THEORIES OF THE MIND

and
PSYCHOPATHOLOGY

PSYCHIATRY II
 Psychopathology
Psychopathology refers to problematic
patterns of thought, feeling, and behavior
Disrupted functioning at home, work, and in
the persons social life
Patterns that cause distress in the person or
in others
Psychopathology literally means sickness of
the mind
Psychopathology varies between and
within cultures
1999 John Wiley and Sons, Inc.
Understanding Psychopathology

What is abnormal?
The definition of ABNORMAL used in
DSM-IV-TR (Diagnostic and Statistical
Manual of Mental Disorders, 4th edition)
Abnormal describes behavioral,
emotional, or cognitive dysfunctions that
are unexpected in their cultural context
and associated with personal distress or
substantial impairment in functioning.
Psychoanalysis
Freud
Office-based psychiatry
Drive theory
Structural model of the mind (ego,
id, superego)
Unconscious
 Psychoanalysis in practice
Free association
Transference
Resistance
Psychoanalytic Theory of
Personality

Sigmund Freud
Components of Personality
Defense mechanisms
Psychosexual stages
 Sigmund Freud
(1856-1939)
Jewish background, though
avowed atheist
Lived in Vienna until Nazi
occupation in 1938
Had medical background-
wanted to do
neurophysiological research
Private practice with specialty in
neurology
Private practice in nervous and
brain disorders
 Early 1900s published many
Freud works--
Interpretation of Dreams (1900)
The Psychopathology of
Everyday Life (1901)
1905 concept of sexual drive
being most powerful
personality component
1906 Psychoanalytic Society
formed
Many works burned in Nazi
occupation (starting 1933)
Left Austria, fled to England
1938
Died of jaw cancer 1939

http://www.pbs.org/wgbh/aso/databank/entries/bhfreu.html
 Freud's Path

How did a medically trained neurologist

come to describe this particular theory of
the mind?

State of art of psychological care in the

19th century

Freudian problems in Victorian context

 Basic Principles
Pleasure Principle: constant drive to
reduce tension thru expression of
instinctual urges
Mind is a dynamic (changing/active)
process based on the Pleasure
Principle
 Basic Principles
Libidinal (sexual, aggressive) instincts
drive people
In children libido isnt purely sexual, its
pleasure thru sensations (oral, anal
gratification, etc.)
Behaviors result from conflicts:
Between instinctual libidinal drives
(aggression, sex) and efforts to repress
them from consciousness)
 More Basic Principles
The Cathartic Method
Primary vs. Secondary Gain
Transference and Countertransference
Ego-Syntonic vs. Ego-Dystonic
 Cathartic Method
Therapy benefits thru release of pent-up
tensions, catharsis
Some inherent value in the talking
cure- being able to unload, or get
stuff off your mind
 Primary vs. Secondary Gain
Primary Gain: symptoms serve a
purpose: they function to decrease
intra-psychic conflict and distress by
keeping such unpleasantries from
conscious awareness
 Primary Gain: Examples:
Comfort of being taken care of thru
assumption of the sick role
Conversion Disorder- psychological
conflict is converted into physical
symptom that allows for more
acceptable expression of an
unacceptable wish
 Secondary Gain
Actual or external advantages that
patients gain from their symptoms, or
from being ill:
Relief from duties, responsibilities (work)
Prescription drugs (ex. Opiates)
Manipulation in relationships
Deferring of legal proceedings, exams
Food, shelter, money (financial gain)
 Transference
Displacement (false attribution) of
feelings, attitudes, behavioral
expectations and attributes from
important childhood relationships to
current ones
 Transference
Traditionally refers to what the patient
projects onto the therapist, but applies
to other situations as well- ex.
relationships in general
Aka emotional baggage
Occurs unconsciously (persons
unaware theyre doing it)
 Countertransference
Feelings toward another are based on
your own past relationships/
experiences.
Traditionally refers to the therapist
projecting their own feelings (issues,
emotional baggage) onto their patient
 Ego-syntonic vs. dystonic
Neurotic symptoms are distressing to
the person, or ego-dystonic
Vs.
Character pathology, which is ego-
syntonic; patient doesnt perceive as a
problem; only problematic in dealings
with others/ external world
 Two Freudian Schemata

The importance of theories of the mind-a

framework in which to understand
presenting problems.

