Who Coined the Term Neurosis? William Cullen and the 18th-Century Concept
Author: Ukrainian Psychological Hub · Published: September 30, 2026 · Editorial Policy
The term neurosis is generally credited to the Scottish physician William Cullen (1710–1790). Cullen introduced the word in the first edition of Synopsis Nosologiae Methodicae, published in Edinburgh in 1769. In Cullen’s system, however, “neuroses” did not mean what the word later came to mean in psychiatry, psychoanalysis, popular psychology, or everyday speech. It named a broad medical class of disorders connected with disturbances of sensation and movement and with the functioning of the nervous system.
That historical distinction is the central fact to keep in view. Cullen did not coin a diagnosis equivalent to generalized anxiety disorder, obsessive-compulsive disorder, depression, somatic symptom disorder, a personality trait, or the later Freudian idea of neurosis. Scholarly histories of the concept explicitly describe Cullen’s eighteenth-century usage as markedly different from later meanings; José M. López Piñero’s historical study identifies Cullen as the coiner of the term and places its first appearance in 1769. Cambridge University Press summarizes that history here.
For the broader meaning of neurosis across later periods, see Neurosis: What It Means Today, Symptoms, History, and Modern Diagnoses. For the changing historical taxonomy of the term, see Types of Neurosis: Historical Categories and Their Modern Equivalents. This page has a narrower job: to identify who coined neurosis, explain what Cullen meant in the eighteenth century, and show why his concept cannot be read as a modern psychiatric diagnosis.
The short answer: William Cullen coined neurosis in 1769
The standard scholarly attribution is William Cullen. The University of Leeds copy of the 1769 first edition identifies Synopsis Nosologiae Methodicae as the first edition of Cullen’s classification system and describes its four great classes as pyrexias, neuroses, cachexias, and local diseases. López Piñero likewise states that the concept of neurosis was coined by Cullen and first appeared in the 1769 Synopsis before appearing again in Cullen’s First Lines of the Practice of Physick.
The date matters because it places the birth of the term more than a century before Sigmund Freud’s mature psychoanalytic theories. William Cullen’s neurosis belonged to eighteenth-century medical nosology: the project of arranging diseases into systematic classes, orders, genera, and species. The word began as part of a medical classification system, not as a theory of unconscious conflict.
What appeared in the 1769 Synopsis Nosologiae Methodicae?
Cullen’s Synopsis was a work of nosology—a systematic arrangement of diseases. The 1769 volume did more than present Cullen’s scheme: the surviving first-edition record shows that it also included classifications associated with François Boissier de Sauvages, Carl Linnaeus, and Rudolph Augustin Vogel before presenting Cullen’s own arrangement. This context is important because Cullen was participating in a larger eighteenth-century effort to classify disease with the rigor and order that natural historians brought to plants and animals. The Leeds Special Collections record documents the structure and contents of this first edition.
Within Cullen’s own system, neuroses constituted one of four major classes. They sat alongside pyrexias, cachexias, and local diseases. That position already shows why a modern reader should resist translating “neuroses” into a single psychiatric disorder: Cullen’s category functioned at a much higher classificatory level and covered phenomena that later medicine would distribute across very different specialties.
An early English translation of Cullen’s Synopsis, published in 1792 and preserved by the Wellcome Collection, allows modern readers to inspect the classification directly. It makes visible a historical medical world in which the boundaries now separating neurology, internal medicine, psychiatry, and psychosomatic medicine had not yet taken their modern form.
What did Cullen mean by “neuroses”?
Cullen’s later First Lines of the Practice of Physic gives a fuller account of what he meant. He treated neuroses as “nervous diseases,” but that phrase should be read inside his own eighteenth-century physiology. Cullen was concerned with disorders in which the powers of sensation and motion were disturbed without an idiopathic fever and without the disorder being reducible to a local disease of a particular organ.
The formulation tied the class to a general affection of the nervous system and especially to the powers on which sense and motion depended. That is very different from saying that Cullen had discovered a group of purely psychological disorders. Historian Sean Dyde’s reconstruction of Cullen’s medicine warns specifically against flattening Cullen’s neurosis into a simple story of “nervous ailments.” Dyde’s peer-reviewed historical analysis shows how Cullen’s physiology, pathology, medical practice, and ideas about nervous function formed a more complex system.
Cullen’s category therefore belongs to a period before the later opposition between “organic” neurological disease and “functional” or psychological neurosis became a standard organizing distinction. Reading the eighteenth-century word through twentieth-century assumptions reverses the historical sequence: the later distinctions emerged after Cullen’s term and transformed its meaning.
