Part 2 of Abnormal Behaviour in Historical Context.

The historical context of psychopathology is supported by 3 main traditions: Supernatural, Biological and Psychological.

The supernatural tradition sounds very much like the superstitions we would think of today. In this tradition, deviant behaviour mirrors the battle between good and evil. Hence, characters such as demons and witches come into play. One with a psychological disorder was thought to be possessed by evil spirits and so, exorcism [their (in)famous treatment method] was commonly used extricate the evil spirits. People then also held a strong (warped) view that insanity was a natural phenomenon. (Try googling King Charles VI of France, aptly known as the “Mad King”).

There was also the belief that movements of the moon and stars affected people’s psychological functioning (which was how the term “lunatic” came about, with “luna” being moon in Latin).

In my (and many others, I hope) opinion, this is absolute trash. I don’t think I should have even bothered typing those out. But I digress…

The biological tradition then paved its way (thank goodness) thanks to Greek physician Hippocrates (father of modern medicine) and Roman physician Galen. Hippocrates believed that genetics played a role in psychological disorders and that the brain logically houses the disorders since he considered it to be “the seat of wisdom, consciousness, intelligence and emotion”. Galen adopted and developed on Hippocrates’ ideas, giving birth to the Hippocratic-Galenic approach which includes the humoral theory of disorders. In this theory, abnormality is linked with brain and chemical imbalances.

American psychiatrist John P. Grey believed that insanity was always due to physical causes and thus, mentally ill people should be treated as physically ill.

One of the interesting developments of biological treatments is that of the shock treatment. It was observed by Joseph von Meduna that schizophrenia was rare in epileptics and so his followers thought that brain seizures could, perhaps cure schizophrenia. They sent 6 small shocks into the brain of a depressed patient which resulted in convulsions. Afterwhich, the patient recovered. With some modifications, this shock treatment is now known as electroconvulsive therapy (ECT).

Drug therapy is also one of the key features of biological treatments. Nevertheless, the use of drug may have limited success and very often carry side effects with them.

Lastly, the psychological tradition is probably the most dominant. There are various approaches to this tradition, namely moral therapy, psychoanalysis (HUGE CHUNK OF IT!), humanistic, and behaviourism. This tradition was a precursor to modern psychosocial approaches, which focus on psychological as well as social and cultural factors.

Moral therapy began in the 19th century, which was a treatment that involved treating mental patients as normally as possible in normal environments. In other words, they are placed in a setting where normal social interaction is encouraged and reinforced. However, moral therapy faced a decline in the mid 19th century due to various reasons (which I don’t think is really important :X). After laying dormant for some time, its ideas began resurfacing in psychoanalysis and behaviorism.

The psychoanalytic theory was pioneered by this interesting (weird and sexist) psychologist, Sigmund Freud (this was where “Freudian slips” came about). His most groundbreaking research and discovery was that of the unconscious mind. Freud (and Breuer) also discovered that it is therapeutic to recall and relive emotional trauma that has been made unconscious and to release the accompanying tension, known as catharsis. It promotes a fuller understanding of the relationship between current emotions and earlier events known as insight.

Psychoanalytic theory has three major facets: the structure of the mind, defense mechanisms and stages of early psychosexual development.

The structure of the mind consists of 3 major parts/functions: the id, ego and superego. Id represents our basic drives at birth, including eating, sleeping and even strong sexual and aggressive feelings or energies. The energy or drive within the id is the libido. When left totally unchecked, the id would turn us into rapists, killers and even barbarians. It operates in accordance to the pleasure principle which aims to maximize pleasure and eliminate any associated tension or conflicts. Its characteristic way of processing information is known as the primary process.

The superego or conscience represents the moral principles instilled in us by our parents and our own culture. It serves to counteract the potential aggressive and sexual drives of the id, which then forms the basis for conflict of the id and superego.

When 2 parties quarrel, a mediator is often needed, hence, the role of the ego. The ego is responsible for finding realistic and practical ways to satisfy the id drives. If it mediates successfully, we can proceed to higher intellectual and creative pursuits of life. Otherwise, the id or superego overwhelms and result in psychological disorders.

These conflicts are known as intrapsychic conflicts, since they all occur within the mind.

The ego can perform defense mechanisms in its attempt to mediate. Defense mechanisms are common patterns of behaviour, often adaptive coping styles when they occur in moderation, observed in response to particular situations. Catch no ball? Read on.

