most likely, no one totally belongs
to either group. Probably everyone falls somewhere between the vertical
and the horizontal axes, and if they so choose, can strive toward the hori­
zontal axis and act accordingly.
 Neurosis According to Adler 429

What is Neurosis?

Adler (in Ansbacher & Ansbacher, 1967, p. 157) described any failure in
adaptation (neurosis, psychosis, crime, addiction, deviations— in short, all
cases of lack of adaptation) in the following words:
One must always consider:

• An increased inferiority feeling within the first five years of childhood, and
closely tied up with this,
• A lack of social interest and courage,
• The quest for the strongest proofs of superiority,
• A new problem that is frightening,
• The patient's distance from the problem,
• The exclusion tendency of the patient,
• His quest for specious relief on the useless side, that is for the semblance of
superiority and not for the overcoming of difficulties. [Author's punctuation
and capitalization]

Factors Constituting Neurosis

One of the first signs of Adler's deviation from Freud's biological model
was the importance Adler placed on feelings of inferiority, even during the
period he was still a part of Freud's circle. (See quotations in following sec­
tions.) This is where a cognitive factor was introduced into human dynamics.

Point of Departure: Inferiority Feelings

To understand neurosis requires an understanding of the different kinds
of inferiority feelings, starting with the "Human Cosmic Inferiority" as de­
scribed by Adler and the normal inferiority feeling that results from it.

Cosmic inferiority and normal inferiority feelings. The human being,

said Adler, is a "weak animal." Evolutionarily, it belongs to the type of ani­
mal that exists in groups and cannot survive alone. "Darwin already pointed
out that one never finds weak animals living alone. Man must be included
among these, particularly because he is not strong enough to live alone"
(Adler, in Ansbacher & Ansbacher, 1967, p. 129).
The human baby needs the caretaking of others for a long time and can­
not survive without them. The human adult cannot obtain food and shelter
or develop a culture without the cooperation of others and the division of
labor. Without others, the human is worthless, inferior. "Man could maintain
himself only when he placed himself under particularly favorable condi­
tions. These, however, were afforded to him only by group life" (Adler, in
Ansbacher & Ansbacher, 1967, p. 129).
430 Zivit Abramson

This is the origin of the existence of inferiority feelings in people, who

experience themselves as small creatures opposite the cosmos, against life's
tasks. Such a normal inferiority feeling includes the wish to overcome it
and w ill bring with it the energy required to act, to cope, and to overcome.
Thus, existential needs are a motive for participating in the general effort.
"Inferiority feelings are not in of themselves abnormal. They are the cause of
all improvements to the state of mankind" (Adler, in Ansbacher & Ansbacher,
1967, p. 117).
An inferiority feeling of this kind (as opposed to a social inferiority
feeling, which w ill be discussed later) in a person with a well-developed
social interest does not involve personal suffering. Often, it will bring posi­
tive feelings of wonder at nature and at society and its accomplishments. It
can bring a wonderful sense of belonging to something endless, of which
humankind has been fortunate to be a part. A normal sense of inferiority, the
sense of the minus striving to the plus, the striving to deal with life's chal­
lenges and to overcome obstacles, may all characterize the person with a
Horizontal worldview.

Organ inferiority. In the early stages of Adler's theorizing (as can be

seen in the following quotes from 1910), he spoke of the importance of
organ inferiority. He pointed to the inferiority feeling that children face fol­
lowing their perception of themselves as having an objective disability that
makes them different from others. This refers to a clear disability or illness,
or factors that a child interprets as organ inferiority.
It can be shown . . . that in children with inferior organs and glandular sys­
tems, motor and general bodily development. . . these objective phenomena
frequently give rise to a subjective feeling of inferiority. . . . Weakness, clumsi­
ness, awkwardness, sickness, childhood disorders, such as enuresis, stutter­
ing, deficiencies in the visual and auditory apparatus, innate or early acquired
blemishes, and extreme ugliness, are all able to give a deep foundation for
the feeling of inferiority in relation to stronger persons and to fixate it for life.
(Adler, in Ansbacher & Ansbacher, 1967, pp. 46-47)

It is important to notice that Adler did not think these factors necessar­
ily cause inferiority feelings. He emphasized that (as in any other area) the
determining factor is each child's subjective interpretation and choice to at­
tribute to their situation the inferior classification. "The degree of the feeling
of insecurity and inferiority depends primarily on the interpretation of the
child" (Adler, in Ansbacher & Ansbacher, 1967, p. 116).
Because the factor determining the feeling of inferiority is the subjective
interpretation of the child (and not a given objective situation), any child—
even those who do not suffer from real organ inferiority—can interpret their
situation as inferior and develop an inferiority feeling.
 Neurosis According to Adler 431

This is a different sense of inferiority than the one previously mentioned.

