Theories of personality and psychopathology Flashcards
Mr. A was a 26-year-old white man who had a history of bipolar I disorder.
He was brought in for treatment after not completing the last required course
for his advanced degree and being arrested for disturbing the peace. He had
consistently lied to his family about where he stood with his coursework and
about having skipped an examination that would have qualified him to use his
professional degree. He had also not told them that he had been using marijuana
almost daily for a number of years and occasionally used hallucinogens. His
arrest for disorderly conduct was for swimming naked in an apartment complex in
the middle of the night while under the influence of hallucinogens. Mr. A spent
most of his time reading and trying to write but compared himself unfavorably
with other famous writers, feeling himself to be inferior. (Adapted from Paul C.
Mohl, MD, and Adam M. Brenner, MD.)
How would Alfred Adler view Mr. A?
A. Mr. A’s problems are a failure of adaptation to his mental illness and adult
life.
B. Mr. A’s rebellion against conformity is a defense against his fear of being
away from his mother’s protection and domination.
C. Mr. A uses drugs and psychosis as escapes to maintain some degree of
self-esteem.
D. Mr. A has been attempting to move from inferiority to mastery in fantasy
rather than in realistic achievement.
E. Mr. A’s process of self-realization has been blocked.
D.
Alfred Adler (1870-1937) posited striving for self-esteem through overcoming a
sense of inferiority, which he saw as an inevitable force in the human condition
as a result of its extended childhood. As seen from the Alderian point of view,
Mr. A has been attempting to make the normal step of moving from inferiority to
mastery in fantasy instead of through realistic achievement. He maintains
himself in fantasy as a writer while failing at the accomplishments that would
enable him to become a writer.
Sandor Rado (1890-1972) theorized that cultural factors often cause excessive hedonic control by interfering with the organism's ability for self-regulation. Rado would have framed Mr. A's difficulties as failures of adaptation to his mental illness and adult life and as a regression to the hedonic level of adaptation in which pleasure is sought and pain avoided.
Wilhelm Reich (1897-1957) made major contributions to psychoanalysis in the area of character formation and character types. The term character armor refers to the personality's defenses that serve as resistance to self-understanding and change. Reich might see Mr. A's rebellion against conformity as a defense against his fear of being away from his mother's protection and domination. The more Mr. A rebels, the more tightly he binds himself to his mother.
Harry Stack Sullivan (1892-1949) would probably see Mr. A as arrested in
childhood. His fear of displeasing his mother led him to give up healthy
self-esteem strivings for independence, favoring a distant yet dependent
position. Mr. A uses drugs and psychosis as escapes to maintain some degree of
self-esteem.
Karen Horney (1885-1952) proposed three separate concepts of the self: the
actual self (the sum total of a person’s experience), the real self (the
harmonious, healthy person), and the idealized self (the neurotic expectation or
glorified image that a person believes he or she should be). From the standpoint
of Horney, Mr. A’s process of self-realization has been blocked in all three
directions. He has not developed the ability to love and trust; he expresses
opposition in an unhealthy way, and he has made self-defeating moves toward
independence.
Adolf Meyer would treat Mr. A by
A. assisting Mr. A in integrating alien parts of himself into his ego complex
B. focusing on the adequate treatment of Mr. A’s mental disorder
C. challenging Mr. A to develop attachments outside of the family
D. encouraging Mr. A to join a support and educational group to better
understand and accept his mental illness
E. none of the above
B
Adolf Meyer (1866-1952) would focus first on the adequate treatment of Mr. A’s
mental disorder. Meyer emphasized the interrelationship of symptoms and
individual psychological and biological functioning. Controlling biological
forces at work to disrupt Mr. A’s life is always a primary goal. Because Mr. A
is still dependent on his parents, they are included in the treatment plan and
might be seen separately by a social worker. Both Mr. A and his parents are told
that failure to control the symptoms of his mental illness could cost him his
life and any satisfaction that he might derive from it. Mr. A’s mood swings are
stabilized on an appropriate medication. Later, Mr. A would begin the distributive
analysis phase of his treatment and would be asked to reflect on the impact of
his bipolar I disorder and his avoidance of responsibility in his life.
