Psychiatry 1 (Dra.
Capitan)
Sigmund Freud: Founder of Classic
Psychoanalysis
Sigmund Freud
- created the discipline of psychoanalysis in the 19th
century
- role of meaning was central to his vision of
psychoanalysis
ex. Auditory hallucinations
◦ biological mechanisms may produce the symptom
but the content of that symptom and its meaning to
the patient relate to specific psychological
characteristics unique to that patient
- psychoanalysis is recognzed today as having 3
crucial aspects:
a. therapeuhc technique
b. body of scientific and theoretical knowledge
c. method of investigation
- some of his basic tenets have remained central to
psychiatric and psychotherapeutic practice:
a. notion of psychic determination
b. unconscious mental activity
- can be seen in dreams and nonverbal behaviors
(parapraxes: slips of the tongue that often reveal
unconscious intent that is outside the indivrdual’s
awareness)
c. role of childhood experience in shaping the adult
personality
- principles of technique are also at the core of
psychoanalysis as a treatment:
a. resistance
- he observed that patients often resists the
physician’s effort to heal
- some patients either become silent or were unable to
follow his suggestion when he asked them to say
whatever come to mind (free association)
b. transference
- patient’s displacement unto the analyst of early
wishes and feelings towards persons from the past
. patients may experience the psychiatrist as a
parental figure from the past and defy the perceived
parental control
- contemporary view: acknowledge that the analyst
or physician’s real characteristics always influence
transference
c. countertransference
- clinician’s feelings towards the patient, based on a
mixture of the real characteristics of the patient and
qualities associated with the figures from the
clinician’s past
Life of Freud
- born of May 6, 1856 in Frelburg, a small town in
Moravia which is now a part of Czech Republic
- specialized in neurology after medical school
- studied with Jean-Martin Charcot
- influenced by Ambroise August Liebault and Hippolyte-
JoY and IsaY
Theories of Personality and
Psychopathology
13 December 2007
Marie Bemheim who both taught him hypnosis
- began clinical work with hysterical patients in Vienna;
where he developed psychoanalysis ( 1 887- 1897)
- died in London (I939)
Beginnings of Psychoanalysis
- in conjunction with his colleague, Joseph Breuer, Freud
studied a series of female patients suffering from
hysterical symptoms that defied neurological
explanation
- he turned to the cathartic method which he used in
conjunction with hypnosis → abreaction: attempt by
Freud to remove symptoms through a process of
recovering and verbalizing suppressed feelings with
which the symptoms were associate
- through his experiments with abreaction and hypnosis,
he learned that patients were unable or unwilling to
recount memories that subsequently proved very
significant
◦reluctance = resistance
◦Resistance was caused by largely unconscious, active
forces in the patient’s mind
◦repression: active process of excluding distressing
material from conscious awareness; essential to
symptoms formation
- he switched to free association or the inviting of his
patients to say whatever came to mind without
censoring their thoughts
- childhood sexual seduction played a role in causing the
neuroses
- the idea that sexual seduction by parental figures was
a fantasy began to discipline his theory that actual
sexual seduction was a pivotal pathogenic factor in
neuroses
The Interpretation of Dreams
- Freud’s most monumental work
- He was struck by the intimate connection
between dream content and unconscious
memories or fantasies that were long
suppressed
- Dream is the distinguished fulfillment of an
unconscIous childhood wish that is not readily
accessible to conscious awareness in waking life
- Freud laid the foundations for ego psychology
o he suggested that unconscious childhood
wishes can be transformed into disguised
conscious manifestations only if a censor
exists in the mind
o censor
 functions to preserve sleep in the
service of the ego
 it disguises disturbing thoughts and
feelings making sure that the
dreamer’s sleep is not disturbed
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 Clincal Pathology – Theories of Personality and Psychopathology
 repressed wishes and impulses must
attach themselves to innocent or
neutral images to pass the scrutiny of
the dream censor
o unconscious thoughts and wishes that are
repressed includes:
 nocturnal sensory stimuli
 day residue – thoughts and ideas that
are connected with the activities and
preoccupations of the dreamer’s
current waking life
 repressed unacceptable impulses
o 2 layer of dream content:
 manifest – refers to what is recalled by
the dreamer
 latent – involves the unconscious
thoughts and wishes that threaten to
awaken the dreamer
o Dream work : unconscious mental
operations by which latent dream content is
transformed into manifest dream
Condensation
- several unconscious impulses, wishes, or
feelings can be combined and attached to one
manifest dream image
ex. A composite character may appear in the dream with
a name like one person in the dreamer’s life
Displacement
- energy or intensity associated with one object is
diverted to a substitute object that is
associatively related but more acceptable to the
dreamer’s ego
- dream censor displaces affective energy in such
a way that the dreamer’s sleep can continue
undisturbed
- projection: special instance of displacement
which involves the attribution of the dreamer’s
own unacceptable impulses or wishes to another
character in the dream
Symbolic Representation
- dreamer would often represent highly charged
ideas or objects by using innocent images that
were in some way connected with the idea or
object being represented → an abstract concept
or a complex set of feelings toward a person
could be symbolized by a simple, concrete, or
sensory image
- he noted that symbols have unconscious
meanings that can be discerned through the
patient’s associations to symbol
- he also believed that certain symbols are
universal
Secondary Revision
- Primary Process – type of thinking which is
characterized by mechanisms of condensation,
displacement, and symbolic process → primitive
mode of cognitive activity that Is characterized
by illogical, bizarre, and absurd images that
seem incoherent
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- according to Freud: a more mature and
reasonable aspect of the go works during
