The psychoanalytic perspective is part of the approach to abnormal behavior

As an offspring of the oldest branch of psychology, namely psychodynamic theory, psychoanalysis developed with a reformed basis of the original theory of Sigmund Freud. Psychoanalysis offers in depth analysis of psychopathological phenomena, based on the core concept that all the disorders of mind originates from the conflicts of the unconscious mind developed during the childhood due to the contrasting demands of social norm and instinctual sexual and aggressive reactions.

This article discusses the basis of mental disorders, and proceeds to introduce the psychoanalytic perspective on the development and prevalence of a mental disorder in an individual based on the structural model of the psyche presented by Freud. The latter part of the article offers an explanation of psychopathologies based on psychoanalysis.

A mental disorder is a condition characterized by abnormal thoughts, feelings and behaviors. Defining the difference between normalcy and abnormality regarding a psychological phenomenon is a difficult but fundamentally essential task when discussing psychopathology. In the normal context, abnormal behavior is defined as anything that deviates from what is considered normal. But this definition is not sufficient due to the cultural differences that exist among the different countries, regions and races. Since behavior and attitudes vary from one culture to another, what is considered normal by one may not be considered as such by another. On the other hand, violating the social or cultural norms does not necessarily put such behavior in the category of a mental disorder.

In order to fully understand the boundary between a healthy mind and an unhealthy one, the definition of mental health should be explored further. To this effect, studying the definitions of mental health in general implies an optimum level of psychosocial functioning. A few of the definitions are given below.

“A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living.”

— Peplau (1952)

“a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

— World Health Organization

“Simultaneous success at working, loving, and creating with the capacity for mature and flexible resolution of conflicts between instincts, conscience, other people and reality.” — American Psychiatric Association

With regard to these definitions a mental disorder can be considered to be any deviation from these definitions.

The definition of mental disorder presented in the current American diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), includes a number of characteristics essential to the concept of mental disorder.

In DSM-IV-TR, mental disorder is defined as:

“A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original causes, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.” — (American Psychiatric Association, 2013, p. xxxi)

This definition highlights the following criterion when diagnosing a mental disorder.

• There are significant disturbances in thoughts, feelings, and behaviors.
• The disturbances reflect some kind of biological, psychological, or developmental dysfunction.
• The disturbances lead to significant distress or disability in one’s life.
• The disturbances do not reflect expected or culturally approved responses to certain events.

Different psychological schools define the term of disorder in various manners. Psychoanalytic theory holds that abnormal behavior stems from childhood conflicts over opposing wishes regarding sex and aggression. According to Freud, children pass through a series of stages in which sexual and aggressive impulses take different forms and produce conflicts that require resolution. If these childhood conflicts are not dealt with successfully, they remain unresolved in the unconscious and eventually bring about abnormal behavior during adulthood. To uncover the roots of people’s disordered behavior, the psychoanalytic perspective analyzes their early life history.

As a basis for diagnostic procedures, defining mental disorder is crucial. To meet this requirement, numerous definitions of mental disorder have been presented to date, but an entirely satisfactory universal definition has not yet been developed, as none can apply to all where a disorder is thought to be present. Some believe that there is no essential criterion or set of criteria that can definitively distinguish all cases of disorder from non-disorder.

The origin of psychoanalytic theory lies in the psychodynamic theory developed by the Austrian physician Sigmund Freud in the early 1900s, arguing that behavior is motivated by inner forces and conflicts about which we have little awareness or control. To uncover the roots of people’s disordered behavior, the psychoanalytic perspective analyzes their early life history. Freud constructed the theory as an explanation for mysterious phenomena such as the meaning behind dreams, slips of the tongue, and behavioral reflex reactions to stressful situations.

The unconscious is a primary focus in psychoanalytic theory due to its typical development in youth and the ways in which it influences nearly every aspect of an individual’s life. The unconscious mind also holds repressed memories and unexpressed urges that make their way into the conscious mind through a variety of different means. However, there is no sure way to link what happens to people during childhood to abnormal behavior that they display as adults. Consequently, we can never be sure that specific childhood experiences can be linked to specific adult abnormal behaviors.