A young woman presents to you complaining of lack of energy, trouble
sleeping, depression, and hopelessness that has been present for the past year.
You diagnose her with major depressive disorder. Which of the following would
have been Freud’s explanation of this disorder?
A. Her depression is actually internally directed anger.
B. Her internal good objects have been destroyed by aggression and greed.
C. She never mastered the trust versus mistrust stage of ego development.
D. She is being persecuted by a tormenting internal object.
E. She feels despair that her self-object needs will not be met by others
The answer is A
Freud originally understood depression as internally directed anger. In his
view, the self-reproaches and the loss of self-esteem commonly experienced by
depressed patients are directed not at the self but rather at an ambivalently
experienced introject. He noted that in some cases, the only way the ego can
give up an object is to introject it, so the anger directed at the ambivalently
held object takes on the clinical manifestation of the depression
How would Kohut conceptualise depression
From the self-psychological point of view associated with Heinz Kohut,
depression is related to a sense of despair about getting one’s self object
needs met by people in the environment
How would Klein conceptualise depression
Melanie Klein suggested that depression
is linked to a reactivation of the depressive position; depressed patients are
convinced that they have destroyed their internal good objects because of their
own aggression and greed. As a result, they feel persecuted by internal bad
objects while longing for the lost love objects.
How would Erikson conceptualise depression
Erikson hypothesized that the depressed patient’s experience of being empty and
of being no good is an outgrowth of a developmental derailment. Depression
therefore results from failing to develop a basic sense of trust or the virtue
of hope.
Object relations perspective on depression
From an object relations perspective, many depressed patients
unconsciously experience themselves to be at the mercy of a tormenting internal
object that is unrelenting in its persecution of them. In cases of psychosis,
that primitive forerunner of the superego may actually be hallucinated as a
voice that is unrelentingly critical.
Lacanian theory
A. places heavy emphasis on linguistics
B. has little place for biology or drives
C. postulates that an individual is embedded in political and societal structure
D. views the analytical process as an effort to recognize alienation from one’s
true self
E. all of the above
The answer is E (all)
The French psychoanalyst Jacques Lacan (1901-1981) made a lasting impression on
French psychoanalysis as well as on literary and film criticism in academic
departments throughout the world. Lacan’s reading of Freud relies heavily on
linguistics. The notion that human beings are constituted by language is one of
three basic principles endorsed by Lacan. The unconscious is structured like a
language that consists only of signifiers; biology and drives have no place in
his theory. Second, the ego does not exist as an autonomous structure. A third
principle is that an individual is inevitably embedded in political and societal
structures that cannot be transcended.
Lacan thrived on being unorthodox. He denied the significance of diagnoses,
rules, or established schools of thought. He saw the analytical process as an
effort to recognize the alienation from one’s true self. Analysis was also
designed to bring out underlying structures and contexts in the unconscious.
The Oedipus complex as described by Freud involves all of the following except A. adult sexuality B. rivalries C. anal phase D. intense love relationships E. both mother and father
The answer is C
The phallic period (not anal phase), during which the Oedipus complex emerges,
is a critical phase of development for the budding formation of the child’s own
sense of gender identity-as decisively male or female-based on the child’s
discovery and realization of the significance of anatomical sexual differences.
Adult sexual adjustment is said to rely on the attachment to one parent and the
identification with the other. The events associated with the phallic phase also
set the stage for the developmental predisposition to later psychoneuroses.
Freud used the term Oedipus complex to refer to the intense love relationships,
together with their associated rivalries, hostilities, and emerging identifications,
formed during this period between the child and parents
The work of Anna Freud, daughter of Sigmund Freud, included all of the
following except
A. contributions to child psychoanalysis
B. development of modern ego psychology
C. studies on the function of the ego in personality development
D. contradictions to her father’s claims about psychosexual development
E. expansion on individual defense mechanisms
The answer is D
Anna Freud (1895-1982) was not known to have contradicted her father’s claims on
psychosexual development. Anna Freud, the daughter of Sigmund Freud, ultimately
made her own set of unique contributions to psychoanalysis. Whereas her father
focused primarily on repression as the central defense mechanism, Anna Freud
greatly elaborated on individual defense mechanisms, including reaction
formation, undoing, introjection, identification, projection, turning against
the self, reversal, and sublimation. She was also a key figure in the development
of modern ego psychology in that she emphasized that there was "depth in the
surface." In other words, the defenses marshaled by the ego to avoid unacceptable
wishes from the id were in and of themselves complex and worthy of attention. Up
to that point, the primary focus had been on uncovering unconscious sexual and
aggressive wishes. She also made seminal contributions to the field of child
psychoanalysis and studied the function of the ego in personality development.
