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All analysts would dubiously agree that there are both current and transferential determinants of the analytic situation, and probably no analyst would argue that a transference of the analytic situation, and probably no analyst would argue that a transference idea can be expressed without contamination, as it was, that is, without any connection to anything current in the patient-analyst relationship. Nevertheless, the implications of this fact for technique are often neglected in practice, as my next point is only to argue for the connection.
Several authors, e.g., Kohut 1959 and Loewald 1960, have pointed out that Freud`s early application by the act or practice of using something or the state of being used, this, however, employ of the quality of being appropriate or valuable to some end as to accommodate the accountable or warrant the use of the term transference. In `The Interpretation of Dreams, in a connection not immediately recognizable as related to the present day use of the term, reveals the fallacy of considering that transference can be expressed free of any connection to the present. That early use was to refer to the fact that an unconscious idea cannot be expressed as such, but only as it becomes connected to a preconscious or conscious content. In the phenomenon with which Freud was then concerned, the dream transference took place from an unconscious wish to a day residue. In `The Interpretation of Dreams, `Freud used the term transference both for the general rule that an unconscious content is expressible only as it becomes transferred to a preconscious or conscious content and for the specific application of this rule to a transference to the analyst. Just as the day residue is the point of attachment of the dream wish, so must there be an analytic-situation residue, though Freud did not use that term, as the point of attachment of the transference.
Analysts have always limited their behaviour, both in variety and intensity, to increase the extent to which the patient‘s behaviour is determined by his idiosyncratic interpretation of the analyst’s behaviour. In fact, analysts unfortunately sometimes limit the behaviour so much as to compare with such an expression or unpiled standard or absolute approximation, that the entire relationship with the patient matter of technique, with no nontechnical personal relation, as Liptop (1977) has pointed out.
Yet, no matter in what manner far the analyst attempts to carry this limitation of his behaviour, the very existence of the analytic situation provides the patient with innumerable cues which can enviably become his rationale for his transference responses. In other words, the current situation cannot be made to disappear - that is, the analytic situation is real. It is easy to forget this truism in one’s zeal to diminish the role of the current situation in determining the patient ‘s responses. One can try to keep past and present determinants relatively perceptible from one another, but one cannot obtain either ‘pure culture‘. Freud wrote: ‘I insist on this procedure [the couch], however, for its purpose and result are to prevent the transference from mingling with the patient’s associations imperceptibly, to isolate the transference and to allow it to come forward in due course sharply defined as a resistance’ (1913). Even ‘isolate’ is too strong a word in the light of the inevitable intertwining of the transference with the current situation.
If the analyst remains under the illusion that the current cues he provides to the patient can be reduced to the vanishing point, he may be led into a silent withdrawal, which is not too distant from the caricature of an analyst as someone who does refuse to have any personal relationship with the patient. What happens then is that silence has become a technique rather than merely an indication that the analyst is listening. The patient’s responses under such conditions can be mistaken fo uncontaminated transference when they are in fact transference adaptions to the actuality of the silence.
The recognition, from which it takes its point of departure, as it were, has a crucial implications for the technique of interpreting resistance to the awareness of transference, in that, if, the analyst becomes persuaded of the centrality of transference and the importance of encouraging the transference to expand within the analytic situation, he has to find the presenting and plausible interpretation of resistance to the awareness of transference he should make. Is that, his most reliable guide is the cues offered by what is actually going on in the analytic situation? : On the one hand, the events of the situation, such as change in time of session, or an interpretation made by the analyst, and, on the other hand, how the patient is experiencing the situation as reflected in explicit remarks about it, however, fleeting these may be. This is the primary yield for technique of the recognition that any transference must have a link to the actuality of the analytic situation. The cue points to the nature of the transference, just as the day residue for a dream may be a quick pointer of the latent dream thoughts. Attention to the current situation for a transference elaboration will keep the analyst from making mechanical transference interpretation, in which he interprets that there are allusions to the transference in association not manifestly about the transference, but without offering any plausible bias for the interpretation. Attention to the current stimulation offers some degree of protection against the analyst’s inevitability whose tendency to project his own views onto the patient, either because of countertransference or because of a preconceived theoretical bias about the content and hierarchical relationships in psychodynamics.
The analyst may be very surprised at what in his behaviour the patient finds important or unimportant, for the patient’s responses will be idiosyncratically determined by the transference, the patient’s responses may seem to be something the patient as well as the analysts consider trivial, because, as in displacement to a trivial aspect of the day residue of a dream, displacement can better serve resistance when it is to something trivial. Because it is connected to conflict-laden material, the stimulus to the transference may be difficult to find. It may be quickly disavowed, so that its presence in awareness is only transitory. With the discovery of the disavowed, the patient may also gain insight into how it repeats as disavowed earlier in his life. In his search for the present stimuli which the patient is responding transferentially, as the analyst must therefore remain alert to both fleeting and apparently trivial manifested reference to himself as well as in the events of the analytic situation.
If the analyst interprets the patient’s attitudes in a spirit of seeing their possible plausibility in the light of what information the patient does have, rather than in the spirit of either affirming or denying the patient’s views, the way is open for their further expression and elucidation. The analyst will be respecting the effort to be plausible and realistic, rather than manufacturing his transference attitudes out of whole bodied material.
Importantly, is to make a transference interpretation plausible to the patient in terms of as current stimulus that, if the analyst is persuaded that the manifest content has important implications for the transference but he is unable to see a current stimulus for the attitude, he should explicitly say so if he decides to make the transference interpretation anyway. The patient himself may then be able to say what the current stimulus is.
It is sometimes argued that the analyst’s attention to his own behaviour is a precipitant for the transference, will increase the patient’s resistance to recognizing the transference. That, on the contrary, that because of the inevitable interrelationship of the current and transferential determinants, it is only through interpretation that they can be disentangled.
It is also argued that one must wait until the transference has reached optimal intensity before it can be advantageously interpreted. It is true that too hasty and interpretation of the transference can serve as a defensive function for the analyst and deny him the information he needs to make a more appropriate transference interpretation. But it is true that delay in interpreting transference interpretation, but it is also true that delay in interpreting runs the risk of allowing an unmanageable transference to develop. It is also true that deliberate delay can be a manipulation in the service of abreaction rather than analysis, and, like silence, can lead to a response to the actual situation which is mistaken for uncontaminated transference. Obviously important, is assumed in the issues of timing are involved, whereas an important clue to when a transference interpretation is apt and which one to makes lies in whether the interpretation can be made plausibly in terms of the determinant, namely, as something in the current analytic situation. Such as, in the approaching transference in the spirit of seeing how it appears plausibly realistic to the patient, it paves the way toward its further elucidation and expression.
