Models of Psychopathology: Psychodynamic models

Question 1

What are the three psychoanalytic schools of thought?

Answer 1

• Sigmund Freud - Founder of psychoanalysis
• Melanie Klein - Developed the major therapeutic model used today
• Jacques Lacan - Post structural reading of psychoanalysis

Question 2

As a school of thought, is psychoanalysis still relevant?

Answer 2

Despite repeated attacks psychoanalysis continues to hold its own and there are 10s of thousands of papers and books related to the subject

Question 3

What is neuropsychoanalysis?

Answer 3

Neuropsychoanalysis explores the interface between neurobiological knowledge and psychoanalytic models of the human mind. Relating biological brain to psychological functions and behavior. Neuropsychoanalysis further seeks to remedy classical neurology’s exclusion of the subjective mind.

Question 4

How did Freud regard personality?

Answer 4

The ‘seeds’ of later psychological disorders are linked to early personality
formation.

Not so much the type but the overall structure.

Question 5

Describe Freud’s “Beyond the pleasure principle”?

Answer 5

His original theory focused on the libidinal drives and conflict between the pleasure principle (unconscious drive to satisfy the expression of the libido) and the reality principle (obstacles from the real and the superego seeking to stem/limit libidinal expression).

• A simplistic reading would understand psychological disorders as the result of the ego’s inability to cope with conflicting demands.

Question 6

Give a brief explanation of Freud’s “Death drive”?

Answer 6

Thanatos (the death drive/instinct, mortido, aggression) appears in opposition and balance to Eros and pushes a person towards extinction and an ‘inanimate state’.

Freud saw drives as moving towards earlier states, including non-existence.

‘The aim of all life is death…inanimate things existed before living ones’ (Freud 1920)

Thanatos is associated with negative emotions such as fear, hate and anger, which lead to anti-social acts from bullying to murder.

As the libido (under the control of life) seeks expression through sexual release. The death drive can be cathartically released.
Outward – aggression
Inward – self harm
Like the libido, it must be released or it will built up to a catastrophic release
Ideally both at cathartically released

Question 7

What are the key assumptions behind psychoanalysis?

Answer 7

• Experience and not just behavior
• Experience of both the internal world and external world
• Those with problems have had a disturbed or protracted development experience
• Difficulties and antecedents often hinted at prior to the development of a classified
• ‘disorder’
• Often people cannot ‘pinpoint’ why the feel or think they way they do
• Nomothetic models often fail to account for individuals

Question 8

What are the case studies which helped Freud understand the different mental conditions?

Answer 8

• Little Hans – phobia of horse
• Anna O – hysteria - cathartic method
• Irma’s injection – analyzing himself
• Rat man – obsessive thoughts
• Wolf man - depression
• Dora – hysteria and repressed desires
• Schreber – psychosis (analysed his memoirs)

Question 9

How can anxiety effect everyone?

Answer 9

Everyone to some degree experiences anxiety

• Worry
• nervous
• agitation

Question 10

What are the positive aspects of having anxiety?

Answer 10

It can foster learning, problem-solving and productivity.

Question 11

What are the three different responses which anxiety can elicit in a person?

Answer 11

Can lead to:

• fight
• flight
• freeze response

Question 12

When does anxiety become a disorder?

Answer 12

When a person is unable to control it and it impacts our life.

Question 13

In the DSM, in which conditions can anxiety play a role?

Answer 13

• Panic disorders
• phobias
• PTSD
• Social Anxiety
• Generalised Anxiety disorder

Question 14

What percentage of the population is affected by Generalised Anxiety Disoder (GAD)?

Answer 14

GAD affects about 5% of the population

Question 15

During what age would a person be most commonly affected by Generalised Anxiety Disorder?

Answer 15

more common in 35-59 ages group, and slightly more women

Question 16

What did Freud initially think of anxiety in relation to his model of the mind?

Answer 16

Initially thought anxiety was the result of unsatisfied libidinal impulses that become ‘toxic’

Question 17

What is the difference between “neurotic anxiety” and “realistic anxiety”?

Answer 17

• Neurotic anxiety is a type of anxiety that the object doesn’t exist.
  i. e: your professor is a cold one, without smile, and suddenly you feel that he is angry toward you, and you’re being anxious to be his object of anger..
• Realistic anxiety is a type of anxiety that the object does exist.
  i. e: you anxious being bitten by a fierce dog that’s standing in front of you.

Question 18

What is signal anxiety?

Answer 18

Signal anxiety: The anxiety arising from a response to internal conflict or an impulse and acts a sign of impending threat that results in a person using a defence mechanism.

“Signal anxiety causes us to use a defence mechanism.”

Also

A defence against automatic anxiety
• functions as a warning about the potential emergence of the automatic anxiety such as a fear of annihilation.
• Draws the egos attention to an external object – away from the true
source of anxiety

Question 19

What is a “defence mechanism” (or an ego defence mechanism?

Answer 19

An adjustive reaction, typically habitual and unconscious, employed to protect oneself from anxiety, guilt, or loss of self-esteem.