Although some of the original Freudian principles have been roundly criticized, the contemporary psychoanalytic perspective has provided a means not only to understand and treat some kinds of psychological disorders but also to understand everyday phenomena such as prejudice and aggression.

The mental apparatus

The Freudian theory of the structure of the mind composed of three components, where he distinguished three structurally different parts.

Id: The “Id” refers to the innate instincts and urges that are present in every human being from birth. During the first few years of life, an infant’s personality is entirely made up of the Id, which causes the child to act in ways that are directed towards immediate gratification. Instant gratification and the pleasure principle are the focus of the Id, which functions in the unconscious mind.

Ego: The “Ego”, the only of the three elements that functions in the conscious mind, works to balance and compromise between the demanding id and superego. Ego acts as the individual between the two other parts, attempting to decide which advice to take. Ideally, a mentally stable individual will find a method of satisfying both parties through the means of a compromise.

Superego: The “Superego”, which functions as the direct opposite of the id, works to force an individual to conform to societal norms and standards. The superego acts as a moral guide. When young children are taught about their conscience, the part of the brain that distinguishes right from wrong, they are actually learning about their superego. Contrary to the id, the superego is developed through social interaction and can form differently from one individual to the next depending on the frequency of rewards granted for acting in ways that conform to societal norms and punishment inflicted for deviant behavior.

The id is the inherited reservoir of chaotic instinctual impulses that have not been harmonized with each other or with the external reality.

The superego embodies the code of the society, which is dependent on the social environment and varies in different cultural values. Through identification with adults this code is gradually incorporated into the personality and becomes part of it. The superego develops with the process of child’s identification with the attitudes, opinions, and judgments of the parents, which is one of the most important factors in the learning process.

The superego is acquired early and it remains unconscious, functions automatically and is not easily changed by later influences. It can be compared to a complex set of conditioned reflexes. The existence of superego explains how in every form of civilization there is a disciplinary force in individuals which is crucial for maintaining social order.

The Ego Functions

The ego is the integrating part of the personality which modifies, selects, controls and coordinates the tendencies of the id and excludes or modifies those in conflict with external reality.

The ego is a product of development and adaptation which is a continuous process which begins at birth. It learns correct behavior through identification with others who have mastered it. This behavior becomes automatic and habitual through repetition.

The ego has two perceptive sources, one directed internally towards the instinctive impulses and needs, the other directed towards the external reality through sense perception.

The Integrative Function of the ego is to satisfy the internal perception with the results of sense perception and to carry out this process so that the demands of the both are satisfied. The executive function of the ego includes its control of voluntary motor behavior, through adaptive behavior; conditions within the organism are maintained in constant homeostatic equilibrium.

The Conscious ego is the most moldable part of the mind , since at any moment it can adjust behavior in a given situation, whereas automatic reactions and rigid reflexes respond to stimuli in an uniform manner so cannot adjust themselves to sudden changes in the situation.

The functioning of the whole mental apparatus can be described as follows: Instincts and needs in the id become conscious because the conscious ego controls the activity on which their satisfaction lies. A large number of instinctual demands becomes conscious and is accepted or rejected after conscious deliberation. Conscious mental activity consists in a continual reconciliation between contrasting desires and needs. Some of these are temporally checked, some are modified, some subordinated to more important demands or reconciled with existing external conditions. Under difficult conditions anyone’s adaptive capacity to carry out these functions effectively might fail. Continued strain creates acute neurotic disturbances in formerly healthy persons.

The breakdown of this adaptive functioning of the ego will result in neuroses and psychoses.

Freud’s theory gives a series of stages to the development of personality in an individual, each stage concerned with a different focus of libido. Freud argued that in order to achieve a healthy personality, an individual must pass through each stage without under-compensation or overcompensation of gratification.