The four orders inside Cullen’s class of neuroses
Cullen divided his class of neuroses into four orders: Comata, Adynamiae, Spasmi, and Vesaniae. The names and contents reflect the medical taxonomy of his period rather than a modern diagnostic system.
Comata
Comata grouped disorders characterized by diminished or interrupted powers of sensation and voluntary motion. Historical forms of apoplexy and paralysis appeared in this territory. Modern medicine would not place all such conditions in a psychiatric neurosis category; many are now understood neurologically or medically through mechanisms unavailable to eighteenth-century nosology.
Adynamiae
Adynamiae concerned weakness or diminished vital and voluntary powers. Cullen’s scheme placed conditions such as syncope, dyspepsia, hypochondriasis, and chlorosis in this broad order. The coexistence of gastrointestinal, constitutional, and historically psychological-sounding labels within one order illustrates how unlike modern specialty boundaries Cullen’s system was.
Spasmi
Spasmi covered irregular motions and contractions and included a strikingly heterogeneous set of conditions, including forms historically labeled tetanus, convulsion, epilepsy, palpitation, asthma, hysteria, and hydrophobia. These labels cannot simply be carried into present-day diagnosis, because both the disease concepts and the medical knowledge used to define them have changed.
Vesaniae
Vesaniae covered disturbances of judgment and mental function and included historical categories such as amentia, melancholia, mania, and oneirodynia. The presence of Vesaniae inside the class of neuroses is especially revealing: Cullen’s “neuroses” could include what later generations would place under mental disorder as well as conditions later understood as neurological or bodily disease.
The Wellcome digitization of Cullen’s Synopsis provides the primary-source classification. The point of reproducing its architecture here is not to revive the categories. It is to show how large the historical semantic distance is between Cullen’s class and any single modern use of neurosis.
Why Cullen’s neurosis was much broader than the later psychiatric term
Modern readers often encounter neurosis through twentieth-century psychiatry or psychoanalysis, where the term became associated with anxiety, phobias, obsessive symptoms, hysterical symptoms, conflict, defense, or distress occurring without the kind of reality-testing impairment historically associated with psychosis. Cullen’s usage predates that conceptual world.
Historical psychiatry confirms this reversal. Research on the later neurosis–psychosis distinction notes that Cullen’s late-eighteenth-century neuroses encompassed diseases of nerves and muscles, while the familiar psychiatric opposition between neurosis and psychosis developed later. The historical literature on the psychosis–neurosis dichotomy shows that “psychosis” itself was coined only in the nineteenth century.
This is why the sentence “Cullen invented the psychiatric diagnosis of neurosis” is historically misleading. He coined a nosological term that subsequent generations repeatedly narrowed, expanded, reinterpreted, and relocated. The continuity is lexical—the word survives—while the underlying category changed dramatically.
Did Cullen invent the idea of nervous disease?
No. Cullen’s achievement was the coinage and systematic use of neurosis within his nosology, not the invention of the broader idea that diseases could be “nervous.” European medicine had already developed traditions of thinking about nerves, sensibility, irritability, spasms, and nervous disease. Cullen worked within and reorganized that intellectual inheritance.
López Piñero’s history describes “nervous disease” as a concept already current in Cullen’s medical environment, while Dyde’s reconstruction places Cullen in relation to predecessors such as Robert Whytt. Cullen’s contribution was to turn neurosis into a formal classificatory term with a defined place in a systematic medical nosology.
That distinction matters for the question “Who coined neurosis?” A person can coin a term without inventing every idea from which the term was formed. Cullen gave the medical vocabulary a new classificatory word and a structured category; he inherited a much older conversation about nerves and disease.
Was Felix Platter the first to use the concept?
Some nineteenth-century writers attributed the idea to the Renaissance physician Felix Platter. The standard historical account summarized by Cambridge University Press rejects that attribution as a misreading of Platter’s terminology. On that account, Platter’s “functionum laesiones” should not be treated as an earlier occurrence of Cullen’s concept of neurosis.
Historical priority claims can depend on what counts as “the same concept,” but the mainstream scholarly answer to the specific lexical and nosological question remains clear: William Cullen coined neurosis, with its first appearance in his 1769 Synopsis.
Why 1769 was the right kind of moment for a term like neurosis
Cullen’s coinage emerged during a period when physicians were attempting to impose systematic order on a vast and unstable field of symptoms and diseases. Eighteenth-century nosology borrowed the classificatory ambition of natural history: diseases could be grouped by observable patterns even when their underlying pathology was unknown.
