Advanced Psychopathology

Friday, March 10, 2006

 

Gillian's Freud V. Independents response

Freud V. Winnicott and Fairbairn

The Independent school of British psychoanalysis emerged in the 1950’s, building on and amending some of Freud’s theories particularly about early development of the child. In general, Object Relations theories were developed in this school of thought, shifting the focus from Freud’s structural model of the id the ego and the superego organized according to drives and discharge of energy, into a model focusing on the ego in relation to itself, and specifically in relation to internalized objects as a means of getting emotional, rather than physical needs met.

Fairbairn was a major proponent of object relations theories. He believed that the libido was primarily object seeking, rather than pleasure seeking, and that anxiety was reduced by a high quality relationship between the ego and the object, either the external object or its internalized form. This differs from Freud’s view that objects were valued only as they facilitated the gratification of physical drives. According to Fairbairn, the major inroad for psychopathology was no longer repression and neurotic compensation, but rather the confusion of several incompatible egos in the self, caused by splitting in response to a lack of intimacy with a primary object. Ultimately, Freud’s model of repression in the development of psychopathology is still seen to apply if a trauma or conflict arises when the child is at an oedipal level of development. However Fairbairn postulated that traumas occuring earlier in development were stored in memories that were dissociated from the central ego, causing psychopathogenic multiple self-representations.

Freud and members of the Independent school agreed that the task of development was to move from fusion to separateness. However, while Freud believed that the infant could not initially differentiate the self from the environment, members of the Independent school such as Donald Winnicott believed that they could, and that this understanding of the mother as a separate being was key to development. According to Winnicott, the “good enough mother” created a holding environment for the infant, wherein during early development she was so attuned to the infant that he could feel that he had omnipotent control over her. Healthy development depended on this initial sense of magical omnipotence, followed by appropriate frustration of that omnipotence once the child was old enough, allowing an opportunity for a reparation with the newly separate mother, and the early development of the true self.

Ultimately, the British Independent School built on Freud’s idea that internal conflict and the thwarting of needs lays the groundwork for psychopathology. However, where Freud saw the internal conflict structurally, with the ego working to repress the desires of the Id, the members of the Independent school saw the conflict as occurring between multiple self-representations in the ego. While Freud believed that the fodder of conflict came from ungratified physical urges and drives, the ego psychologists postulated that it was the ungratified need for intimacy with a good object that led to internal conflict, and eventuallyl to the splitting of the ego.

Monday, March 06, 2006

 

that was hysterical!! (or was it compulsive?)

The obsessive-compulsive and hysterical characters seem to lie on opposite sides of a continuum, in terms of their cognitive and defensive styles. On one hand, the obsessive tends to overthink, overvaluing rational thought and intellectualization while the hysteric tends to be overly feeling, operating through pure emotion and sexualization, often regressing into childlike states. In a sense, one might argue that the two complement one another and could probably benefit from a mutual exchange of characteristic traits in order to achieve a better balance in their lives. In reading about these two personality styles, I could not help but think of two of my closest friends, whom I shall call Katie and Allison.

Katie was brought up in a Midwestern suburb, the younger of two. Her family is the picture of the “ideal” American family: her father is the head of a successful family business and her mother, a former homecoming queen, is a homemaker who maintains a perfect, immaculate home. She was raised to be a high achiever and to always present an outward appearance of perfection. While Katie is extremely personable and does not present with the typical isolative quality one might expect from an obsessive-compulsive, she is consumed with constant feelings of guilt at not doing enough, in spite of a highly successful record of professional achievement as a medical resident in dermatology (in addition to graduating first in her class from medical school) as well as having many close interpersonal relationships, including one with her husband of almost two years. Much of her daily life is characterized by an overarching need for control, manifested through her compulsive list-making, her intellectual dissection of problems, and many sleepless nights spent cleaning, cooking, or doing whatever she thinks it will take in order for things to be perfect. She tends to make decisions based upon what she thinks will please others, devaluing her own desires, yet often expresses feelings that somehow she has disappointed them regardless. During her adolescence, she suffered mildly from bulimia.

Allison, on the other hand, in spite of great intelligence and genuine concern for others, often comes across as being overly dramatic and insincere, as she tends to seek attention, looking for affirmation from others. Her parents are very doting; however, her mother is a rather helpless, anxious individual who has been further enfeebled by her father’s desire to take care of her. While her relationship with her father is very loving and seemingly nurturing, the implicit expectation for Allison has always been that she will rise above and be better than her mother. Unfortunately, although she is quite a capable individual, Allison often falls prey to feelings of being overwhelmed and unable to take care of herself. She frequently seeks out male companionship in order to feel good about herself and gain some sense of power, using seductive tactics to attract them to her. While she can certainly be manipulative at times, it is generally due to an intense anxiety that overcomes her, forcing her to act out in ways that appear to be self-serving and appear to quell her sometimes overly emotional state.