Oral Stage: The oral stage, which takes place from birth to two years of age, occurs when an infant’s libido is centered on the mouth area. Individuals who do not properly move past this phase exhibit overeating and/or smoking habits in adulthood.

Anal Stage: The anal stage begins once a child reaches two years of age and continues approximately until his or her fourth birthday. During this time, the libido switches from the mouth to the anus when the child begins to develop the skills to hold in and release defecation at will. Typically, the anal stage is triggered by potty-training. If this stage is not properly resolved, it can result in an anal explosive character (someone who is messy and careless in adulthood) or an anal retentive character (someone who is extraordinarily neat and orderly in adulthood).

Phallic Stage: The Phallic Stage begins after a child’s fourth birthday when he or she discovers gender. Male children are said to experience the Oedipus complex, while female children experience the Electra complex.

Latency Stage: The latency stage refers to a period of sexual absence between the ages of 7 and 11. During this time, boys and girls begin to form same-sex groups and shy away from closeness with members of the opposite sex.

Genital Stage: The genital stage occurs once an adolescent begins puberty, typically around the age of 12, and lasts for the remainder of the individual’s life. During this phase the libido becomes focused in the genital region, which causes individuals to seek out sexual partners and concentrate more on reproductive means than during previous stages.

When anxiety occurs, in the form of unacceptable or potentially harmful stimuli, within the mind a range of defense mechanisms may be triggered. These are tactics which the Ego develops to help deal with the conflicts between Id and the Superego.

All Defense Mechanisms share two common properties:

1. They often appear unconsciously.

2. They tend to distort, transform, or otherwise falsify reality. In distorting reality, there is a change in perception which allows for a lessening of anxiety, with a corresponding reduction in felt tension.

Repression, one of the most frequently used defense mechanisms, involves individuals pushing the troubling event or circumstance out of the conscious part of the brain in order to prevent it from causing a great deal of sorrow or despair.

Denial involves the individual not accepting the reality of a circumstance and instead going about his or her life as if it had not occurred.

Displacement occurs when the individual is unable to direct his or her anger at the cause of the unfortunate events after a stressful event or circumstance transpires, and instead takes it out on a less threatening target, such as a spouse or pet.

Projection occurs when an individual is incapable of dealing with the way he or she feels about a person or event and expresses sentiments that other individuals feel that way instead.

Reaction Formation involves an individual acting in ways that run contrary to the way he or she actually feels.

Regression involves individuals reverting back to behaviors commonly put to use in their childhood, such as thumb sucking or hair twirling, in order to cope with a difficult situation or stressful circumstance.

Rationalization, the healthiest of defense mechanisms, occurs when an individual copes with a traumatic event by focusing on the good that it has brought to their life and discovering how the setback can actually become beneficial.

Sublimation, the only defense mechanism that involves conscious thought, occurs when an individual redirects frustration towards something productive.

Pleasure Principle, the instinctual force guiding the id, which involves seeking pleasure and avoiding pain to satisfy biological and psychological needs.

In the terms of modern psychoanalytic theory mental disorders can be understood as evidences of malfunctioning of the psyche to various degrees and in various ways.

The ego is the part of psyche that assumes the task of harmoniously gratifying our needs and desires, which are often in conflict with each other and with external conditions. The ego must reckon with different desires and interests and accepted standards and must compromise by giving as much satisfaction as possible to each. Whenever ego is unable to perform this task, the results of its failure in coordinating manifest as a mental disorder.

During the early years of childhood, there are many possibilities for trouble when the various parts or functions of the mind are in the process of developing. For example, an infant deprived of normal physical handling and stimulation by a maternal figure during its first year of life, will fail to develop many of its ego functions properly, and its capacity to relate and deal with its external environment may be impaired. Due to the underdeveloped ego, it may be unable to perform its essential task of mediating between the id and the superego, of controlling and neutralizing the drives, leading to a psychological impairment.