The normal sense of inferiority discussed above expresses the person's feel­
ing of smallness in face of the cosmos and life in general, whereas the feel­
ing of inferiority discussed here expresses the individuals' interpretation that
they are worth less than others around them.
It should be noted that a child's perception of his or her condition as
inferior is preceded by a Vertical worldview. Otherwise, the children could
perceive themselves as different rather than inferior. They could have
thought, "I am a clumsy child who learns and reads books, and my friend is
a quick and athletic child who hates to learn and to read," without assum­
ing that one of the two is superior and the other is inferior. Understanding
objective physical or emotional situations as pointing to inferiority hints at a
"ladder" outlook of relations among different individuals.

Social inferiority. Social inferiority is the most important type in under­

standing neurosis. It is described and explained in the Striving for Superior­
ity section, following.

Underdeveloped Social Interest

Children and adults who feel inferior lack a sense of belonging. They do
not see themselves as a part of a family, a group, or a community. Thus, their
social interest does not develop as it would in someone who feels they hold
a place of honor in their group just like anyone else.
Social interest means identifying with the other members of the group
and feeling empathy toward them. It means that the good of the person and
the good of the group intertwine. Conversely, a feeling of inferiority that
says, "I am not part of the group," hinders the development of social interest.
This deficit is prominent in the neurotic person. To understand a case of
failure, "one must always consider an increased inferiority feeling within the
first five years of childhood, and closely tied up with this, a lack of social
interest and courage . . . All failures . . . are failures because they are lacking
in social interest" (Adler, 1931, p. 8).

Striving for Superiority

When children interpret their situation as inferior, they strive for supe­
riority. That is one of the most original and important of Adler's ideas: One
could assume that the reaction to the feeling of inferiority would be to strive
to get out of the position of inferiority and be like everyone else, but that
is not so. In order to compensate for the feeling of inferiority, people turn
to the opposite direction and strive for superiority. They strive to be above
everyone, more than everyone—to be at the top. This means they strive for
others to be inferior in comparison. This striving for superiority is embodied
432 Zivit Abramson

in self-created goals that they set for themselves. "The painful insecurity is
reduced to its lowest possible . . . and this is transformed into its very antith­
esis which in the form of the fictional goal is made the guiding point of all
wishes" (Adler, in Ansbacher & Ansbacher, 1967, p. 99).
In describing the continuation of this process, it becomes clear that this
goal of superiority—and not the feelings of inferiority themselves— makes
the person a natural candidate for developing a neurosis. "Neurosis is the
natural logical development of an individual who is . . . filled with a per­
sonal, egocentric striving for superiority" (Adler, 1935, p. 9).
Adler called the high ambition wanting to be "Godlike," referring to
ambitions such as: always being perfect, all-knowing, moral, suffering more
than any other human, stronger or weaker than everyone, someone who is
never wrong or never makes a mistake. "They speak a language which . . .
expresses the idea: here is an individual who is striving incessantly from the
sphere of insecurity and the feeling of inferiority towards a godlike dominance
over his environment" (Adler, in Ansbacher & Ansbacher, 1967, p. 244).
This high goal—the goal individuals create for themselves as compen­
sation for the feeling of inferiority, as Adler thought in the beginning— itself
becomes the origin of an inferiority feeling of the kind found in neurosis.

A feeling of social inferiority along with striving for superiority. Once

the high goal is created, feelings of inferiority appear when faced with the
fact that this high goal is not fulfilled. The goal can never be truly fulfilled
because no human being can uphold a Godlike position with the goal of
eternal success and perfection. Thus, the goal of superiority is referred to as
overambition as opposed to normal ambition. When the overambition is not
fulfilled, the neurotic interpretation appears:
If I cannot succeed in achieving my goal (according to the individual's per­
sonal interpretation of success), then I am worthless and that means that I am
inferior. If I am not at the top, or at the very least I am not more successful than
others, then I am inferior.

