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Psychiatry 1 (Dra.

Capitan)
Theories of Personality and
Psychopathology
13 December 2007

Marie Bemheim who both taught him hypnosis


- began clinical work with hysterical patients in Vienna;
Sigmund Freud: Founder of Classic where he developed psychoanalysis ( 1 887- 1897)
Psychoanalysis - died in London (I939)

Sigmund Freud
- created the discipline of psychoanalysis in the 19th
century Beginnings of Psychoanalysis
- role of meaning was central to his vision of - in conjunction with his colleague, Joseph Breuer, Freud
psychoanalysis studied a series of female patients suffering from
ex. Auditory hallucinations hysterical symptoms that defied neurological
◦ biological mechanisms may produce the symptom explanation
but the content of that symptom and its meaning to - he turned to the cathartic method which he used in
the patient relate to specific psychological conjunction with hypnosis → abreaction: attempt by
characteristics unique to that patient Freud to remove symptoms through a process of
- psychoanalysis is recognzed today as having 3 recovering and verbalizing suppressed feelings with
crucial aspects: which the symptoms were associate
a. therapeuhc technique - through his experiments with abreaction and hypnosis,
b. body of scientific and theoretical knowledge he learned that patients were unable or unwilling to
c. method of investigation recount memories that subsequently proved very
- some of his basic tenets have remained central to significant
psychiatric and psychotherapeutic practice: ◦reluctance = resistance
a. notion of psychic determination
b. unconscious mental activity ◦Resistance was caused by largely unconscious, active
- can be seen in dreams and nonverbal behaviors forces in the patient’s mind
(parapraxes: slips of the tongue that often reveal ◦repression: active process of excluding distressing
unconscious intent that is outside the indivrdual’s material from conscious awareness; essential to
awareness) symptoms formation
c. role of childhood experience in shaping the adult - he switched to free association or the inviting of his
personality patients to say whatever came to mind without
- principles of technique are also at the core of censoring their thoughts
psychoanalysis as a treatment: - childhood sexual seduction played a role in causing the
a. resistance neuroses
- he observed that patients often resists the - the idea that sexual seduction by parental figures was
physician’s effort to heal a fantasy began to discipline his theory that actual
- some patients either become silent or were unable to sexual seduction was a pivotal pathogenic factor in
follow his suggestion when he asked them to say neuroses
whatever come to mind (free association)
b. transference The Interpretation of Dreams
- patient’s displacement unto the analyst of early - Freud’s most monumental work
wishes and feelings towards persons from the past
- He was struck by the intimate connection
. patients may experience the psychiatrist as a
between dream content and unconscious
parental figure from the past and defy the perceived
memories or fantasies that were long
parental control
suppressed
- contemporary view: acknowledge that the analyst
or physician’s real characteristics always influence
- Dream is the distinguished fulfillment of an
unconscIous childhood wish that is not readily
transference
accessible to conscious awareness in waking life
c. countertransference
- clinician’s feelings towards the patient, based on a - Freud laid the foundations for ego psychology
mixture of the real characteristics of the patient and o he suggested that unconscious childhood
qualities associated with the figures from the wishes can be transformed into disguised
clinician’s past conscious manifestations only if a censor
exists in the mind
o censor
Life of Freud  functions to preserve sleep in the
- born of May 6, 1856 in Frelburg, a small town in service of the ego
Moravia which is now a part of Czech Republic  it disguises disturbing thoughts and
- specialized in neurology after medical school feelings making sure that the
- studied with Jean-Martin Charcot dreamer’s sleep is not disturbed
- influenced by Ambroise August Liebault and Hippolyte-

