Advanced Psychopathology

Friday, February 10, 2006

 

Gillian's Response #2

As happens with many aspects of psychological unrest, psychodynamic theory and the DSM are not particularly congruent. The DSM has a largely visible, and symptomatic set of criteria that “make up” a depressive diagnosis. For two weeks or more, an individual must endorse having a certain number of symptoms nearly every day. Once the interviewer has established at least the existence of “feeling depressed or down” or endorsing unreasonable guilt during this time period, the patient may then endorse disturbances in eating or sleeping, a lack of enjoyment in things that usually afford them pleasure, mention by others that they seem unusually sad, etc. Following the medical model, this diagnostic system seeks to pinpoint the particular aspects of the disorder that are measurable and that are causing the patient trouble in terms of life or work, without any attention paid to the potential underpinnings of the disorder. The DSM also classifies depression with mania and hypo-mania under the catchall of “mood disorders.” As Nancy McWilliams notes, in doing that the category of a depressive personality goes unnoticed, and the myriad components and antecedents of depression are eclipsed by the visibly affective aspects of dysthymic conditions. The defensive processes involved in any of these “mood disorders” are also ignored by the DSM.

Psychodynamic explanations of depression center on symptomatology involving interaction with the therapist. The depressive personality has been posited as a constellation of developmental history, beliefs about the self, and defensive tendencies. It is also noted in psychodynamic theory that a depressive personality, i.e. a particular way of experiencing the world and one’s self in it, can stand alone from a discrete depressive episode. The depressive personality of the psychodynamic bent has a strong but hated sense of self, was formed by a large degree of introjection by parental objects and now may have a crushing or punitive superego, and may initially see the therapist as a whole and empathic person trying to help them, before their tendency to internalize aggression begins to be healed and is turned upon the therapist who is then seen negatively for awhile. While the DSM is focused on symptoms and the meeting of certain criteria, psychodynamic theory deals with the personality tendencies of the depressive personality, and also lays out a potential path that treatment with depressive individuals may take.

Monday, February 06, 2006

 

sara's response

Sara Petrasso
2/5/06
Advanced Psychopathology
Essay #1

The premise of Daniel Stern’s theory is the notion that the infant possesses the psychic capacity to differentiate a subjective sense of self from the other. Furthermore, this self-differentiating infant is a social creature whose relationships serve a central function in distinguishing both a sense of self and other. In essence, Stern argues that the infant is pre-wired to be both relatable and self-differentiated. This poses a challenge to Margaret Mahler’s conception of the infant as existing in a psychologically fused state with the mother—only arriving at a sense of self after successfully emerging from symbiotic union with the mother, and subsequently proceeding through discrete phases that further facilitate the self-individuation process.
Stern accounts for the infant’s sense of a core self by referring to a large body of developmental research that points to the existence of certain self-invariants that function as a framework for providing consistent ways of organizing the world, and more importantly, one’s position and agency within the world. Stern believes that the infant has certain nascent ego capacities that facilitate its ability to adapt to reality (e.g. by playing an active role in relationship formation). Stern disputes the ego psychological view of the infant as a mere undifferentiated, psychologically embedded entity, reliant on the mother as an “auxiliary ego” for mediating the world around him. It should be noted that while Stern promotes the notion of a self-differentiated infant, he does not dismiss the central role that the mother plays as a self-regulating other whose patterns of interaction with the infant become internalized and go on to become the enduring, relational prototype by which future relationships and interactions with others come to be understood.

 

alex's response

Perhaps the most striking difference between the theories of Dan Stern and those of ego psychology is the degree to which there is attribution to either interactive, relational experiences or physiological/internal drives, respectively, as the force behind development of the self. Whereas Stern postulates that the major task of the infant is to create ties with others and increase relatedness, ego psychology maintains that development is spawned by the maturational pull of naturally occurring drives and internal psychic conflict. At its very core, Stern’s theory challenges ego psychology by placing development within an interpersonal, external social context, rather than an internal, individual one.

Ego psychology describes the self as beginning to emerge within the first half of the first year, which may parallel Stern’s notion of self/differentiation beginning at birth or before. Further similarities may include the discussion of development of object relations within each of these theories. However, the processes are inherently different in that ego psychology posits, for example, that good object relations are the direct result of successful neutralization or sublimation of aggression, as a function of the ego, while Stern regards internal objects as representations of actual interactions which have been generalized, referred to as RIGs.