A few examples of defense mechanisms can be found in the DSM-IV-TR. Namely:

Denial: refusal to acknowledge some aspect of objective reality or subjective experience that is apparent to others (this is obvious).

Displacement: transferring a feeling about or a response to, an object that causes discomfort onto another, usually less threatening, object or person. Analogy: Your tutor gave you shit grades for an essay you drained yourself over. You are angry, but you know that confronting your tutor is probably the stupidest thing to do unless you are prepared to get more shit grades. So you go home and “displace” your anger at your stress ball (cps stress ball!) by whacking it up down left right on your wall.

Projection: falsely attributing own unacceptable feelings, impulses or thoughts to another individual or object. Analogy: Jac jac is pissed off because she got nagged at by her mum. So when she met up with peace-loving gabby, she suddenly yells at him, “WHY ARE YOU PISSED OFF WITH ME!?!!?!!!#$#$#%$^^%^#!!!@@” and gabby’s jaw drops as he does some soul searching but couldn’t find his soul…ahem. I mean anything wrong. And he says to himself, “jac jac must be having pms.”

Rationalization: Conceals true motivations for actions, thoughts or feelings through elaborate reassuring or self-serving but incorrect explanations (layman: cook up some excuse to make yourself feel better).

Reaction formation: substituting behaviour, thoughts or feelings that are the direct opposite of unacceptable ones. Analogy: You the tendencies of a compulsive gambler but due to certain obligations to avoid it, you condemn gamblers as a result.

Repression: blockage of disturbing wishes, thoughts or experiences from conscious awareness. (layman: forcing yourself to forget traumatic experiences).

Sublimation: directing potentially maladaptive feelings or impulses into socially acceptable behaviour. Analogy: when I feel stressed out or pissed off, I go running to relief tension.

Psychosexual stages of development is the part of Freud’s theory which I think is the most absurd and unimaginable. It includes the oral, anal, phallic, latency and genital stages.

Oral stage: at roughly 2 years old, characterized by the need for food. Sucking, lips, mouth, tongue become focus of libidinal drives. When not appropriately gratified (fixation), it might result in excessive thumb sucking and oral stimulation through eating, biting nails etc when they grow older.

Phallic stage: the most unacceptable stages of all to me. :X It involves the weird intrapsychic known as the Oedipus complex: young boys at the certain time will begin to fall in love with their mothers and hope to have sexual interactions with them. At the same time, they feel angry towards their father because they are jealous of him. However, knowing that their father is far more powerful and might cut off their penises as a punishment for their lust (castration anxiety), they control their lust (out of respect and love maybe) and model themselves upon their fathers and parental love from their mothers are enough. The female version would be the Elektra complex, where young girls fall in love with their fathers and want to possess them. On top of that, they have a strong desire for a penis (penis envy). Nevertheless, the conflict is resolved when girls look toward healthy heterosexual relationships and anticipation for a baby as a substitute for having a penis. (warped right!?)

Freud termed psychological disorders resulting from unconscious conflicts and anxiety they cause as neurosis (plural: neuroses).

Anna Freud developed his father’s ideas and came up with the object-relations theory, which states that children incorporate images, memories and values of a person who was important to them and to whom they were/are emotionally attached. Object refers to people and the process of incorporation is introjection. According to the theory, you tend to see the world through the eyes of the person incorporated into your self.

Carl Jung and Alfred Adler were students of Freud, but broke off from him to develop their own school of thoughts. Unlike Freud, they believed that human nature is positive and there is a strong drive toward self-actualization, very similar to the humanistic theory. While acknowledging the presence of the subconscious mind, they focus on the influence of culture and society on personality as well.

Psychoanalytic psychotherapy includes free association which explores threatening material repressed into the unconscious. The patient is instructed to say whatever comes to mind without censoring. Another technique is dream analysis, where dream contents are examined as symbolic of id impulses and intrapsychic conflicts (for example, if you dream of a snake, it symbolizes the penis. Erps.)

Between the therapist and the patient, there can be a relationship of transference, where patients come to relate the therapist as they to do important authority figures, like their parents and feel accordingly to the therapist (either resent or fall in love with the therapist). There can also be a relationship of counter transference where the therapist project his/her personal issues and feelings onto the patient.

Psychodynamic theory and therapy is the contemporary version of psychoanalysis. On the whole, there is little efficacy for this theory because it is not testable and hence, unscientific.
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Right. It’s 4am now and I’m kind of tired. To be continued…