JoY and IsaY 1 of 12


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 repressed wishes and impulses must - according to Freud: a more mature and
attach themselves to innocent or reasonable aspect of the go works during
neutral images to pass the scrutiny of dreams to organize primitive aspects of dreams
the dream censor into a more coherent form
o unconscious thoughts and wishes that are - dreams become somewhat more rational
repressed includes: - reated to secondary process
 nocturnal sensory stimuli → mature activity characteristic of waking life
 day residue – thoughts and ideas that
are connected with the activities and Affects in Dreams
preoccupations of the dreamer’s - secondary emotions may not appear in the
current waking life dream at all
 repressed unacceptable impulses - they may be experienced in altered form
o 2 layer of dream content:
- feelings may also appear as their opposite
 manifest – refers to what is recalled by
the dreamer
Anxiety Dreams
 latent – involves the unconscious
thoughts and wishes that threaten to
- Freud’s understanding of dreams stresses the
importance of discharging drives or wishes
awaken the dreamer
through the hallucinatory contents of the dream
o Dream work : unconscious mental
operations by which latent dream content is - Mechanisms he believed to be facilitating of
transformed into manifest dream latent impulses, rather than protecting dreamers
from anxiety and pain
Condensation o Condensation
- several unconscious impulses, wishes, or o Displacement
feelings can be combined and attached to one o symbolic representation
manifest dream image o projection
ex. A composite character may appear in the dream with o secondary vision
a name like one person in the dreamer’s life - reflects a failure in the protective function of the
dream work mechanisms
Displacement → repressed succeed in working their way into
- energy or intensity associated with one object is the manifest in a more or less recognizable
diverted to a substitute object that is pattern
associatively related but more acceptable to the
dreamer’s ego Punishment Dreams
- dream censor displaces affective energy in such - seem to represent an exception to Freud’s wish
a way that the dreamer’s sleep can continue fulfillment fheory of dreams
undisturbed - reflects a compromise between the repressed
- projection: special instance of displacement wish and the repressing agency or conscience
which involves the attribution of the dreamer’s - ego anticipates condemnation on the part of
own unacceptable impulses or wishes to another dreamer’s conscience if the latent unacceptable
character in the dream impulses are allowed direct expression in the
manifest dream content
Symbolic Representation → wish for punishment on the part of the
- dreamer would often represent highly charged patient’s conscience is satisfied by giving
ideas or objects by using innocent images that expression to punishment fantasies
were in some way connected with the idea or
object being represented → an abstract concept TOPOGRAPHICAL MODEL OF THE MIND
or a complex set of feelings toward a person (SIGMUND FREUD’S Interpretation of Dreams)
could be symbolized by a simple, concrete, or 3 REGIONS:
sensory image
- he noted that symbols have unconscious 1. the CONSCIOUS
meanings that can be discerned through the - part of the mind in which perceptions coming from the
patient’s associations to symbol outside world or from within the body or mind are
- he also believed that certain symbols are brought into awareness
universal Consciousness - subjective phenomenon whose
content can be communicated by means of language or
Secondary Revision behavior; used a form of neutralized psychic energy
- Primary Process – type of thinking which is (ATTENTION CATHEXIS)
characterized by mechanisms of condensation,
displacement, and symbolic process → primitive 2. the PRECONSCIOUS
mode of cognitive activity that Is characterized - Comprises mental events, processes, and contents that
by illogical, bizarre, and absurd images that can be brought into conscious awareness by the act of
seem incoherent focusing attention
- Interfaces with both unconscious and conscious regions
of the mind
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- Contents of the unconscious become linked with words Freud’s view, instinct has 4 principal characteristics:
(preconscious) 1. source: part of the body from w/c the instinct
- Maintain the repressive barrier and censor arises
unacceptable wishes and desires 2. impetus: amount of force or intensity
associated w/ the instinct
3. the UNCONSCIOUS 3. aim: any action directed toward tension
- Dynamic; its mental contents and processes are kept discharge or satisfaction
from conscious awareness through the force of 4. object: target (often a person) for this action
censorship or repression
- Closely related to instinctual drives; INSTINCTS consist INSTICTS
of sexual and self-peservative and UNCONSCIOUS Libido: (Freud) that force by w/c the sexual instinct is
contain mental representations and derivatives of the represented in the mind; linkage of genital sexuality with
sexual instinct libido was viewed as the end result of a course of dev’t
- its content is limited to wishes seeking fulfillment which in w/c libidinal expression took a variety of forms
provide motivation for dream and neurotic symptom
formation (reductionist) Ego Instincts
- Characterized by Primary process thinking: - Freud maintained a dual instinct theory:
◦Principally aimed at facilitating wish fulfillment and subsuming sexual instincts & ego instincts
connected w/ self-preservation
instinctual discharge
- 1904 (On Narcissism) Freud invested ego
◦Governed by pleasure principle and disregards logical instinct w/ libido by postulating an ego libido &
connections, no concept of time, represents wishes as an object libido, thus he viewed narcissistic
fulfillments, permits contradictions to exist investment as an essentially libidinal instinct &
simultaneously and denies existence of negatives called the remaining nonsexual components the
◦Characterized by extreme mobility of drive cathexis; Ego instincts
investment of psychic energy can shift from object to
object w/o opposition Aggression: originally conceptualized by Freud as a
- Memories have been divorced from their connection component of the sexual instincts in the form of sadism;
with verbal symbols eventually he categorized it w/ hate as part of the ego
- Become conscious only by passing the preconscious instincts & the libidinal aspects of sadism as
components of the sexual instincts
1923 (Freud) Aggression instinct was conceived as a
separate instinct in its own right; its source accdg to