These two women, while perhaps not the most extreme examples of obsessive-compulsive and hysterical personalities, respectively, certainly exhibit strong degrees of each in their respective character organization.

 

OC/Hysterical: Robert's Reaction

Shapiro suggests that aberrant modes of cognitive processing define both obsessive-compulsive and hysterical disorders. According to Shapiro, obsessive/compulsives and hysterics are more or less opposite in their cognitive functioning. McWilliams, while focusing primarily on the defensive operations of obsessively, compulsively, and hysterically organized people, also notes these patients’ cognitive styles.

Obsessive/compulsives are notable for their attentional style, moralistic thinking, indecisiveness, and “loss of reality.” Obsessive/compulsives maintain a hypervigilant and narrowly focused state of attention at all times. Their sharp focus exacts a heavy cost: obsessive/compulsives are so occupied with their primary object of interest that they’re unable to attend to anything outside the beam of their attention; as a result, their perceptual, cognitive and affective range is constricted. Shapiro notes that healthy attentional functioning is defined by oscillating between states of willful concentration and relaxed receptivity – this attentional flexibility is impossible for the obsessive/compulsive. As a result, “surprises” and “hunches” are absent from his experience.

An oppressive sense of moral burden drives the obsessive/compulsive’s relentless activity. Shapiro notes that these patients are hyperaware of duty, propriety, and authority, and search for rules and expectations to guide their actions. Their ceaseless toil, Shapiro suggests, reflects a desire to please a higher power and to forestall criticism and culpability. The obsessive/compulsive patient is most likely to report discomfort (feelings of “losing control” or “going crazy”) in the absence of a goal towards which to extend himself. McWilliams suggests this moralistic drive results from unsatisfactory resolution during the anal period of development and associated feelings of shame. (This shame, McWilliams says, is one of the few emotions an obsessive/compulsive patient will allow himself to feel).

The indecision typical of the obsessive/compulsive patient also reflects an orientation towards external authority and disinterest in his own emotions. Shapiro suggests that normal decision-making hinges on an acceptance of one’s own freedom, and the ability to entertain one’s impulses. The obsessive/compulsive patient abhors personal freedom, has no idea what he wants, and is interested only in what he “should” do; as a result, his decision making process involves an logic-based vacillation between this and that, with no gut feelings to expedite the process.

Shapiro suggests that the obsessive/compulsive patient tends to “lose reality” in a sense. By this, Shapiro doesn’t mean that the patient is delusional, but that in applying himself to his endless directives, he’s lost the Gestalt – he’s lost the forest for the trees. For example, Shapiro notes that obsessive/compulsives have a difficult time stating how they feel, how they perceive the world around them, and how they perceive themselves. McWilliams describes the obsessive/compulsive’s cognitive manipulation of reality differently, suggesting that completion of rituals and internally generated directives give the patient the illusion of magical or omnipotent control. By controlling what he can via ritual or thought, the obsessive/compulsive keeps at bay that which is threatening (e.g. fantasies, emotions).

Hysterical patients’ cognitive style is roughly opposite the obsessive/compulsive’s. The hysterical cognitive mode is impressionistic, lacking in factual detail, labile, and responsive to the most obvious or impressive stimuli present. As a result of this cognitive style, hysterical patients are lacking in factual information about themselves and the world at large, and the memories they articulate in therapy are long on impressions and short on facts. Shapiro suggests that hysterics never fully encode factual information into memory. In contrast to the narrow hypervigilance of the obsessive/compulsive, the hysteric is always struck by things, and always ready to act on a hunch. Interestingly, McWilliams suggest that the hypersensitivity and spontaneity of higher-functioning hysterics is an asset in creative and artistic endeavors.

The hysteric’s poverty of factual information and responsivity to compelling stimuli extends to himself and his feelings. (This lack of self-knowledge is a resemblance between the hysteric and the obsessive-compulsive). The hysteric responds to his own fleeting thoughts with an investment of energy without considering their context or importance, and without considering whether they merit a dramatic response. Even the most violent of his “emotional outbursts” may be experienced as something he doesn’t own or recognize, as though they are mild states of possession. The hysteric’s responses to fleeting stimuli, both internal and external, coupled with the inability to perceive and encode facts leads to a feeling of lacking a stable, factual self. Instead, the hysteric experiences himself as the sum of his reactions and dramatizations. To combat this poverty of coherence and factual information, McWilliams suggests that the hysterical patient’s must reconstruct a “credible,” (if not totally accurate) narrative of himself in therapy.