Freud’s emphasis on remembering as the goal of the analytic work implies that remembering is the principal avenue to the resolution of the transference. But the delineation of the successive steps in the development of the analytic technique (1920) makes clear that he saw this development as a change from an effort to reach memories directly to the utilization of the transference as the necessary intermediacy to reaching the memories.
In contrast to remembering as the way the transference is resolved, Freud also described resistance for beings primarily overcome in the transference, with remembering following relatively easily afterwards, ‘From the repetitive reactions which are exhibited in the transference we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it was, after the resistance has been overcome’ (1914), and ‘This revision of the process of repetition can be accomplished only in part in connection with the memory traces of the process which led to repression. The decisive part of the work’s achieved by creating in the patient’s relation to the analyst - in the ‘transference‘ new editions of the old conflicts . . . Thus, the transference becomes the battlefield on which all the mutually struggling forces should meet one another’ (1917). This is the primary indication for which Strachey (1934) classified in his seminal paper on the therapeutic action of psychoanalysis.
There are two main ways in which resolution of the transference can take place through work with the transference in the here and now. The first lies in the clarification of what are the clues in the current situation which are the patient‘s point of departure force a transference elaboration. The exposure of the current point of departure at once raises the question of whether it is adequate to the conclusion drawn from it. The relating of the transference to a current stimulus is, after all, parts of the patient‘s effort to make, the transference attitude plausibly determined by the present. The reverse and ambiguity of the analyst’s behaviour are what increases the ranges of apparently plausible conclusions the patient may draw. If an examination of the basis for the conclusion makes clear that the actual situation to which the patient responds is subject to other meanings than the one the patient has reached, he will more reality consider his pre-existing bias, that is to say, in that of the transference.
Being that of a distinctive feature of, it is suggested that, in speaking of the current relationship and the relation between the patient’s conclusion and the information on which they seem plausibly based, such in some absolute conception of what is real in the analytic situation, of which the analyst is the final arbiter. That is not the case, that what the patient must come to see is that the information he has is subject to other possible interpretations implies the very contrary to an absolute conception of reality. In fact, analyst and patient engage in a dialogue in a spirit of attempting to arrive at a consensus about reality, not about some factious absolute reality.
The way in which resolution of the transference can take place within the work with the transference in the here and now is that in the very interpretation of the transference the patient had a new experience. He is being treated differently from how he expected to be. Analysts seem reluctant to emphasize his new experience, as though it endangers the role of insight and argue for interpersonal influence as the significant factor in change. Strachey’s emphasis on the new experience in the mutative transference interpretation has unfortunately been overshadowed by his views on introjection, which have been mistaken to advocate manipulating the transference. Strachey meant introjection of the more benign superego of the analyst only as a temporary strep on the road toward insight. Not only is the new experience not to be confused with the interpersonal influence of a transference gratification, but the new experience occurs together with insight into both the patient’s biassed expectation and the new experience. As Strachey points out, what is unique about the transference interpretation is that insight and the new experience take place in relation to the very person who was expected to behave differently, and it is this which gives the work in the transference, its immediacy and effectiveness. While Freud did stress the effective immediacy of the transference, he did not make the new experience explicit.
It is important to recognize that transference interpretation is not a matter of experience, in contrast to insight, but a joining of the two together, both are needed to bring about and maintain the desired changes in the patient. It is also important to recognize that no new techniques of intervention are required to provide the new experience. It is an inevitable accompaniment of interpretation of the transference in the here and now. It is often overlooked that, although Strachey said that only transference interpretations are outside the transference.
Rosenfeld (1972) has pointed out that clarification of material outside the transference is often necessary to know what is the appropriate transference interpretation, and that both genetic transference interpretations and extratransference interpretation taking to consider an inclination as marked by or indication of notable worth or simply the consequence based upon the role in working through. Strachey said relatively little about working through, but surely nothing against the necessary provision with which every thing needfully is explicitly recognized as the role for the recovery of the past in the resolving dissection of the purposiveness determined by the transference.
In taking positions, as to emphasize the role of the analysis of the transference in the here and now, both in interpreting resistance to the awareness of transference and in working toward its resolution by relating to the actuality of the situation. In that of opinion or purpose with the evidence that extratransference and genetic transference interpretation and, of course, working through is important too, that the matter is one of emphasis. Also, interpretation of resistance to awareness of the transference should figure in the majority of sessions, and that if this is done by relating the transference to the actual analytic situation, the very same interpretation is a beginning of work to the resolution of the transference. To justify this view more persuasively would require detailed case material.
The concern and considerations that the Kleinian annalists whom, many analysts feel, are in error in giving the analysis of the transference too great if not even as exclusive role in the analytic process. It is true that Kleinians emphasize the analysis of the transference more, in their writing at least, than does the general run of analysts. As, Anna Freud (1968) complained that the concept of transference has become overexpanded seems to be directed against the Kleinians. One of the reasons the Kleinians consider themselves the true followers of Freud in technique are precisely because of the emphasis they put on the analysis of the transference. Hanna Segal (1967), for example, writes, `Too say that all communications are seen as communications about the patents phantasy as well as current external life is equivalent to saying that all communications contain something relevant to the transference situation. In Kleinian technique, the interpretation of the transference is often more central than in the classical technique.
A validatory point of view or way of regarding that Freud and transference had accedingly connected by simulating observations that we can only offer, that Freud wrote briefly about transference, and did so, to sustain the way in which, is, as a whole, that his actions were justly taken in and around 1917. Another observation which can rarely be made about Freud’s works, and which everyone may not agree with, is that, with one or two exceptions, what he did write on transference did not reach the high level of analytical thought which has come to be regarded as standard for him. Some indication of what his contribution consists of is given by the editors of the Standard Edition, who list them in several places. One of the longer lists, in a footnote on page 431 of Volume 16, includes six references: ‘Studies of Hysteria’ with Breuer (1895), the Dora paper (1905), ‘The Dynamics of Transference’ (1912), ‘Observations on Transference-Love’ (1915), the chapter on transference in the Introductory Lectures (1917), and ‘Analysis Terminable and Interminable’ (1937). Although the editors, in no sense suggest that these six papers include everything Freud wrote on the subject. It does seem evident that, considering the essential importance of transference to analysis, he wrote, ‘The Dynamics of Transference’, ‘Transference-Love’, and the transference chapter in the Introductory Lectures, came across, as, perhaps, his least significant contribution.
