Ch 11 - Jeff Standen

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Psychic conflict In psychoanalytic theory, every individual experiences conflict between the different parts of the psyche. The root cause of this is that society can only exist if our unconscious sexual and aggressive impulses are kept in check. As a result, we are torn between our desires to gratify our impulses, and our wish to live in a peaceful, ordered society (Freud, 1930). This creates conflict between the pleasure principle and the reality principle within the individual psyche. The Id demands instant gratification for its erotic and aggressive desires, regardless of whether they are socially acceptable or even possible; the Ego tries to police these desires into acceptable and realistic channels; and the Superego seeks to impose moralistic rules to block many of the Id's desires altogether. Ego defences In its struggle to referee the psychological civil war going on in our heads, the Ego uses a number of defence mechanisms. Among these defences are: • Displacement Redirecting repressed desires and impulses on to a relatively safe target. For example, if we are angry with the boss, we take it out on the dog. • Sublimation Transforming aggressive and sexual desires into some socially acceptable expression - for example, artists and musicians expressing these desires in their work. • Projection Attributing your own unacceptable impulses to someone else. For example, a person who cannot acknowledge hating their brother accuses their brother of hating them. • Denial An extreme form of self-protection which denies what has happened - for example, a terminal cancer patient refusing to accept they are dying. • Repression This is the most important defence mechanism in Freud's theory. The Ego censors Id impulses and refuses to allow them access to conscious awareness. The Ego also uses repression to protect itself from threatening or traumatic experiences from the outside world. Traumas (from the Greek trauma meaning wound) may include experiences we all share, like the first realisation in childhood that we are not the centre of our mother's life. For some people, they may also include extremely painful experiences such as child abuse. Without defences the Id would run amok, the Ego would be destroyed and society would be ripped apart. However, we pay a price for our defences. Psychological disorder It is repression in particular that leads to a range of psychological disorders which Freud called neuroses - anxiety disorders, panic attacks, hysteria, phobias and obsessive and compulsive behaviour. Repression pushes things out of conscious awareness - it does not make them go away. Repressed memories of traumatic experiences continue to haunt us, producing neurotic symptoms (Freud & Breuer, 1895). Repression of sexual and aggressive impulses can result in similar symptoms. These traumas and impulses often originate in childhood. Repression keeps them frozen in their childish state so we cannot grow out of them. We remain haunted and threatened by these childish anxieties and fears. Struggles between the Ego and the Id cause neurosis, and struggles between the Ego and Superego cause moral anxiety. Psychoanalytic therapy can deal with these (see below). However, if Id impulses prove too strong for the Ego, the Id may invade the Ego and take control of it. This wrecks the reality principle, and insanity results (Freud, 1923). Freud did not think that insanity was treatable - certainly not by psychoanalytic techniques. Depression Freud explained depression as arising from a sense of loss. Typically, when a person is bereaved, the process of mourning involves taking the character of the lost loved one into their own psyche, so 'keeping them alive'. If your feelings towards the lost loved one were positive, then the preserved loved one in your psyche will be loving and comforting. However, if your feelings towards the loved one contained repressed hatred or resentment, then the preserved loved one in your psyche will turn malevolent and be punishing and hostile. Your hatred is directed back at your own Ego, leading to feelings of being unloved and worthless, and the Ego is destroyed by what it tried to preserve (Freud, 1917). Later losses reactivate this earlier bereavement, leading to depression. Depression can also arise if there is conflict between the Superego and Ego, where the Superego harasses the Ego as immoral and unworthy (Freud, 1923). Later developments Freud's followers developed psychodynamic thinking in a number of different ways. Some put more emphasis on the role of the Ego. Alfred Adler (1870-1937) focused on the Ego struggling for mastery over the self and seeking to adjust to society. Adler had a major influence on American psychodynamic theory and on the beginnings of humanistic psychology. In Britain, Freud's daughter Anna (1895-1982) did important work on the Ego and its defences. Others put more emphasis on the unconscious, like Carl Gustav Jung (1887-1961) whose interest in the religious and spiritual side of human nature has made him popular with more mystically inclined therapists and New Age groups. British psychodynamic theory was greatly influenced by Melanie Klein (1882-1960) and object relations theory. This focuses on the importance of emotional bonds, especially with the mother, in the development of the child. Disruption of these bonds is seen as a source of psychological disorder.