Limitations of Topographical Theory (2 main deficiencies Freud was largely in skeletal muscles, and its aim was
1. Patients’ defense mechanisms that guard destruction.
against distressing wishes, feelings or thoughts
were themselves not initially accessible to Life and Death Instincts
consciousness. - 1920 Freud subsumed the ego instincts under a
2. Freud’s patients frequently demonstrated an broader category of life instincts; juxtaposed w/ death
unconscious need for punishment. instincts & referred to as Eros and Thanatos (Beyond
the Pleasure Principle)
These difficulties lead Freud to discard the topographical - regarded as forces underlying the sexual &
theory, but certain concepts derived from the theory aggressive instincts
continue to be useful:
Repetition compulsion - a person’s tendency to repeat
- 1o & 2° thought processes
past traumatic behavior
- Fundamental importance of wish fulfillment
- Existence of a dynamic unconscious Death instinct (Thanatos): dominant force in
- Tendency toward regression under frustrating biological organisms
conditions Life instinct (Eros): tendency of particles to reunite or
bind to one another (as in sexual repd’n)
INSTINCT OR DRIVE THEORY
Instinct: refers to a pattern of species-specific behavior, PLEASURE AND REALITY PRINCIPLES
genetically derived & therefore is more or less 1911: 2 Basic Tenets of Mental Functioning
independent of learning 1. Pleasure Principle: Pleasure principle: inborn
tendency of organism to avoid pain & to seek
Confusion from the ambiguity inherent in a concept on pleasure through the discharge of tension
the borderland between biological and psychological: 2. Reality Principle: learned function closely
Should the mental representation aspect of the term and related to the maturation of the ego; modifies
psychological component be integrated or separated? the pleasure principle & requires delay or
postponement of immediate gratification
Drive may have been closer than Instinct to Freud’s *Both are aspects of ego functioning.
meaning, in contemporary usage, the tow terms are
often used interchangeably INFANTILE SEXUALITY
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3 major tenets of Psychoanalytic theory (Three o normal sleep (libido withdrawn &
Essays on the Theory of Sexualily) reinvested in a sleeper’s own body)
 Broadened the definition of sexuality to include - other examples:
forms of pleasure that transcend genital sexuality o homosexuality- instance of a narcissistic
 Established a developmental theory of childhood form of object choice; persons fall in love
sexuality that delineated the vicissitudes of erotic with idealized version of themselves
activity from birth through puberty projected into another person
 Conceptual linkage between neuroses and o beliefs/myths of primitive people -
perversions ability to influence external events through
magical omnipotence of thought processes
Stages of psychosexual development (See Table 6.1- o children - belief in their own omnipotence
1) (which is part of normal dev’t)
1. oral stage - occupies the first 12-18 months of
life, centers on the mouth & lips Freud’s postulates:
2. anal stage - 18-36 months of age, involves • Primary Narcissism (ego libido)
bowel fxn & control o at birth; infantile state of self-absorption
3. phallic stage - 3-5 yrs of life, urination o libido stored in the ego
o neonate is completely narcissistic; entire libidinal
- Accdg to Freud, penis remains the principal investment in physiological needs & their
sexual organ throughout male psychosexual satisfaction
dev’t while females have 2 principal erotogenic • Object Attachment (object libido)
zones, vagina & clitoris (chief erotogenic focus o libidinal investment on the object
during the infantile genital period but erotic • Secondary narcissism
primacy shifted to vagina after puberty) o if child suffers rebuffs or trauma from the
- He also discovered that in psychoneuroses, only caretaking figure, object libido maybe withdrawn
a limited number of sexual impulses that had & reinvested in the ego
undergone repressicn & were responsible for
creating & maintaining the neurotic symptoms Narcissism as description of different dimensions of
were normal human experiences:
- These were the same impulses that were given - as a perversion - person used their own bodies
overt expression in the perversions; neuroses or body parts as objects of sexual arousal
were the negative of perversions
- a developmental phase - e.g. state of primary
narcissism
OBJECT RELATIONSHIP IN INSTINCT THEORY
Nature & Quality of children’s relationships during
- a particular object choice - object resembles the
subject’s idealized or fantasied self-image
early years of life: affect the choice of a love object in
(“according to the narcissistic type”) - object
adult life; love relationship itself; & nature of all other
resembles a caretaker from early in life
object relationships
(anaclitic)
Libidinal phases of psychosexual dev’t: can be
described through child’s relationships with parents & - as self-esteem
other significant persons in the env’t
EGO PSYCHOLOGY
Concept of Narcissism - began with the publication of The Ego and the Id
Narcissism (by Freud) - situations in which libido was which represented in Freud’s thinking from
invested in the ego itself rather than in other persons topographical model of the tripartite structural
- presented Freud with vexing problems for his model of ego, id, and superego
instinct theory & essentially violated his
distinction between libidinal instincts & ego or Structural Theory of the Mind
self-preservative instincts ID
- Reservoir of unorganized instinctual drives
- Operate under the primary process; lacks capacity to
delay/modify instinctual drives. Not synonymous with
Narcissistic neuroses - collection of disorders in which the unconscious
a person’s libido is withdrawn from objects and turned EGO
inward - Executive organ of the psyche
- accounted for the loss of reality testing in - Controls motility, perception, contact w/ reality, delay &
modulation of drive expression
psychotic patients; grandiosity & omnipotence in
- Spans all 3 topographical dimensions:
such patients reflected excessive libidinal
conscious logical/abstract thinking,
investment in the ego
preconscious verbal expression
- also observed in: unconscious →defense mechanism
o States of physical illness &
hypochondriasis (libidinal investment was
SUPEREGO
frequently withdrawn from external objects
- establishes and maintains an individual’s moral
and from outside activities and interests
conscience(bases on ideals and values)
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- Heir to the Oedipus complex ANXIETY (by Freud) – “dammed up libido”