Looking at the same scenario from a point of view of the drives, it can be understood that they must be suitably controlled, but not excessively so. Too little control of the drives will result in an individual who is unfit to be a part of normal society. On the other hand, excessive suppression of drives will result in diminished capacity of sexual intimacy and competitiveness, and most likely lead to self-destructive behaviors. It is also possible for the normal process of the superego to be impaired during the course of development, which also will result in incorrect handling of the drives.

Many of the ego’s interests or the activities it chooses as outlets for drive energy and sources of pleasure are selected on the basis of identification that is the assimilation of an aspect of another by an individual who will transform himself by the model the other provides. However, instinctual conflict, “conflict between the ego and an instinct” (Nagera, 2014), is another major factor which sometimes be even of a greater importance than identification in the process of ego outlets. In most cases this factor will manifest itself as the defense mechanism of sublimation, but if an inhibition or restriction of ego activity occurs, the instinctual conflict may be resolved or stilled. Such restrictions of ego may be of little consequence in an individual’s life or on the other hand may have severe consequences. Such ego restrictions, as well as fixations and regressions of both the ego and the id produce character traits which we may call normal if they do not interfere unduly with individual’s capacity for pleasure and his ability to avoid severe conflicts with his environment, while they could be called abnormal if they interfere with pleasure to a great extent and cause severe conflicts with his environment. Here, it must be emphasized that there is no sharp dividing line between the normal and the abnormal.

The central dynamic factor in neurosis is repression and the measures taken by the ego to keep all the unacceptable impulses out of itself. Repression is normal in a child, but undesirable in adults. However, every adult carries some degree of repression, with the exception of an ideal ego. The ego develops gradually with growth. It is not heritable, and is a product of our learning. Ego must learn to execute the complex task of coordinating the impulses and needs such hunger, sex and aggression, present at birth, with the conditions in the nature and society.

In young children, only the primitive impulses of id exist, from which the socially adjusted person must be created. The child represses his impulses in this process of ego construction. These repressed impulses can become a problem later in his life, which will lead his unconscious mind to take defensive measures to keep them out of the consciousness. They might emerge to surface as dreams, or neurotic symptoms, irrational anxieties, obsessions and impulsive behavior.

Now, a question of importance must be considered here. As everyone has similar infantile experiences and regresses some of the impulses, why does not everyone develop a neurosis? Here, the earlier mentioned blurred line between the normality and abnormality reemerges. The psychology of neurosis and normality is the same in quality, while the differences merely exist in the quantitative aspect. As discussed earlier, repression is not an efficient method of adjusting needs to life’s requirements. As the ego has to constantly direct defenses against the repressed impulses, the ego is impoverished, constituting a threat to the development of a healthy ego. Therefore, the degree of repression is the major factor in determining the normal and abnormal aspects, as the less the child has to repress and more his adjustment is based upon efficient control, the better his development will be.

As the infant and early childhood ego is too weak to judge and endure frustration, it excludes many desires from the consciousness, by repression. Repression operates as an automatic pattern like a reflex. If an impulse is too strongly suppressed, the ego will repress all the impulses of the type resulting in a maladaptive person as an adult.

In order to compromise reconciling different needs according to their importance and practicality, the desires and needs of the unconscious must be made conscious. Then the ego can get a full perspective about the concerning needs and the conditions upon which their gratification depends. Repressed wishes and desires are excluded from this process of mediation and compromise of the ego, since they are in the unconscious. As the ego gains coordinating and integrating power through experience, it becomes increasingly able to endure temporary frustrations and to control and harmonize needs with accepted standards. All the experiences with an overwhelming intimidating effect (trauma) will get repressed and reduce the ego’s chances to learn how to handle the impulses which need adjusting.

Psychoanalysis recognizes one of the major factors in precipitating neuroses as the negative parental attitudes and influences upon the child during the early childhood. Whether The child’s ego will be encouraged to deal with the impulses successfully or withdraw from this task and repress the impulses depends largely upon parental guidance.