Freud’s first direct mention of transference comes upon the pages ascribed within the ’Studies of Hysteria’ (1895), his first significant reference to it, however did not appear until five years later, when, in a letter to Fliess on April 16, 1900, he said (Freud, 1887-1902) he was ‘beginning to see that the apparent endlessness of the treatment is something of an inherent feature and is connected with the transference’. In a footnote to this letter the editors said that, ‘This is the first insight into the role of transference in psychotherapy.’
Despite these early references, it seems correct to say that yet another five years were to go by before the phenomenon of transference was actually introduced. Even so, the introduction was far from prominent, for it was tacked on like an afterthought as a four-page portion of a postscript to what was perhaps Freud’s most fascinating case history to date, the case of Dora (1905).
Using data from Dora’s three-month-long, unexpectedly terminated analysis, and especially from her dramatic transference reaction which had taken him quite unawares, Freud now gave to transference its first distinct psychological entity and for the first time indicated its essential role in the analytic process. His account, although in general more than adequate - in the elegant fact and unmistakably ‘finished’ - was brief, and almost to the point, and perhaps not an entirely worthy introduction so much more a truly great discovery. What was uniquely great was his recognizing the usefulness of transference. In his analysis of Dora he had noted not only that transference feelings existed and were powerful, but, much to his dismay, he had realized what a serious, perhaps, even insurmountable obstacles that objectively would be. Then, in what seems like a creative leap, Freud made the almost unbelievable discoveries that transference was in fact, the key to analysis, that by properly taking the patient’s transference and therapeutic force was added to the analytic method.
The impact on analysis of this startling discovery was actually much greater and much more significant than most people seem to appreciate. Although the role of transference as the sine quo non of analysis and is widely accepted, and was stated by Freud from the first, it has almost never been acclaimed for having brought about an entire change in the nature of analysis. The introduction of free association to analysis, a much lesser change, receives and still receives much more recognition.
One of the reasons for the relatively unheralded entry of transference into analysis may have been for circumstances of its discovery. Although Freud’s new ideas were recorded as if they arose as sudden inspiration during the Dora analysis, they may in fact have developed somewhat later. In the paper‘s precatory remarks, for instance, Freud said he had not discussed transference with Dora at all, and in the postscript, he said he had been unaware of her transference feelings. Also, pointing to a later discovery date is the extraordinary delay in the paper’s publication. According to the editor’s note, the paper had been completed and accepted for publication by late January 1901, but this date was then actually set back more than four and a half years until October 1905. The editors said, ‘We have no information as to how it happened that Freud, . . . deferred publication.’ It readily seems that for reasons to have been that only during those four and a half years, as a consequence to his own self-analysis, that he came to a better understanding of the relevantly significant as the applicable reason to posit of the transference. Only then may it have been possible for him to turn again to the Dora case, to apply to it of what he had learned in himself, to write this essay as part of the postscript, and at last to release the paper for publication.
Freud’s self-analysis has been considered from many angles, but not significantly, as can be of valuing measure, in at least from the standpoint of transference. Opponents of the idea that there is such a thing as definite self-analysis, some of whom say it is impossible, generally an object on grounds that without any analyst there can be no transference neurosis. Freud clearly demonstrated, as, perhaps, that the situation that may be necessary to fill this need: Self-analysis may require that, at least a halfway satisfactory transference object. In Freud`s case, the main transference object at this time seems to have been Fliess, who filled the role rather well. As with any analysis, the authenticity as known in the unfeigned design as if existing or having no illusions and facing reality squarely, by which the ‘real’ impact on Freud was slight, he was essentially a neutral figure, relatively anonymous and physically separates. All of this, and Fliess`s own reciprocal transference reactions, made it possible for Freud to endow Fliess with whatever qualities and whatever feelings were essential to the development of Freud`s transference, and, it should be added, his transference neurosis. In the end, of course, the transference was in part resolved. Freud`s eventual awakening of its self realization in its presence within him of such strange and powerful psychological forces must have come to the conclusion as a stupefied disilluionary dejection toward Fliess, however, his subsequent working out of some of these transference attachments must have been both an intellectual triumph and an immensely healing and releasing of actions, operations or motions involved in the accomplishment of an ending that makes from its process.
In the years following this revolutionary discovery, the central role of transference in analysis increased in remarkable acceptance, and it has easily held this central position ever since. What the substance of this central position is noticeable composed in having or being capable of having within the constructs to which is something of a mystery, for, it seems as nothing about analysis and is, of least to be, the well known than how individual analysis actually uses transference in their day-to-day work with patients. As a guess, as, perhaps of each analysts concept of transference derives variably but significantly from his own inner experience, transference probably means many and varying differentiations to things as to different analysts
In the same differentiated individuals, as that Freud’s own disciples must have differed on this issue, not only from him but from each other. Although some of their differences may have been slight, others, my have contributed significantly to later analytic developments. A question could be raised, for instance, whether differences in handling the transference which at first were the property of one analyst gradually develop into formal clinical methods used by many, and whether these clinical methods, after having been conceptualized, serve as the beginning of variously divergent schools of analysis. Such occurrences, consistent with certain beliefs that analytic ideas do arise in this way, primarily out of transference experiences in the analytic situation, would lead to the question whether the history of the ideological differences in what was actually said and done in response to transference reactions that to any other factor. Whatever the case, many differences and divergencies did occur among the early analysts, and all of that is supposed to have had to do in some major way with differences in the handling of the transference.
Strangely, Freud himself seems to have taken little part in influencing this rapid and divergent period of growth. Usually accused of being too dominating in such matters, Freud seems to have done just the opposite during the development of this most critical aspect of analysis, the process itself, and, for reasons unknown, detached himself from it.
What was needed, one might be inclined to say, was not leadership in the form of domination, but leadership in trying to provide what was lacking, and still lacking, namely an analytical rationale for transference phenomena. The question must be asked, of course, whether in fact this would have been a good thing at that particular time in psychoanalytic history. Perhaps not. The exercise of closure, from which Freud’s structuring might have amounted to. But although adding to understanding and stability at ceratin theoretical levels, could at another level, so such closures have often done, have placed many obstacles in the way of further analytical developments. Thus, his leaving the matter of transference wide open, even though it led to confusion and uncertainty, may have been just as well.
In many ways the closest Freud ever came to laying the groundwork for a formal analytical rationale for transference was his first attempt, in the postscript to the case of hysteria (1905). These few pages are and among the most important of all Freud’s writings, outweighing by far the paper to which they are appended. Yet, in the case of Dora has always been taught as an entity rather than the ancillary to the essay on transference. In that essay Freud was clear: His ideas revealed tremendous insights and promised more to come, and that, the powers of the neurosis are occupied in creating a new edition of the same disease. Just think of the analytic implications of his saying that this new edition consists of a special class of mental structures, for the most part unconscious, having the peculiar characteristic of being able to replace earlier persons with that of the person of the analyst, and in the fashion applying all components of the original neurosis to the person of the analytical at the present time. Surely as profound a statement as any he ever made.