- Scrutinize behaviour, thoughts, feelings; compare with
expected standards of behavior; approve/disapprove (all
◦Physiological increase in sexual tension to a
coreesponding increase in libido
3 occur unconsciously)
◦Actual neuroses are caused by this build-up
Ego ideal – component of superego; prescribes what to
do accdg to internalized standard/value vs. superego w/c SIGNAL ANXIETY – second type of anxiety and new
prescribes (dictates what not to do) theory developed Freud

Functions of the Ego


◦in this model, anxiety operates at an unconscious
and serves to mobilize the ego’s resources to avert
Control & Regulation of Instinctual Drives – danger
capacity to delay/ postpone drive discharge (pleasure to ◦External or internal sources of danger may produce a
reality principle) signal that leads the ego to marshal specific defense
- essential in ego’s medication between id and mechanism to guard against, or reduce, instinctual
outside world excitation
Judgement – ability to anticipate consequence of
actions FREUD’s later theory of ANXIETY
- together with secondary process thinking ◦neurotic symptoms as the ego’s partial failure to
function
cope with distressing stimuli
Relation to Reality – mediate between external reality ◦drive derivatives associated with danger not
& internal world; 3 aspects: adequately contained by defense mechanism used by
- sense of reality – distinguish what is in/outside ego
- reality testing – distinguish internal fantasy from  i.e. phobias (fear of external threat) – externalization
externsl reality of internal dangers
- danger situations can be linked to developmental
- adaption to reality – ability to use resources to
stages & create developmental hierarchy of anxiety
develop effective responses to changing
circumstances on the basis of previous
Developmental Hierarchy of Anxiety: Danger
experience with reality
Situations
1. fear of disintegration/annihilation – associated
Object Relationships – satisfying relatedness depends
with concerns about fusion with an external
on ability to integrate positive & negative aspects of
object
others & self and to maintain an internal sense of others
2. separation anxiety- fear of the loss of an object
even in their absence
3. oedipal stage – losing love of most important
figure in their lives (girls); bodily injury/castration
Synthetic Function of the Ego – ego’s capacity to
(boys)
integrate diverse elements into an overall unity
4. superego anxiety – fear that internalized
- involves organizing , coordinating, and parental representations will cease to love, or
generating or simplifying large amounts of data will angrily punish the child
Primary Autonomous Ego Functions – rudimentary CHARACTER
apparatuses present at birth that develop independently
- Neurotic symptoms - develop as a result of the
of intrapsychic conflict between drives and defenses
failure of repression
- includes perception, lerning, intelligence,
- Character traits - owe their existence to the
intuition, language, thinking, comprehension,
success of repression to the defense system that
motility
achieves its aim through a persistent pattern of
reaction formation and sublimation
Secondary Autonomous Ego Functions – defense
o Ego can only give up important objects by
against primary ego conflicts
identifying with them or introjecting them
o Freud specifically emphasized the
Defense Mechanisms
importance of superego formation in the
- each phase of libidinal development has drive
construction of character
components that evoke characteristic ego
defenses - Contemporary psychoanalysts regard character
as a person’s habitual or typical pattern of
- Defenses hierarchically grouped by maturity:
adaptation to internal drive forces and to
o Narcissistic defenses- most primitive; in
external environmental forces
children & the psychotic
o Immature defenses -
- Character - influenced by constitutional
temperament
adolescents/nonpsychotic patients
o interaction of drive forces with early ego
o Neurotic defenses - obsessive-compulsive,
defenses arid with environmental influences
hysterical patients, adults under stress
o various identifications with and
internalizations of other persons throughout
THEORY OF ANXIETY
life
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- exaggerated development of certain character TREATMENT AND TECHNIQUE


traits at the expense of others → may lead to - Free association - cornerstone of psychoanalytic
personality disorders or produce a vulnerability technique
or predisposition to psychosis o Patients say whatever comes to mind
o Induces necessary regression and dependency
CLASSIC PSYCHOANALYTIC THEORY OF NEUROSES connected with establishing and working thru the
- Classic view of genesis of neuroses: regards transference neurosis
conflict as essential o All the original wishes, drives & defenses
- Conflict: may arise between instinctual drives associated with the infantile neurosis ore
and external reality or between internal agencies transferred to the person of the analyst
- Conflicts not worked out through realistic o Transference that develops toward the analyst
solutions = drives or wishes that seek discharge may also serve as resistance to the process of
thru repression or other defense mechanism free association
- Deprivation during the first few months of life o Resistance
(absent or impaired caretakers) → may adversely  As discovered by Freud, is not simply the
affect ego development → may result in failure to stoppage of a patient’s associations but also
make appropriate identifications important revelation of the patient’s internal
- Lack of capacity for constructive expression of object relations as they were externalized
drives (especially aggression) may lead some and manifested in the transference
children to turn their aggression on themselves relationship with the analyst
and become overtly self-destructive o Countrtransference may be a source of useful
- Parents who are inconsistent, excessively harsh information about the patient
or overtly indulgent → may influence children to  The analyst’s feelings in response to provide
develop disordered superego functioning some indications of the patient’s own internal
o Severe conflict can’t be managed thru object relations
symptom formation → may lead to extreme o By understanding the intense feelings that occur
restrictions in ego functioning and in the analytic relationship, the analyst can help
fundamentally impair the capacity to learn the patient broaden understanding of past and
and develop new skills current outside the analysis
- Traumatic events that seem to threaten survival
may break through defenses when the ego has
been weakened
o More libidinal energy is then required to ERIK HOMBURGER ERIKSON
master the excitation that results - Born on June 15, 1902 in Karisruhe, Germany,
o Libido thus mobilized is withdrawn from the died in 1994
supply that is normally applied to external - Grew up in the home of his Danish Jew mother
objects and German Jewish stepfather; biological father
o This withdrawal diminishes the strength of and mother separated before he was born
the ego and produce a sense of inadequacy - Immigrated to the US in 1933
- Different of type of childhood neuroses - Worked at Austen Riggs Center in Stockbride,
o Neurotic reactions in the adult are Massachusetts, and conducted research at
associated frequently with neurotic Harvard, Yale and University of California at
reactions in childhood; Berkeley
o the connection is sometimes continuous but - Became interested in the influence of culture on
more often separated by a latent period of child development
non-neurosis; - In 1950, published book - Childhood and Society
o infantile sexuality, both fantasized and real, o Presented psychosocial theory of development
occupies a memorable place in the early that describes crucial steps in persons’
history of the patient relationship with the social world, based on the
interplay of biology and society
Certain differences worth taking note in Table 6.1-3 - Drew much on Freudian psychology
- Phobic reactions tend to start at about 4 or 5 - He concluded that human personality is
years of age determined not only by childhood experiences
- Obsessional reactions between 6 and & but also those of adulthood
- Conversion reactions at 8
- Amount of background disturbance is greatest in EPIGENETIC PRINCIPLE
the conversion reaction & mixed neurosis, only - Based on the concept of epigenesis (term
slight in phobic & obsessional reactions borrowed from biology)
- Course of phobic reaction seems little influenced - Holds that development occurs in sequential,
by severe traumatic factors clearly defined stages and that stage must be
- Traumatic factors (i.e. sexual seductions) play satisfactorily resolved for development to
important role in the three other subgroups proceed smoothly
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- If successful resolution of particular stage does - Child’s increasing mastery of locomotor and
not occur, all subsequent stages reflect the language skills expands its participation in the
failure in the form of physical, cognitive, social or outside world and stimulates omnipotent
emotional maladjustment fantasies of wider exploration and conquest
- Mode of participation: active and intrusive
Relation to Freudian Theory - Social modality: being on the make
- Erikson accepted Freud’s concept of instinctual - Intrusiveness is manifested in the child’s fervent
development and infantile sexuality curiosity and genital preoccupations,
- Described a corresponding zone with a specific competitiveness and physical aggression
pattern or mode of behavior - Oedipus complex - child competes with the
- Emphasized that the development of the ego is same-sex parent for the fantasized possession of
more than the result of intrapsychic wants or the other parent
inner psychic energies - The stage highlights the child’s expanding
initiative and forms the basis for the subsequent
Eight Stages of the Life Cycle development of realistic ambition and the virtue
of purpose
STAGE 1: Trust versus Mistrust (Birth - 18 Mo) - If not resolved, the person may ultimately
- Infant “lives thru and loves with” its mouth develop a conversion disorder, inhibition or
- Mouth forms basis of its first mode or pattern of phobia
behavior
- The baby is learning a cultural modality that STAGE 4: Industry versus Inferiority (about 5 years to
Erikson termed to get, that is, to receive what is about 13 years)
offered and elicit what is desired • Child discovers the pleasures of production; he
- With development of infant’s teeth - second oral or she develops industry for learning new skills
stage and takes pride in the things made
o Active - incorporative mode • Child receives systematic instruction and learns
o Infant no longer passive to stimuli: it reaches the fundamentals of technology as they pertain
out for sensation and grasps at its surrounding to the use of basic utensils and tools
o Social modality shifts to that of taking and • A child unprepared for this stage may develop a
holding on to things sense of inferiority and inadequacy
- Infant’s development of basic trust in the world • Society becomes crucially important in the
stems from its earliest experiences with its child’s ability to overcome that sense of
mother or primary caretaker inferiority and to achieve competence