dreams to organize primitive aspects of dreams
into a more coherent form
- dreams become somewhat more rational
- reated to secondary process
→ mature activity characteristic of waking life
Affects in Dreams
- secondary emotions may not appear in the
dream at all
- they may be experienced in altered form
- feelings may also appear as their opposite
Anxiety Dreams
- Freud’s understanding of dreams stresses the
importance of discharging drives or wishes
through the hallucinatory contents of the dream
- Mechanisms he believed to be facilitating of
latent impulses, rather than protecting dreamers
from anxiety and pain
o Condensation
o Displacement
o symbolic representation
o projection
o secondary vision
- reflects a failure in the protective function of the
dream work mechanisms
→ repressed succeed in working their way into
the manifest in a more or less recognizable
pattern
Punishment Dreams
- seem to represent an exception to Freud’s wish
fulfillment fheory of dreams
- reflects a compromise between the repressed
wish and the repressing agency or conscience
- ego anticipates condemnation on the part of
dreamer’s conscience if the latent unacceptable
impulses are allowed direct expression in the
manifest dream content
→ wish for punishment on the part of the
patient’s conscience is satisfied by giving
expression to punishment fantasies
TOPOGRAPHICAL MODEL OF THE MIND
(SIGMUND FREUD’S Interpretation of Dreams)
3 REGIONS:
1. the CONSCIOUS
- part of the mind in which perceptions coming from the
outside world or from within the body or mind are
brought into awareness
Consciousness - subjective phenomenon whose
content can be communicated by means of language or
behavior; used a form of neutralized psychic energy
(ATTENTION CATHEXIS)
2. the PRECONSCIOUS
- Comprises mental events, processes, and contents that
can be brought into conscious awareness by the act of
focusing attention
- Interfaces with both unconscious and conscious regions
of the mind
 Clincal Pathology – Theories of Personality and Psychopathology
- Contents of the unconscious become linked with words
(preconscious)
- Maintain the repressive barrier and censor
unacceptable wishes and desires
3. the UNCONSCIOUS
- Dynamic; its mental contents and processes are kept
from conscious awareness through the force of
censorship or repression
- Closely related to instinctual drives; INSTINCTS consist
of sexual and self-peservative and UNCONSCIOUS
contain mental representations and derivatives of the
sexual instinct
- its content is limited to wishes seeking fulfillment which
provide motivation for dream and neurotic symptom
formation (reductionist)
- Characterized by Primary process thinking:
◦Principally aimed at facilitating wish fulfillment and
instinctual discharge
◦Governed by pleasure principle and disregards logical
connections, no concept of time, represents wishes as
fulfillments, permits contradictions to exist
simultaneously and denies existence of negatives
◦Characterized by extreme mobility of drive cathexis;
investment of psychic energy can shift from object to
object w/o opposition
- Memories have been divorced from their connection
with verbal symbols
- Become conscious only by passing the preconscious
Limitations of Topographical Theory (2 main deficiencies
1. Patients’ defense mechanisms that guard
against distressing wishes, feelings or thoughts
were themselves not initially accessible to
consciousness.
2. Freud’s patients frequently demonstrated an
unconscious need for punishment.
These difficulties lead Freud to discard the topographical
theory, but certain concepts derived from the theory
continue to be useful:
- 1o & 2° thought processes
- Fundamental importance of wish fulfillment
- Existence of a dynamic unconscious
- Tendency toward regression under frustrating
conditions
INSTINCT OR DRIVE THEORY
Instinct: refers to a pattern of species-specific behavior,
genetically derived & therefore is more or less
independent of learning
Confusion from the ambiguity inherent in a concept on
the borderland between biological and psychological:
Should the mental representation aspect of the term and
psychological component be integrated or separated?
Drive may have been closer than Instinct to Freud’s
meaning, in contemporary usage, the tow terms are
often used interchangeably
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Freud’s view, instinct has 4 principal characteristics:
1. source: part of the body from w/c the instinct
arises
2. impetus: amount of force or intensity
associated w/ the instinct
3. aim: any action directed toward tension
discharge or satisfaction
4. object: target (often a person) for this action
INSTICTS
Libido: (Freud) that force by w/c the sexual instinct is
represented in the mind; linkage of genital sexuality with
libido was viewed as the end result of a course of dev’t
in w/c libidinal expression took a variety of forms
Ego Instincts
- Freud maintained a dual instinct theory:
subsuming sexual instincts & ego instincts
connected w/ self-preservation
- 1904 (On Narcissism) Freud invested ego
instinct w/ libido by postulating an ego libido &
an object libido, thus he viewed narcissistic
investment as an essentially libidinal instinct &
called the remaining nonsexual components the
Ego instincts
Aggression: originally conceptualized by Freud as a
component of the sexual instincts in the form of sadism;
eventually he categorized it w/ hate as part of the ego
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
Freud was largely in skeletal muscles, and its aim was
destruction.
Life and Death Instincts
- 1920 Freud subsumed the ego instincts under a
broader category of life instincts; juxtaposed w/ death
instincts & referred to as Eros and Thanatos (Beyond
the Pleasure Principle)
- regarded as forces underlying the sexual &
aggressive instincts
Repetition compulsion - a person’s tendency to repeat
past traumatic behavior
Death instinct (Thanatos): dominant force in
biological organisms
Life instinct (Eros): tendency of particles to reunite or
bind to one another (as in sexual repd’n)
PLEASURE AND REALITY PRINCIPLES
1911: 2 Basic Tenets of Mental Functioning
1. Pleasure Principle: Pleasure principle: inborn
tendency of organism to avoid pain & to seek
pleasure through the discharge of tension
2. Reality Principle: learned function closely
related to the maturation of the ego; modifies
the pleasure principle & requires delay or
postponement of immediate gratification
*Both are aspects of ego functioning.