Finally, while ego psychology has moved away from traditional Freudian theory of psychosexual stages and the ego as a complete offshoot of the id, instead viewing the ego as developing autonomously with discrete adaptive functions, it still retains the notion of conflict as a force of growth, the ego being linked to the id, and the idea that the crowing achievement of development is the coherent function of the ego. Stern, on the other hand, rejects the notion of successive phases preferring instead to see development as an ongoing process whereby the various selves which have emerged engage in a dynamic interaction to differentiate the self and other; there is no “final” phase, per se.

 

Dana's Response Paper #1

Dana Haywood

2/6/06

Psychopathology RP #1

Stern focuses on the self, an individual’s subjective sense of their self, and their relation to others. Development occurs at major stages, or domains, which are specific periods of development. During these domains, the subjective self is reorganized and a major shift in behavior and interpersonal relations occur. The challenge with this theory is that it seems rather simplified to say that deficiency or problems in interaction between an infant and caregiver at one domain would result in a deficiency within that particular sense of self, in which the domain corresponds to. For one, seeing as this is a sequential developmental process, if one of the four sense of selves were deficient due to a negative experience during that domain, this would make it difficult for the successive sense of selves to develop properly there after. It is difficult to imagine that a disturbed interpersonal relationships during a particular domain would effect and individual’s development on such a global level, especially when conflict on some level is almost inevitable at all points of development.

On the other hand, ego psychologist such as Hartmann recognizes the complexity of development. It is assumed that conflict at one point does not necessarily predetermine psychopathology or abnormal development at a particular level of functioning. Instead, environmental factors are considered along side an individual’s genetic predisposition. Furthermore, it is not conflict or trauma per se that would predetermine pathology. Instead it is the ability or inability of an individual’s ego to compromise with the id at certain periods of maturation, which would then result in normal development or abnormal development.

Ego Psychology accounts for several aspects of a child’s development such as the individual’s predisposition and their environment, the interaction of the id and ego, the resiliency of the ego in the face of conflict or frustration, which all arise during the gradual maturation phases of development. This assumption resolves the oversimplification of Stern’s theory of development, in which there are critical periods of significant shifts in functioning and pathology would ensue if there were a deficiency of an interpersonal relationship at one of these domains.


 

Advanced Psychopathology

Advanced Psychopathology

Dana Haywood
2/6/06
Psychopathology RP #1

Stern focuses on the self, an individual’s subjective sense of their self, and their relation to others. Development occurs at major stages, or domains, which are specific periods of development. During these domains, the subjective self is reorganized and a major shift in behavior and interpersonal relations occur. The challenge with this theory is that it seems rather simplified to say that deficiency or problems in interaction between an infant and caregiver at one domain would result in a deficiency within that particular sense of self, in which the domain corresponds to. For one, seeing as this is a sequential developmental process, if one of the four sense of selves were deficient due to a negative experience during that domain, this would make it difficult for the successive sense of selves to develop properly there after. It is difficult to imagine that a disturbed interpersonal relationships during a particular domain would effect and individual’s development on such a global level, especially when conflict on some level is almost inevitable at all points of development.
On the other hand, ego psychologist such as Hartmann recognizes the complexity of development. It is assumed that conflict at one point does not necessarily predetermine psychopathology or abnormal development at a particular level of functioning. Instead, environmental factors are considered along side an individual’s genetic predisposition. Furthermore, it is not conflict or trauma per se that would predetermine pathology. Instead it is the ability or inability of an individual’s ego to compromise with the id at certain periods of maturation, which would then result in normal development or abnormal development.
Ego Psychology accounts for several aspects of a child’s development such as the individual’s predisposition and their environment, the interaction of the id and ego, the resiliency of the ego in the face of conflict or frustration, which all arise during the gradual maturation phases of development. This assumption resolves the oversimplification of Stern’s theory of development, in which there are critical periods of significant shifts in functioning and pathology would ensue if there were a deficiency of an interpersonal relationship at one of these domains.


Sunday, February 05, 2006

 

Stern vs. the Ego Psychologists

Jay Kosegarten

2-5-06

Psychology 755

Stern versus the Ego Psychologists

The central challenge Stern's theory presents for the ego psychologists’ theory of human development is that of the formation of the self, and, as Stern calls it, the sense of self. For the ego psychologist, the infant is born with an undifferentiated sense of itself from its mother and the world. All are merged together, indistinguishably, in the infant’s experience, the phase which Mahler referred to as autistic, and there is a profound sense of oneness. It is through myriad interactions with the mother, in particular experiences marked by frustrations and anxiety, which the infant begins to feel a senses of separateness from the mother. From this point, the infant, then, gradually generalizes this sense of separateness to the rest of the world, as his/her field of interaction expands with increased motility.