 

Obsessive Compulsive v. Hysterical Styles

Obsessive compulsive people are characterized by rigid thinking, tense activity, and loss of reality. The first trait may be observed by a stiff body posture, overly formal social behaviors, and unyielding, unrealistic perseverance. Cognitively, it can manifest in inattentiveness to new facts or different perspectives. This is related to a general inability to easily direct their attention from one task to another. While their attention to detail is sometimes adaptive, they can be so intent upon capturing fine points that they miss the whole picture. Their tense activity is evidenced in continuous involvement with some type of routine or technical work. The motivation behind their intense efforts is usually related to thoughts of “I should do…” (out of propriety, obligation, supervisor expectations, cultural moors, etc). Their loss of reality is associated with an exceptionally harsh and insufficiently integrated superego. They commonly defend against this punishing superego using regression, reaction formation, isolation of affect, and undoing. Unfortunately, these defenses disconnect them from their true desires, resulting in great difficulty making decisions.

Hysterical individuals can be characterized by a relative absence of active concentration, vulnerability to transitory influences, and existence within a relatively nonfactual, subjective world. The first trait results in an inability to capture fine detail. They respond to stimuli by identifying the most impressive, striking, or obvious attribute. Actual facts and consequences of events are noticed only vaguely, peripherally. Consequently, they lack a sense of themselves as factual beings with solid convictions and consciousness of the objective world. Furthermore, since their attention is always fleeting, they are highly distractible, highly suggestible, and easily surprised. These traits are all related to their hallmark defense - repression. Through repression they construct wistful and idealized memories of important figures and a sentimental view of the present. This results in an internal and external reality that is vibrant, colorful, and emotionally charged.


 

Obsessive-compulsive vs. Hysterical neurotic style: Lucy's Reaction

According to Shapiro's chapters, obsessive-compulsives and hysterics represent profoundly, almost diametrically opposed styles of cognitive and defensive functioning. Cognitively, the obsessive-compulsive patient is a precise, clear thinker and remember; fact-based, rational modes of thinking predominate and attention is narrowly focussed. The obsessive-compulsive person almost never has a moment of wandering attention, in which they just happen to notice an extraneous detail, and never has the experience of a fleeting thought or impression. Their attention is wholly self-directed and restricted so that they may better accomplish tasks and concentrate on serious matters, although Shapiro makes the interesting point that they feel as if they are being directed from the outside -- from a place of “shoulds”-- instead of internally. Their sense of humanness and spontaneity is sacrificed and, according to McWilliams, their predominating defense is isolation (by which I assume she means isolation of affect). McWilliams adds a nice dimnension to the Shapiro chapter by culturally contextualizing the obsessive-compulsive style as a style that may be more prevalent in the West as it is valued for its driven, productive qualities. McWilliams also historically contextualizes this personality style as one that was understood by Freud and others to have originated in the context of harsh or overly rigid toilet training, leading the person to become fixated on issues of withholding, control and external pressure to be clean and accurate.

The hysteric, by stark contrast, lives almost totally in world of impressions, fleeting thoughts and unfocussed attention. The hysteric seems to live in a foggy world where feelings predominate and intellectual focus/curiosity is scarce. Quite unlike obsessive-compulsives, hysterics employ repression both cognitively and defensively. Shapiro points out that where the obssesive-compulsive has a historically accurate, detail and fact-based memory the hysteric affectively-charged memories that lack factual basis. According to Shapiro, this is not necessarily a dynamic, defense-based system but a cognitive one, which is based on how the hysteric originally perceives and experiences the world. Consequently, the hysterical personality, also in contrast to the obsessive-compulsive, lives in a knowledge and detail-impoverished world where emotion and sensation are the primary modes of “knowing.” Shapiro notes that hysterics often have problematic relationships with their own sexuality, an issue which he does not address in terms of the obessional personality. McWilliams also connects hysterical symptoms to repressed sexuality, and adds to Shapiro’s chapter in her discussion of how the hysteric uses regression as a defense against unconscious guilt and fear. McWilliams also suggests that the hysteric uses idealization of a strong, protecting object as a defense against feelings of powerlessness and inadequacy.

To me it seems that the biggest difference between the two styles must be in their internal experience of the world. While obsessive-compulsives seem to experience things as orderly, contained and manageable, the hysteric’s experience seems far more messy and even overwhelming. They are subject to all kinds of external influence and suggestion while the obsessive-compulsive patient is able to defend against almost any kind of cognitive/emotional disorganization.