INFANTILE SEXUALITY
 Clincal Pathology – Theories of Personality and Psychopathology
3 major tenets of Psychoanalytic theory (Three
Essays on the Theory of Sexualily)
 Broadened the definition of sexuality to include
forms of pleasure that transcend genital sexuality
 Established a developmental theory of childhood
sexuality that delineated the vicissitudes of erotic
activity from birth through puberty
 Conceptual linkage between neuroses and
perversions
Stages of psychosexual development (See Table 6.1-
1)
1. oral stage - occupies the first 12-18 months of
life, centers on the mouth & lips
2. anal stage - 18-36 months of age, involves
bowel fxn & control
3. phallic stage - 3-5 yrs of life, urination
- Accdg to Freud, penis remains the principal
sexual organ throughout male psychosexual
dev’t while females have 2 principal erotogenic
zones, vagina & clitoris (chief erotogenic focus
during the infantile genital period but erotic
primacy shifted to vagina after puberty)
- He also discovered that in psychoneuroses, only
a limited number of sexual impulses that had
undergone repressicn & were responsible for
creating & maintaining the neurotic symptoms
were normal
- These were the same impulses that were given
overt expression in the perversions; neuroses
were the negative of perversions
OBJECT RELATIONSHIP IN INSTINCT THEORY
Nature & Quality of children’s relationships during
early years of life: affect the choice of a love object in
adult life; love relationship itself; & nature of all other
object relationships
Libidinal phases of psychosexual dev’t: can be
described through child’s relationships with parents &
other significant persons in the env’t
Concept of Narcissism
Narcissism (by Freud) - situations in which libido was
invested in the ego itself rather than in other persons
- presented Freud with vexing problems for his
instinct theory & essentially violated his
distinction between libidinal instincts & ego or
self-preservative instincts
Narcissistic neuroses - collection of disorders in which
a person’s libido is withdrawn from objects and turned
inward
- accounted for the loss of reality testing in
psychotic patients; grandiosity & omnipotence in
such patients reflected excessive libidinal
investment in the ego
- also observed in:
o States of physical illness &
hypochondriasis (libidinal investment was
frequently withdrawn from external objects
and from outside activities and interests
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o normal sleep (libido withdrawn &
reinvested in a sleeper’s own body)
- other examples:
o homosexuality- instance of a narcissistic
form of object choice; persons fall in love
with idealized version of themselves
projected into another person
o beliefs/myths of primitive people -
ability to influence external events through
magical omnipotence of thought processes
o children - belief in their own omnipotence
(which is part of normal dev’t)
Freud’s postulates:
• Primary Narcissism (ego libido)
o at birth; infantile state of self-absorption
o libido stored in the ego
o neonate is completely narcissistic; entire libidinal
investment in physiological needs & their
satisfaction
• Object Attachment (object libido)
o libidinal investment on the object
• Secondary narcissism
o if child suffers rebuffs or trauma from the
caretaking figure, object libido maybe withdrawn
& reinvested in the ego
Narcissism as description of different dimensions of
human experiences:
- as a perversion - person used their own bodies
or body parts as objects of sexual arousal
- a developmental phase - e.g. state of primary
narcissism
- a particular object choice - object resembles the
subject’s idealized or fantasied self-image
(“according to the narcissistic type”) - object
resembles a caretaker from early in life
(anaclitic)
- as self-esteem
EGO PSYCHOLOGY
- began with the publication of The Ego and the Id
which represented in Freud’s thinking from
topographical model of the tripartite structural
model of ego, id, and superego
Structural Theory of the Mind
ID
- Reservoir of unorganized instinctual drives
- Operate under the primary process; lacks capacity to
delay/modify instinctual drives. Not synonymous with
the unconscious
EGO
- Executive organ of the psyche
- Controls motility, perception, contact w/ reality, delay &
modulation of drive expression
- Spans all 3 topographical dimensions:
conscious logical/abstract thinking,
preconscious verbal expression
unconscious →defense mechanism
SUPEREGO
- establishes and maintains an individual’s moral
conscience(bases on ideals and values)
 Clincal Pathology – Theories of Personality and Psychopathology
- Heir to the Oedipus complex
- Scrutinize behaviour, thoughts, feelings; compare with
expected standards of behavior; approve/disapprove (all
3 occur unconsciously)
Ego ideal – component of superego; prescribes what to
do accdg to internalized standard/value vs. superego w/c
prescribes (dictates what not to do)
Functions of the Ego
Control & Regulation of Instinctual Drives –
capacity to delay/ postpone drive discharge (pleasure to
reality principle)
- essential in ego’s medication between id and
outside world
Judgement – ability to anticipate consequence of
actions
- together with secondary process thinking
function
Relation to Reality – mediate between external reality
& internal world; 3 aspects:
- sense of reality – distinguish what is in/outside
- reality testing – distinguish internal fantasy from
externsl reality
- adaption to reality – ability to use resources to
develop effective responses to changing
circumstances on the basis of previous
experience with reality
Object Relationships – satisfying relatedness depends
on ability to integrate positive & negative aspects of
others & self and to maintain an internal sense of others
even in their absence
Synthetic Function of the Ego – ego’s capacity to
integrate diverse elements into an overall unity
- involves organizing , coordinating, and
generating or simplifying large amounts of data
Primary Autonomous Ego Functions – rudimentary
apparatuses present at birth that develop independently
of intrapsychic conflict between drives and defenses
