The psychoneurotic condition reconsidered: An integrative biopsychosocial analysis with implications for social work assessment, intervention, and multidisciplinary mental health practice

The concept of psychoneurosis, though largely absent from contemporary diagnostic nosology following its exclusion from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980, retains considerable heuristic and clinical value for understanding the complex interplay of biological vulnerability, psychological conflict, and social context in the genesis and maintenance of common mental health conditions. This paper traces the historical evolution of the psychoneurosis concept from its origins in nineteenth-century railway spine and traumatic neurosis debates through its psychoanalytic elaboration by Freud and Breuer and its subsequent integration into social work practice, arguing that its core insights, particularly the recognition that psychological symptoms arise from unconscious conflicts rooted in developmental experience and mediated by social environment, remain essential for holistic mental health practice. Through the lens of Engel's biopsychosocial model and contemporary psychoneuroimmunology research, the researcher demonstrates how modern neuroscience validates rather than invalidates the psychoneurosis framework, revealing the neurobiological mechanisms through which psychological and social factors produce enduring alterations in brain function and immune system regulation. The paper further examines the distinctive contribution of social work to the assessment and treatment of psychoneurotic conditions, emphasizing the profession's historical engagement with the person-in-environment perspective and its practical application of psychodynamic concepts in social context. Drawing on archival clinical data from institutions such as the Austen Riggs Foundation, contemporary neurobiological research, and social work practice literature, the researcher proposes an integrated model for understanding and addressing psychoneurotic presentations that bridges the gap between biomedical and psychosocial approaches. The implications for clinical practice, social work education, and mental health policy are discussed, with particular attention to the need for a renewed emphasis on developmental, individual, and contextual perspectives in an era of symptom-focused, manualized treatment paradigms.