He then goes on to say that there is no way to avoid transference, that this ‘latest creation of the desire must be combatted like all the earlier ones’, and that, although this is by far the hardest part of analysis, only after the transference has been resolved can a patient arrive at a sense of conviction of the validity of the connection which have been constructed during analysis.
He concludes by saying, ‘In psychoanalysis . . . all the patients’ tendencies, including hostile ones, are aroused, they are then turned to account for reasons to explain or the internalization of justification, and by the same measure was to purposively give a sensible reason for the proposed change in the analysis by which of being made conscious. That, in this way, the transference is constantly being put-down, however, transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerfully . . .
These remarkable observations, in conveying a sense of deep conviction that could arise, one feels, only from Freud’s own hard-won inner experience, that nowhere is there a suggestion that transference is a mere technical matter. Far from it, as Freud announces that he has come upon as new and exciting kind of mental function, or, as it is to believe, that a new and exciting kind of ego function.
Very quickly, and, in whatever way, Freud’s conviction sees to have failed him. Nothing he wrote afterwards about transference was at this level, and most of his later references were a retreat from it, for instance, he never did develop the promising idea that the mind constantly creates new editions of the original neurosis and meaningfully incline the minded inclusion in them, an ever-changing series of persons. Instead, he tended to become less specific, even referring to transference at times in a broad terms as if it were no more than rapport between patient and analysts, or as if it was an interpersonal or psychosocial relationship, concepts which, of course, a great many analysts have since adopted, but which were not part of Freud’s original ideas.
Perhaps his most persistent deviation was an on-and-off tendency to regard transference merely as a technical matter, often writing of it as an asset to analysis when positive and a liability when negative.
Significantly, because it indicated that an active struggle was still going on within him, Freud occasionally expressed once again, even though briefly his earlier insights, particularly his ideas that transference is an essential although unexplored part of mental life. An example of this appears in his alternative obtainability such that is gainfully to appear of as quality of being pleasant or agreeable to a feature that makes for pleasantness or ease, among the amenities of the central geniality, otherwise, the prevailing indifference account for the transference in ‘An Autobiographical Study’ (1925). Transference, he says, ‘is a universal phenomenon of the human mind. And in fact dominated the whole of each person’s relations to his human environment. In these few words’ Freud again made the point, and in declarative fashion, that transference is a mental structure of the sizeable order of magnitude, but he never really followed it up.
Rather extensive evidence of his departure from the original concept and his continuing struggle with that concept is seen most clearly, wherein, the ‘Analysis Terminable and Interminable’ is much more than a courageous, brilliant, and pessimistic, appraisal of the difficulties and limitations of analysis, although transference is briefly mentioned in its content, yet a great deal about it comes through, some quite directly, some by easy inference. When looked at in this way, two themes stand out: Freud’s personal frustration with the enigmas of transference and his tacit placing of transference in the centre of success and failure in analysis, both as a therapy and as a developing science. What also comes through, is the perplexing realization of how far Freud had, by now, seemingly moved away from his original concepts. Or had he?
Judging unacceptable, that it is insufficient for exclusive reliance in relations to the complicated neurosis, for which it would be fallacious to assign to the recall and reconstruction of the past an exclusively explanatory value (in the intellectual sense), important though that functions be, and difficult as its full-blown emotional correlate may be to come by. There is no doubt that, even in complicated neurosis, equivalently complicated transference neurosis, the genuine complex and complicated transference neurosis, the genuinely experienced linking of the past and present can have, at times, a certain uniquely specific dynamic effect of its own, a type of telescoping or merging of common elements in experience, which must be connected with the meaninglessness of time in unconscious life, compared with its stern authority in the life of consciousness and adaptation to everyday reality. Contributing decisively to such experiences as to whatever degree it occurs, is, a course of study, that vivid currency of the transference neurosis, and central in this, the reincarnations of old objects in an actual person, the analyst.
Thus, an allied problem in the general sphere of transference is the fascination and often enigmatic interplay of past and present. If one wishes to view this interplay in terms of a stereotyped formulation, the matter can remain relatively uncomplicated - as a formulation. Unfortunately. , This is too often the case. The phenomenon, however, retains some important obscurities, which cannot thoroughly dispel, but to which I would like to call attention. To concentrate on the dimension of time, it seems in reference to the complication and immediate aspects of technique, nonetheless, essential. For example, we can assume that the transference neurosis re-enacts the essential conflicts of the infantile neurosis in a current setting. If a reasonable degree of awareness of transference is established, the next problem is the genetic reduction of the neurosis to its elements in the past, through analysis of the transference resistance and allied intrapsychic resistances, ultimately genetic interpretations, recollections and reconstructions and working through. Such that the transference is related to its genetic origins, the analyst thereby emerges in his true, i.e., real, identity to the patient, the transference is putatively ‘resolved’. To the extent that one follows the traditional view that all resistances, including the transference itself, is ultimately directed against the restoration of early memories as, this is a convincing formulation. Is that, only to say, that in his own right as such as having to a certain tightly logical quality? However, we know that it this is not so readily accomplished, apart from the special intrapsychic considerations described afterward by Freud in ‘Analysis Terminable and Interminable’. Although in a favourable case, much of the cognitive interpretative work can be accomplished, there remains the fact that cognition responsibility, in its bare sense, does not necessarily lead to the subsidence of powerful dynamism, to the withdrawal of ‘cathexes’ from importantly real objects. For, as mentioned, a short while ago, the analyst is a real and living object, apart from the representations with which the transference invests him, and which are interpretable as such, for which there is no, at any time a seldom, a confusing interrelations and commonly of the emergent responses, due to the same old seeking, and this is directed toward a new individual in his own right, both are important, furthermore, there are large and important ones of overlapping. Apart from such considerations, even the explicitly incestuous transference is currently experienced (as, at least in good part) by a full-grown adult (like the original oedipus), instead of a totally and actually helpless child. To be sure, the latter state is reflected in the emergent transference elements of instinctual striving, but it is subject to analysis, and the residual is something significant, if not totally different. It is these residual sexual wish, presumably directed toward the person of the analyst, as such, which must be displaced to others, if, as generally agreed, the revival of infantile fantasies and strivings in the biologically mature adolescent presents a new and special problem, one must assume distinctiveness of experience for the adult, although it is true that in the majority of instances, adequate solution is favoured by the adult state. There is, in any case, a residual relationship between persons who have worked together in a prolonged, arduous and intimate relationship, which, strictly speaking, are reversibly disconnected or divorced of services, in that the transference merely ushers out the retirement for which its rendering retreat of that state of mind or feeling by an inner avoidance of something usually felt as unpleasant or pronounced for it’s adverse but mutual colouration. Blending to some confusion between the two spheres of feeling. The general tendency is that both components are fully gratified to some degree. But, there is the ubiquitous power of the residual primordial transference, yet, argue to cling to an omnipotent partisan to resist the displacement of its ‘sublimated’ anaclitic aspects, even if the various representation of the wishes for bodily intimacy has been thoroughly analysed and successfully displaced. The outcome is largely the transference of the transference, as mentioned earlier, in a different context. For everyday reality can provide no actual answer to such cravings. In this connection, note, Freud’s genial envy of Pfister. If the man of faith finds this gratification in revealing religion, others in a wide range of secular beliefs and ‘leaders’ the modern rational and sceptical intellectual is less fortunate in this respect. Presumably free, he is prone to invest even intellectual disciplines or the proponents with inappropriate expectations and partisan passions, but, least of mention, that within these fields of analytical and theoretical thought, is not to provide exceptions to this tendency.