Topographic theory

Structural theory
 Topographical Model
Freuds first model of psychopathology
Division of the mind into three different
layers of consciousness:
Unconscious
Preconscious
Conscious
 Topographic Model
Conscious (cs)-the part of the mind that
interacts with the external world, and which
can reflect on itself.

Pre-conscious (pcs)-the part of the mind in

which thoughts, feelings and ideas are being
prepared for outward expression. Can be
brought to attention.

Unconscious (ucs) governed by the pleasure

principle. The cauldron of wishes, desires and
fears that make up the bulk of our mind.
3 Levels of Awareness
Conscious
Preconscious
Unconscious
 Conscious
Current contents of
your mind that you
actively think of
What we call
working memory
Easily accessed all
the time
 Unconscious
Contains repressed thoughts and
feelings
Unconscious shows itself in:
Dreams
Hypnosis
Parapraxes (Freudian slips)
Driven by Primary Process Thinking
 Primary Process Thinking
Not cause-effect; illogical; fantasy
Only concern is immediate gratification
(drive satisfaction)
Does not take reality into account
Seen in dreams, during hypnosis, some
forms of psychosis, young children,
psychoanalytic psychotherapy
 Freudian Slips (Parapraxes)
A slip of the tongue
Errors of speech or hearing that reveal
ones true but unconscious feelings
 Preconscious
Contents of the
mind you are not
currently aware of
Thoughts, memories,
knowledge, wishes,
feelings
Available for easy
access when
needed (cues)
 Unconscious
Contents kept out of
conscious
awareness
Not accessible at all
Processes that
actively keep these
thoughts from
awareness
 Structural (Tripartite) Theory
Freuds second model of the mind to
explain psychopathology
Developed in the early 1900s
Freudian Components of
Personality
The Id
The Ego
The Superego
Freuds structure of the mind
 Id
Resides completely at
the unconscious level
Acts under the pleasure
principle
immediate gratification,
not willing to compromise
Generates all of the
personalitys energy
The home of our sexual
and aggressive urges.
Fully unconscious,
although the
unconscious is not fully
id.
the dark inaccessible
part of our
personality...We
approach the id with
analogies: we call it
chaos, a cauldron full
of seething
excitation.
 The ID
Home of instinctual Drives
I want it and I want it NOW
Completely unconscious
Present at birth
Operates on the Pleasure Principle and
employs Primary Process Thinking
 To Review:
Pleasure Principle: constant drive to
reduce tension thru expression of
instinctual urges
Primary Process Thinking: Not cause-
effect; illogical; fantasy; only concern is
immediate gratification (drive
satisfaction)
 Superego
The moralist and idealistic
part of the personality
Resides in preconscious
Operates on ideal
principle
Begins forming at 4-5 yrs of
age
initially formed form
environment and others
(society, family etc)
Internalized conventions
and morals
Essentially your
conscience
 The Superego
Internalized morals/values- sense of
right and wrong
Suppresses instinctual drives of ID (thru
guilt and shame) and serves as the
moral conscience
 The Superego
Largely unconscious, but has conscious
component
Develops with socialization, and thru
identification with same-sex parent (via
introjection) at the resolution of the
Oedipal Conflict
Introjection: absorbing rules for behavior
from role models
 Ego
Resides in all levels
of awareness
Operates under
reality principle
Attempts negotiation
between Id and
Superego to satisfy
both realistically
 The Ego
Created by the ID to help it interface
with external reality
Mediates between the ID, Superego,
and reality
Partly conscious
Uses Secondary Process Thinking:
Logical, rational
 How does the ego develop?
Ego development occurs as result of:
meeting basic needs
identification with others
learning
mastery of developmental tasks
effective problem-solving
successful coping
The ego develops capacities to function in the world,
known as ego functions
Enable people to function in coherent, organized manner
 List of ego functions:
Reality testing
Judgment
Sense of reality of the world & the self
Modulating & controlling drives, affects, & impulses
Object or interpersonal relations
Thought processes
Adaptive regression in the service of the ego
Defensive functioning
Autonomous functioning
Mastery-competence
 Conflicts of Personality
Components
Conflicts between the Id, Superego and Ego
arise in unconscious mind
Cant be reached bc in unconscious
Come out in various ways
Slips of tongue (Freudian slip)
Dreams
Jokes
Anxiety
Defense Mechanisms.
 Ego Defense Mechanisms
Result from interactions between the ID,
Ego, and Superego
Thus, theyre compromises:
Attempts to express an impulse (to satisfy
the ID) in a socially acceptable or
disguised way (so that the Superego can
deal with it)
 Ego Defense Mechanisms
Less mature defenses protect the
person from anxiety and negative
feelings, but at price
Some defense mechanisms explain
aspects of psychopathology:
Ex. Identification with aggressor: can
explain tendency of some abused kids to
grow into abusers
 How defenses operate:
Defense mechanisms operate out of conscious
awareness, while coping mechanisms are conscious