STAGE 2: Autonomy versus Shame and Doubt (about 18 STAGE 5: Identity versus Role Confusion (13 yrs-21 yrs)
Mo to about 3 years) • Formation of cliques and an identity crisis occur
- Toddler practices the social modalities of holding at the end of adolescence
on and letting go and experiences the first o Erikson calls this normative because it is
stirrings of virtue that Erikson termed will a normal event
- Depends on the amount and type of control • Failure to negotiate this stage leaves the
exercised by adults over child adolescent without a solid identity; they suffer
o Control exerted too rigidly or too early defeats from identity diffusion or role confusion,
the toddler’s attempts to develop its own characterized by not having a sense of self and
internal controls and regression or false by confusion about their place in the world
progression results • They defend against role diffusion by joining
o Parental control that fails to protect toddler cliques or cults or by identifying with folk heroes
from consequences of his own lack of self- • Falling in love – process in which adolescent may
control or judgment can be equally disastrous clarify a sense of identity by projecting a diffused
- In “Identify: Youth and Crisis”, Erikson asserted: self-image onto the partner and seeing it
“this stage, therefore becomes decisive for the gradually assume a more distinctive shape and
ratio between loving good will and hateful self- an overidentification with idealized figures are
insistence between cooperation and willfulness means by which adolescent seeks self-definition
and between self-expression and compulsive self- • Delinquency, gender-related identity disorders,
restraint or meek compliance.” and borderline psychotic episodes can result if
o Where ratio is favorable, the child will youth is unable to formulate a sense of identity
develop an appropriate sense of autonomy and belonging
and capacity to “have and to hold”
o Where unfavorable, doubt and shame will STAGE 6: Intimacy versus Isolation (21 yrs-40 yrs)
undermine free will • Freud: love – generosity of intimacy as well as
genital love
STAGE 3: Initiative versus Guilt (about 3 years to about 5 • Erickson: love and work – general work
years)
productiveness
• Intimacy – closely tied to fidelity in young adults
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o Ability to make and honor commitments • Lack of trust later in life may be manifested by
to concrete affiliations and partnerships dysthymic disorder, depressive disorder, or
even with sacrifice and compromise sense of hopelessness
• Person who cannot tolerate the fear of ego is apt • Persons who develop and rely on these defense
to become deeply isolated and self absorbed of projection experienced a sense of social
• Distantiation – readiness to repudiate, isolate, mistrust in the first years of life; likely to develop
and destroy those forces and persons whose paranoid or delusional disorders
essence seems dangerous to one’s own • Basic mistrust – major contribution to the
o Pathological outcome of conflicts development of schizoid personality disorder and
surrounding intimacy schizophrenia
o Forms the basis from various forms of • Substance dependent personalities have strong
prejudice, persecution, and oral-dependency needs and use chemical
psychopathology substances to satisfy themselves
• Critics say that Erickson’s emphasis on • If not nurtured properly, infants may feel empty,
separation and occupationally based identity starved not just for food but for sensual and
formation fails to take into account the visual stimulation as well
importance for women of continued attachment Autonomy
and the formation of an identity based on • Stage where children develop into autonomous
relationships
beings (called terrible two’s)  refers to
toddlers’ willfulness at this period of
STAGE 7: Generativity vs. Stagnation (40 – 60 yrs)
development
• Generativity – primarily the concern for • If shame and doubt dominate, compulsive
establishing and guiding the next generation doubling may occur
o Encompasses productivity and creativity • Over abundance of doubt = inflexibility of the
• Care – virtue that coalesce at this stage obsessive personality
• Through generative behavior, the individual can • Too rigorous toilet training – produce overly
pass on knowledge and skills while obtaining compulsive personality (stingy, meticulous,
satisfaction selfish)
• Failure of generativity can lead to profound o Such persons are called 3P’s (anal
stagnation marked by escapisms (alcohol, drugs, personalities): parsimonious, punctual,
and sexual and other infidelities); premature and perfectionist)
invalidism and midlife crisis may occur • Too much shaming – children feel evil or dirty,
• Failure to develop at midlife can lead to sick, may pave way for delinquent behavior
withered, destructive organizations that spread • Paranoid personalities – when coupled with
the effects of failed generativity throughout mistrust, the seeds are planted for persecutory
society delusions
• Impulsive disorder – person’s refusing to be
STAGE 8: Integrity vs. Despair (60 yrs – death) inhibited or controlled
• Integrity - acceptance of one’s own and only Initiative
life cycle and of the persons who have become • Conflict over initiative expressed in hysterical
significant to it as something that had to be and denial which causes repression of the wish
that, by necessity, permitted of no substitutions • Hysteria – pathological regression in this area;
• the individual possession of the virtue of wisdom psychosomatic is more common now
and sense of integrity has room to tolerate the • Excessive guilt – lead to anxiety disorders and
proximity of death and to achieve a detached yet
phobias
active concern with life
• when the attempt to attain integrity has failed, • Punishment – sexual inhibitions
the individual may become deeply disgusted • Conversion disorder or specific phobia may
with the external world and contemptuous of result when oedipal conflict is not resolved
persons as well as institutions • Brutal developing superego – repression of
o this disgust may lead to fear of death wishes and begin to deny them
and despair that time is short • Fear of not living up to what is expected of them
PSYCHOPATHOLOGY lead to psychosomatic disease
Industry
Basic Trust • Sense of being able to make things and make
• Impairment of basic trust leads to basic mistrust them well and even perfectly
• Infants: social trust is characterized by ease of • Sense of inferiority develops when children’s
feeding, depth of sleep, smiling, and general efforts are thwarted
physiological homeostasis • Adults sense of inferiority – severe work
o Prolonged separation can lead to inhibitions, feelings of inadequacy
hospitalism or analectic depression Identity
Clincal Pathology – Theories of Personality and Psychopathology Page 9 of 12