What Stern argues, and what is empirically supported, is that infants are born already with a sense of separateness and a sense of self and, thus, interactions with the mother do not ultimately construct an essential differentiation of the self but serve to establish a sense of symbiosis and connectedness, the building blocks for our evolutionarily advantageous social orientation. The contrasting paradigms are then one in which autism moves to merger then to individuation versus an inborn sense-of-self moves towards the propagation of sophisticated relatedness and communication.

A small but fascinating point that Stern mentions is that as the infant’s sense of self develops through subjective experience there is, concurrently, a generalized assumption the infant has that if he/she has this inner sense of separateness, others must as well.


 

Desiree's Reaction Stern vs. Ego

Daniel Stern posits that early social development is dominated by the infant’s acquisition of new senses of the self, which in effect, lies in direct contrast to the Freudian notion that phases of development are dependant upon the completion of and progression through task-oriented phases that allow for entrance into subsequent phases. Stern’s four different phases of “self” development are predicated upon a layered model whereby the completion of each phase of self-development remains fully functional and continues to grow and coexist intrapsychically with each other phase throughout the lifespan. Freud’s developmental model is explained primarily by the infant’s completion of independent, age-specific clinical phases which once completed in late adolescence lay the groundwork for the continued development of the ego structure. One of the key tenets of Stern’s developmental theory lies in its core belief that the infant never experiences conflict with self/other differentiation. Instead, Stern proposes that the infant is imbued with an innate sense of self that is further developed when engaging in subjective interactive experiences with another, allowing for the infant to integrate and organize the experience of the self being with another.
Another contrast that is seen between Stern’s theory and the ego psychologists concerns Mahler’s proposition that it is the role of the caregiver to facilitate successful separation between infant and primary love object during a critical phase of development. However, Stern dictates that there is no need for the primary caregiver to be involved in the self-differentiation process since infants possess a core sense of self as well as a core sense of other. Mahler’s theory of separation/individuation is so central to the healthy development of the infant’s ego that if improperly performed by the parent, then the groundwork has been laid for the development of difficulties in adaptation to the external environment for the infant. Stern’s theory in effect safeguards against the development of these difficulties by stating that the development of the infant’s sense of self is in relation to but not dependent upon the interaction with others.

 

Gillian's response

Gillian Boudreau
2/5/06
Psychopathology 2
Response essay 1

What challenges do Dan Stern’s theory present for the understanding of ego psychology?

Ego psychology was built on the structural model put forth by Freud, concerning the id, the ego, and the superego. As a response to “id” psychology or the “drive theory,” which posited that the ego was only a compartment of the id which served to balance drives with the values of the superego, ego psychologists focused on the ego as a separate and somewhat free-standing entity, which developed apart from the id. They looked at more surface manifestations of compromises between the id ego and superego, focusing on defenses and ego strength.

Ego psychologists saw the developmental task of the infant as a journey from fusion to separateness. Margaret Mahler, for example, put forth a theory stating that infants move from primary autism, through symbiosis, ultimately into autonomy through the process of separation-individuation. Stern finds the opposite to be true, stating that infants are born with a pre-existing sense of self and non-self. For Stern, the task of normal development is to move from a state of differentiation, towards the creation of ties. Stern observes that infants do this through an intense process of distinguishing variants and invariants in their caregivers, and that one can sense the infant’s understanding of self and other through their interactions with others, which often center around gauging the behaviors and actions of caregivers, and modifying appropriately.

Stern also presents a general challenges to ego psychology, in that he is not concerned with the ego or id at all. For him, subjective ways of experiencing the self and the world are the building blocks of the developmental model, rather than the structural id and the ego which grow out of such ways of experiencing for the ego psychologists.

 