The strength of the ego in maintaining its functional efficiency is the main factor determining the occurrence or the absence of a neurosis in two people who had the same experience. This also explains the later onset of neurosis in some cases. Anyone Can be subjected to experiences so overwhelming that surpass the functional efficiency of his ego. Here, a weak ego will yield to less pressure than a strong one, thus explaining the importance of positive childhood experiences to the mental health of the adult.

Psychoanalysts discuss three factors which together in various digressions contribute to neurotic disease. These are heredity, early experiences of life and actual difficulties in life. A person with an inherited vulnerability will develop neurosis no matter how good the experiences and circumstances of the life will be. In another case, early experiences may have been so unfavorable and created too much vulnerability in the mind, that the person can no longer withstand ordinary difficulties. There are also many neurotic people with no negative heredity or early experience factors but in later life were exposed to situations beyond their control. This view of neurosis is called the relativistic interpretation. This perspective shows that a neurosis must be defined as a relationship between a personality and its social setting. Neurosis sets in when heredity and infantile experience combining in conflict with the environment.

Neuroses

Irrationality: The neurotic symptoms appear to be less rational to the observers and the patients themselves than the normal psychological symptoms.

Disconnectedness of symptoms: The neurotic symptoms are completely isolated and dissociated from the conscious normal life.

Regressive nature of symptoms: The symptoms would seem completely normal if the patient were a child. In cases where this cannot be applied, the symptoms may be a revival of early traumatic experiences that have been repressed.

When the unconscious links in symptom formation are reconstructed, the symptom would no longer be irrational and disconnected. The knowledge of the repressed motivation makes it intelligible and shows its connection with the rest of the personality.

Psychoses

The symptoms are irrational and regressive, same as neuroses, but they are not always disconnected from the normal conscious life. This is particularly true of paranoid delusions. In paranoid psychosis, the unconscious thoughts break its barrier of repression and become a part of the conscious personality, which will lose its cohesiveness as a result. The paranoid patient is aware of his hostile impulses and they are rationalized with delusions, the attempts to create an imaginary situation where the symptoms appear rational and acceptable. As the patient’s ego has an impaired critical sense, the irrationality of the symptoms is not recognized by him.

Freud reasons that the hallucination’s gratifying needs is a regression to infantile ego, which has not yet differentiated between inner and outer worlds. Delusions of a person are also regressions to infantile attitudes towards self, while those of grandeur are overcompensation from the feelings of inferiority. Delusions of self-depreciation are regressions to infantile feelings of inferiority in the adult world.

The common development of a neurosis can be explained as follows:

1. The precipitation factors: A situation the patient cannot cope
2. Failure in the solution of the actual problems: Unsuccessful attempts at adaptation of shorter or longer duration
3. Regression: the replacement of realistic effort to gratify needs by repressive fantasies or/and behavior
4. Primary conflict revived by regression: the revival of old conflicts by regression to old adaptive patterns abandoned the course of growing up.
5. Self-punitive measures: A futile struggle to resolve neurotic conflict by substituting gratifications and self-punishment which are expressed as symptoms. The futility in the attempt is due to the fact that all the regressive desires, guilt and the resulting need for punishment are all unconscious.
6. Secondary conflict and impoverishment of the ego: The symptoms decrease a patient’s energy and make him unable to deal with life realistically. (Secondary Conflict) This makes it necessary to further regress which in turn increases conflict and absorbs more energy, creating a vicious cycle the longer the neurosis continues.

Anxiety Disorders

For the anxiety disorders, the main symptom is free-floating anxiety which has no explicable conscious reason. The anxiety is a reaction to repressed impulses which threaten to emerge through the conscious. As anxiety emerges the ego gradually develops defenses to curb the anxiety. The types of the defense employed will determine the disorder developed. In most neurotic symptoms, the guilt resulting from the expression of destructive impulses requires self-punishment. Each disorder has a complicated procedure aimed at eliminating anxiety. Anxiety disorder occurs in a state where the ego is not very successful with defending itself against anxiety.