This feeling of inferiority gets closer to the heart of neurosis. Children,

and later adults, who feel inferior to others and worthless as they are, cre­
ate the belief that they can be of value only under the condition that they
achieve a goal that is, in essence, being "more" or "most" than everyone in
a particular way and in many ways. Once they develop the overambition,
they feel inferior when they do not achieve the high goal.
Thus, it becomes clear that the high goal not only is the attempt to com­
pensate for the feeling of inferiority, but also causes it. The perception is, "If I
am not at the top, then I am at the bottom." One could potentially think that
telling individuals who strive for the top that despite not reaching it, they are
 Neurosis According to Adler 433

not worth less than others, but rather like everyone else— normal, not infe­
rior— might encourage them. However, this seemingly consoling message
not only w ill not encourage the neurotic person, but rather w ill cause anxi­
ety. People with high ambitions, just like people with feelings of inferiority,
are terrified of being like everyone else. They think in terms of either-or, feel­
ing, "Either I am at the top, or at the very least 'above [someone else],' or— I
am inferior. That is why if you tell me that I am like every other person— you
are telling me that I am inferior."
It is evident that the issue here is dialectic in nature. The feeling of infe­
riority brings with it high ambitions, and the high ambitions are the origin of
the feeling of inferiority. So the question is: W hich precedes which? Heinz
Ansbacher raised this issue (Adler, 1933/1979, p. 50) and pointed to the de­
velopment in Adler's thought. At the beginning, the overambition appeared
as a compensation reaction to the feeling of inferiority, and toward the
end— in Adler's writings from 1933 on— the feeling of inferiority appeared
secondary to striving for superiority and, in general, Adler mentioned it very
little. In Ansbacher's eyes, during the later period the origin of the feeling of
inferiority was the vain striving for superiority, the ambition to be Godlike.
"It is only against this background [of being finalistically oriented to­
ward a goal of perfection, security, completion, as striving for overcoming
and superiority] that the individual experiences a sense of inferiority." It is
only because of the unreached goal of superiority that the individual experi­
ences "a minus situation" that is reflected in "the feeling of incompletion, of
insecurity, of inferiority," wrote Adler in 1933 (Adler, 1933/1979, p. 50).
"It is interesting to notice," wrote Ansbacher (Adler, 1933/1979, p. 50),
"that even amongst these secondary states of the psyche, the feeling of infe­
riority gets the last place."
Adler was of the opinion that it is not possible to find one part without
its counterpart. Where a severe feeling of inferiority is found in a person,
so also is always found the high ambitions; and where condescension and
arrogance are found, so also w ill always be found the feeling of inferiority
with the horrifying fear of the fall, of the mistake, of embarrassment, of hu­
miliation, and of ridicule.
Summing up thus far, the initial factors necessary for development of
a neurosis are the feeling of inferiority, the striving for superiority, and an
underdeveloped social sense. Following is the next factor necessary for the
development of a neurosis.

According to interpretation, obtaining the goal of superiority is impos­

sible. Earlier sections described persons who (mistakenly) believe they have
value only if and when they are located in a place higher than everyone in
the areas they have chosen. The abstract goal of superiority always translates
434 Zivit Abramson

into concrete goals that represent success as one interprets it. However, in­
dividuals with the neurotic potential either (a) do not believe in their ability
to obtain the high goal they set for themselves, or (b) have no willingness to
invest the effort required to achieve this goal, or (c) a combination of both.
Individuals who do not believe they can obtain their high goal are of­
ten people with low self-esteem, who perceive themselves as incapable
or lacking means, or as belonging to a social or economic class that does
not allow them to reach the top (as they perceive it), and other factors of
this kind. An attempt to understand the situation in which such people
find themselves will show that they perceive themselves as hopeless, lose
courage, are desperate, do not see options for action that can help achieve
their goal, and do not believe they are of value as they are. They do not
fulfill their abilities and are unaware of the possibilities they do have to
contribute to what is happening around them. Again, their social interest is
underdeveloped.
Individuals who are unwilling to invest effort into achieving their goal
are the spoiled ones, with the expectation that grandeur w ill appear all on
its own. Just as with every spoiled child, they expect their wish to come true
through the efforts of others and with no delay or grey and tedious interim
stages. Being pampered is the most fertile ground for the development of
neurosis, said Adler (1935, p. 9): "From the beginning of his life the neurotic
manifests the pampered style of life, which is not adequate for the solution
of the social problems of life."
Thus, it is not a coincidence that Adlerian educators devote such great
efforts to prevent parents from pampering their children. However, Adler
emphasized that a pampered lifestyle can also be the independent creation
of the children themselves or can also develop in neglected children.
In the majority of cases of neurosis, both factors can be found—their
lack of faith in their chances of success and their unwillingness to pay the
price of the ongoing, patient, and mundane effort required to achieve the
high goal.
Great passivity is a prominent characteristic of neurosis, which can be
explained by the fact that motivation for action can be either horizontal
or vertical. Horizontal motivation requires a well-developed social inter­
est that does not exist in the pampered person, and vertical motivation to
act toward a personal goal requires willingness to invest work, effort, and
faith in the odds of success— both factors missing in the neurotic. That is
why, said Adler (1935, p. 9), "The life force of the neurotic is weak. . . . We
always find that in cases of neurosis we are dealing with comparatively less
active individuals."
With all of these factors, potential neurotics arrive at a point in time
where they must deal with the tasks of life.
 Neurosis According to Adler 435