- includes perception, lerning, intelligence,
intuition, language, thinking, comprehension,
motility
Secondary Autonomous Ego Functions – defense
against primary ego conflicts
Defense Mechanisms
- each phase of libidinal development has drive
components that evoke characteristic ego
defenses
- Defenses hierarchically grouped by maturity:
o Narcissistic defenses- most primitive; in
children & the psychotic
o Immature defenses -
adolescents/nonpsychotic patients
o Neurotic defenses - obsessive-compulsive,
hysterical patients, adults under stress
THEORY OF ANXIETY
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ANXIETY (by Freud) – “dammed up libido”
◦Physiological increase in sexual tension to a
coreesponding increase in libido
◦Actual neuroses are caused by this build-up
SIGNAL ANXIETY – second type of anxiety and new
theory developed Freud
◦in this model, anxiety operates at an unconscious
and serves to mobilize the ego’s resources to avert
danger
◦External or internal sources of danger may produce a
signal that leads the ego to marshal specific defense
mechanism to guard against, or reduce, instinctual
excitation
FREUD’s later theory of ANXIETY
◦neurotic symptoms as the ego’s partial failure to
cope with distressing stimuli
◦drive derivatives associated with danger not
adequately contained by defense mechanism used by
ego
 i.e. phobias (fear of external threat) – externalization
of internal dangers
- danger situations can be linked to developmental
stages & create developmental hierarchy of anxiety
Developmental Hierarchy of Anxiety: Danger
Situations
1. fear of disintegration/annihilation – associated
with concerns about fusion with an external
object
2. separation anxiety- fear of the loss of an object
3. oedipal stage – losing love of most important
figure in their lives (girls); bodily injury/castration
(boys)
4. superego anxiety – fear that internalized
parental representations will cease to love, or
will angrily punish the child
CHARACTER
- Neurotic symptoms - develop as a result of the
failure of repression
- Character traits - owe their existence to the
success of repression to the defense system that
achieves its aim through a persistent pattern of
reaction formation and sublimation
o Ego can only give up important objects by
identifying with them or introjecting them
o Freud specifically emphasized the
importance of superego formation in the
construction of character
- Contemporary psychoanalysts regard character
as a person’s habitual or typical pattern of
adaptation to internal drive forces and to
external environmental forces
- Character - influenced by constitutional
temperament
o interaction of drive forces with early ego
defenses arid with environmental influences
o various identifications with and
internalizations of other persons throughout
life
 Clincal Pathology – Theories of Personality and Psychopathology
- exaggerated development of certain character
traits at the expense of others → may lead to
personality disorders or produce a vulnerability
or predisposition to psychosis
CLASSIC PSYCHOANALYTIC THEORY OF NEUROSES
- Classic view of genesis of neuroses: regards
conflict as essential
- Conflict: may arise between instinctual drives
and external reality or between internal agencies
- Conflicts not worked out through realistic
solutions = drives or wishes that seek discharge
thru repression or other defense mechanism
- Deprivation during the first few months of life
(absent or impaired caretakers) → may adversely
affect ego development → may result in failure to
make appropriate identifications
- Lack of capacity for constructive expression of
drives (especially aggression) may lead some
children to turn their aggression on themselves
and become overtly self-destructive
- Parents who are inconsistent, excessively harsh
or overtly indulgent → may influence children to
develop disordered superego functioning
o Severe conflict can’t be managed thru
symptom formation → may lead to extreme
restrictions in ego functioning and
fundamentally impair the capacity to learn
and develop new skills
- 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
master the excitation that results
o Libido thus mobilized is withdrawn from the
supply that is normally applied to external
objects
o This withdrawal diminishes the strength of
the ego and produce a sense of inadequacy
- Different of type of childhood neuroses
o Neurotic reactions in the adult are
associated frequently with neurotic
reactions in childhood;
o the connection is sometimes continuous but
more often separated by a latent period of
non-neurosis;
o infantile sexuality, both fantasized and real,
occupies a memorable place in the early
history of the patient
Certain differences worth taking note in Table 6.1-3
- Phobic reactions tend to start at about 4 or 5
years of age
- Obsessional reactions between 6 and &
- Conversion reactions at 8
- Amount of background disturbance is greatest in
the conversion reaction & mixed neurosis, only
slight in phobic & obsessional reactions
- Course of phobic reaction seems little influenced
by severe traumatic factors
- Traumatic factors (i.e. sexual seductions) play
important role in the three other subgroups
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TREATMENT AND TECHNIQUE
- Free association - cornerstone of psychoanalytic
technique
o Patients say whatever comes to mind
o Induces necessary regression and dependency
connected with establishing and working thru the
transference neurosis
o All the original wishes, drives & defenses
associated with the infantile neurosis ore
transferred to the person of the analyst
o Transference that develops toward the analyst
may also serve as resistance to the process of
free association
o Resistance
 As discovered by Freud, is not simply the
stoppage of a patient’s associations but also
important revelation of the patient’s internal
object relations as they were externalized
and manifested in the transference
relationship with the analyst
o Countrtransference may be a source of useful
information about the patient
 The analyst’s feelings in response to provide
some indications of the patient’s own internal
object relations
