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; where he developed psychoanalysis ( 1 887- 1897) - died in London (I939)

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-

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

JoY and IsaY

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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 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 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 Dream work : unconscious mental operations by which latent dream content is transformed into manifest dream

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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

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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

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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

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:

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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

◦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 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

◦Characterized by extreme mobility of drive cathexis;

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

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 6.11) 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
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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)

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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

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)

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

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 ANXIETY (by Freud) – “dammed up libido”

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◦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 - danger situations can be linked to developmental stages & create developmental hierarchy of anxiety
i.e. phobias (fear of external threat) – externalization of internal dangers

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

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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

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

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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

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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 selfcontrol 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 selfinsistence between cooperation and willfulness and between self-expression and compulsive selfrestraint 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 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 o •

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STAGE 7: Generativity vs. Stagnation (40 – 60 yrs) • Generativity – primarily the concern for establishing and guiding the next generation o Encompasses productivity and creativity


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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

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 •

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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 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 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 o

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Franz • • •

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)

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 selfidentity 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

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 patients with borderline • •

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• •

Otto Kernberg (1928) • clinical work with 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)

• • • •

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 Otto Frank (1884-1939) • 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, selfdeprecatory 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 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 •

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personality: set of behavior as a response to 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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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