“In the course of his development, every individual gradually acquires a set of defensive reactions, dynamism or, as Karen Horney calls them, “safety devices,” which are automatically called into play when he finds himself in situations that threaten his ego.”

Question 20

What is psychoanalysis?

Answer 20

Psychoanalysis, as formulated by its developer, Dr. Sigmund Freud, is a treatment of psychological disorder and treatments. It is based on the assumption that the majority of mental activity is unconscious. And, as such, understanding the workings of the mind requires uncovering the unconscious meaning behind or influencing their behavior. Tools in this search for understanding and clarity include looking at repressed impulses, internalized conflicts and early traumas experienced by the individual.

Question 21

What is the id?

Answer 21

The id is the primitive and instinctive component of personality. It consists of all the inherited (i.e., biological) components of personality present at birth, including the sex (life) instinct – Eros (which contains the libido), and the aggressive (death) instinct - Thanatos.

Question 22

What is the ego?

Answer 22

The ego develops to mediate between the unrealistic id and the external real world. It is the decision-making component of personality. Ideally, the ego works by reason, whereas the id is chaotic and unreasonable.

The ego operates according to the reality principle, working out realistic ways of satisfying the id’s demands, often compromising or postponing satisfaction to avoid negative consequences of society. The ego considers social realities and norms, etiquette and rules in deciding how to behave.

Question 23

What is the super ego?

Answer 23

The superego incorporates the values and morals of society which are learned from one’s parents and others. It develops around the age of 3 – 5 during the phallic stage of psychosexual development.

The superego’s function is to control the id’s impulses, especially those which society forbids, such as sex and aggression. It also has the function of persuading the ego to turn to moralistic goals rather than simply realistic ones and to strive for perfection.

Question 24

What is one of the key roles of the ego in relation to anxiety?

Answer 24

One of the key roles of the ego, with its various defences and
symptoms is all about avoiding anxiety

Question 25

What type of meaning do the symptoms of anxiety have according to Freud?

Answer 25

The symptoms themselves have ‘unconscious meaning’ drive and unconscious wish
- Often castration anxiety

Question 26

How can anxiety be beneficial?

Answer 26

Anxiety is not a negative thing, it’s what you do with it that is the problem.

e.g. Finishing an exam strengthens the ego.

Question 27

What is primary anxiety?

Answer 27

PRIMARY ANXIETY: The spontaneous response to trauma. The theory also suggests that primary anxiety is a response to the dissolution of the ego.

“Karla’s withdrawal from her public life was her primary anxiety brought on after the assault.”

Question 28

What is automatic anxiety?

Answer 28

• A persons reaction when in a traumatic situation
• This can be a confrontation or excitation
• Can be external or internal in origin
• Key is the ego is unable to master/manage.
• (Laplanche and Pontalis The Language of Psychoanalysis 1985).

Question 29

What is the psychoanalytic aetiology of Generalised Anxiety Disorder?

Answer 29

• Develops a set of core beliefs that what is expected from others will not be meet or will be difficult.
• Avoid others or objects
• Worry is displaced onto current concerns and preoccupations, and internalized expectation

Question 30

What other aspects of aetiology are involved in General Anxiety Disorder?

Answer 30

• Fantasy – must maintain control and be hypervigilant or bad things will happen
• Results – persistent fear of conscious emergence of unconscious feelings and fantasies, and associated fear of loss of control
• Defences ineffective in neutralising UC wishes, which result in ongoing threats and difficulty dealing with unacceptable feelings

Empirical support

• Cassidy et al (2009) GAD, high levels of emotional avoidance
• Worry is a means of avoiding even more troubling emotions
  
  • Mennin et al (2005) GAD sufferers difficulty in regulating and
• identifying their emotions

Question 31

How is anxiety a generic feeling?

Answer 31

• Any feeling can be transformed or ‘discharged’ into anxiety
• The ego seeks ways of dealing with these feeling, by discharging it toward something that appears rationale or provides ‘temporary’ relief.

Question 32

How is depression understood by psychodynamics?

Answer 32

• Depression, as a symptom, is also a means of ‘managing’ anxiety
• Self-criticism, sense of being unworthy, a failure and often excess guilt
• Can be very hard working and goal oriented but satisfaction doesn’t last long
• We will return to depression a bit later

Question 33

How does Freud explain how a patient experiences a phobia?

Answer 33

Freud said that having a phobia caused the patient to want to get away but be attracted to the same things.

Question 34

What is a psychic fixation?

Answer 34

Psychic fixation - when you only think about one thing where you risk becoming OCD.

Question 35

How do you explain what an addiction is?

Answer 35

Traditionally engaging in an activity or ingesting substances in a compulsive
manner , and that interferes with everyday life

Question 36

Why are addictions seen as compulsive behaviours?

Answer 36

Anxiety emerges, the ego looks to manage it – find temporary relief in the
behaviour or substance

Question 37

What are the differences between normal and abnormal repetitive behaviour in addiction?