Models of abnormality John Bowlby's work on attachment (see <strong>Ch</strong>apters 4 and 5) was influenced by object relations theory. 0B Treatment and the psychodynamic model Psychoanalytic treatment is designed to uncover repressed impulses and traumatic memories and bring them to conscious awareness. Freud's favoured method was to focus on the patient's dreams. He believed that dreams contain repressed material in a disguised form (Freud, 1900). Psychoanalysis invites patients to free associate on dreams, neurotic symptoms or childhood memories. Free association involves the patient letting their mind wander freely and saying whatever comes into their head. This in itself often uncovers repressed events and exposes uncomfortable desires. The psychoanalyst interprets the patient's words, dreams and behaviour, identifying and challenging their defence mechanisms. Bringing repressed material to consciousness is a painful process and leads to the release of pent-up emotion. This process is known as catharsis. Neurotic symptoms should now disappear, leaving the patient with conscious awareness of what they had tried to repress. The patient is now able to grow out of their childish fears and anxieties, working through the repressed material, making sense of their experience, and coming to terms with it. An important sign that therapy is actually taking place is when the patient engages in transference. This involves transferring repressed feeling towards others - for example, parents and siblings - in the patient's life, and 'taking them out' on the analyst. The patient loves, hates, fears or provokes the analyst, displacing pent-up feelings on to the analyst. When transference is over, psychoanalytic therapy is complete. The ultimate aim of psychoanalysis is to make the unconscious conscious, to cure neurotic symptoms, and to help the patient gain greater insight and self understanding. Evaluation of the psychodynamic model The psychodynamic model differs from the biological model in several important ways. • It rejects the biological model's view that abnormality is sharply distinct from normality. Everybody suffers from mental conflicts, but some are more extreme than others. • It does not try to explain psychological disorder in terms of brain dysfunction or inherited predispositions. • It considers drug treatments, shocks and brain surgery as unhelpful in getting to grips with the underlying causes of psychological disorders. • The psychodynamic model was more optimistic than early 20th century psychiatry, and held out the promise that some disorders at least could be cured. • Although it accepted the broad outlines of psychiatric classification, the psychodynamic model has always focused on the individual case. Two people may be depressed, but their depression may have very different origins and meanings, and simply to label both as having 'mood disorder' does not get us very far. In one important respect the psychodynamic model resembled the biological model. It retained a doctor-patient relationship, with the psychoanalyst taking the role of the professional and the patient seeking expert guidance. The psychodynamic model is very controversial. It has been supported for producing powerful insights into the human mind and dismissed as little more than fantasy. First the criticisms. It is unscientific Evidence supporting the psychodynamic model comes from clinical case studies of individual patients. These studies rely heavily on the therapist's interpretations and are open to bias. They are largely based on information acquired retrospectively - adults recalling their early years. The accuracy of childhood memories is open to question. In addition, concepts like Id, Ego and Superego and processes such as repression cannot be directly observed and measured. According to the philosopher Karl Popper (1959), psychodynamic theory fails to produce testable hypotheses and is simply not scientific. Freud was quite prepared to go beyond empirical evidence - 'hard facts' and observable and measurable data - if his theories produced greater meaning and insight. If his findings could not be confirmed in the laboratory, then that was just too bad. For Freud, supporting evidence from Shakespeare's plays was of much greater significance than evidence from experimental psychology. Kline (1988; 1989) claims that there is strong evidence to support Freud's theory from real life, and that experimental psychology has yet to find a way of evaluating psychodynamic theory. It does not work Eysenck (1952) published figures which suggested that psychodynamic therapy was worse than useless in the treatment of psychological disorders. However, this claim has been questioned. Psychoanalysis in the USA has been attacked as little more than a money spinner with some people spending their entire adult lives in analysis - which costs them a fortune. However, Freud's own cases usually lasted only a few weeks. And some recent studies suggest that short-term psychodynamic therapy can be beneficial to some patients (Messer et al., 1992). It is deterministic and pessimistic Freud's theory has been criticised for suggesting that people's lives are dominated by unconscious drives and childhood experiences. Critics argue his theory is pessimistic because it offers little escape from these determining influences - people are pictured as prisoners of their drives and early experiences. However, Freud argued that this only happens if these factors are repressed. The whole point of psychoanalysis is to give people greater insight and the freedom to take control of their lives. Freud does claim that people have antisocial sexual and aggressive desires. But, in a more optimistic
Page 1 and 2: Introduction The last chapter looke
Page 3 and 4: Models of abnormality Kraepelin (18
Page 5 and 6: - M Models of abnormality diathesis
Page 7: Models of abnormality ( Unit 3 The
Page 11 and 12: The psychodynamic model The psyche
Page 13 and 14: odels of abnormality This often inv
Page 15 and 16: Unit 5 The humanistic model of abno
Page 17 and 18: Consider the following 'irrational
Page 19 and 20: syndromes - psychological disorders
Page 21: c American Psychiatric Association

Ch 11 - Jeff Standen

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