• Many disorders can be traced to identity Dreams and Free Association


confusion • Patient’s association to the dream best leads to
• Danger is role diffusion – inability to settle on an understanding its meaning
occupational identity that disturbs young • Interpretation: primary therapeutic agent
persons • Free-floating attention: method that enabled to
• Disorders at this stage: conduct disorder, discovery to occur
disruptive behavior disorder, gender identity
disorder, schizoprebiform disorder, and other Goals (4 Dimensions):
psychotic disorders FIRST: the patient’s desire to be cured and the analyst’s
• To leave home and live independently is an desire to cure
important task during this period • Help the patient’s ego to be stronger and cure
Intimacy itself
• Successful formation of stable marriage and SECOND: objectivity participation
family depends on the capacity to become • New generalizations must be made and arranged
intimate in new configurations
• Gender identity determines the object of choice THIRD: knowledge-participation
(homo/heterosexual) • Therapist applies selected insights to more
• Making an intimate connection is a major task strictly experimental approaches
• Persons with schizoid disorder remain isolated FOURTH: Tolerance-indigantion
from other because of fear, suspicion, the • Control widens the gap between doctor and
inability to take risks or lack of capacity to love patient
Generativity • Goal of therapy is to recognize how patient’s
• 40-65 years old passed through the various stages of the life
• Middle aged higher rate of depression rather cycle and how the various crises in each stage
than younger adults (due to midlife crisis) have or have not been mastered
• Increased use of alcohol and psychoactive
substances SCHOOLS DERIVED FROM PSYCHOANALYSIS AND
Integrity PSYCHOLOGY
• Anxiety disorders often develop in older persons • Designed to understanding prediction and
o Related to person’s looking back on their eventual therapeutic control of human behavior
lives with a sense of panic Karl Abraham (1877-1925)
• Decline in physical functions contribute to • Freud’s earliest disciples
psychosomatic illness, hypochondriacs, and • Explication of depression from a psychoanalytic
depression perspective
• Suicide rate highest over the age of 65 • Elaborated Freud’s stages of psychosexual
• Acceptance of life or feel despair and development
hopelessness (result to depressive disorder) • Oral stage: biting and sucking phase
• Anal stage: destructive-expulsive phase (anal
Treatment sadistic), mastering retentive (anal-erotic)
• Establishing a state of trust between doctor and • Phallic phase: early phase of partial genital love
patient (true phallic phase)
• Basic mistrust – reestablish trust o Later mature genital phase
• Therapist must have a sense of trustworthiness • Linked psychosexual stages to specific
Techniques syndromes
• Therapist actively convey to the patient the • Postulated that obsessional neurosis resulted
belief that they are understood from fixation at the anal-sadistic phase and
o Done through emphatic listening, verbal depression from fixation at oral stage
assurances Alfred Adler (1870-1937)
• Identification of problem first before treatment • Freud’s prized pupil
• Erickson turned to play as treatment modality • Put importance to aggression rather than sexual
o Play is a function of ego and gives development
children a chance synchronize a social • Masculine protest: tendency to move from
and bodily processes with self passive, feminine role to masculine, active role
o Children create models in an effort to • Theories are collectively known as individual
gain control of reality; adults use play to psychology
correct the past and redeem their • Inferiority complex: inadequacy and weakness
failures that is universal and inborn
• Mutuality is also vital to cure • Organ inferiority: compromised self-esteem in a
• Abandon hypnosis child due to physical defect
• Observer must teach the one observed to be • Recognized order of children’s birth to their
self-observant families of origin
Clincal Pathology – Theories of Personality and Psychopathology Page 10 of 12