According to Freud, the Oedipus complex is resolved through
A. the castration complex
B. the acting out of symbolic rivalries
C. moving on to the genital stage of development
D. the realization of one’s gender identity
E. identification with the opposite-sex parent
The answer is A
There is some differentiation between the sexes in the pattern of development.
Freud explained the nature of this discrepancy in terms of genital differences.
Under normal circumstances, he believed that, for boys, the Oedipal complex was
resolved by the castration complex. Specifically, the boy had to give up his
strivings for his mother because of the threat of castration-castration anxiety.
In contrast, the Oedipus complex in girls was also evoked by reason of the
castration complex. Unlike in boys, little girls are already castrated, and as a
result, they turn to their fathers as bearers of the penis out of a sense of
disappointment over their own lack of penises. Little girls are thus more
threatened by a loss of love than by actual castration fears.
Erikson differs from Freud by his placing greater emphasis on A. interpersonal relationships B. cultural factors in development C. instinctual drives D. psychosexual development E. object relations
The answer is B
Erikson’s work concentrated on the effects of social, cultural, and psychological
factors in development. Although Erikson acknowledged the important role of
sexuality, it was less central to his theory. The concepts of instinctual drives
and psychosexual development are essential parts of Freud’s theories, not
Erikson’s. Object relations, which refer not to interpersonal relationships but
to the interactions of internalized constructs of external relationships, is the central idea in object relation psychology.
You have a 72-year-old patient who has been very concerned with her
appearance ever since you met her. She has had three facelifts, never leaves the
house without makeup, and refuses to allow her grandchildren to call her
"grandmother." Which of the following of Erikson’s stages is this woman having
difficulty mastering?
A. Narcissistic
B. Generativity versus stagnation
C. Egocentric
D. Identity versus role confusion
E. Integrity versus despair
The answer is E
Erikson’s theory of psychosocial development centers around eight stages of ego
development. Integrity versus despair is the last of the stages and takes place
between age 65 years and death. If this stage is successfully mastered, the
individual arrives at a peaceful acceptance of his or her own mortality without
losing interest in life. The patient in this case, however, is clearly having
difficulties with this stage as she attempts to deny the passage of time and
refuses to prepare for this endpoint of the life cycle. A person in a stage of
despair is unconsciously fearful of death and lives in basic self-contempt.
Generativity versus stagnation is another of Erikson’s stages that takes place
from ages 40 to 65 years and is focused on raising children with nurturance and
love and not living in isolation. The stage of identity versus role confusion
occurs between age 11 years and the end of adolescence, during which the
adolescent must begin to establish a future role in adult society.
Which of the following about Melanie Klein is false?
A. She denounced Freud’s "death instinct."
B. She described the "depressive position."
C. She coined the term "persecutory anxiety."
D. She stressed the role of intrapsychic fantasy.
E. She was a child analyst
The answer is A
Melanie Klein thought that Freud’s concept of the "death instinct" was central
to understanding aggression, hatred, sadism, and other forms of badness, which
she viewed as derivatives of the death instinct. Her perspective grew largely
from her psychoanalytic work with children. She became impressed with the role
of unconscious intrapsychic fantasy and proposed that infants project derivatives
of the death instinct onto the mother and then fear attack from the "bad
mother," a phenomenon referred to as persecutory anxiety. This anxiety is
associated with Klein’s paranoid-schizoid position. Through the integration of
good and bad internal object relations, infants develop concern for the mother
toward whom they have developed harmful fantasies. This concern results in
repression and entering of the depressive position.