Phobias

The phobias are usually connected with childhood experiences and fears. the patient regress to an early situation where he experienced anxiety to replace the actual one. Usually the activities or objects avoided have unconscious meanings.

Three phases in the formation of phobias exist as

1. Failure in life and loss of initiative
2. Regression to fantasy or earlier situations with corresponding anxiety and guilt
3. The substitution of dependence for self-assertion

The phobia is an attempt to localize the anxiety to a single situation while keeping the ego from recognizing the real unresolved problem and dealing with it.

Obsessive-Compulsive Disorder

The disorder combines obsessive thoughts and compulsive rituals.

The obsessive thoughts are usually asocial, disconnected from the rest of the personality. These are usually undisguised and express infantile impulses that had been repressed. The patient usually isolates these from the rest of his character and assumes no responsibility for them. This is a process called bribing the superego, which is needed to allow asocial repressed fantasies in the conscious mind.

Compulsive rituals are often exaggerations of social behavior, most common being prolonged cleaning, hand washing or meticulous cleanliness. The patient views the rituals as the “good” side of his personality, which allows him to indulge in prohibited fantasies in the “bad” side of the personality. These two sides are in constant conflict with each other, and the whole neurosis is an attempt to maintain equilibrium between the two.

Depression

Depressive disorders are the preliminary result of uninhibited and repressed hostile impulses turned inward. The sense of guilt is predominant in depression which is increased by the self-destructive hostile impulses.

A characteristic of depressive patients is their dependence on love relationships. When frustration from these occurs, they react with hostility turned against the self, which discharges the hostility and relieves the sense of guilt.

Manic-Depressive Disorder

The psychoanalytic view of the shift in the moods in this disorder is the changes in the ego’s handling of rejected impulses, specially the hostile and aggressive ones. In the depressive phase the hostile impulses are internally focused, while in the manic phase the same impulses are outwardly focused. During the manic phase the restraint of conscience responsible for control and inhibitions are removed. Freud reasoned this happened due to the psychology of guilt feelings.

The first phase of the disorder, depressive or manic, is always precipitated by an event which disturbs the equilibrium between the repressing and the repressed forces of the personality.

During manic phase the patient freely expresses otherwise repressed feelings of sexual and aggressive nature/ the conscience is temporarily ignored. the patient appears free from superego’s restraints for a time. When the superego has been made too rigid by early experiences, an event that might increase the severity of repressions might provoke a manic attack as a revolution against it.

The depressive phase is a reaction to the manic. During this the conscience imposes punishment which seems appropriate to the crimes of fantasy committed during the manic phase.

The two phases are both the cause and the effect of each other, establishing a vicious cycle.

Personality Disorders

Personality disorders differ from the other neuroses mainly in the fact that these patients gratify their needs and impulses by coordinated behavior and transitions in life, in contrast to other neuroses where the gratification occurs mainly in fantasy and the privacy of the patient. The patients with personality disorders affect their surrounding environment and society with their impulsive activities, thus marking them as “troublemakers” in the society’s eye.

The patient with a personality disorder acts out his unconscious needs freely, not in mere fantasy, but their conduct towards other people, as they, like healthy people, require realistic activity to satisfy their needs. Their impulsive acts have three major features: Irrationality, Stereotyped repetition of behavior, Self-destructiveness. The first two are due to the dominance of unconscious factors, while the self-destructiveness is caused by the superego’s rigidity. The mechanism of bribing the superego is more noticeable in these patients where the guilt from the repressed conflicts are displaced to a tangible crime, so that they engage in a forbidden act less objectionable than the forbidden desire in the unconscious.

Psychoanalysis places a great importance the role of environment in this disorder, particularly the early child-parent relationship.

Martin, P. (1990). Peplau’s interpersonal model: clinical applications. In: Psychiatric and Mental Health Nursing. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3011-8_13

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Nagera, H. (Ed.). (1970). Basic Psychoanalytic Concepts on Metapsychology, Conflicts, Anxiety and Other Subjects (1st ed.). Routledge. https://doi.org/10.4324/9781315769776

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