Junction w ith Threatening Life Tasks

The neurosis, or partial neurotic phenomena, appears when the indi­
viduals discussed come across a requirement they perceive as a threat to
their personal value w hile going through the course of life's tasks. They do
not believe they w ill succeed in performing the task as excellently as they
would have liked, or they are unw illing to invest effort in trying to fulfill it.
They fear the possibility they w ill be exposed when it is revealed they are
like everyone else— imperfect and not "Godlike."
At this point where moving forward is required, neurotics create dis­
tance between themselves and the task. "We are always struck by the fact
that the patient at this particular stage is certain to interpose a 'distance'
between himself and the expected action or decision" (Adler, in Ansbacher
& Ansbacher, 1967, p. 274).
It is as if the neurotic is saying, "I give up, I'm not in the game. Do not
judge me! I have quit the race." This concession brings a person to an un­
bearable situation. As established before, neurotics believe that if they are
not at the top they aspire to, then they have no place, have no value, and do
not belong. In this position— feeling the lack of self-esteem and lack of sense
of belonging— human beings cannot linger, just as they cannot survive w ith­
out air. The sense of belonging is an existential necessity. A solution is there­
fore required. People in this situation require a way through which to achieve
the high goal— if not in reality, at least as a hypothetic possibility that would
have been available to them had fate not prevented it. One of the unfortunate
creative solutions that appears at this point with high frequency is neurosis.

Symptom or Excuse to Retrieve Sense o f Value

As previously mentioned, in the face of the threat of what these indi­
viduals perceive as a failure, they w ill halt their movement and retract from
the tasks of life. They are unw illing to take a risk, yet must salvage their self­
esteem. They must maintain the illusion of superiority and pretend they have
good intentions of fu lfillin g the requirements of social interest of which they
are secretly aware. They know they must fu lfill life's tasks and contribute
to others and to society. As a solution for all these difficulties, the neurotic
produces a symptom or an excuse or both.
The individual in question w ill suffer from a particular symptom,
whereas the excuse relates to the individual's life circumstance, such as a
difficult childhood, a spouse who supposedly hindered development and
advancement, a particular economic situation, or any other factor that can
be interpreted as an objective-environmental factor.
The symptom and excuse provide a complex and sophisticated solution
to the issue of personal value and bring with them a long list of "benefits,"
including:
436 Zivit Abramson