 

Obsessive-Compulsive V. Hysterical Neurotic Styles

Shapiro took a very interesting approach to explaining aspects of the obsessive-compulsive and hysteric styles, and their cognitive deviation from that of a normal case, as well as the cognitive distinctions between them. His explanation regarding the pervasiveness of these maladaptive styles, were attributed to their particular cognitive functioning, in a very comprehensive manner. Shapiro offers to significant aspects of the cognitive process involved in the neurotic styles of the obsessive-compulsive and hysterical individual. The first, he refers to as, the original cognition. I took this to be equivalent to a schema, or a template, which governs how new information is perceived and assimilated into that cognition. The second significant process is recollection; the particular output of the information held in an individual’s original cognition. I say particular output, because the style of recollection is determined by the way in which it is organized in the original cognition. What is perceived, and held in memory, and then later recalled depends on how the original cognition is organized. These two major factors of cognition were a distinguishing factor among obsessive-compulsive and hysteric personality styles.

In regards to the obsessive-compulsive style, it is thought that the organization of the original cognition has the capacity to gather detailed information and maintain sharp focus on technical details and factual information. This results in the intense concentration and “good” memory that is characteristic of an obsessive-compulsive individual. However, this organization and the manner in which information is obtained and recalled, manifests in the characteristics of the obsessive-compulsive individual, such as their intellectual rigidity, difficulty in making decisions, and perhaps the quasi-external pressures that govern functioning and behavior. Although Shapiro didn’t specifically emphasize the role of the original cognition in the pressure an obsessive-compulsive has for the necessity to direct him/her self in a particular “role”, one could postulate that the sharp focus and the capacity to hold in memory such technical details, would cause a person to not be able to be swayed by other information and, instead adhere to certain roles with such tenacity. This seems to be maintained without the ability to reject or question certain aspects of this cognition due to the characteristic dogmatic mentality. One does not have the capacity to look past their roles and accept any other distractions, else they would experience discomfort. Shapiro does, however, explain this how the cognitive process creates the intellectual rigidity and difficulty in making decisions. The information that is held so rigidly in cognition is inducive to extreme concentration and the inability to be more flexible in attention. This also disallows a person to relax his cognition, to realize what he/she wants in order to make an intuitive decision, based on wants and desires. The flavor of life and experiences is lost in the rigorous focus on technical details.

The original cognition of the hysteric personality style is quite distinctive from that of the obsessive-compulsive style. Instead of a cognition that is organized to apprehend factual, detailed information as an obsessive-compulsive individual, the cognition of the hysterical person is organized in such a way that it is less capable of receiving and holding detailed information. The information that is assimilated into the original cognition, instead are more like impressions. This can be observed when giving a hysterical person a Rorschacs or other psychological tests. The tendency is to quickly give more generalized response with very little detail. There doesn’t seem to be the capacity to focus on details or remember factual information, so their responses are more of an vague impression. This particular type of original cognition and recollection is significant because it explains how the hysterical individual is capable of repressing painful or anticipated, painful experiences. Their original cognition is designed to not readily able to perceive and appraise all aspects of the information presented, and if, for instance, there is the notion that a situation may cause discomfort of any kind, the cognitive process readily undergoes a method of repressing that information, so that it never is truly experienced by the conscience.

One can clearly see the distinction between the obsessive-compulsive and hysterical style based on their distinctive cognitive styles. It is as if they are almost clear opposites when considering the cognitive styles employed by both. With regards to Shapiro’s approach in explaining these particular neurotic styles, it is interesting that he focuses on the mechanisms of cognitive functioning, that result in maladaptive personality styles, giving a comprehensive theoretical approach as to why obsessive-compulsive and hysterical individuals function as they do.


 

Hysterics v Obsessionals-Desiree

One of the most consistently pronounced and supported differences in cognitive and defensive style concerning obsessionals and hysterics concerns the notion of repression, reaction formation, isolation of affect and undoing. The defense mechanism of repression places a strong foothold in the hysterical cognitive style lending itself to be the main variant in allowing hysterics to be unable to clearly define and recollect memory contents. This behavior pattern in turn renders them more dependent upon emotionally driven instead of rationally thought-out affect responses. In contrast, the obsessive-compulsive personality type is driven by the need to achieve high expectations and to defend against anxiety induced by fear of failure and does so by placing significant attention and value to cognition and focus on detail. Obsessionals spend considerable time and effort attempting to separate affect from cognition while hysterics tend to defend against having to accurately remember occurrences of their past that may induce conflictual or overwhelming emotions by adopting an emotionally laden interaction style. Obsessionals appear to be consistently entrenched in a state of rigidity and order as a means of defending against unconscious/conscious wishes to be impulsive, messy and irresponsible, which is reflective of the use of reaction formation as a means of coping with ambivalent feelings.