Though if one is to admit as valid and beneficially confine its bothering of reservations about the clarity of conceptualization, the explanatory discussion of Kohut and Seitz, is a very useful contribution to the direct complication or which by some understanding the awkwardness of oneself. Both Loewald and Kohut have deliberately associated a special but the different use of one of Freud’s three conceptions of transference, i.e., the transference from the unconscious to the preconscious.
Yet, to furthering comments on primordial transference, at least potentially, are largely psychological (mental) component, the concept of ‘transference of the transference’ would be applicable to this component. For it does appear that certain aspect of the search for the omnipotent and omniscient caretaking parents are implicitly practical as virtually capable for being turned to use or account for its functional practicability for something of a process or the procedure for being all but the essential purpose to come to or tend toward a common point, for which are the knowledgeable information or ideas, is nothing but causative effectuality. As suggested earlier, there are important qualitative and quantitative distinctions in the mode of persistence and such strivings, however, even to the extent that they are detached from the analyst and carried into some reasonably appropriate expression in everyday life, they retain at least a subtle quality which contravenes reality, one which derives from earliest infancy, and remains - to this extent - a transference. ‘Santa Claus’ lives on, where one might least expect to meet him, whether as a donor of miracle drug or of far more complex panaceas.
If one prescribes to this parasymbiotic transference drive, a true primordial origin, it is necessary to take cognizance of certain important concepts dealing with the earliest period of life. If we assume a powerful original organismic drive toward an original ‘object’, a striving to nullify separation from the beginning, how does this make something legally valid or operative usually by formal approval or sanctioned with concepts such as ‘primary narcissism’ or the ‘objectless phase’ or ‘the primary psycho physiological self’ (We note in passing that there are those who do not accept these as usually construed in the technique of Balint), for example, or Fairbairn or - conspicuously - Melanie Klein. These are states, variously defined or conceived, which apply to the earliest neonatal period, in which life, to state more simply, exists only as the potential in physiological processes. Since there is (we postulate) no clear awareness of self-withdrawal from the mother, there can be no ‘mentally’ represented or experienced drive to obliterate the separation (concerning oneself and object, conceiver of as separate, in a continuing sense). There are, of course, discharge phenomena, the precursors of purposive activity, and there are urgent physiological needs, directed toward fulfilment or relief, rather than toward an object as such. However, in relation to these physiological needs as archaistic precursors of object relationships, it must be noted that in all, except respiration and spontaneous sphincter relief (even in these instances, not without exception or reservation), the need fulfilment must be mediated by the primordial object (or her surrogate). There is also, of course, the uniquely important requirement for ‘holding’, in a literal expression, from the outset. The material partner in human symbiosis which supplies what the neonate cannot seek by ‘clinging’, as for Bowlty and Murphy, in the sense that must be experienced to the physiological ebb and flow of tension, even if restricted to the kinaesthetic, connected with a peripheral sensory registration, which is the protophase of the recognition of separation from the object or nonpresence of the object, as a painful instance of, her presence in apposition the converse? That the general context may be only in which the sense of unity is preponderant, or, more accurately, that there is no general awareness of ‘separation’ as such, means that the drive for union does not exist in a general psychological sense. It is, so to speak, satisfied. That object continuity, with its cognate word ‘longing’, is quite a different experience from the urgencies of primitive need fulfilment is true, however, regardless of what may be added by maturational and developmental considerations, instinctual and perceptual, there is no reason to assume other than a core of developmental continuity from the earliest needs and their fulfilment to the later state, and some continuing degree of contingency based on them.
There is a very rough parallel in the way certain analytic patients, before a firm relationship with the analyst is established, signal certain primitive experiences and tendencies in special reactions to the end of the hour, to the nonvisibility of the analyst, to interruption of their association, to failure of the analyst to talk, and similar matters. We must note that in the basic formation of the ego is evident amongst the primitive reactions and beyond to separations, in the form of very early identifications as based on care taking functions. Certainly in the very development of autonomous ego of the mother’s investment in the, have a decisive role in the character of the their development. And in the case of object constancy, in its connotation of libidinal cathexis, where is no need whatsoever (emotional or otherwise) is needed for prolonged periods. The importance of the object is, to put it mildly, liable to deteriorate, or to differ complicating aggressive change. Probably the characteristic feature of later developing relations to the object (love and the wish for love), as separate if not always separated from demonstrable primitivity, in the need fulfilment, have a special relationship to those ‘ancillary’ aspects of neonatal nurture, whose lack has been shown to be an actual threat to life in some instances, not to speak of sound emotional development. So that from the first, regardless of the assumed state of libidinal (and aggressive) economy, or the assumed state of psychological nondifferentiation between self and potential object, there are critical percussive phenomena, objectively observed, and probably prototypic subjective experiences of separation, which are the forerunners of all subsequent experiences of the kind. One may generalize to the effect that, with maturation and development, secondary identifications, and the various other processes of ‘internalization’ in its broadest sense, the problem of separation and its mastery becomes correspondingly more complex, and changes with the successive phase of life, but never entirely disappears.
