Advanced Psychopathology

Saturday, February 04, 2006


James's Reaction

The acquisition of psychopathology is certainly predicated upon the development of the infant and infant experience. Ego psychologists are most concerned with the ego's defense mechanisms; particularly defenses that were once adaptive in childhood, but have proven to be maladaptive later in life. They propose stage theories which are deterministic in nature. While these theories are important, they seem to take the focus off of early infancy and focus predominantly on later childhood. Dan Stern insists that more attention needs to be paid to infancy as both a period of critical developmental sensitivities, and a time of an 'emergent sense of self'. Clinically, Stern's proposal seems to warrant some merit. Central to Stern's developmental theory of pathology is the idea that we should abandon the rigidity of stage theories and instead look at "self-experience." He argues that since traditional psychoanalytic issues can no longer be attributed to "age-specific sensitive periods", it is more helpful for a clinician to be able to look at a patient's self-experience to locate the origin of pathology. In doing so, we should not neglect early infancy. Perhaps Stern's most salient contribution to existing psychoanalytic theories involves his assertion that the infant does not experience a 'normal autism' phase, but is socially engaged from birth. While it is obvious that physiological regulation is a central aspect of infant-caregiver relatedness, it should not be assumed that the infant experiences this care asocially. In order to 'discover the mental capacities that might lead the infant to use these experiences to differentiate a sense of self or of other', we must look at the infant's social experience. This is important clinically because the way the child interprets and experiences the external world is predicated upon this early social experience. We need to look at Stern's theory almost as a precursor to the understanding of Ego Psychology and particularly the ego's development of defenses.


Stern vs. Ego Psychology, Joshua's Reaction

According to Stern, there are senses of the self that exist prior to self-awareness and language, including the senses of agency, of physical cohesion, of continuity in time, and of having intentions in the mind, among others. Abnormal social functioning and psychopathology occur when any of these senses of the self are impaired.
Beginning at birth, infants begin to experience a sense of an emergent self, never going through the autistic phase proposed by Mahler. From two to six months, the infants begin to experience themselves as having a core self that is a “separate, cohesive, bounded, physical unit, with a sense of their own agency, affectivity, and continuity in time.” From nine to eighteen months, the infant learns that the contents of her mind, her subjective experience, can be shared with others. Finally, from eighteen to twenty-four months, children develop the capacity for symbolization and verbalization. Before this point, according to Stern, an infant’s capacity for reality testing is strong and not distorted. It is only after the sense of a verbal self emerges and children can symbolize that delusions of merger or fusion, splitting, and defensive or paranoid fantasies occur. Therefore, Stern believes that psychoanalytic theory is misapplied to infancy and is more descriptive of life following infancy.
Unlike the psychoanalytic and developmental views of the infant which emerged as an attempt to understand adult psychopathology, Stern’s approach is descriptive of the normal development of the sense of self of the infant. Stern also disputes the psychoanalytic assumption that each age or phase of development is a sensitive/critical period for the development of some particular clinical issue of personality style. He highlights the issues of independence and autonomy, which he believes emerge gradually from birth rather than at the specific ages of 24, 15, or 12 months as proposed by Erikson and Freud, Spitz, and Mahler, respectively.
Stern’s infant is capable of having an integrated sense of self and others. This view is in conflict with the proposition by Mahler that infants experience a state of fusion with the mother lasting from 2-9 months. For Mahler, the infant gradually separates and individuates from its mother. Stern argues that it is only after an infant has developed a sense of self (and of symbolization) that merger or fusion with the mother or other objects can occur.
Therefore, Stern’s view of the development of the sense of self of the infant begins earlier than traditional psychoanalytic theories. Also, for Stern the sequence of developmental tasks is inverted, with the emergence of the self occurring antecedent to delusions of merger or fusion, splitting, and defensive or paranoid fantasies.


Stern v. EgoPsy: Kelly's Reaction

Unlike the structural theorists, Stern’s observations are not based on integration with classical drive theory. Rather than the self deriving from drive impulses and conflict laden states, Stern’s infant is pre-wired with an organizing pattern of awareness and arrives endowed with a basic notion of self-other differentiation. From this constitutional basis, developmental achievements are centered on a progressive culmination of senses of self, socio-affective competencies and self-other relatedness - all of which are consistently re-evaluated and revised throughout the lifespan. Unlike stage theory, Stern proposes a layered model of development in which each domain remains accessible to the individual not via regression but simply as a point of reference. Stern views psychopathology in terms of maladaptive strategies and problems in attachment rather than regression to symbiotic (psychosis) or autistic (narcissistic) phase.
Stern’s view presents a challenge for the ego psychologists, namely Hartmann, who despite allowing for a “conflict free sphere” of ego development maintains a reliance on drive energy. Hartmann accords an autonomous maturational pull in the development of memory, motility and perception that is separate from id frustrations. In this sense, he frees psychoanalytic theory from its libidinal origins and moves a step closer to Stern’s position. However, Hartmann maintains the deleterious effects of aggressive impulses and contends that neutralization and sublimation of aggression is required for adaptive object relations. Unlike Stern’s layered view of development, Hartman (like Erikson) is a stage theorist and views psychopathology as unresolved conflict “fixed” in an early stage of development. Under periods of intense internal conflict, an individual may need to regress to a previous stage to master the developmental task.