This mattered because medicine did not yet have modern neuropathology, neuroimaging, microbiology, genetics, or standardized psychiatric diagnosis. A classification could therefore unite conditions on the basis of functional patterns, presumed nervous mechanisms, and clinical resemblance that later medicine would separate once anatomy, physiology, pathology, and epidemiology changed the explanatory landscape.
Cullen’s neuroses are best understood as one such classificatory solution. The category was useful in its own system because it organized a field of disorders that seemed to involve sensation, motion, nervous function, weakness, spasm, or mental disturbance without fitting neatly into fever, cachexy, or a local lesion. Its later transformation reflects the transformation of medicine itself.
Cullen’s First Lines made the concept clinically influential
Cullen returned to the class of neuroses in First Lines of the Practice of Physic, first published beginning in 1777. The work became one of the influential medical textbooks of its period and went through multiple editions. The surviving Wellcome copy of the 1784 fourth edition makes Cullen’s clinical exposition accessible as a primary source.
The importance of First Lines is that it did more than list a taxonomic label. It connected the class to Cullen’s broader account of nervous function and to the clinical description and management of individual diseases. W. F. Knoff’s classic historical review, A history of the concept of neurosis, with a memoir of William Cullen, traces the later career of the word from Cullen onward.
How the meaning changed after Cullen
The history after 1769 is not a straight line from Cullen to Freud. During the nineteenth century, changing ideas about pathological anatomy, nervous disease, functional disturbance, psychiatry, and neurology repeatedly altered what could be called a neurosis. Conditions once grouped together were separated; some acquired anatomical or physiological explanations; others remained contested functional syndromes; and still others moved toward psychiatric interpretation.
Simo Køppe’s peer-reviewed study of nineteenth-century conceptual development emphasizes the changing relationship between neurology and psychiatry in the constitution of the term. This period is where much of the semantic work occurred that eventually made twentieth-century neurosis look so different from Cullen’s eighteenth-century class.
By the time psychoanalysis gave neurosis one of its most famous meanings, the term had already traveled through more than a century of conceptual change. Freud’s neuroses were organized around a psychological and psychodynamic model that cannot be read backward into Cullen’s nosology.
Freud did not coin the term neurosis
This is one of the most persistent misconceptions. Freud transformed the intellectual importance of neurosis, developed influential theories of neurotic symptom formation, and helped make the term central to twentieth-century psychodynamic thought. He did not invent the word.
Chronology alone makes the point: Cullen’s first documented use dates to 1769, whereas Freud was born in 1856. More than eighty years separated Cullen’s coinage from Freud’s birth, and more than a century separated it from mature psychoanalytic formulations.
The useful distinction is therefore: Cullen owns the historical coinage; later psychiatry and psychoanalysis own major reinterpretations. Treating those as the same conceptual act erases the history that explains why one word has carried so many different meanings.
Neurosis and psychosis were not an original pair
Today, historical summaries often introduce neurosis by contrasting it with psychosis. That can be useful for explaining twentieth-century psychiatric language, but it does not describe the setting in which Cullen coined the term. Cullen’s category existed before “psychosis” was coined in the nineteenth century.
Historical research on the dichotomy shows that psychosis initially emerged within a classificatory world in which neurosis could still have a much broader meaning. The familiar opposition—roughly, neurosis with preserved reality testing versus psychosis with major disturbances of reality testing—was a later construction, not Cullen’s original definition.
What does neurosis mean in DSM-5-TR and ICD-11 today?
For modern clinical interpretation, Cullen’s term must be separated from current diagnostic systems. Neurosis is not a standalone diagnosis in DSM-5-TR, and the current ICD-11 mental, behavioral, and neurodevelopmental classification does not restore Cullen’s eighteenth-century class as a modern diagnosis.
The American Psychiatric Association’s history of the DSM records the major reorganization represented by DSM-III in 1980: explicit diagnostic criteria, a multiaxial system, and an approach intended to be more neutral about etiology. The place of neurosis in DSM-III was itself controversial. Bayer and Spitzer’s historical analysis documents the professional dispute over psychodynamics and the proposed retention of neurosis in the nomenclature; see Neurosis, psychodynamics, and DSM-III: A history of the controversy.
For ICD, the relevant current clinical reference is the World Health Organization’s ICD-11 Clinical Descriptions and Diagnostic Requirements, published in 2024. Current diagnosis should be made using current categories and criteria, not by assigning a patient Cullen’s label or treating neurosis as a catch-all modern disorder.
For a focused explanation of this classification question, see Is Neurosis Still a Diagnosis? DSM-5-TR, ICD-11, and Modern Psychiatry.