Freud theorized that obsessive-compulsive individuals tended to experience early object relations as being associated with feelings of being expected to conform and display obedience and to expect to experience intense feelings of guilt if one does not comply with these expectations. As a result of this persistent push and pull of emotions experienced by the individual, conflicted feelings of rage and fear towards the object develop and are played out in persistent behavioral patterns of working towards order while defending against disorder.

Regarding hysterical personality style, both Shapiro and McWilliams emphasize the importance of repression in terms of its role as the main cognitive process that drives the behavior of hysterics. Freud substantiated the theory that hysterical individuals pushed back conflictual and anxiety inducing feelings concerning power and danger of the opposite sex as an explanation for these individuals needing to store factual memories at an inaccessible level. Among hysterics, object relations are represented by internalized feelings of anger, fear, power, and seduction towards the opposite gender as a result of power differentials and values assigned to males and females experienced by an individual in early childhood.

 

reaction 4

In order to adequately assess the cognitive styles of obsessionals and hysterics, it seems important to recognize specific aspects of the etiology of each personality style. First, those with obsessive and compulsive ways of functioning are most classically associated with toilet training and the sensitivities surrounding development during this time period. Their parents were either too early or too strict, leaving the child to feel judged and dooming them to a life motivated by control of everything. McWilliams suggests that the predominant affective conflict with this personality style “is rage (at being controlled) versus fear (of being condemned or punished).” She goes on to reveal that in her work with these patients, she has noticed that their affect is ‘muted, suppressed, unavailable, or rationalized’. These obviously tap into some of the defensive processes and cognitive styles of obsessive compulsives. Most notably, obsessive-compulsives tend to rely on isolation of affect as their most dominant defense. Thoughts, rationalizations, and intellectualizations replace feelings because feelings can be too uncontrollable and childish.


David Shapiro and Nancy McWilliams are in agreement of the fact that hysterical personalities are marked by the employment of repression as a primary defense. Because repression relies on the formation and interpretation of memories, Shapiro suggests that we must attempt to understand the cognitive world of hysterics. Here thought processes are diffuse, undefined, and vulnerable to external influences. Their global and scattered cognitive style is summed up by Shapiro as “impressionistic”, especially when compared to the sharp, detail-oriented style of obsessionals.

Sunday, March 05, 2006

 

Sheila's Reaction: #4

The thought processes of the obsessive compulsive personality have a distinct quality that sets them apart from other styles. Most salient for Shapiro is the rigidity that characterizes the obsessive compulsive individual’s mode of thinking. A constant state of “active attention” enables the person to focus intensely on details, but impedes the ability to perceive the “big picture,” the true substance of an event or interaction. Decision-making can be especially problematic as the individual considers all possibilities and struggles to make the “right” choice based on some internal rule or principle. Ironically, very often these decisions end up making themselves; the person is forced to make a hasty choice because of time constraints, for example.

Particularly interesting is Shapiro’s description of the “loss of conviction” or certainty about the world. When it comes right down to it, the obsessive-compulsive person doesn’t completely believe, for instance, that his neighbor has contracted the bird flu. But he might have, and that is quite enough. McWilliams discusses at length the defense mechanisms most employed by such individuals, which include isolation of affect, undoing, reaction formation and displacement. Acknowledging and experiencing feelings is equated with childishness, loss of control and leaves them vulnerable to shame. As McWilliams observes, emotions are essentially turned into cognitions which, it could be argued, are for many much more easily handled.

In sharp contrast is the cognitive style of the hysterical personality, best described by both Shapiro and McWilliams as “global, impressionistic and imaginal”. Here thought processes are scattered, undefined and completely open to external influence. The hysterical person’s mode of cognition makes the individual particularly susceptible to repression, which together with sexualization and regression, is one of the personality’s most used defense mechanisms. Repression is made much easier when the original experience isn’t processed in a sharp, discriminating way in the first place. Unlike the decision making of obsessive-compulsive personalities, that of the hysteric is quick and based on “hunches”, not consideration of actual facts. Shapiro goes as far as to say that hysterics are generally “deficient in knowledge” and imagines that they are not among the world’s scientists or scholars. McWilliams seems to offer a more appreciative view of such personalities, observing that there are hysterically organized individuals whose “rich integration of intellectual and artistic sensibility” is of special value.