o By understanding the intense feelings that occur
in the analytic relationship, the analyst can help
the patient broaden understanding of past and
current outside the analysis
ERIK HOMBURGER ERIKSON
- Born on June 15, 1902 in Karisruhe, Germany,
died in 1994
- Grew up in the home of his Danish Jew mother
and German Jewish stepfather; biological father
and mother separated before he was born
- Immigrated to the US in 1933
- Worked at Austen Riggs Center in Stockbride,
Massachusetts, and conducted research at
Harvard, Yale and University of California at
Berkeley
- Became interested in the influence of culture on
child development
- In 1950, published book - Childhood and Society
o Presented psychosocial theory of development
that describes crucial steps in persons’
relationship with the social world, based on the
interplay of biology and society
- Drew much on Freudian psychology
- He concluded that human personality is
determined not only by childhood experiences
but also those of adulthood
EPIGENETIC PRINCIPLE
- Based on the concept of epigenesis (term
borrowed from biology)
- Holds that development occurs in sequential,
clearly defined stages and that stage must be
satisfactorily resolved for development to
proceed smoothly
 Clincal Pathology – Theories of Personality and Psychopathology
- If successful resolution of particular stage does
not occur, all subsequent stages reflect the
failure in the form of physical, cognitive, social or
emotional maladjustment
Relation to Freudian Theory
- Erikson accepted Freud’s concept of instinctual
development and infantile sexuality
- Described a corresponding zone with a specific
pattern or mode of behavior
- Emphasized that the development of the ego is
more than the result of intrapsychic wants or
inner psychic energies
Eight Stages of the Life Cycle
STAGE 1: Trust versus Mistrust (Birth - 18 Mo)
- Infant “lives thru and loves with” its mouth
- Mouth forms basis of its first mode or pattern of
behavior
- The baby is learning a cultural modality that
Erikson termed to get, that is, to receive what is
offered and elicit what is desired
- With development of infant’s teeth - second oral
stage
o Active - incorporative mode
o Infant no longer passive to stimuli: it reaches
out for sensation and grasps at its surrounding
o Social modality shifts to that of taking and
holding on to things
- Infant’s development of basic trust in the world
stems from its earliest experiences with its
mother or primary caretaker
STAGE 2: Autonomy versus Shame and Doubt (about 18
Mo to about 3 years)
- Toddler practices the social modalities of holding
on and letting go and experiences the first
stirrings of virtue that Erikson termed will
- Depends on the amount and type of control
exercised by adults over child
o Control exerted too rigidly or too early defeats
the toddler’s attempts to develop its own
internal controls and regression or false
progression results
o Parental control that fails to protect toddler
from consequences of his own lack of self-
control or judgment can be equally disastrous
- In “Identify: Youth and Crisis”, Erikson asserted:
“this stage, therefore becomes decisive for the
ratio between loving good will and hateful self-
insistence between cooperation and willfulness
and between self-expression and compulsive self-
restraint or meek compliance.”
o Where ratio is favorable, the child will
develop an appropriate sense of autonomy
and capacity to “have and to hold”
o Where unfavorable, doubt and shame will
undermine free will
STAGE 3: Initiative versus Guilt (about 3 years to about 5
years)
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- Child’s increasing mastery of locomotor and
language skills expands its participation in the
outside world and stimulates omnipotent
fantasies of wider exploration and conquest
- Mode of participation: active and intrusive
- Social modality: being on the make
- Intrusiveness is manifested in the child’s fervent
curiosity and genital preoccupations,
competitiveness and physical aggression
- Oedipus complex - child competes with the
same-sex parent for the fantasized possession of
the other parent
- The stage highlights the child’s expanding
initiative and forms the basis for the subsequent
development of realistic ambition and the virtue
of purpose
- If not resolved, the person may ultimately
develop a conversion disorder, inhibition or
phobia
STAGE 4: Industry versus Inferiority (about 5 years to
about 13 years)
• Child discovers the pleasures of production; he
or she develops industry for learning new skills
and takes pride in the things made
• Child receives systematic instruction and learns
the fundamentals of technology as they pertain
to the use of basic utensils and tools
• A child unprepared for this stage may develop a
sense of inferiority and inadequacy
• Society becomes crucially important in the
child’s ability to overcome that sense of
inferiority and to achieve competence
STAGE 5: Identity versus Role Confusion (13 yrs-21 yrs)
• Formation of cliques and an identity crisis occur
at the end of adolescence
o Erikson calls this normative because it is
a normal event
• Failure to negotiate this stage leaves the
adolescent without a solid identity; they suffer
from identity diffusion or role confusion,
characterized by not having a sense of self and
by confusion about their place in the world
• They defend against role diffusion by joining
cliques or cults or by identifying with folk heroes
• Falling in love – process in which adolescent may
clarify a sense of identity by projecting a diffused
self-image onto the partner and seeing it
gradually assume a more distinctive shape and
an overidentification with idealized figures are
means by which adolescent seeks self-definition
• Delinquency, gender-related identity disorders,
and borderline psychotic episodes can result if
youth is unable to formulate a sense of identity
and belonging
STAGE 6: Intimacy versus Isolation (21 yrs-40 yrs)
• Freud: love – generosity of intimacy as well as
genital love
• Erickson: love and work – general work
productiveness
• Intimacy – closely tied to fidelity in young adults
