Psychiatry 1 The Mind

AY 2018-2019 Dr. Emma Concepcion Mendoza, MD

1st Bimonthly 09/14/2020

OUTLINE Range from realistic trust, over idealization, eroticized

fantasy to mistrus
Pa ien . feeling o a d he doc o ho emind
him/her of the past
Contents
THE MIND ................................................................................. 1 Countertransference
SIGMUND FREUD ..................................................................... 1 Physicians have unspoken expectations of patients.
If expectations are not met, the patient may be
Basic Theory Of Psychoanalysis ............................................ 1
disapproved of and experienced as unlikable,
History Of Sigmund Freud...................................................... 1 unworkable or bad.
Dreams ................................................................................. 1
Freud's Topographical Model Of The Mind.............................. 2 Basic Theory Of Psychoanalysis
Instinct/ Drive Theory............................................................. 2 1. Unconscious / factors outside conscious awareness affect
personal behavior
Libido.................................................................................... 3
2. Dreams & behavior / activities show unconscious conflicts &
Structural Theory of the Mind ................................................. 3 wishes
Stages of Psychosexual Development.................................... 3 The role of unconscious factors in determining the
shape of symptoms and their meaning is crucial to a
Theory of Anxiety .................................................................. 3
psychoanalytic point of view.
Character.............................................................................. 4 Example, in auditory hallucinations, biological
Classical Psychoanaltics Theory of Neurosis ......................... 4 mechanisms may produce the symptom, but the
content of that symptom and its meaning to the
Free association .................................................................... 4
patient relate to specific psychological
Dual Instinct Theory............................................................... 4 characteristics unique to that patient.

History Of Sigmund Freud

Born on May 6, 1856
THE MIND Born in Friesberg, Czechoslovakia
Of Jewish descent but grew up in Vienna
Is the complex of cognitive faculties that enables Studied Medicine in Vienna, specialized in Neurology
consciousness, thinking, perception and judgment Studied HYPNOSIS in France
Worked w/ hysterical pts. leading to the development of
The concept of mind is understood in many different ways by
psychoanalysis
many different cultural and religious traditions Treated pts. by method of ABREAC ION
To remember & verbalize pts. suppressed feelings
SIGMUND FREUD to remove symptoms
Founder of Classical Psychoanalysis Resistance noted during process of abreaction
Theory of personality Repression noted
Method of investigation by: Active process of separating painful thoughts from
Conscious awareness may have caused symptoms to pts.
a) Scientific Discipline
De elo ed FREE ASSOCIATION
b) Techniques Used
Encourage to say anything pt. wants to say
- transference W/o censorship
- resistance
Emergence of psychoanalysis
Resistance
Emergence of psychoanalysis as a:
Noted when pt. uses method of free association a) Method of investigation
Noted by b) Therapeutic technique
c) Body of scientific knowledge based on an increasing
Pauses/blanks in interview
fund of information and basic theoretical
Doe n d ink med propositions.
Misses appointments

Transference Dreams
Famo book: In e e a ion Of D eam
The set of expectations, beliefs and emotional responses During the early 1890s he was convinced that childhood
that a patient brings to the patientdoctor relationship sexual seduction played a major role in causing the neuroses.
Not necessarily based on how the doctors act