In the view of the psychoanalytic situation described earlier, the comprehending mobilization of experiences of separation stimulated by the situational structure awakens the driving primordial urge to undo or to master the painful separations which it represents, usually embodied in the various forms of clinical transference that which we are familiar. One legitimate gratification which tends to mitigate superfluous transference regression is the transmission of understanding that at times, are thought that by the ‘mature transference’, in effect, the ‘therapeutic alliance’ or a group of mature ego functions which enter into such an alliance. Now, there is one blurring and overlapping at the conceptual edges in both instances, but the concept as such is largely distinct from either one, as it is from the primitive transference, which we have been discussing. Whether the concept is thought by others to comprehend a demonstrable actuality, which is a further question. This question, of course, can only follow on conceptual clarity. This in saying, of a nonrational urge, not directly dependent on the perception of immediate clinical purposes, a true transference in the sense that it is displaced (in currently relevant form) from the parent of early childhood to the analyst. Its content is not anti-sensational, but largely non-sensual of sometimes transitional, as the child’s pleasure in the assemblages of ‘dirty words’ and encompasses a special and not minuscule sphere of the object relationship: The wish to understand, and to be understood, the wish to be given understanding, i.e., teaching, specifically by the parent (or later surrogate); the wish to be taught to use ingenuity in making or doing o r achieving an end through the actions in a nonpunitive way, corresponding to the growing perception of hazard and conflict and very likely the implicit wish to be provided with and taught channels of substitutional drive discharge. With this, there may well be a wish, corresponding to that element in Loewald’s description of therapeutic process, to be seen in terms of one’s developmental potentialities by the analyst. No doubt, the list could be extended into many subtleties, details, and variations. However, one should not omit to specify that, in its peak development, it would include the wish for increasingly accurate interpretations and the wish to facilitate such interpretations by providing adequate material ultimately, of course, by identification, to participate in, or even be the author of the interpretations. The childhood system of wishes which underlies the transference is a correlate of biological maturation, and the latent (i.e., teachable) autonomous ego function, appearing with it, however, there is a drive-like quality in the participation phenomena, which disqualifies any conception of the urge’s identical with the functions. No one who has ever watched a child importune a parent with questions, or experiment with new words, or solicit her interests in a new game, or demand a storytelling or reading, can doubt this. That this powerful support and integration in the ego identification with a loved parent is undoubtedly true, just as it is true of the identification with an analyst toward whom a positive relationship has been established. That ‘functional pleasure ‘ inscribes the part, where certain specific ego energies, perhaps very likely the ego’s own urge to extend its hegemony in the personality. However, it can be stressed in the derive element, even the special phase configurations and colourations, and with its importance of object relations, libidinal and aggressive, for a specific reason. For just as the primordial transference seeks to undo separation, in a sense to obviate object relationships as we know them, the ‘mature transference’, tends toward separation and individuation, and increasing contact with the environment, optimally with a large affirmative (increasing neutralized) relationship toward the original object toward whom (or her surrogates) a different dynamic of demands is now increasingly directed. The further considerations which has led to the emphasis that the drive-like element in these attitudes are integrated phenomena, as examples of ‘multiple functional’ rather than the discrete exorcize of function or functions, is the conviction that there is a continuing dynamic relation of relative interchangeability between the two series, at least based on the response to gratifications in a significant zone of complicated energetic overlap, possibly including the phenomenon of neutralization. That the empirical ‘interchangeability’ is limited, and that goes without saying, that in no way diminishes its decisive importance. The linguistic communications as in mention, that the excessive transference neurosis regression, which can seriously vitiate the affirmative psychoanalytic process, finds a prototype in the regressive behaviour and demands of certain children, who do not receive their share of teaching, ‘attention’, play, nonseductive, affectionate demonstration, as to use the quality of being appropriate or valuable to some end, even the act or practice of using something or the state of being used to which of responsible interests in development, and similar matters, from their parents. In the psychnalytic situation, both the gratifications offered by the analyst and the freedom of expression by the patient, are diversely limited and concentrated, practically entirely (in the every day demonstrable sense) in the sphere of linguistic expression, on the analyst’s side, further, in the transmission of understanding.
Whereas, the primordial transference exploits the primitive aspects of linguistic communication, by expressing the mature transference as to advocate the seeking mastery of the outer and inner environments, a mastery to which the mature elements in speech contribute importantly, for which these are stressed upon the clear-cut genetic prototype for the free associating its interpretative dialogue is the original learning and teaching of speech, the dialogue between child and mother. It is interesting to note that just as the profundities of interests between people who often include - in the service of the ego - transitory introjection and identifications, of the very word ‘communication’, representing the central ego function of speech, from which is a closely intimate relation to the etymologically certain, in actual usages, to the word chosen for that major of religious sacrament for that which is the physical ingestion of the body and blood of the Deity. Perhaps, this is just another suggestion that the oldest of individual problems does, after all, continue to seek its solution, in its own terms if only in a minimal sense, and in channels so remote as to be unrecognizable.
The mature transference is dynamically integral as raised in part of the therapeutic alliance, only with the tender aspect of the erotic transference, even more attenuated (and more dependable) friendly feeling of adult type, and the ego identification with the analyst. Indispensable, of course, are the genuine adult need for help, the crystallizing rational and intuitive appraisal of the analyst, the adult sense of confidence in him, and innumerable other nuances of adult thought and feeling. With these, giving a driving momentum and power to the analytic process, but always, by its very nature, a potential source of resistance, and always requiring analysis, is the primordial transference and its various appearances in the specific therapeutic transference. That it is, if well managed, not only a reflection of the repetition compulsion in its menacing sense, but a living presentation from the id, seeking new solutions, and trying again, so to speak, to find a place in the patient’s conscious and effective life, has important affirmative potentialities. This has been specifically emphasized by Nunberg, Lagache and Loewald among others. Loewald has recently elaborated very effectively the idea of ‘ghosts’ seeking to become ‘ancestors’ based on an early figure of speech of Freud. The mature transference, in its own infantile right, provides some of the unique qualities of propulsive force, which comes from the world of feeling, rather than the world of thought. If one views it in a purely figurative sense, that fraction of the mature transference which derives from ‘conversion’ is somewhat like propulsive fraction as the wind in a boats sailing to windward currents into motion, the strong headwind, the ultimate source of both resistance and propulsion, is the primordial transference. This view, however, should not displace the original and independent, if cognate, a favourable tide or current would also be required. It is not that the mature transference is itself entirely exempt from analytic clarification and interpretation. For one thing, in common with other childhood spheres of experience, there may have been traumas in this sphere, punishments, serious defects or lacks of parental communication, Listening, attention or interest. In general, this is probably far more important than has hitherto appeared in our prevalent paradigmatic approach to adult analysis, even taking into account the considerable changes due to the growing interest in ego psychology. ‘Learning’ in the analysis can, of course, be a troublesome intellectualizing resistance. Furthermore, both the patient’s communications and his receptions and utilization of interpretations may exhibit only too clearly, as sometimes in the case of other ego mechanisms, their origin in and tenacious relation to instinctual or anaclitic dynamism; the longing implement out of silence for which the analyst is to override the uncritical acceptance (or rejection) of interpretations, in that the patient revealingly is to mention the unmindful assimilation, fluently, rich, endlessly detailed associations without spontaneous reflection or integration. In the direct demands for solution of moral and practical probability for an entirely intellectual scope, and a variety of others. It may and always be easy to discriminate between the utilization of speech by an essentially instinctual demand, and an intellectual or linguistic trait or having to be determined by specific factors in their own developmental sphere, however, the underlying and essentially genuine dynamism which have to continue to be placed for a taken time interval or remain to an arbitrary or conventional character reference to which is most favoured to the purposes of process analysis, as it was to the original processes of maturational development, communication, and benign separation. Lagache, on the desirability of separating the current unqualified usage, ‘positive’ and ’negative’ transference, as based on the patient‘s immediate state of feeling, from a classification based on the essential effect on analytic processes. Yet, the later of mature transference is, in general, a ‘positive transference’.