 Clincal Pathology – Theories of Personality and Psychopathology
o Ability to make and honor commitments
to concrete affiliations and partnerships
even with sacrifice and compromise
• Person who cannot tolerate the fear of ego is apt
to become deeply isolated and self absorbed
• Distantiation – readiness to repudiate, isolate,
and destroy those forces and persons whose
essence seems dangerous to one’s own
o Pathological outcome of conflicts
surrounding intimacy
o Forms the basis from various forms of
prejudice, persecution, and
psychopathology
• Critics say that Erickson’s emphasis on
separation and occupationally based identity
formation fails to take into account the
importance for women of continued attachment
and the formation of an identity based on
relationships
STAGE 7: Generativity vs. Stagnation (40 – 60 yrs)
• Generativity – primarily the concern for
establishing and guiding the next generation
o Encompasses productivity and creativity
• Care – virtue that coalesce at this stage
• Through generative behavior, the individual can
pass on knowledge and skills while obtaining
satisfaction
• Failure of generativity can lead to profound
stagnation marked by escapisms (alcohol, drugs,
and sexual and other infidelities); premature
invalidism and midlife crisis may occur
• Failure to develop at midlife can lead to sick,
withered, destructive organizations that spread
the effects of failed generativity throughout
society
STAGE 8: Integrity vs. Despair (60 yrs – death)
• Integrity - acceptance of one’s own and only
life cycle and of the persons who have become
significant to it as something that had to be and
that, by necessity, permitted of no substitutions
• the individual possession of the virtue of wisdom
and sense of integrity has room to tolerate the
proximity of death and to achieve a detached yet
active concern with life
• when the attempt to attain integrity has failed,
the individual may become deeply disgusted
with the external world and contemptuous of
persons as well as institutions
o this disgust may lead to fear of death
and despair that time is short
PSYCHOPATHOLOGY
Basic Trust
• Impairment of basic trust leads to basic mistrust
• Infants: social trust is characterized by ease of
feeding, depth of sleep, smiling, and general
physiological homeostasis
o Prolonged separation can lead to
hospitalism or analectic depression
Page 8 of 12
• Lack of trust later in life may be manifested by
dysthymic disorder, depressive disorder, or
sense of hopelessness
• Persons who develop and rely on these defense
of projection experienced a sense of social
mistrust in the first years of life; likely to develop
paranoid or delusional disorders
• Basic mistrust – major contribution to the
development of schizoid personality disorder and
schizophrenia
• Substance dependent personalities have strong
oral-dependency needs and use chemical
substances to satisfy themselves
• If not nurtured properly, infants may feel empty,
starved not just for food but for sensual and
visual stimulation as well
Autonomy
• Stage where children develop into autonomous
beings (called terrible two’s)  refers to
toddlers’ willfulness at this period of
development
• If shame and doubt dominate, compulsive
doubling may occur
• Over abundance of doubt = inflexibility of the
obsessive personality
• Too rigorous toilet training – produce overly
compulsive personality (stingy, meticulous,
selfish)
o Such persons are called 3P’s (anal
personalities): parsimonious, punctual,
and perfectionist)
• Too much shaming – children feel evil or dirty,
may pave way for delinquent behavior
• Paranoid personalities – when coupled with
mistrust, the seeds are planted for persecutory
delusions
• Impulsive disorder – person’s refusing to be
inhibited or controlled
Initiative
• Conflict over initiative expressed in hysterical
denial which causes repression of the wish
• Hysteria – pathological regression in this area;
psychosomatic is more common now
• Excessive guilt – lead to anxiety disorders and
phobias
• Punishment – sexual inhibitions
• Conversion disorder or specific phobia may
result when oedipal conflict is not resolved
• Brutal developing superego – repression of
wishes and begin to deny them
• Fear of not living up to what is expected of them
lead to psychosomatic disease
Industry
• Sense of being able to make things and make
them well and even perfectly
• Sense of inferiority develops when children’s
efforts are thwarted
• Adults sense of inferiority – severe work
inhibitions, feelings of inadequacy
Identity
 Clincal Pathology – Theories of Personality and Psychopathology
• Many disorders can be traced to identity
confusion
• Danger is role diffusion – inability to settle on an
occupational identity that disturbs young
persons
• Disorders at this stage: conduct disorder,
disruptive behavior disorder, gender identity
disorder, schizoprebiform disorder, and other
psychotic disorders
• To leave home and live independently is an
important task during this period
Intimacy
• Successful formation of stable marriage and
family depends on the capacity to become
intimate
• Gender identity determines the object of choice
(homo/heterosexual)
• Making an intimate connection is a major task
• Persons with schizoid disorder remain isolated
from other because of fear, suspicion, the
inability to take risks or lack of capacity to love
Generativity
• 40-65 years old
• Middle aged higher rate of depression rather
than younger adults (due to midlife crisis)
• Increased use of alcohol and psychoactive
substances
Integrity
• Anxiety disorders often develop in older persons
o Related to person’s looking back on their
lives with a sense of panic
• Decline in physical functions contribute to
psychosomatic illness, hypochondriacs, and
depression
• Suicide rate highest over the age of 65
• Acceptance of life or feel despair and
hopelessness (result to depressive disorder)
Treatment
• Establishing a state of trust between doctor and
patient
• Basic mistrust – reestablish trust
• Therapist must have a sense of trustworthiness
Techniques
• Therapist actively convey to the patient the
belief that they are understood
o Done through emphatic listening, verbal