Answer 37

Repetition – more likely to do they same thing in the future

• Normal – having a glass of wine to deal with stress
• Abnormal – need wine to think straight and function

Question 38

How does freud explain the ego’s role in reducing anxiety for those who have an addiction?

Answer 38

Issue for the ego

• the relief is only temporary, so the drive to reduce the anxiety increases.

Question 39

What is the relationship between anxiety and addiction?

Answer 39

• Both are associated with normal function that can help the system
  survival and deal with the conflicts the personality system needs to
  deal with.
• Excessiveness and regularity can produce neurotic behaviours and
  traits that exacerbate the problem.

Question 40

Who was Melanie Klein?

Answer 40

• Analysed by Ferenczi while in Budapest
• Began child analysis in Berlin before moving to London in 1926
• Integrated the death drive more directly into psychoanalytic theory
• Hanna Segal (1988) Introduction to the work of Melanie Klein. Karnac books.

Question 41

What was the Paranoid Schizoid Position by Melanie Klein?

Answer 41

• A constellation of various ‘partial’ things – anxieties, defences, internal and external objects
• Characteristic of earliest months after birth, but characteristics of this position can play an important role throughout life
• Spitting the self and object (good and bad) with no integration (at first)
• Two separate, part-objects, the ideal and loved feelings into one object (the ’good’ breast) ; the persecuting and hated into another (the ‘bad’ breast’)
• Here anxiety is only about the self
• Lots of splitting and paranoia but these two different parts are vital as will allow the child to build an ego that is both good and bad (a whole object)

Question 42

What is Projective identification?

Answer 42

• Aspects of self are split off and attributed to an external object.
• Can be good or bad
• The fantasies may evoke behaviour (unconscious intent) to induce the external object to act according to projection.
• Also involved ‘getting into the mind’ of the other and acquiring aspects of the others psyche – therefore also involve introjection

Question 43

What was the depressive position (1)?

Answer 43

• These part object, brought together via numerous points of projection and introjection
  
  • The child integrates the parts of mother into a whole and this is mirroredin the emergence of a whole self.
• Now anxiety also centres on the welfare of the other as a whole object.
• Gives rise to emotions such as guilt, sadness
• Pines for what was lost via hate, which in turn leads to the urgew to repair.

Question 44

What is the depressive position (2)?

Answer 44

• Depressive anxiety and pain are counter by various obsessive defences which can prevent the depressive position from being worked through.
  
  • Worked through by mourning the loss of the partial objects.
• Positivie Aspects
  
  • We can take personal responsibility and see our self as separate.
• Negative aspects
  
  • self punishing and overly dependant on others.

Question 45

Some stats about depression?

Answer 45

• Lifetime prevalence around 17%
• 6% will suffer a major episode
• It is estimated that around 70% of people with depression symptoms recover within a year (no treatment)
• But there is a 85% of a reoccurrence within 10-15 years.
• On average 4 ‘episode’ in lifetime, each last roughly 20 weeks
• 90% of patients develop ‘new’ symptoms post recovery

Question 46

Mourning and depression as natural reactions to loss

Answer 46

• Trigger flight or fight responses but also disturbances in our emotions associated with nurturance.
• Freud: Mourning and melancholia
  
  • Essentially ability to mourn is about letting go
    
    • Which in term leads to growth and the capacity to ‘love again’.
• Depressed individuals struggle to let go and tolerate the separation from the love object (unconsciously).
• Therefore cannot cope with the emotions (love and hate) that are connected to that loss
  
  • The loss in adulthood evoke earlier - ‘unresolved’ childhood loss.

Question 47

Melanie Klien on Depression (1)?

Answer 47

• The difference between mourning and depression is to do with acceptance
• Depression prone individuals feel the loosening of ties to the love object is not possible.
• Can lead to a form of splitting, in severe cases fragmentation.
  
  • Ambivalence and insecurity
  • Love and antagonism

Question 48

Melanie Klein on Depression (2)

Answer 48

• The egois faced with the painful struggle to ‘protect’ the love object from any aggressive feelings.
  
  • Creates an ethical dilemma
  • Where does that aggression/hostility go if not to the object - it goes inwards
  • Leads to the view of the self as bad, hated or hateful
• This also strengthens the superego - it takes up the hostility and uses it.
  
  • Feelings and particularly arousal are repressed (along with hostility)
• Now depressed - little or no pleasure in life, not because the person is sad but because in holding down the hostility toward the other positive affect is also repressed.

Question 49

Evaluation of Psychodynamic personality theories?

Answer 49

• Some of the related concepts re difficult to operationalise and quantify
  
  • Difficult to study psychoanalytic concepts in a controlled laboratory setting
  • Concepts are ambiguous and difficult to define operationally
• Can be difficult to isolate causality as the same even can have a number of different explanation or causes.
• Little empirical support
• Difficult to disprove
• Does not allow clear behavioural predictions
  
  • But some consistency between theoretical cause of disorder and individuals actions.
• Ignores the situatoin and context
• Implies a specific treatment approach is needed.