Robert's reaction to Stern v Ego

Stern’s developmental model offers an appealingly intuitive alternative to the developmental model proposed by the ego psychologists. Two aspects of his theory resonate with good common sense, and by doing so, they challenge some of ego psychology’s more theoretical and speculative elements. First, there’s the way Stern constructs his argument. Stern builds his theory of the developing infant’s subjectivity (and intersubjectivity) around something observable: baby’s everyday perceptual experience. A sensitive observational method seems to underpin Stern’s model and is mirrored in his writing -- he watches baby’s daily activities (e.g., feeding, games of “peekaboo” and “I gotcha”, Mom’s “baby talk”), speculates about how baby experiences the activities perceptually and emotionally, and only then elaborates his theories. Stern’s model is inductive, and involves a relatively small speculative jump about how the infant experiences life. Given the formidable task of understanding what it feels like to be an infant, it seems like sound logic to begin with specific, observable episodes of baby’s behavior.
Contrasted with Stern’s model, ego psychology’s account of infant development – which emphasizes intrapsychic conflicts and associated milestones – is harder to understand intuitively, and a bit harder to believe. In addition, ego psychology as it’s represented in Fonagy & Target seems quite orthodox and therefore prone to a deductive approach to explaining infant behavior.

The second distinction between Stern’s model and the ego psychologists’ concerns the differentiation of the infant. Simply put, Stern believes the infant is a differentiated subjective being from (and perhaps before) birth, where the ego psychologists believe the infant is an undifferentiated being, both in psychic terms and in terms of its relationship to mother. Here again, Stern’s argument seems more logical and seems to shore up better with what it’s like to be with an actual baby.

Friday, February 03, 2006


Stern vs. Ego Psychology: Matt's Reaction

Stern seems to present four main challenges to traditional ego psychology. First and most fundamentally, he turns upside down the notion that infants begin in an undifferentiated state and have as their central task separation-individuation. Second, he rejects the concept that development progresses through discreet stages. Third, he transforms the concept of regression, advancing the idea that all previously attained senses of self are available at any time to the normal individual, and that it is normal and healthy to experience the world through each of these lenses even as an adult. Fourth, he places the infant in what seems to me to be a much more complex, proactive, and essentially positive position in relation to others. I’ll elaborate a bit on this last one.
Among the ego psychologists, others (external objects) often seem to be reduced to mechanisms that place pressure on the infant, inducing guilt, fear, and other forms of intrapsychic conflict. This is in large part their necessary developmental purpose. For Stern, the infant is driven to create and explore bonds with others, and the “conflict-free zone” that Hartmann describes seems much expanded. Partly it’s because Stern’s is a normative theory there appears to be less conflict all around. In ego psychology, parents sometimes seem like necessary evils, a bias that’s easy to understand when we’re faced with tragically damaged patients in a clinical setting. (This is the origin of the “clinical infant” that Stern talks about. In adding the “observed infant” to the picture he makes parents look a bit better, which I must say I appreciate.) Stern is setting up a model in which psychopathology will turn out to derive more from the failure to achieve interdependence than from the failure to achieve independence, because for him individuation is really just the emergence of the core sense of self. It comes to the infant much more easily and gracefully—and much earlier—than any of the ego psychologists predicted.

Wednesday, February 01, 2006


This week's reaction

It came up today that it's not totally clear what we're reacting to: this week's readings or last. When put to Nick, he said, "Whatever you want." FYI.

Also, I changed the format of this here blog to something that seemed easier to read.

Monday, January 30, 2006


Just post it

hey peeps -

for the record, i just want to say that i love all of you and that never changes. i do, however, want to give EXTRA shout outs to: LUCY, JENNI, ROB, & GILLIAN...for gracing their lovely selves at my fabulous soiree...and also add that the LIU represent wasn't so great and i expect attendance to be MUCH BETTER at nirit's this weekend...

regarding psychopathology writings, i was originally in the rob camp with respect to paper-sharing; however, now presented with matt's perspective, i would tend to agree...i'm probably not going to be wanting to print all that stuff out each i would be okay just posting here...let's keep it simple people...:)

and that's all i have to say right now...mwah!


Begin the psycho-blogging

This is a place for us to post our psychopathology reaction papers.

Unfortunately it doesn't look like we can upload word documents to the blog, so if we go with this system we'll have to just read them online. (If anyone can prove me wrong, please do!) At least one person (Rob) would rather do this by email, so he can print the papers. I personally feel like I just wouldn't take the time to open 14 emails, print them, and then read them. If others have strong opinions, this blog will accept comments on the subject until Wednesday, at which time we'll go with the majority opinion. Sound ok?

PS Don't forget to also send your papers to Nick:


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