assurances
• Identification of problem first before treatment
• Erickson turned to play as treatment modality
o Play is a function of ego and gives
children a chance synchronize a social
and bodily processes with self
o Children create models in an effort to
gain control of reality; adults use play to
correct the past and redeem their
failures
• Mutuality is also vital to cure
• Abandon hypnosis
• Observer must teach the one observed to be
self-observant
Page 9 of 12
Dreams and Free Association
• Patient’s association to the dream best leads to
understanding its meaning
• Interpretation: primary therapeutic agent
• Free-floating attention: method that enabled to
discovery to occur
Goals (4 Dimensions):
FIRST: the patient’s desire to be cured and the analyst’s
desire to cure
• Help the patient’s ego to be stronger and cure
itself
SECOND: objectivity participation
• New generalizations must be made and arranged
in new configurations
THIRD: knowledge-participation
• Therapist applies selected insights to more
strictly experimental approaches
FOURTH: Tolerance-indigantion
• Control widens the gap between doctor and
patient
• Goal of therapy is to recognize how patient’s
passed through the various stages of the life
cycle and how the various crises in each stage
have or have not been mastered
SCHOOLS DERIVED FROM PSYCHOANALYSIS AND
PSYCHOLOGY
• Designed to understanding prediction and
eventual therapeutic control of human behavior
Karl Abraham (1877-1925)
• Freud’s earliest disciples
• Explication of depression from a psychoanalytic
perspective
• Elaborated Freud’s stages of psychosexual
development
• Oral stage: biting and sucking phase
• Anal stage: destructive-expulsive phase (anal
sadistic), mastering retentive (anal-erotic)
• Phallic phase: early phase of partial genital love
(true phallic phase)
o Later mature genital phase
• Linked psychosexual stages to specific
syndromes
• Postulated that obsessional neurosis resulted
from fixation at the anal-sadistic phase and
depression from fixation at oral stage
Alfred Adler (1870-1937)
• Freud’s prized pupil
• Put importance to aggression rather than sexual
development
• Masculine protest: tendency to move from
passive, feminine role to masculine, active role
• Theories are collectively known as individual
psychology
• Inferiority complex: inadequacy and weakness
that is universal and inborn
• Organ inferiority: compromised self-esteem in a
child due to physical defect
• Recognized order of children’s birth to their
families of origin
 Clincal Pathology – Theories of Personality and Psychopathology
o First-born: reacts with anger to birth of
siblings; struggles against giving up
powerful position
o 2nd child: compete with 1st born
o Primary therapeutic approach:
encouragement
Franz Alexander (1891-1964)
• Specificity association – association between
specific personality traits and certain
psychosomatic ailments
• An analyst must adopt a particular mode of
relatedness with patient to conteract noxious
childhood experiences from the patient’s parents
• Trusting, supportive analyst-parent of patient
relationship enable patient to master childhood
trauma
Gordon Allport (1896 -1967)
• founder of humanistic school of psychology
(each person has an inherent potential for
autonomous function and growth)
• person’s sense of self-guarantee person
existence
• Propriem: strivings of maintainance of self-
identity and self-esteem
• traits: units of personality structure
• personal dispositions: individual traits that
represent the essence of individual’s unique
character
• maturity: capacity to relate to others with
warmth and intimacy
• mature persons have security, humor, insight,
enthusiasm, and zest
• therapy is geared to helping patients realize
theses characteristics
Michael Balint (1896-1970)
• urge for primary love object underlies virtually
all psychological phenomena
• basic fault is the feeling of patient that
something is missing
• deficit in internal structures result in maternal
failures
• did not abandon drive theory
• certain preverbal phenomena are reexperienced
in analysis and that the relationship itself is
decisive in dealing with this realm of early
experience
Eric Berne (1910-1970)
• developed his own school known as transaction
analysis
• transaction is a stimulus presented by one
person that evokes a corresponding response in
another
• all persons have 3 ego states that exist within
them:
1. Child
2. Adult
3. Parent
Page 10 of 12
Wilfred Bion (1897-1979)
• expanded Melanie Klein’s concept of projective
identification to include an interpersonal process
in which a therapist feels coerced by a patient
into playing a particular role in the patient’s
internal world.
John Bowlby (1907-1990)
• founder of attachment theory
Raymond Cattell (1905-1998)
• introduced the multivariate analysis and factor
analysis
Ronald Fairbairn (1889-1964)
• suggested that infants are not primarily
motivated by the drives of libido and aggression
but by an object-seeking instinct.
Sandor Ferenczi (1873-1933)
• he understood the symptoms of his patients as
related to sexual and physical abuse in childhood
and proposed that analysts need to love their
patients in a way that compensates them for the
love they did not receive as children.
Erich Fromm (1900-1980)
• 5 character types that are common to, and are
determined by Western Culture:
a. receptive personality – passive
b. exploitative personality – manipulative
c. marketing personality – opportunistic and
changeable
d. hoarding personality – saves and stores
e. productive personality – mature and enjoys
love and work
Anna Freud (1895-1982)
• elaborated an individual defense mechanisms,
including reaction formation, regression,
undoing, introjections, identification, projection,
turning against the self, reversal, and
sublimation
Merton Gill (1914-1994)
• elaboration of ego psychology
Kurt Goldstein (1878-1965)
• was influenced by existentialism and Gestalt
psychology
Karen Horney (1885-1952)
• a person’s current personality attributes result
from the interaction between the person and the
environment and are not solely based on
infantile libidinal strivings carried over from
childhood.