It is a disquieted fact, whereas the dynamic meaning to the importance of the transference neurosis have been well established since Freud gave this the phenomenon a central position in his clinical thinking, the clinical reference, when the term is used, remains variable and somewhat ambiguous. For example, Greenson, in his excellent recent paper, speaks of it as appearing, ‘when the analyst and the analysis become the central concern in the patient’s life’. However, previous remarks in this connection, for which it is worthwhile to specify certain aspects of Greenson’s definition, for the term ‘central’ is somewhat ambiguous, as to its specific reference. Certainly, the term could apply to the symbolic position of the analyst in relation to the patient’s experiencing ego and the symbolically decisive position which he correspondingly assumes in the relation to the other important figures in the patient’s current life. However, while the analysis is in any case, and for multiple reasons, exceedingly important the seriously involved patient, there is a free observing portion of is ego, also involved, not in the same sense as that involved in the transference regression and revived in infantile conflicts. And here is here being, of course, always the integrated adult personalty, however diluted in may seem at times, of its rarity, although certainly does occur, that the analysis actually exceeds the quality or state of being of notable worth or influence that the other major concerns, attachments, and responsibilities of the patient’s life, nor is it desirable that his should occur, on the other hand, if construed with proper attention to the economic considerations as mentioned, the concept is important, both theoretically and clinically. In the theoretical direction to the assumption that there is a continuing system of object relationships and conflict situations, most important in the unconscious representations, but participating to some degree in all others, deriving in a successive series of transference from the experiences of separation from the original object, the mother. In this sense, the analyst’s applicability to a uniquely important portion of the patient‘s personality, the portion that ‘never grew up’, to maintain a central figure. In the clinical sense, to call or direct attention especially to a supposed cause, source, or to refer to the importance of the transference neurosis as outlining for the essential and central analytic task, providing by its very currency and demonstrability a relatively secure cognitive base for procedural duties. By its inclusion of the patient’s essential psychopathological processes and tendencies, in their original functional connection, it offers, in its resolution or marked reduction, the most formidable lever for analytic cure. Nonetheless, transference neurosis must be seen in its interweaving with the patient’s extra-analytic system of personal contacts. The relationship to the analyst may influence the course of relationships to others, in the same sense that the clinical neurosis did, except that the former is alloplastic, relatively exposed, and subject to constant interpretation. It is also an important fact that, except in those rare instances where the original dyadic relationship appears to turn, the analyst, even in the strict transference sphere, cannot be assigned all the transference role simultaneously. Other actors are required. He may at times oscillate with confusing rapidity between the status of mother and father, but he is usually predominantly in one of the roles for long periods, someone else representing the other. Furthermore, apart from ‘acting out’, complicated and mutually inconsistent attitudes of the anterior apprehensions for realizing often about something not generally realized in the verbalization, may require the seeking of other transference actualities, i.e., The husband or wife, friend, another analyst and so forth. Children, even the patient’s own children, may be invested with strivings of the patient, displaced from the analysis, even experience the impulses which they would wish to call forth in the analyst. The range is extensive, varied, and complicated, requiring constant alertness. Transference interpretation therefore often has a necessarily paradoxical inclusiveness, which is an important reality of technique. There is another aspect, and that is the dynamic and economic impact of the intimate and actual dramatist personate of the transference neurosis in the progress of the analysis as such, and on the patient ‘s motivation, as well as his real lifer avenues for recovery. For the persons in his milieu may fulfill their ‘positive’ or ‘negative ‘ roles in transference drama, which may facilitate or impede interpretative effectiveness, they provide the substantial and dependable real life gratification which ultimately facilitate the analysis of the residual analytic transference, or their capacities or attitudes may occasion overload of the anaclitic and instinctual needs in the transference which renders the same process far more difficultly. In the most unhappy instances, there can be a serious undercounting of the motivation for basic change.
There is also the fundamental question of the role of the transference interpretation. At the Marienbad Symposium most of Strachey’s colleagues appeared to accept the essential import of his contribution and thus unique significance of the transference interpretations, despite the various reservations as to detail and emphasis on other important aspects of the therapeutic process. Nevertheless, there are still many who, if not in doubt regarding the great value of transference interpretations are inclined to doubt their uniqueness, and to stress the importance of economic considerations in determining the choice as to whether transference or extratransference interpretations may be indicated. Now, apart from the realistic considerations mentioned in the preceding passage (in a sense the necessarily ‘distributed’ character of a variable fraction of transference interpretation). There is in fact that the extra-analytic life of the patent often provides indispensable data fo the understanding of detailed complexities of his psychic functioning, because of the sheer variety of its references, some of which cannot be reproduced in the relationship to the analyst. For example, there is no repartee (in the ordinary sense ) in the analysis. The way the patient handles the dialogue with an angry employee may be importantly revealing. The same may be true of the quality of his reaction to a real danger of dismissal. There is not only the realities, but the ‘formal’ manifestations of this response. These expressions of personality remain significantly important, even though his ‘acting out‘ of the transference (assuming this was this was the case) may have been more important, and, of course, requiring transference interpretation. Furthermore, they remain useful, if discriminatingly and conservatively treated, even if they are inevitably always subject that epistemological reservations, which haunts so much of analytic data. Of course, the ‘positive’ transference has a role in the utilization of such interpretations that what enables the patent to listen to them and them seriously.