 

Hysterical Vs. Obsessive-compulsive:Nirit Sagee

The underlying sense of self of the Hysterical person is of a small, fearful and defective child coping with a world dominated by powerful others. The obsessive-compulsive’s (o-c) personality on the other hand, is organized around an underlying conflict between rage against being controlled versus fear of being punished. Their opposite cognitive styles match their different inner-subjective experiences. The o-c cognitive pattern focuses sharp attention on technical details, many times irrelevant ones, without the ability to shift attention to different sets of stimuli such as flavor and tone (affective) of a situation, and their possible impact on the self. It seems as if the o-c, with constant hard work and sharp attention to dry details, is trying hard to hide and escape his rage and avoid the consequences of punishment. The Hysterical cognitive pattern, on the other hand, is floating, impressionistic and vague while “half-baked hunches” are the final cognitive product. In this case, is as if the un-rooted but colorful and noisy affect will help the little child this time to be noticed and maybe even loved.
The o-c person as well as the hysterical one is “governed” by out-of-touch parts of their personalities so that if asked “how do you feel?” the o-c would say: “I don’t feel” and the hysterical person would say “this is what I feel – isn’t it?” Then what is their governing entity? The o-c functions under the “should” orders of his harsh super ego. The Hysterical functions under half-baked surface affective impressions that although identified as the real affective experience, are actually not tottaly connected to the true self.
In order to cope with those inner feelings and outside stimuli, the hysterical person would defensively use repression, sexualization and regression that create demeanor of a charming child-like adult that attains attention that might make him/her feel accepted and loved by the powerful others. The defensive coping styles of the o-c are isolation, rationalization, moralization and intellectualization, reaction formation and displacement, anything that would keep him isolated and safe from his uncontrolled rage.

 

Matt: A Tale of Two Sisters

In a family I know well there are three daughters, all now in their 50’s. The father, who immigrated to the US in his teens—leaving behind his family—was controlling and authoritarian. The daughters experienced him as unpredictably angry, and spent much of their time and energy second-guessing his moods in an effort to avoid being the focus of his shaming outbursts. Their mother, who had left her own family in order to be with a man they didn’t approve of, was weak and passive, though the girls glimpsed reserves of rage in her frequent passive-aggressive comments.
The oldest sister has been thought of as strange and bizarrely withdrawn by the rest of the family since childhood, when she would lock herself in her room and scream at anyone who touched her things. In adulthood she married and had two children, now grown, but seemed not to enjoy them. She and her husband divorced and her older daughter ran away from home as a teenager. She will not speak to this daughter now and when asked if she is sorry not to have met her grandchild replies, apparently without malice, that it was her husband’s idea to have kids. She restricts herself to a small world—home, work, a Starbucks. She is constantly redecorating her home. Her clothes are arranged in color order in the closet, with space between each item. Her kitchen is spotless, with a full set of expensive cookware that has never been used and all of the Williams-Sonoma cookbooks, also unused. Unlike her sisters, she expresses no anger about her childhood, and in fact the only affect I have seen in her is a decided nervousness. She reports satisfaction with her life, saying that it is just as she imagined it would be as a girl. In this she is referring to the state of her home (all Laura Ashley), her car (a Mercedes), her exercise routine (every day), and her independence from others. Perhaps the most striking thing about her life is that almost nothing in it seems to change.
The middle sister is the highest-functioning member of the family, and was the only daughter to move away from her parent’s city. She was favored by the father but also found him frightening. After college she moved to New York and enrolled in an acting class. She ended up marrying her acting teacher, a man 20 years her senior, and having two children with him before she became disillusioned and furiously angry with him. They divorced almost 20 years ago and she has expressed little interest in romantic and/or sexual attachments since then. In stark contrast to her older sibling, the middle sister is unapologetically dramatic and emotional in her presentation. She is highly extroverted and appears to say whatever comes into her head, though she frequently regrets her statements later and dwells on her shameful feelings. A large group of friends surrounds her, and she considers these women to be a kind of replacement family. She is quite intelligent, though in conversation she often takes an anti-intellectual stance, aligning herself with emotion—especially love, compassion, and the like—above all else. She seems to identify strongly with the young children (under age 5) with whom she works.
The older daughter appears to have a decidedly obsessive character. The middle daughter, while clearly less pathological, seems oriented toward hysteria. The youngest leans well toward narcissism, though I won’t elaborate on that here.