o First-born: reacts with anger to birth of


siblings; struggles against giving up Wilfred Bion (1897-1979)
powerful position • expanded Melanie Klein’s concept of projective
o 2nd child: compete with 1st born identification to include an interpersonal process
o Primary therapeutic approach: in which a therapist feels coerced by a patient
encouragement into playing a particular role in the patient’s
Franz Alexander (1891-1964) internal world.
• Specificity association – association between
specific personality traits and certain John Bowlby (1907-1990)
psychosomatic ailments • founder of attachment theory
• An analyst must adopt a particular mode of
relatedness with patient to conteract noxious Raymond Cattell (1905-1998)
childhood experiences from the patient’s parents • introduced the multivariate analysis and factor
• Trusting, supportive analyst-parent of patient analysis
relationship enable patient to master childhood
trauma Ronald Fairbairn (1889-1964)
• suggested that infants are not primarily
Gordon Allport (1896 -1967) motivated by the drives of libido and aggression
• founder of humanistic school of psychology but by an object-seeking instinct.
(each person has an inherent potential for
autonomous function and growth) Sandor Ferenczi (1873-1933)
• person’s sense of self-guarantee person • he understood the symptoms of his patients as
existence related to sexual and physical abuse in childhood
• Propriem: strivings of maintainance of self- and proposed that analysts need to love their
identity and self-esteem patients in a way that compensates them for the
love they did not receive as children.
• traits: units of personality structure
• personal dispositions: individual traits that Erich Fromm (1900-1980)
represent the essence of individual’s unique • 5 character types that are common to, and are
character determined by Western Culture:
• maturity: capacity to relate to others with a. receptive personality – passive
warmth and intimacy b. exploitative personality – manipulative
c. marketing personality – opportunistic and
• mature persons have security, humor, insight,
changeable
enthusiasm, and zest
d. hoarding personality – saves and stores
• therapy is geared to helping patients realize e. productive personality – mature and enjoys
theses characteristics love and work

Anna Freud (1895-1982)


Michael Balint (1896-1970) • elaborated an individual defense mechanisms,
• urge for primary love object underlies virtually including reaction formation, regression,
all psychological phenomena undoing, introjections, identification, projection,
turning against the self, reversal, and
• basic fault is the feeling of patient that sublimation
something is missing
• deficit in internal structures result in maternal Merton Gill (1914-1994)
failures • elaboration of ego psychology
• did not abandon drive theory
• certain preverbal phenomena are reexperienced Kurt Goldstein (1878-1965)
in analysis and that the relationship itself is • was influenced by existentialism and Gestalt
decisive in dealing with this realm of early psychology
experience
Karen Horney (1885-1952)
Eric Berne (1910-1970) • a person’s current personality attributes result
• developed his own school known as transaction from the interaction between the person and the
analysis environment and are not solely based on
• transaction is a stimulus presented by one infantile libidinal strivings carried over from
person that evokes a corresponding response in childhood.
another
• all persons have 3 ego states that exist within Edith Jacobson (1897-1978)
them: • structural model and an emphasis on object
1. Child relations are not fundamentally incompatible
2. Adult
3. Parent Carl Gustva Jung (1875-1961)
Clincal Pathology – Theories of Personality and Psychopathology Page 11 of 12