Which of the following statements regarding Freud’s view of hypnosis is
not true?
A. Freud believed hypnosis encouraged the patient to please the hypnotist.
B. Freud believed no patient was completely refractory to hypnosis.
C. Freud eventually abandoned the use of hypnosis for the use of free association.
D. Freud believed hypnosis concealed aspects of transference.
E. None of the above
The answer is B
Freud’s concept of transference was to become a cornerstone of psychoanalytic
theory and technique, a discovery that eventually contributed to his abandonment
of hypnosis as a tool. Freud first observed that many patients were simply
refractory to hypnosis. When a patient could be hypnotized, he noted, after the
discovery of transference, that hypnosis concealed aspects of the transference,
so these aspects could not be investigated as part of the process. He also
believed that hypnosis encouraged the patient to please the hypnotist instead of
learning about the origins and the meanings of symptoms. By the late 1890s,
Freud abandoned hypnosis. Instead, he had the patient lie on the couch and say
whatever came to mind without censorship, which is the method of free association
that remains a central part of psychoanalytic technique today
According to Otto Rank, death fear is
A. the fear of dying usually associated with a phobia
B. the fear of losing all ties in the process of becoming separate
C. the fear of dying "before one’s time"
D. the fear of losing one’s identity by fusing with another person
E. none of the above
The answer is D
Death fear is the fear of losing one’s identity by fusing with another person.
The weaker one’s personal identity, the stronger the death fear.
Life fear, by contrast, is fear of losing all ties in the process of becoming
separate. Every person experiences the cycle of movement from union to
separation and back again as part of the life process. This movement takes place
at various levels, including family, societal, artistic, and spiritual. At each
level, there is one or more movement toward union and rebirth. Each person, for
example, usually yields to a love experience in which personal differences are
set aside to experience unity with another, to experience self-worth and to be
relieved of the sense of difference. The yielding to another ends when the will
asserts its separateness, and a new affirmation of individuality occurs.
Fear of dying associated with a phobia or "before one’s time" are not ideas
associated with Otto Rank (1884-1939).
A patient of yours reports having recurrent dreams of snakes shedding their skins. According to Carl Gustav Jung, this image is an example of which of the following? A. Illusions B. Phallic symbol C. Archetypes D. Manifest content E. Primary process
The answer is C
Carl Gustav (1875-1961) Jung believed archetypes to be instinctual patterns.
Archetypes represent the basic motivations and drives that become organizational
units of the personality. Snakes shedding their skins are usually interpreted as
a symbol for change and renewal. Primary processes, manifest content of dreams,
and phallic representations are Freudian concepts.
Which of the following theorists is considered the founder of the attachment theory? A. John Bowlby B. Otto Kernberg C. Melanie Klein D. Heinz Kohut E. Adolf Meyer
The answer is A
John Bowlby (1907-1990) is generally considered the founder of attachment
theory. He formed his ideas about attachment in the 1950s while he was
consulting with the World Health Organization (WHO) on the problems of
homelessness in children. He stressed that the essence of attachment is
proximity (i.e., the tendency of a child to stay close to the mother or
caregiver). A basic sense of security and safety is derived from a continuous
and close relationship with the caregiver, according to Bowlby. He believed that
without this early proximity to the mother or caregiver, the child does not
develop a secure base, which he considered a launching pad for independence. In
the absence of a secure base, the child feels frightened or threatened, and
development is severely compromised.
Otto Kernberg works as one of the most influential object relations theorists in
the United States. Melanie Klein evolved a theory of internal object relations
intimately likened to motivational drives. Heinz Kohut is best known for his
writings on narcissism and the development of self-psychology. Adolf Meyer
introduced the concept of common sense psychiatry, which focused on the ways a
patient’s current life situation could be realistically improved.