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 He was moved by the fact that there always seemed to be a
clo e connec ion be een hi a ien d eam and hei
mental abnormalities
Dreams are fulfillment of unconscious childhood wishes which
is not accessible to conscious awareness when awake
Division of Dream
1. Manifest
what is recalled by the dreamer
2. Latent content
unconscious thoughts & wishes that usually
awakens the dreamer.
Dreamwork
Unconscious mental work by which latent dream is changed
to manifest dream
Dreams tell us many unpleasant biological truths about
ourselves and only very free minds can thrive on such a diet.
Self-deception is a plant which withers fast in the pellucid
atmosphere of dream investigation.
Freud pointed out a constant connection between some part
of e e d eam and ome de ail of he d eame life d ing
the previous waking state.
F e d af e d ing he d eame life and mode of ho gh ,
after noting down all his mannerism and apparently
insignificant details of his conduct which reveal his secret
thoughts, came to conclusion that there was in every dream
the attempted or successful gratification of some wish ,
conscious or unconscious
He proved that many of our dream visions are symbolical,
which causes us to consider them as absurd and
unintelligible; the universality of those symbols, however,
makes them very transparent to the trained observer
Freud showed that sexual desires play an enormous part in
our unconscious, a part which hypocrisy has always tried to
minimize, if not ignore entirely
Freud established a direct connection between dreams and
insanity.
The insane who have not been made so by actual injury to the
brain or nervous system are victims of unconscious forces
which cause them to do abnormally things which might be
helped to do normally.
Primary Process
1. Condensation is the mechanism by which several
unconscious wishes, impulses, or attitudes can be combined
into a single image in the manifest dream content.
2. The mechanism pf displacement refers to the transfer of
amounts of energy (cathexis) from an original object to a
substitute or symbolic representation of the object
3. Freud noted that the 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
Condensation, displacement, symbolic
representation, projection, and secondary revision
(mature and responsible aspect of ego) primarily as
facilitating the discharge of latent impulses, rather
than as protecting dreamers from anxiety and pain.
Freud's Topographical Model Of The Mind
Freud's topographical model of the mind, in which he divided the
mind into three regions: the conscious system, the preconscious
system, and the unconscious system.
Psych The Mind
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.
They could also be ideas coming from within the body/mind
which are brought to awareness
Consciousness is a subjective phenomenon whose content
can be communicated only by means of language or
behavior.
The Preconscious
Composed of those mental events, processes, and contents
that can be brought into conscious awareness by the act
of focusing attention.
To reach conscious awareness, contents of the unconscious
must become linked with words and thus become
preconscious.
Serves to maintain the repressive barrier and to censor
unacceptable wishes
The Unconscious
Very dynamic
Its mental contents and processes are kept from conscious
awareness through the force of censorship or repression
and it is closely related to instinctual drives.
Sexual
Selfpreservative drives
The unconscious was thought to contain primarily the mental
representations and derivatives of the sexual instinct.
Limited to wishes seeking fulfillment
Characterized by primary process thinking, which is principally
aimed at facilitating wish fulfillment and instinctual discharge
It is governed by the pleasure principle and, therefore,
disregards logical connections
“What I like is I like”
Limitations of Topographical Theory
1. Defense mechanism that protects painful memory are not
easy accessible in consciousness
2. Wi h ncon cio ne , he e he need fo ni hmen
Instinct/ Drive Theory
Instinct, for example, refers to a pattern of speciesspecific
behavior that is genetically derived and, therefore, is more or less
independent of learning.
4 Principal Characteristics of Instinct
1. Source refers to the part of the body from which the instinct
arises
2. Impetus is the amount of force or intensity associated with
the instinct
3. Aim refers to any action directed toward tension discharge or
satisfaction
4. Object is the target (often a person) for this action.
Object Relationships in Instinct Theory
Freud suggested that the choice of a love object in adult life, the
love relationship itself, and the nature of all other object
relationships depend primarily on the nature and quality of
children's relationships during the early years of life
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 Libido e) Synthetic function of the ego
Libido refers specifically to the mental manifestations of the o Capcity to undify def elements
sexual instinct o Involves organizing, coordination, generalizing,
Sexual instinct underwent a complex process of development simplifying data
at each phase of which the libido had specific aims and f) Primary autonomous ego function
objects that diverged in varying degrees from the simple aim o System present at birth which develops
of genital union independent of intrapsychic conflict between
According to Freud drives and defenses in an acceptable
Linkage or fenital sexuality with libido is the environment
indi id al e l of man de elo men o Involves percention, learning, intelligence,
Sexual drives (Webster), high in men, low in female. intuition, language, comprehension, motility
g) Secondary autonomous ego function
o With the concept of free-sphere of ego
functioning
Structural Theory of the Mind
a) Id
Refer to a reservoir of unorganized instinctual drives.
Superego
Lacks the capacity to delay/modify drives Establishes and maintains an individual's moral conscience
NOT synonymous with unconscious on the basis of a complex system of ideals and values
b) Ego internalized from parents.
Affects the 3 aspect of topographical Children understanf parental values and standard by 5-6y/o
The executive organ of the psyche, controls motility, Agency which evaluate person;s behavior, thought, feeling
perception, contact with reality, and, through the defense Largely conscious
mechanisms available to it, the delay and modulation of Agency which dicatates what person should do/ not do
drive expression.
Formation of moral standards, aspiration, dieals based on
Logical and abstract thinking and verbal expression contacts which admiring figures.
are associated with conscious and preconscious
functions of the ego
c) Superego
Stages of Psychosexual Development
Executive organ of the psyche
1. Oral stage
Controls movement, thoughts, contact of reality with 2. Anal stage
delay or toning down of drive expression 3. Urethral stage
Pressure from external world makes ego substitute 4. Phallic stage
pleasure principle of the id to reality principle 5. Latency stage
6. Genital stage