• formed a psychoanalytic school known as • first to publish a comprehensive history of


analytic psychology psychology and made major contributions to
• expanded on Freud’s concept of unconscious social, general, and educational psychology
• two types of personality organizations: • 3 essential stages of personality development:
a. introverts – focus on inner world of thoughts, 1. Undifferentiated wholeness
intuitions, emotions, and sensations 2. Differentiation
b. extroverts – oriented toward the other world, 3. Integration
other persons and material goods • stages are uneven with regression and
progression
Otto Kernberg (1928) • 4 inborn human needs
• clinical work with patients with borderline 1. visceral
personality disorder 2. motor
3. sensory
Melanie Klein (1882-1960) 4. emergency-related
• theory of internal object relations that was • canalization: brings changes by establishing a
intimately linked to drives connection between a need and a specific way of
satisfying the need
Heinz Kohut (1913-1981) • interested in parapsychology
• best known for writings in narcisism and the • states such as sleep, drowsiness, certain drug
development of self psychology and toxic conditions, hypnosis and delirium tend
to be favorable to paranormal experiences
Jacques Lacan (1901-1981) • impediments to paranormal awareness –
• integrated the intrapsychic concepts of Freud intrapsychic barriers - conditions in the general
with concepts related to logistics and semiostics social environment and heavy investment in
ordinary sensory experiences
Kurt Lewin (1890-1947)
• adapted the field approach of physics to a Henry Murray (1893-1988)
concept called field theory • founder of Boston Paychoanalytic Insitute
• Personology: describe the study of human
Abraham Maslow (1908-1970) behavior
• believed in self-actualization theory: the need to • focused on motivation – aroused by internal or
understand the totality of a person external stimulation
o Once aroused produces continued
Karl A. Menninger (1893-1990) activity until the need is reduced or
• pioneered the concept of a psychiatric hospital satisfied
based on psychoanalytic principles and founded • Thematic Apperception Test (TAT): objective
the Menninger Clinic in Topeka, Kansas technique used to reveal both unconscious and
• wrote The Human Mind, Man Against Himself conscious mental processes and problem areas
• The Vital Balance (his magnum opus) – theory of
psychopathology Frederick S. Perls (1893-1970)
• interest in the criminal justice system (The Crime • applied Gestalt theory to a therapy that
of punishment) emphasizes the current experiences of the
• Theory of Psychoanalytic Technique-examine the patient in the here and now, as contrasted to the
theoretical underpinning of psychoanalysts’ there and them on psychoanalytic schools
intervention • patients learn to recognize their needs to any
given time and the ways that the drive to satisfy
Adolph Meyer (1866-1950) these needs may influence their current behavior
• preferred to examine verifiable and objective • Gestalt: behavior represents more than the sum
aspects of person’s like of its parts
• theory explained disordered behavior as reaction o “whole” includes and goes beyond, the
by genetic, physical, psychological, sum of smaller, independent events;
environmental and social stresses o Deals with essential characteristics of
• introduced the concept of common sense actual experience
psychiatry
• coined the concept of ergasia, the action of total Sandor Frado (1890-1972)
organism • founded the Columbia Psychoanalytic Institute in
• goal in therapy was to aid patients’ adjustment New York
by helping them modify unhealthy adaptations • theories of adaptational dynamics: organism is a
• too autobiological life chart by the patient biological system
• cultural factors often cause excessive hedonic
Gardner Murphy (1895-1979) control and disordered behavior by interfering
with the organism’s ability for self-regulation
Clincal Pathology – Theories of Personality and Psychopathology Page 12 of 12

Otto Frank (1884-1939) • personality: set of behavior as a response to


• protégé of Freud stimuli
• The Trauma of Birth
• anxiety is correlated with separation from the Harry Stack Sullivan (1892-1949)
mother • concept of observable data
• sleep and dreams: symbolizes return to the • 3 modes of experience
womb 1. prototaxic mode: undifferentiated thought
• personality: impulses, emotions, will that cannot separate the whole into parts or use
• children impulses: seek immediate discharge symbols
and gratification 2. parataxic mode: events are causally elated
because of temporal or serial connections
• if will carried too far – pathological traits
3. syntaxic mode: logical, rational, and most
(stubbornness, disobedience, inhibitions)
mature type of cognitive functioning
Wilhelm Reich (1897-1957)
Donald Winnicott (1897-1971)
• character formation and character types
• multiple self-organization
• character armor: personality’s defenses that
• true self: develop a concept of responsive
serve as resistance to self-understanding and
holding environment provided by a good-enough
change
mother
• 4 major character types:
1. Hysterical character: sexually seductive, • transitional object: provides security in the
anxious and fixated at the phallic phase libido absence of the mother (pacifier, blanket, teddy
development bear)
2. Compulsive: controlled, distrustful, indecisive
and fixated at the anal phase ------------------------------- end of transcription
3. Narcissistic: fixated at the phallic phase of ----------------------------
development
4. Masochistic: long-suffering, complaining, self- The earlier transcription was copied and retyped
deprecatory with an excessive demand for love from the transcription of last’s semester’s
• Will Therapy: help patients accept their psychology class, which is from the book.
separateness *****tables from the book are attached at the end
part of this VERY LONG TRANSCRIPTION. (“,)
Carl Rogers (1920-1987)
The following transcription is from the powerpoint
• Person-centered Theory: self-actualization and presentation of Dra. Capitan.
self-direction
• persons are born with the capacity to direct
themselves in the healthiest way, toward a level
8888888888888888888888888888888888888
of completeness – (self-actualization) 88888
• personality as a dynamic phenomenon involving
ever-changing communication, relationships, and
self-concepts

Jean-Paul Sartre (1905-1980)


• German prisoner of war
• influenced by Martin Heidegger
• developed existential psychoanalysis
• reflective self: it was a key concept
• experience of “being” in humans is unique in the
natural world
• allows human to create his own essence

B.F. Skinner (1904-1990)


• Operant learning: groundwork formany current
methods of behavior modification, programmed
instruction and general education
• Behaviorism: concerned only with the
observable, measurable behavior that can be
operationalized
• Self, ideas, ego: unnecessary for understanding
behavior