Erik Erikson’s epigenetic principle states
A. the genetic component of personality must be explored to fully understand the
ego
B. development spans the entire life cycle, from infancy through old age and
senescence
C. each developmental stage must be completed but in no particular order
D. each sequential stage must be satisfactorily resolved for development to
proceed smoothly
E. none of the above
The answer is D
Erikson’s formulations were based on the concept of epigenesis, a term borrowed
from embryology. His epigenetic principle holds that development occurs in
sequential, clearly defined stages and that each stage must be satisfactorily
resolved for development to proceed smoothly. According to the epigenetic model,
if successful resolution of a particular stage does not occur, all subsequent
stages reflect the failure in the form of physical, cognitive, social, or
emotional maladjustment
According to Erich Fromm, which of the following character types are typical of modern capitalist society? A. Exploitative B. Hoarders C. Marketers D. Receptive E. All of the above
The answer is E (all)
As a social philosopher and critic, Fromm did not really develop a systematic
theory of psychopathology. Rather, he identified three major mechanisms of
retreat from individuation. Some individuals, he said, may seek an authoritarian
solution, trying to live through someone or something external to themselves,
relying on that for their sense of adequacy. Others may become destructive,
attacking anything that confronts them with their separateness and loneliness.
Most individuals develop a conformist attitude, warding off the anxiety of
experiencing their own intentionality by accepting socially offered thoughts,
roles, and attitudes.
These mechanisms result in four different unproductive orientations or
characters typical of modern capitalist society: receptive, exploitative,
hoarding, and marketing. The receptive character often appears to be cooperative
and open; however, the primary agenda is to establish a passive relationship
with a leader who solves problems magically. Exploitative characters are
likewise interested in filling themselves up from the outside; however, they
aggressively manipulate and usurp whatever reduces their terror. Hoarders
collect, store, and close in on themselves, often being cold and aloof in their
efforts to feel secure. Marketers treat themselves as a plastic commodity to be
manipulated as needed to achieve externally validated success
Separation and individuation
A. have no associated anxiety
B. involve attaining a sense of object permanence
C. involve a "practicing" subphase
D. begins at approximately 8 or 9 months of age
E. is based on the work of Dan Stern, MD
The answer is C
Margaret Mahler (1897-1985) has conceptualized the process of development in
terms of phases of separation and individuation. The "practicing" subphase of
this process follows the first or "hatching" subphase, which arises at
approximately 4 or 5 months of age. The third subphase, "rapprochement"
involves separation anxiety. The child’s wishes to be separate from the mother
are tempered by an increasing awareness of the need for and dependence on the
mother. The fourth, and final phase, the subphase of "object constancy,"
involves consolidation of individuality and mature psychological involvement
with others. Object permanence, the knowledge that objects in the external world
have an existence independent of the child’s actions on them or interactions
with them, is a major accomplishment of Piaget’s sensorimotor period of
intellectual development. Dan Stern, a psychiatrist and psychoanalyst, who
focused his work on infant observation, brought into clearer focus the intense
affective and interactional matrix between mother and child and directed
attention more specifically to the emergence of a sense of self.
Which of the following is not considered a mature defense mechanism? A. Suppression B. Somatization C. Asceticism D. Anticipation E. Altruism
The answer is B
Somatization is an immature defense mechanism. In it, psychic derivatives are converted into bodily symptoms, and patients react with somatic manifestations
rather than psychic manifestations. All of the others are mature defenses.
Anticipation is goal directed and involves realistic anticipation or planning
for future inner discomfort. Suppression involves the conscious postponement of
attention to a conscious impulse or conflict. Altruism uses constructive and
instinctually satisfying service to others to undergo a vicarious experience.
Asceticism involves the assignment of value to specific pleasure and is directed
against all base pleasures.
According to Carl Gustav Jung, archetypes are
A. instinctual patterns
B. expressed in mythological images
C. expressed in representational images
D. organizational units of the personality
E. all of the above
The answer is E (all)
Carl Gustav Jung believed archetypes to be instinctual patterns. He believed
that all psychic energy is transmitted in forms of experience, behavior, and
emotion, which are expressed in representational or mythological images. Thus,
the archetypes represent the basic motivations and drives that become organizational
units of the personality
Conformity archetype
The “persona” (or mask) is the outward face we present to the world. It conceals our real self and Jung describes it as the “conformity” archetype. This is the public face or role a person presents to others as someone different to who we really are (like an actor).