 

Sara- Paper #4

Sara Petrasso

As an undergraduate student attending NYU, I have had my share of roommates. All came equipped with their own, distinct personality styles and idiosyncratic behaviors. Perhaps my most memorable roommate experience came my senior year when I lived with two young women who had starkly different ways of relating to, conceptualizing, and experiencing the world.

A typical day for Molly would start off with her organizing her emails into folders based on: who sent it, the time it was sent, its length, whether it had a subject heading, and whether or not it was sent to multiple respondents. Although she dedicated an inordinate amount of time towards this process, she often overlooked the very essence of the emails themselves. For instance, one semester, school-wide emails were sent informing the students that one of the university’s most popular and beloved professors had passed away, and a memorial service would be held to commemorate his life. When the memorial service came and went, Molly, who had taken many classes with the professor, stated that she was never informed of his death. She was confounded as to how she could have missed the emails bearing the news of his passing, and immediately began devising a new and improved, fool-proof, email organizational system.

This example serves to illustrate the cognitive and defensive styles of the obsessional personality as marked by an over-reliance on thinking, a devaluation of feeling, and a reliance on isolation of affect, undoing, and reaction formation. Freud proposed that the obsessional character structure derives from a fixation at the anal phase of development, where issues of control and shame can emerge. According to Shapiro (1999), the obsessive-compulsive (o-c) cognitive style is characterized by rigidity, lack of cognitive flexibility and mobility, and a hyper-focused attention to extraneous detail. Affect is generally concealed, with the exceptions of shame and rage; these are considered “acceptable” emotions in circumstances that warrant righteous indignation and guilt over not living up to one’s standards. Shapiro also sees the subjective experience of the o-c as being characterized by concentrated effort and tense deliberateness. Consequently, the experience of true joy and fun is unattainable, impossible.

In contrast, my other roommate, Tanya, had more of a hysterically organized personality. When she found out about the death of the aforementioned professor, she was much more emotionally reactive than Molly. Her reaction was one of overly dramatized sadness and shock (even though we had known that our elderly professor had been ill for some time). When I asked her about her memories of him, she couldn’t distinctly recount anything, and instead gave me a sentimental, though vague and impressionistic account.
Such kind of an affective and cognitive style is typical of someone with hysterical personality organization. Their general mode of cognition allows for repression, the dominant defense for hysterics (though regression and sexualization are also typical defenses). Shapiro proposes that hysterical cognition is general, diffuse, and lacking in clarity and attunement. Their tendency to rely on impressions and vivid environmental cues facilitates their ability to repress discomforting and painful affects and memories, and can serve to recreate their factual world. When their unconscious anxiety and guilt manifest in the form of outbursts, they tend to dissociate the experience as being one that is ego-alien, further supporting Shapiro’s assertion that hysterics lack a sense of genuineness.
Gender inequity issues seem to be at the heart of the hysterical personality make-up. Typically, femininity is associated with powerlessness with which the hysteric identifies. During the oral phase, Freud believed, the mother is seen as inept by failing to make the child feel safe and secure. Later, during the oedipal phase, the child goes on to devalue her mother and direct her object-cathexis at the powerful father. Power, though, will go on to be regarded as an exclusively, male entitlement.

 

Joshua's Response, Obsessive-Compulsive and Hysterical

Freud believed the obsessive-compulsive personality style (OCPS) to be characterized by issues revolving around the anal stage of development, including cleanliness, stubbornness (rigidity), concerns about punctuality, and tendencies towards withholding (McWilliams). It was believed that such persons were prematurely toilet-trained or done so with undue force or control. Others view this atmosphere of control as a present force during all stages of development. According to McWilliams, the families of those with OCPS exert control in moralized, guilt-inducing ways (traditional conception). However, contemporary views of OCPS recognize families that exert control in shame-inducing ways and families that under-parent.
This atmosphere of control results in a personality style characterized by intense, sharply focused attention, rigidity in thinking, and “tense deliberateness” (Shapiro). Obsessive-compulsive appear to be driven to act, as being pressed and motivated to act. The duties and responsibilities that drive the obsessive-compulsive are the product of their harsh superego.
Given the harsh-superego of the OCPS, it is not surprising that a primary defense of obsessive-compulsive persons is moralization, specifically “moral masochism” (McWilliams). Rationalizers find cognitively acceptable ways of validating their actions, while moralizers find it is their duty to perform certain actions. This fits with the driven nature of the OCPS. Other defenses in operation include reaction formation and undoing. McWilliams views the obsessive-compulsive persons’ rigid deliberateness as a reaction formation against wishes to be irresponsible or messy. She also identifies undoing in response to the feeling of having committed some crime.
Finally, affective experience requires a person to relax, to a certain degree, their deliberateness. However, the intense rigidity and deliberateness of the OCPS causes the restriction in affective expression characteristic of obsessive-compulsive persons (Shapiro).
According to Freud (as cited in McWilliams), the hysterical personality is the result of a fixation at the Oedipal stage of psychosexual development. The histories of hysterical individuals are filled with events that assign varying levels of importance to the sexes. The hysterical woman both identifies with her mother and sees her as a source of competition.
The cognitive life of those with a hysterical personality style is impressionistic (McWilliams and Shapiro). Unlike those with an OCPS, hysterical individuals are easily distracted. This cognitive style lends itself to a primary defense of the hysterical person, repression. Recollection of facts or emotionally charged information that is built on an impressionistic, distractible frame is unlikely (Shapiro).
Other defenses employed by the hysterical personality include sexualization and regression. Their wish for love, for approval and validation, may be amplify into sexualization or produce childlike flirtation. The emotional expressiveness may have an insincere flavor, but it is a mechanism aimed at allowing the hysterical individual deal with their own anxiety.