Why does the National Library of Medicine still list “Neurotic Disorders”?
The U.S. National Library of Medicine still maintains a Medical Subject Headings entry titled Neurotic Disorders, with entry terms including “neuroses” and “psychoneuroses.” This can look confusing if it is mistaken for a current diagnostic manual.
MeSH is a controlled vocabulary used to index biomedical literature. Its terminology helps retrieve papers written across different decades and naming systems. The survival of a legacy indexing heading does not convert neurosis into a current DSM-5-TR or ICD-11 diagnosis. Indexing language and clinical diagnostic classification serve different functions.
What Cullen’s neurosis does—and does not—map onto today
There is no one-to-one modern equivalent of Cullen’s class. That is the most important practical conclusion for anyone reading an eighteenth-century medical text. Some conditions he classified among neuroses would now be approached as neurological disorders; some as internal-medical conditions; some historical labels have disappeared; some phenomena overlap with contemporary psychiatric categories; and some terms changed meaning so much that direct translation is misleading.
The same rule applies in the opposite direction. A person with a modern anxiety disorder, OCD, depression, PTSD, functional neurological disorder, somatic symptom disorder, or another current diagnosis should not be described as having Cullen’s “neurosis” merely because later historical versions of neurosis sometimes covered superficially similar symptoms. The categories were constructed in different medical systems with different boundaries and explanatory assumptions.
The English Hub’s Types of Neurosis: Historical Categories and Their Modern Equivalents maps later historical forms cautiously and explains why “modern equivalent” usually means a relationship or partial overlap rather than identity.
What Cullen did not mean by neurosis
Cullen did not mean the Big Five personality trait neuroticism. Neuroticism is a modern personality construct describing a dimension of emotional reactivity and negative affect; it is not Cullen’s disease class and not a psychiatric diagnosis.
Cullen did not mean an everyday “neurotic person.” Colloquial labeling developed from later cultural uses of the word and should not be projected onto eighteenth-century nosology.
Cullen did not mean Freud’s theory of repression, unconscious conflict, defense, transference, or psychosexual development. Those belong to a later psychoanalytic framework.
Cullen did not mean “anxiety disorder” as defined by a current diagnostic manual. Anxiety-related phenomena eventually became important within later neurosis concepts, but Cullen’s class was far wider.
Cullen did not mean a disorder defined by preserved reality testing in opposition to psychosis. That neurosis–psychosis contrast emerged later.
For the separate personality-trait distinction, see Neurosis vs Neuroticism: Historical Disorder Concept vs Big Five Personality Trait.
Common misconceptions about who coined neurosis
“Freud coined neurosis.”
No. Freud became one of the most influential theorists of neurosis, but Cullen introduced the term in 1769.
“Cullen’s neurosis was an old name for anxiety disorder.”
No. Anxiety can appear in the later history of neurosis, but Cullen’s class included a much wider range of nervous, motor, constitutional, and mental phenomena.
“Neurosis has always meant a nonpsychotic mental disorder.”
No. That is a later psychiatric meaning. Cullen’s original category preceded the coinage of psychosis and covered many conditions that modern medicine would not call mental disorders.
“Because MeSH still lists neurotic disorders, neurosis is still an official diagnosis.”
No. MeSH is a bibliographic indexing vocabulary. Current clinical diagnostic status must be determined from current diagnostic systems such as DSM-5-TR and ICD-11.
“If a historical source says neurosis, we can translate it directly into one modern diagnosis.”
Usually not. The correct translation depends on the author, date, classification system, symptoms described, and theoretical tradition. A word can remain stable while its diagnostic referent changes.
Why the history of one word matters clinically
Historical terminology is not merely antiquarian. Old diagnostic words continue to circulate in books, clinical records, family histories, psychoanalytic writing, online health discussions, and database indexing. When a legacy term is treated as if it had one timeless definition, it can produce false equivalences between historical and current diagnoses.
With neurosis, the risk is unusually high because the word has traveled through several distinct conceptual regimes: eighteenth-century nervous disease, nineteenth-century neurological and functional theories, later psychiatric classifications, psychoanalytic theory, everyday personality language, and modern historical indexing.
For a modern reader, the safest method is therefore chronological. First identify the period and author. Then reconstruct what the term meant in that specific system. Only after that should the historical concept be compared with current diagnostic language.
How to read the word “neurosis” in an old source
If the text is from Cullen’s own period, begin with his nosological class and nervous-system framework. Do not assume a psychoanalytic meaning.
If the text is nineteenth-century, identify the specific medical school and date. The relationship between neurosis, nervous disease, functional disorder, hysteria, and emerging psychiatry changed substantially across the century.