Defenses protect individuals from intolerable or

unacceptable impulses

Effective defenses enable optimal functioning

without undue anxiety, while maladaptive defenses
distort reality & impair overall ego functioning
 Primary Repression
Conflict arises when the IDs drives
threaten to overwhelm the controls of
the Ego and Superego
Ego pushes ID impulses deeper into the
unconscious via repression
Material pushed into unconscious does
not sit quietly- causes symptoms
 Anna Freudian Ego Defenses

Repression
Reaction formation
Projection
Isolation
Undoing
Regression
Introjection (internalization)
Turning against the self
Reversal
Sublimation
Displacement
 Classification of Defenses
Mature
Immature
Narcissistic
Neurotic
 Mature Defenses
Altruism
Anticipation
Humor
Sublimation
Suppression
Sublimation
Healthiest defense
mechanism
Compromise
Takes socially
unacceptable
impulses and turns
them into something
positive & acceptable
 Altruism
Unselfishly assisting others to avoid
negative personal feelings

Anticipation

Thinking ahead and planning

appropriately
 Immature Defenses
Acting Out
Somatization
Regression
Blocking
Introjection
Hypochondriasis
 Neurotic Defenses
Dissociation
Reaction Formation
Repression
Displacement
Isolation of Affect
Intellectualization
Rationalization
 Narcissistic Defenses
Denial
Distortion
Projection
 Repression Denial
Internal impulses and Refusal to accept
memories too external realities
threatening so bared
because too
from entering
awareness threatening to enter
awareness
Displacement
Shifting attention from
one target that is no
longer available to a
more acceptable or
safer substitute
Redirection of unacceptable
feelings, impulses from their
source onto a less
threatening person or object
Ex. Mad at your teacher, so
you go home and kick the
dog
Projection
Attribute unacceptable
thoughts or impulses
onto others (project
these inappropriate
thoughts etc onto
others)
Falsely attributing ones
own unacceptable
impulses or feelings onto
others
Can manifest as
paranoia
Rationalization
Explaining an
unacceptable behavior
in a way that
overlooks present
shortcomings or
failures
Giving seemingly reasonable
explanations for
unacceptable or irrational
feelings
Reaction Formation
Converting
unacceptable and
dangerous impulses
into something positive
to reduce anxiety
Transforming an unacceptable
impulse into a diametrically
opposed thought, feeling,
attitude, or behavior; denying
unacceptable feelings and
adopting opposite attitudes
Ex. Person who loves
pornography leads a
movement to outlaw its
sale in the neighborhood
 Regression
Reverting to behavior that is
characteristic to an earlier
stage of development when
confronted with stress or
anxiety
Return to earlier level of
functioning (childlike
behaviors) during stressful
situations
Ex. Kids regress after
trauma
 Somatization
Unconscious transformation of
unacceptable impulses or feelings into
physical symptoms

