What Is the Difference Between the Words ‘Neurotic’ and ‘Psychotic’?

The terms ‘neurotic’ and ‘psychotic’ both indicate, effectively enough, that something is not entirely well with someone’s mental state. However, the precise distinction between the two terms can be hard to grasp. What does each one mean – and how and where should we use it? The question of neurotic vs psychotic can be especially confusing.

Both words describe a form of mental pain. The difference lies in people’s relative degree of conscious awareness of its actual origins.

Neurotic vs Psychotic

As a general rule, the neurotic person knows they are not well. They may be in difficulty, but they know they are, and have some inkling of why. They can say, in plain enough terms, that they are anxious about their ex, or that they are depressed about their work, or that they are underconfident because of neglect at the hands of their parents. The distress isn’t easy to shift, but its existence and causes don’t need to be ignored.

The psychotic person, for their part, is also in pain, but they have an additional struggle: they are a lot further from knowing what is really at play within them. And this is for a poignant reason: they are scared of their own suffering. Their illness is that they are too unwell to know how ill they are.

For example, someone in a psychotic state may spend a lot of time getting their front room clean and tidy because they’re soon to be visited by a grandee from an alien civilisation. Their main conscious worry is that they need to get more snacks and that the carpet has some stains on it.

Deep down, a lot else is, of course, going on. The obsession with an alien who loves them is linked – in complex but traceable ways – to a parent who ignored them. The king of planet Kepler 2b is filling in for a missing caregiver closer to home. In their psychotic states, our minds spin creative narratives that privilege what feels bearable over what is true.

Or a psychotic person might, deep down, be stricken by their mother’s preference for their sibling while consciously thinking only that their nose was too large and needs to be corrected by plastic surgery in order that they might feel good enough about themselves.

Someone who is psychotic might be highly anxious about forming a close relationship with anyone after abuse by a parent while, on the surface, spending all their free time on an imaginary love story involving a celebrity who could never know of their existence.

Becoming Less Psychotic

However forbidding the word psychotic can sound, we should accept that we all have moments when we are in the zone covered by the term – in other words, when thinking becomes too hard to bear: for example, when we hit the bedside table or develop backache rather than register that we are sad; or develop a political grudge without understanding that we’re furious with our father; or become sure the police are following us instead of understanding our sense of guilt around feelings of aggression towards a colleague.

With these two terms in mind, and returning to the question of neurotic vs psychotic, we might say that one of the goals of mental life should be not so much to be happy – that’s a very hard task indeed – but to be, whenever we can manage it, slightly less psychotic and ever more neurotic.