 

Obsessive-Compulsive vs. Hysterical Character Styles

Obsessive-Compulsive versus Hysterical Character Styles

For cognitive style, the obsessive-compulsive type is the polar opposite of the hysterical type. That is, in the former case, the person scrutinizes life, attending to selected details almost exclusively at the expense of broader themes as well as other unselected details. This feature is in large part due to the deficiency in attention-shifting. In the latter case, the hysterical person is overly global, and this is at the expense of important discrete facts. However, like the obsessional character, this orientation is also based on selectivity, only here it is not the lack of the attention-shifting capacity, but the frequent implementation of repression. The capacity for repression is so profound that it defines this neurotic type, distorting their experience of life and relationships, their memory, and personal narrative.

Unlike the hysteric, who is, in a way, over-engaged in the world, the obsessive-compulsive is disengaged from the world. In both cases, this way of being is naturally a defense. The hysteric’s perpetual attention-seeking behavior is driven by an intense inner dread that they are unwanted and disliked- they feel devalued, though maybe not consciously. The obsessive-compulsive is driven away from the world, isolating himself, as an attempt at control and preservation of an unconscious wish for omnipotence. The illusion (delusion) of control is maintained by the person’s rejecting of the world, avoiding the fear of being rejected. Thus he is making the choice before the world makes it for him.

Thematically, it seems as though the hysteric’s organizing way of managing their anxiety and fear is through the usage of defenses which ultimately manipulate and distort their own conscious experience, where as the obsessive-compulsive is generally prone to externalizing the causes of his thoughts, feelings, and behavior. Hysterics tend toward controlling how they experience the world. Obsessive-compulsives tend toward controlling what of the world they experience.


 

Kelly's reaction on Shapiro

Shapiro positions cognition as the starting point in delineating hysterical and obsessive compulsive styles. He contends that it is the underlying cognitive process and mode of thinking that facilitates the matrix of defenses and attributes specific to these styles. For example, the hysteric’s tendency to respond rapidly and reflect a global, diffuse, and vividly affective impression is indicative of the cognitive organization of the data and dictates that which the recollection draws upon. Likewise, the obsessive compulsive’s reliance on factual and minute technical detail is primarily indicative of the original cognitive mapping of the experience. For Shapiro, the defensive operations, intellectualization in the obsessive compulsive and repression in the hysteric, are seen as secondary to and facilitated by the parameters of original cognitive process.

Shapiro outlines the general mode of thinking in the hysteric and obsessive compulsive along the following lines:
Hysterical Cognition
Incapacity for concentration as exhibited by the tendency to operate off of hunches
Rigidity in attention to detail
Impressionability
Obsessive Compulsive Cognition
Quality of "active inattention"
Deficiency in factual knowledge as evidenced by the lack of emotionally neutral content in hysterical thinking
Loss in volitional mobility of attention

QUESTIONS:
First, I wonder how a successful analysis would affect recollection. For example, would a hysteric who relies significantly less on repression due to a successful analysis then recollect childhood memories in a more factual, less impressionistic style? Surely one of the main goals of therapy is creating a coherent and relevant narrative. In order to do this, I assume one must be able to fill in deficiencies by recalling unrecognized aspects of past experiences - extending beyond the original cognitive style.

Second, how would Shapiro account for content represented in dreams that may contradict the confines of original cognition? For example, might the obsessive dream of a childhood experience laden with affective content or the hysteric a dream fraught with factual detail? (My "hunch" is that his response would be the dream belongs to the realm of the unconscious not the conscious experience to which the cognitive style belongs.)

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