Jenni's Rxn Paper #1

Dan Stern’s theory of infant development joins his objective knowledge as a developmentalist with his clinical work as a psychoanalyst. The former offers new observational data on the infant’s subjective life while the latter extrapolates upon researcher’s observations with analytic insights and inferences. Several central features of his theory challenge longstanding beliefs within ego psychology. For instance, Stern disputes the entire concept of phases of development linked solely to certain clinical issues, including orality, attachment, autonomy, independence, and trust. In his view, these tasks are central to an individual’s entire lifespan, not just infancy. Instead, his stages of development involve acquiring four separate senses of the self: emergent, core, subjective, and verbal. Once attained, each sense of self continues to function fully and completely throughout life, constantly growing and coexisting. Stern also challenges Margaret Mahler’s theory of an autistic phase of development. According to Stern, infants never undergo an autistic-like phase. Rather, they are born with an emergent sense of self that never becomes confused with the other. Stern also refutes Mahler’s symbiotic phase. From age two to six months, he views infants as attempting to combine a core self as a separate, consistent, delimited, physical entity, with a sense of their own agency, affectivity, and continuity in time. Unification events are seen as an achievement acquired through actively organizing the experience of self-being-with-another, as opposed to the result of a passive inability to differentiate self from other. Finally, Stern refutes Mahler’s perspective on separation-individuation. According to him, infant’s age nine to eighteen months are not principally concerned with achieving independence or autonomy. While he agrees that infants at this age may be exploring the concept of individuation, he believes they are equally interested in finding and forming an intersubjective union with another. They want to know that their thoughts and feelings can be felt by and shared with others. The aforementioned challenges to ego psychology form the basis for Dan Stern’s theory of infant development.


 

technology humbles me

Does anyone know how to separate paragraphs? When I hit 'return', it doesn't advance to the next line.

 

Sheila's Reaction: Stern vs.Ego Psychology

Stern’s view of development is a distinct departure from the psychoanalytic theories previously put forth. Most basic is its focus on the development of the “sense of self” rather than that of the ego. This “sense of self” is seen as a primary organizing principle; the infant’s subjective experience is itself what Stern considers the “working part” of the theory instead of the ego and id from which it originates.
Stern paints quite a different portrait of the infant than that presented by other theorists, particularly that of Mahler. In her view, the infant during the first few weeks of life is in a state of “normal autism” and is, in a sense, essentially asocial. Relationships with others are closely bound up with satisfaction of physiological needs. Such is not the case for Stern’s interactive infant, who is more autonomous and possesses an innate ability to self-differentiate, right from the get-go. His argument is supported by a number of interesting clinical observations that illustrate the infant’s early capacity for real activity and independence. During the period that Mahler’s infant is lingering in a phase of fusion with the mother, Stern’s is busy developing a sense of core self. While for Mahler the major task for the infant is a gradual separation from the mother, Stern sees the establishment of relatedness as the infant’s goal. Moreover, in his view, achieving symbiosis is an important accomplishment made possible only by the infant having already developed a coherent sense of self.
The confinement of developmental tasks to particular stages such as those proposed by Mahler is also problematic for Stern. He refers instead to “domains” of relatedness rather than phases, which he feels are better suited to discussions of motor or cognitive abilities. Phases imply defined beginnings and endings, each new one subsuming the last. Conversely, Stern’s model allows the four senses of self to exist simultaneously and therefore enables the individual to fluctuate back and forth between these dimensions of experience. Clinical issues such as attachment and autonomy are not limited to finite stages, but are rather life span issues. In other models, what might be understood as regression is instead seen as part of healthy growth and development.

 

Nirit's reaction

Imagine a depressed mother who has two infants. One is an “Ego Psychology infant” and the other is a “Stern infant”. How would they psychologically-react to the depressed mother? According to Stern, the infant is equipped with mechanisms that are highly sensitive to the quality of interaction (e.g. mirror neurons) and help him organize and regulate his states. Thus, from the very first interaction with its caregivers, the infant actively uses the mechanisms. The interactions with the caregiver, or in Stern’s words the “ways-of-being-with”, are significant events from which the infant organizes his range of mechanisms. Since an infant from day one is a relationship-seeking, outward-looking organism who organizes itself around interpersonal interactions, those mechanisms function as a gestalt with affective domains as well as cognitive and physiological ones, in a coordinated way to create schemas that represent how it is to be with the other. In our example, the depressed mother may try to alleviate her state of mind in an artificial way, and the infant may experience the artificial quality of interaction and organize his experience of being with her in a matched way, therefore equally respond in a false reaction. On the other hand, the “Ego Psychology infant” would have some problems reacting to the quality of interaction of the depressed mother. First, would that infant be able to detect the false affect of the depressed mother? Since the self/other differentiation is not in place yet, the infant would not be able to detect the quality of interactions and ways-to-be-with as long as its drives are gratified. Second, let’s assume that the infant’s drives are not gratified -- would he be able to react and manage the drives’ demands as early as day one? Since his ego is not yet differentiated from the id, his ego’s adapting-to-the-surrounding mechanisms are not yet in place, therefore the infant cannot regulate its ungratified drives. The Ego Psychology model doesn’t address how early on the infant “makes sense” of the quality of interactions as an important factor shaping the sense of self.

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