1. Pseudosuperiority: They bring back individuals' sense of value by serving

as an alibi for the fact that they are not at the top, which is supposedly their
natural place, the place they would undoubtedly be if it were not for the
symptom or the excuse. "If it were not for my headaches I would undoubt­
edly be in the CEO position today," or, "What couldn't I accomplish if I
were well" (Adler, in Ansbacher & Ansbacher, 1967, p. 243). Thus, neurot­
ics deny the existence of free w ill and place a deterministic view that re­
moves individual responsibility for the way they conduct themselves in life.
2. Pseudosocial lnterest:The symptom or the excuse relieves the individual of
responsibility for not acting according to social interest and fulfilling life's
tasks or a part of them. "It's not that I don't want to work, I can't because
of the symptom or excuse," or, "To the question 'what use are you making
of your talents?' [they give] the answers: 'This thing stops me; I cannot go
ahead' and [point] to [their] self-erected barricade" (Adler, 1929, p. 13).
3. Special Status: They provide neurotics with a special status of meaningful­
ness and superiority that cannot be taken away from them. "As a person
who suffers from anxiety attacks, I am entitled to special treatment and I
should be treated with extraordinary care and consideration."
4. Victory over Others: They allow individuals to achieve a place of superior­
ity, power, and victory in face of the people around them who they perceive
to be humiliating them. Unlike in psychoanalytical theory, according to
Adler the neurosis is not an internal event; it is directed at the surrounding
area. "It secures some triumph or at least allays the fear of defeat" (Adler,
1929, p. 80). They feel entitled to say, "After I gave up for you the higher
position that I would have undoubtedly moved up to, you can no longer
blame me for anything."
In neurosis, said Adler, you can always find the "enemy." "I regard it
as an extremely useful guide for the illum ination of a psychogenic disease
picture to raise the question of 'the opponent.' The answer to this question
shows us the patient no longer in an artificial isolation, but in his socially
given system" (Adler, 1929, pp. 81-82).
This enemy is often the spouse. "The depreciation of the partner is the
most usual phenomenon in neurotics" (Adler, 1912/1967, p. 268).
1. Special Privileges: They often allow the individual to receive from the sur­
roundings special rights and services. "I cannot take care of shopping, cook­
ing, laundry, and such when I don't sleep at nights," or, "One cannot ask so
much of me; one must take my disorder into account." (Adler, 1935, p. 10)
Neurotics create a distance between life and themselves. For this, they
pay a price. The symptom causes them to suffer, but they are w illin g to pay
the price. The suffering is easier than carrying the sense of lack of value (of
not being at the top). "W ithout doubt the neurotic does suffer, but he always
prefers his present sufferings to those greater sufferings he w ould experience
were he to appear defeated in regard to the solution of his problem" (Adler,
1933, p. 164).
 Neurosis According to Adler 437

The excuse also bears a heavy price: Neurotics relinquish self-

realization. They are outside— not in—the stream of life; they miss out on it.
Neurotics live next to life with no light and no air, but they are willing to pay
even that price so as long as they are not forced to experience the sense of
lack of value.
Despite the excuse and/or symptom, the feeling of inferiority always
lurks and the neurotic is forced to defend from it constantly. Dealing with
life's tasks, as small as they may be, raises a fear of failure (or, to be more
precise, of not excelling). To avoid this severe anxiety, the neurotic with
the symptom is busy fighting it. The endless struggle against the symptom
strengthens and maintains the symptom. "Dreikurs was trying to point out
that many neurotic symptoms could be maintained only by trying to control
them, by "fighting" against them" (Schulman & Dreikurs, 1978, p. 158). The
struggle against the symptom means that neurotics are constantly occupied
with themselves. Thus, it turns out that their energy is invested in nothing, as
if "full gas in neutral." Their actions are of no use to anyone— not to them­
selves and, moreover, not to others. This is the nature of activity that is not in
accordance with social interest.

Therapy

This article intends to describe the neurotic choice according to Adler

and not to deal with the therapeutic process. Therefore, it addressed the
therapeutic process only briefly and in accordance with the neurotic com­
ponents described above.
Looking at these components, one can see that the Adlerian therapist
does not focus on the precise differential diagnosis of and directly treating
the symptom, despite the fact that the symptom causes suffering that of­
ten brings the individual to the decision to seek help. Instead, the Adlerian
therapist focuses on both sides of the Vertical axis and on lifestyle analysis.

Feelings of Inferiority
Lifestyle analysis points to the precise and particular process through
which during childhood patients reached the mistaken conclusion that they
are not of value as they are. Understanding this process, along with en­
couragement, w ill help patients change their perceptions of themselves as
inferior. The therapist will encourage the patient, point out strengths, ad­
vantages, and value so the patient will no longer need compensation in the
form of a high aspiration. That is why Dreikurs said that encouragement is
the heart of therapy. "It is obvious that any procedure which conveys to the
patient his sense of worth and value promotes a reconsideration of his self
438 Zivit Abramson

concept. He just is no longer the same person when he loses his prejudice
against himself and discovers that he is good enough as he is" (Dreikurs,
1973, p. 72).