Edith Jacobson (1897-1978)
• structural model and an emphasis on object
relations are not fundamentally incompatible
Carl Gustva Jung (1875-1961)
 Clincal Pathology – Theories of Personality and Psychopathology
• formed a psychoanalytic school known as
analytic psychology
• expanded on Freud’s concept of unconscious
• two types of personality organizations:
a. introverts – focus on inner world of thoughts,
intuitions, emotions, and sensations
b. extroverts – oriented toward the other world,
other persons and material goods
Otto Kernberg (1928)
• clinical work with patients with borderline
personality disorder
Melanie Klein (1882-1960)
• theory of internal object relations that was
intimately linked to drives
Heinz Kohut (1913-1981)
• best known for writings in narcisism and the
development of self psychology
Jacques Lacan (1901-1981)
• integrated the intrapsychic concepts of Freud
with concepts related to logistics and semiostics
Kurt Lewin (1890-1947)
• adapted the field approach of physics to a
concept called field theory
Abraham Maslow (1908-1970)
• believed in self-actualization theory: the need to
understand the totality of a person
Karl A. Menninger (1893-1990)
• pioneered the concept of a psychiatric hospital
based on psychoanalytic principles and founded
the Menninger Clinic in Topeka, Kansas
• wrote The Human Mind, Man Against Himself
• The Vital Balance (his magnum opus) – theory of
psychopathology
• interest in the criminal justice system (The Crime
of punishment)
• Theory of Psychoanalytic Technique-examine the
theoretical underpinning of psychoanalysts’
intervention
Adolph Meyer (1866-1950)
• preferred to examine verifiable and objective
aspects of person’s like
• theory explained disordered behavior as reaction
by genetic, physical, psychological,
environmental and social stresses
• introduced the concept of common sense
psychiatry
• coined the concept of ergasia, the action of total
organism
• goal in therapy was to aid patients’ adjustment
by helping them modify unhealthy adaptations
• too autobiological life chart by the patient
Gardner Murphy (1895-1979)
Page 11 of 12
• first to publish a comprehensive history of
psychology and made major contributions to
social, general, and educational psychology
• 3 essential stages of personality development:
1. Undifferentiated wholeness
2. Differentiation
3. Integration
• stages are uneven with regression and
progression
• 4 inborn human needs
1. visceral
2. motor
3. sensory
4. emergency-related
• canalization: brings changes by establishing a
connection between a need and a specific way of
satisfying the need
• interested in parapsychology
• states such as sleep, drowsiness, certain drug
and toxic conditions, hypnosis and delirium tend
to be favorable to paranormal experiences
• impediments to paranormal awareness –
intrapsychic barriers - conditions in the general
social environment and heavy investment in
ordinary sensory experiences
Henry Murray (1893-1988)
• founder of Boston Paychoanalytic Insitute
• Personology: describe the study of human
behavior
• focused on motivation – aroused by internal or
external stimulation
o Once aroused produces continued
activity until the need is reduced or
satisfied
• Thematic Apperception Test (TAT): objective
technique used to reveal both unconscious and
conscious mental processes and problem areas
Frederick S. Perls (1893-1970)
• applied Gestalt theory to a therapy that
emphasizes the current experiences of the
patient in the here and now, as contrasted to the
there and them on psychoanalytic schools
• patients learn to recognize their needs to any
given time and the ways that the drive to satisfy
these needs may influence their current behavior
• Gestalt: behavior represents more than the sum
of its parts
o “whole” includes and goes beyond, the
sum of smaller, independent events;
o Deals with essential characteristics of
actual experience
Sandor Frado (1890-1972)
• founded the Columbia Psychoanalytic Institute in
New York
• theories of adaptational dynamics: organism is a
biological system
• cultural factors often cause excessive hedonic
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
• The Trauma of Birth
• anxiety is correlated with separation from the
mother
• sleep and dreams: symbolizes return to the
womb
• personality: impulses, emotions, will
• children impulses: seek immediate discharge
and gratification
• if will carried too far – pathological traits
(stubbornness, disobedience, inhibitions)
Wilhelm Reich (1897-1957)
• character formation and character types
• character armor: personality’s defenses that
serve as resistance to self-understanding and
change
• 4 major character types:
1. Hysterical character: sexually seductive,
anxious and fixated at the phallic phase libido
development
2. Compulsive: controlled, distrustful, indecisive
and fixated at the anal phase
3. Narcissistic: fixated at the phallic phase of
development
4. Masochistic: long-suffering, complaining, self-
deprecatory with an excessive demand for love
• Will Therapy: help patients accept their
separateness
Carl Rogers (1920-1987)
• Person-centered Theory: self-actualization and
self-direction
• persons are born with the capacity to direct
themselves in the healthiest way, toward a level
of completeness – (self-actualization)
• personality as a dynamic phenomenon involving
ever-changing communication, relationships, and
self-concepts
stimuli
Harry Stack Sullivan (1892-1949)
• concept of observable data
• 3 modes of experience
1. prototaxic mode: undifferentiated thought
that cannot separate the whole into parts or use
symbols
2. parataxic mode: events are causally elated
because of temporal or serial connections
3. syntaxic mode: logical, rational, and most
mature type of cognitive functioning
Donald Winnicott (1897-1971)
• multiple self-organization
• true self: develop a concept of responsive
holding environment provided by a good-enough
mother
• transitional object: provides security in the
absence of the mother (pacifier, blanket, teddy
bear)
------------------------------- end of transcription
----------------------------
The earlier transcription was copied and retyped
from the transcription of last’s semester’s
psychology class, which is from the book.
*****tables from the book are attached at the end
part of this VERY LONG TRANSCRIPTION. (“,)
The following transcription is from the powerpoint
presentation of Dra. Capitan.
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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