Magical Thinking
A thought is given great power, deemed
to have more of a connection to events
than is realistic
Ex. Thinking about a disaster can bring it
about
 Psychosexual Development
Children pass thru a series of age-
dependent stages during development
Each stage has a designated pleasure
zone and primary activity
Each stage requires resolution of a
particular conflict/task
 Psychosexual Stages
Failure to successfully navigate a
stages particular conflict/ task is known
as Fixation
Leaving some energy in a stage
Specific problems result from Fixation,
depending on which stage is involved
Fixation may result from environmental
disruption
 Psychosexual Development
Stages of development in which conflict
over Ids impulses plays out
Ego must control these impulses
If not resolved, psychological issues can
emerge later in life
 Psychosexual Stages
Freud's stages are based on clinical
observations of his patients
The Stages are:
Oral
Anal
Phallic
Latency
Genital
 Freudian Psychosexual
Stages
Oral stage (First year of life)
Focus on primary gratification through oral means
Anal stage (2-3 yrs)
Focus on primary gratification through holding on & letting
go, corresponds with toilet training
Phallic (Oedipal) stage (3-5 yrs)
Focus on primary gratification through genitals; awareness
of erotic feelings for parents; emergence of triangular
relationships
Latency stage (5 or 6 through puberty)
Focus on repression of erotic feelings
Genital stage (puberty through adulthood)
Focus on primary gratification though meeting adult sexual
needs
 Psychosexual Stages
Oral Stage (0-18 months)
Pleasure centering around the mouth
(sucking, biting etc)
Focus: weaning- becoming less dependent
Not resolved? aggression or dependency
later in life-- fixation with oral activities
(smoking, drinking, nail biting etc.
 Psychosexual Stages
Oral (0-18 months)
Anal (18-35 months)
Fixation on bowel and bladder elimination
Focus: search for control
Not resolved? anal retentive (rigid and
obsessive personality) or anal expulsive
(messy and disorganized personality)
 Psychosexual Stages
Oral (0-18 months)
Anal (18-35 months)
Phallic (3-6 years)
Focus: genital area and difference btwn
males and females
Electra Complex or Oedipus Complex
 Complexes in the Phallic
Stage
Oedipus Complex (boys)
Unconscious sexual desires towards mother,
father is competition
Simultaneously fears the dad- castration anxiety
Electra Complex (girls)
Unconscious sexual desires towards father and
mother is completion
Penis envy
Resolution?
Kid identifies with same sex parent
 Psychosexual Stages
Oral (0-18 months)
Anal (18-35 months)
Phallic (3-6 years)
Latency (6 yrs to puberty)
Sexual interest is repressed
Kids play with same sex others-- until
puberty
 Psychosexual Stage
Oral (0-18 months)
Anal (18-35 months)
Phallic (3- 6 years of age)
Latency (6 yrs to puberty)
Genital (puberty and beyond)
Sexual urges awaken
If developed properly develop these urges
towards opposite sex members with fixation on the
genitals
 Key Contributions of Freud
Psychic Determinism/ Dynamic Model
Topographical Model of the Mind
Unconscious, Preconscious, Conscious
Stages of Psychosexual Development
Structural Model of the Mind
Defense Mechanisms
Transference and Countertransference
 Eriksonian Ego Psychology

The work of Erikson not only grew out of

a critique of Freud's psychsexual stages,
it also integrated observations from post-
Freudian ego psychology.
Ericksons Eight Stages of Man

Epigenetic Stages Ages Virtues

Basic trust vs. mistrust (0-18 mo) Hope

Autonomy vs. shame & doubt (18-3 yr) Will
Initiative vs. guilty (3-6 yr) Sense of purpose
Industry vs. inferiority (6-11 yr)
Competence
Identity vs. confusion (11-18 yr)
Personal identity
Intimacy vs. isolation (young adulthood)
Love
Generativity vs. stagnation (middle adulthood)
Care
Integrity vs. despair (old age)
Wisdom
 What is a crisis?
An upset in psychological equilibrium triggered by:
outside harm or threat from the environment
internal developmental or biological changes
interpersonal challenges, conflicts, or losses

Symptoms may include anxiety, guilt, shame,

sadness, envy, disgust, fear
Traumatic stressactual or threatened severe
injury or death of oneself or significant others
Psychopathology, according to
classical theory
Unresolved conflicts of the mind between id, ego, &
superego or between ego & external environment:
May cause fixation at developmental stages
May cause weak ego functioning , leading to difficulties with
adaptation
May cause inadequate defensive functioning leading to symptoms

Symptoms of unresolved conflict (e.g., anxiety, depression,

compulsions, or sociopathy) are:
Efforts to overcome or work through conflicts
Efforts to compensate for conflicts
Transferencea key to treatments

Transference defined as:

The feelings & wishes from past experiences
placed onto another in the present
The central component of the talking cure
A means for viewing clients unresolved conflicts
by the interaction with the clinician

Countertransference defined as:

The clinicians feelings about the client in treatment

Through understanding transference, clients may develop

insight & self-understanding, leading to change
Treatment based on ego psychology
EGO-MODIFYING
TREATMENT
Focus: past & present; conscious,
unconscious, & preconscious
Nature of change: insight & conflict
resolution
Curative process: make unconscious
conscious through interpretation
Use of relationship: use &
understand positive & negative
transference
EGO-SUPPORTIVE
TREATMENT
Focus: current behavior, conscious
thoughts/feelings; limit past focus
Nature of change: ego mastery,
increased understanding, better person-in-
environment fit
Curative process: strengthen ego,
shore up defenses, promote adaptation
Use of relationship: real
relationship, positive transference,
corrective relationship
THANK YOU!