If the text is psychoanalytic, identify the theorist and the particular psychoanalytic category involved. Freud, Jung, Adler, Horney, and later traditions did not use every neurosis concept in the same way.
If the text is a twentieth-century diagnostic manual, identify the exact edition. A label in DSM-I, DSM-II, DSM-III, ICD-9, or ICD-10 cannot automatically be assigned the status it has in DSM-5-TR or ICD-11.
If the text is contemporary and informal, determine whether neurosis is being used historically, psychoanalytically, colloquially, or as a loose synonym for distress. None of those uses by itself establishes a current clinical diagnosis.
The historical answer in one sentence
William Cullen coined the medical term neurosis in 1769, but his neuroses were an eighteenth-century class of nervous diseases whose scope and logic were fundamentally different from later psychoanalytic neurosis and from current DSM-5-TR or ICD-11 diagnoses.
FAQ
Who coined the term neurosis?
Scottish physician William Cullen is generally credited with coining neurosis. The term first appeared in his Synopsis Nosologiae Methodicae in 1769.
What year was neurosis coined?
The standard date is 1769, the year of the first edition of Cullen’s Synopsis Nosologiae Methodicae.
Did Sigmund Freud coin neurosis?
No. Freud was born in 1856, decades after Cullen’s coinage. Freud later transformed the meaning and importance of neurosis within psychoanalytic theory.
What did William Cullen mean by neurosis?
Cullen used neuroses for a broad class of “nervous diseases” involving disturbances of sensation and motion and related nervous-system powers, without idiopathic fever and without being explained as a local disease. The category was far broader than later psychiatric neurosis.
What book first used the term neurosis?
The first appearance is generally identified in William Cullen’s Synopsis Nosologiae Methodicae, first published in Edinburgh in 1769.
What were Cullen’s four orders of neuroses?
Cullen divided the class into Comata, Adynamiae, Spasmi, and Vesaniae. These were eighteenth-century nosological orders and should not be converted directly into current diagnostic groupings.
Was Cullen’s neurosis the same as anxiety disorder?
No. Cullen’s class was much broader and included conditions that modern medicine distributes across neurological, medical, psychiatric, and obsolete historical categories.
Is neurosis a diagnosis in DSM-5-TR?
Neurosis is not a standalone DSM-5-TR diagnosis. Modern assessment uses current disorder-specific criteria rather than a single neurosis umbrella diagnosis.
Is neurosis a diagnosis in ICD-11?
ICD-11 does not restore Cullen’s neuroses as a current umbrella diagnosis. Current ICD-11 clinical diagnosis uses the modern categories and requirements published by the World Health Organization.
Why do historical sources disagree about what neurosis means?
Because the word survived while its conceptual framework changed. Cullen’s nervous-disease class, nineteenth-century functional concepts, psychoanalytic neurosis, twentieth-century diagnostic labels, and modern colloquial usage belong to different historical systems.
Related Articles
References
American Psychiatric Association. DSM History. American Psychiatric Association
Bayer, R., & Spitzer, R. L. (1985). Neurosis, psychodynamics, and DSM-III: A history of the controversy. Archives of General Psychiatry, 42(2), 187–196. https://doi.org/10.1001/archpsyc.1985.01790250081011
Beer, M. D. (1996). The dichotomies: Psychosis/neurosis and functional/organic: A historical perspective. History of Psychiatry, 7(2), 231–255. https://doi.org/10.1177/0957154X9600702603
Cullen, W. (1769). Synopsis nosologiae methodicae. Edinburgh. First-edition record: University of Leeds Special Collections
Cullen, W. (1784). First lines of the practice of physic (4th ed.). Edinburgh: C. Elliot & T. Cadell. Digitized copy: Wellcome Collection
Dyde, S. (2015). Cullen, a cautionary tale. Medical History, 59(2), 222–240. https://doi.org/10.1017/mdh.2015.7
Knoff, W. F. (1970). A history of the concept of neurosis, with a memoir of William Cullen. American Journal of Psychiatry, 127(1), 80–84. https://doi.org/10.1176/ajp.127.1.80
Køppe, S. (2009). Neurosis: Aspects of its conceptual development in the nineteenth century. History of Psychiatry, 20(1), 27–46. https://doi.org/10.1177/0957154X08092426
López Piñero, J. M. (1983). The concept of neurosis. In Historical Origins of the Concept of Neurosis. Cambridge University Press. Cambridge Core
National Library of Medicine. Neurotic Disorders. Medical Subject Headings (MeSH). NCBI
World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. World Health Organization