Basic Functions of Ego Theory of Anxiety

1. Control and regulate instinctual drives Damned uo libido (Freud)
Physiological increase in sexual tension
Development of the capacity to delay or postpone drive
Increase in libido is the mental expression of the physiological
discharge
event (Kaplan)
Capacity to test reality
Mental uneasiness for fear/solicitude (Webster)
Mediator between Id and outside world Building up of anxiety leads to Neurosis
2. Judgement
Ability to anticiplate results of action
Ability to think logically Neurosis
3. Relation to reality
Mediator between internal world and external reality A chronic/ recurrent non psychotic disorder
Aspects of reality in relation to outside world Disorder is experienced/ expressed directly or altered thru
defense mechanis
a) Sense of reality Appears as symtoms:
o Developed when infant aware of bodily o obsession
sensation o compulsion
o Develops in concert with an infant's dawning o phobia
awareness of bodily sensations. o sexual dysfunction
b) Reality testing Panic disorder due to advance thinking
o Ability to tell internal fantasy from external Anxiety disorder management
reality 1. Stop advance thinking
o Diff. psychotic from non-psychotic 2. Think happy thought
o An ego function of paramount importance, 3. Deep breathing exercise
refers to the capacity to distinguish internal 4. Medication
fantasy from external reality. Symptoms distressing to the individual and recognized as
c) Adaptation to reality NOT acceptable
o Abili o e one e i ance f om effec i e Reality testing is still intact
response based previous experience with Behavior is NOT violating social norms
reality Disturbing is enduring/ recurring without treatment
d) Object relationship
o Ability to form good relationship due to Signal Anxiety
interaction from parents and other prominent
figures in our lives Second type of anxiety developed by Freud
o A fundamental function Anxiety is in the unconscious level
o Satisfying relationship based on integration of Ego acts on it to prevent danger
positive and negative of others

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 External/internal stimuli produces certainsignal we
triggers the ego to let specific defense mechanism
act on it to lessen anxiety
If ego cant cope with distressing stimuli neurotic
s/ms results
Defense mechanism used is not enough
The unconscious mental process that the
ego uses to resolve conflict
Lodestar of inner life
1. Instinct (wishes/needs)
2. Important people
3. Reality
4. Conscience

Character
A e on habi al/ ical a e n of ada a ion o in e nal
drive forces and to external environmental forces
Synonymous with personality
Refers to style to defenses and observable behavior
Influenced by
1. Constitutional temperament
2. Interaction of driving forces with early ego defenses
and environmental influences
3. ID and internalization of people through out life

Classical Psychoanaltics Theory of Neurosis

Regards conflict as important
Conflict that results are
Between instinctual drives and ecternal reality
Between integral agency eg: id vs ego
Deprivation during few months due to absent/ impaired
caretaker we affects ego development
Lack of capacity for constructive expression of drives we may
cause aggression directed to self
Paretns who are very inconsistent, very strict, over indulgent
causes children to develop disordered superego functioning

Free association
Pateint say whatever comes in mind
All original wishes, drives, defenses are transferred to the
analyst (transference)
Countertransference
Analysts feelings in response to the patient
May reflect how other people may respond to the
patient

Dual Instinct Theory

Libido and aggression
Aggression as a component of the sexual instincts in the form
of sadism
Later he proposed that the source of this instinct, according to
Freud, was largely in skeletal muscles, and the aim of the
aggressive instincts was destruction.
The pleasure principle is defined as an inborn tendency of the
organism to avoid pain and to seek pleasure through the
discharge of tension.
The reality principle, on the other hand, is considered to be a
learned function closely related to the maturation of the ego;
this principle modifies the pleasure principle and requires
delay or postponement of immediate gratification

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