Striving for Superiority

Lifestyle analysis w ill also reveal the childhood origin of the patient's
overambition. In order to cope with the Vertical outlook, the therapist will
fulfill a role as an educator and act to "erase faulty social values" (Dreikurs,
1973, p. 37), which Adler and Dreikurs saw as a fundamental component
of therapy. Correcting faulty social values w ill help patients forgo their exag­
gerated ambitions and embrace the possibility of a Horizontal worldview,
according to which all human beings are equal. When they believe in this
worldview, they w ill be able to accept without fear that they, as are all hu­
mans, are not perfect and can still belong to and be a contributing member
of society. "The cure or reorientation is brought about by a correction of
the faulty picture of the world and the unequivocal acceptance of a mature
picture of the world" (Adler, 1936, p. 3).
Underdeveloped Social Interest
During the therapeutic process, social interest should develop slowly.
This can occur through a relationship between the therapist and the pa­
tient characterized by warmth and mutual respect, and with the modeling
influence the therapist presents to the patient through behavior and person­
ality. The therapist w ill also try to steer patients toward experiences that will
provide a sense of belonging by way of contributing. All of these— lifestyle
analysis, encouragement, education for remodeling values, and the nurtur­
ing of social interest—will occur simultaneously.

Passivity, lack of trust, and pampered style. Encouragement and the

change in worldview w ill raise patients' belief in their ability to fulfill life's
tasks, which in turn w ill raise motivation for action and reduce the level of
passivity. The struggle to get rid of the pampered style is the hardest, and the
therapist must assist the patient to go through it in small steps.

Symptoms and excuses. When patients choose to change something in

their mistaken basic assumptions or conduct in life, it w ill be possible to
move on to the last stage of the treatment and deal with the symptoms and
the excuses directly. It is important to remember that the patients did indeed
suffer from the prices paid for the symptoms and excuses and want to be rid
of them— but they w ill be only after the "danger" of loss of value in their
perception is removed. Only then, if they do not forgo the symptoms and/or
the excuses by themselves, w ill there be a need to deal with them directly
and to practice new behaviors in the context of the fourth component of
therapy Dreikurs (1973, p. 11) called Reorientation.
 Neurosis According to Adler 439

References

Adler, A. (1929). Problems o f neurosis: A book o f case histories. London,

United Kingdom: Kegan Paul, Trench, Truebner & Co.
Adler, A. (1931). What life should mean to you. Boston, MA: Little, Brown
& Company.
Adler, A. (1933). Social interest: A challenge to mankind. London, United
Kingdom: Faber & Faber.
Adler, A. (1935). Prevention of neurosis. International Journal o f Individual
Psychology, 1(4), 9-10.
Adler, A. (1936). The neurotic's picture of the world. International Journal o f
Individual Psychology, 2(3), 3-13.
Adler, A. (1967). Safeguarding through aggression. In H. L. Ansbacher &
R. R. Ansbacher (Eds.), The Individual Psychology o f Alfred Adler: A sys­
tematic presentation in selections from his writings (pp. 267-272). New
York, NY: Harper & Row. (Original work published 1912)
Adler, A. (1979). Advantages and disadvantages of the inferiority feeling. In
H. L. Ansbacher & R. R. Ansbacher (Eds.), Superiority and social inter­
est: A collection o f later writings (pp. 50-58). New York, NY: W. W.
Norton & Company. (Original work published 1933)
Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1967). The Individual Psychol­
ogy o f Alfred Adler: A systematic presentation in selections from his
writings. New York, NY: Harper & Row.
Dreikurs, R. (1973). Psychodynamics, psychotherapy, and counseling: Col­
lected papers o f Rudolf Dreikurs. Chicago, IL: Alfred Adler Institute.
Schulman, B., & Dreikurs, S. (1978). The contribution of Rudolf Dreikurs to
the theory and psychotherapy of Adlerian psychology. Journal o f Indi­
vidual Psychology, 34(2), 153-169.
Sicher, L. (1991). The collected works o f Lydia Sicher: An Adlerian perspec­
tive. A. K. Davidson (Ed.). Fort Bragg, CA: QED Press.

Zivit Abramson is a Psychologist and a certified Family, Couple and Individ­

ual Psychotherapist and Supervisor. She has been with the Alfred Adler Insti­
tute of Israel since 1973; currently she is the founder and head of clinic for
the Psychotherapy Department, and was previously head of the Parent Edu­
cation Department for 12 years. She has been teaching as a member of the
faculty of ICASSI each year since 1990, and is currently in private practice
and teaching at the 3-year postgraduate program for Adlerian Psychotherapy
at the Adler Institute. Abramson is the author of three books in Hebrew on
sexuality and couples from an Adlerian perspective. Her book Learning
Couples was published in English by the Adlerian Society UK & Institute for
Individual Psychology (ASIIP). Abramson received her PhD in Philosophy
for completing a dissertation comparing Alfred Adler and Jean Paul Sartre.
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