In an operational sense, it would seem that extratransference interpretations cannot set aside, or underestimated in importance, but the unique effectiveness of transference interpretations is not thereby disestablished. No other interpretation is free, within reason, of the doubt introduced by not really knowing the ‘other person’s’ participation in love, or quarrel or criticism or whatever the issue. And no other situation provides the patient the combined sense of cognitive acquisition, with the experience of complete personal tolerance and acceptance, that is implicit in an interpretation by an individual who is an object of the emotion, drive, or even defences, which are active at the time. There is no doubt that such interpretations must not only (in common with all others) include personal tact, but must be offered with special care as to their intellectual reasonability, in relation to the immediate context, lest they defeat their essential purpose. It is not too often likely that a patient who has just been jilted in a long-standing love affair, and suffering exceedingly, will find an immediate interpretation that his suffering is due to the fact that the analyst does not reciprocate his love, even though a dynamism in this general sphere of influence may be ultimately demonstrated, and acceptable to the patient. On the other hand, once the transference neurosis is established, with accompanying subtle (sometime gross) colouration of the patient’s life, th n more far-reaching anticipatory, transference interpretations are indicated, for, if all of the patient’s libidinal and aggression is not, in fact, invested in the analyst, he has at least an unconscious role in all important emotional transactions, and, if the assumption is correct that the regressive drive, mobilized by the analytic situation, is in the direction of restoration of a single all-encompassing relationship, specified pragmatically in the individual case by the actually attained level of development, then there is a dynamic factor at work, importantly meriting interpretation as such, to the extent that available material supports it. This would be the immediate clinical application on the material regarding the ‘cognitive lag’ or ‘cognitive fall-back’.
People with this disorder relive the traumatic event again and again through nightmares and disturbing memories during the day. They sometimes have flashbacks, in which they suddenly lose touch with reality and relive images, sounds, and other sensations from the trauma. Because of their extreme anxiety and disruptive opposition to events, they try to avoid anything that reminds them of it. They may seem emotionally numb, detached, irritable, and easily startled. They may feel guilty about surviving a traumatic event that killed other people. Other symptoms include trouble concentrating, depression, and sleep difficulties. Symptoms of the disorder usually begin shortly after the traumatic event, although some people may not show symptoms for several years. If left untreated, the disorder can last for years.
Post-traumatic stress disorder can severely disrupt one’s life. Besides the emotional pain of reliving the trauma, the symptoms of the disorder may cause a person to think that he or she is ‘going crazy.’ In addition, people with this disorder may have unpredictable, angry outbursts at family members. At other times, they may seem to have no affection for their loved ones. Some people try to mask their symptoms by abusing alcohol or drugs. Others work very long hours to prevent any ‘down’ periods when they might relive the trauma. Such actions may delay the onset of the disorder until these individuals retire or become sober.
Studies have set or to bring into a new found control from 1 to 14 percent of people that suffer from post-traumatic stress disorder at some point during their lives. The findings vary widely due to differences in the populations studied and the research methods used. Among people who have survived traumatic events, the prevalence appears to be much higher. The disorder may be particularly prevalent among people who have served in combat. For example, one study of veterans of the Vietnam War (1959-1975) found that veterans exposed to a high level of combat were nine times more likely to have post-traumatic stress disorder than military personnel who did not serve in the war zone of Southeast Asia.
Post-traumatic stress disorder is an extreme reaction to extreme stress. In moments of crisis, people respond in ways that allow them to endure and survive the trauma. Afterward those responses, such as emotional numbing, may persist even though they are no longer necessary.
Not everyone who experiences a traumatic event develops post-traumatic stress disorder. Several factors influence whether people develop the disorder. Those who experience severe and prolonged trauma are more likely to develop the disorder than people who experience less severe trauma. Additionally, those who directly witness or experience death, injury, or attack are more likely to develop symptoms.
Reasoning in which of positing our concern and considerations that are marked and noted, through which the essence of functional dynamics as based of the transference in the psychoanalytic process or the basic underlying the most basic of beliefs that in politics there is neither good nor evil, however, in that something that forms part of the minimal body, character or structure of that thing predetermines the properties to the good life. Nonetheless, most psychoanalysts maintain that schizophrenic patients cannot be treated psychoanalytically because they are too narcissistic to develop with the psychotherapist as interpersonal relationship that is sufficiently reliable and consistent for psychoanalytic work. Freud, Fenichel and others have recognized that a new technique of approaching patients psychoanalytically must be found if analysts are to work with psychotics. Among those who have worked successfully in recent years with schizophrenics, Sullivan, Hill, and Karl Menninger and his staff have made various modifications of their analytic approach. The techniques that are in use with psychotics is different from our approach to psychoneurotics. This is not a result of the schizophrenic’s inability to build up a consistent personal relationship with the therapist but due to his extremely intense and sensitive transference reactions.
Let us see first what the essence of the schizophrenic’s transference reactions are and how we try to meet these reactions.
We think of a schizophrenic as a person who has had serious traumatic experiences in early infancy at a time when his ego and its ability to examine reality were not yet developed. These early traumatic experiences seem to furnish the psychological basis for the pathogenic influence of the flustrations of later years. At this early time the infant lives grandiosely in a narcissistic world of his own. His needs and desires seem to be taken care of by something vague and indefinite which he does not yet differentiate. As Ferenczi noted, they are expressed by gestures and movements since speech is as yet undeveloped. Frequently the child’s desires are fulfilled without any expression of them, a result that seems to him a product of his magical thinking.
Are a person’s characteristics primarily shaped by early influences, remaining relatively stable thereafter throughout life? Or does change spontaneously occur continuously throughout life? Many people believe that early experiences are formative, providing a strong or weak foundation for later psychological growth. This view is expressed in the popular saying ‘As the twig is bent, so grows the tree.’ From this perspective, it is crucial to ensure that young children have a good start in life. But many developmental scientists believe that later experiences can modify or even reverse early influences; studies show that even when early experiences are traumatic or abusive, considerable recovery can occur. From this vantage point, early experiences influence, but rarely determine, later characteristics.
Traumatic experiences in this early period of life will damage a personality more seriously than those occurring in later childhood such as are found in the history of psychoneurotics. The infant’s mind is more vulnerable the younger and less used it has been, further, the trauma has quickened the infant ‘s egocentricity. In addition early traumatic experiences shortens the only period in life in which an individual ordinarily enjoys the most security, thus endangering the ability to store up as it were a reasonable supplies of assurance and self-reliance for the individual’s later struggles through life. Thus, as such, a child sensitized considerably more toward the frustrations of later like than by later traumatic experiences. hence many experiences in later life which would mean little to a ‘healthy’ person and not much to a psychoneurotic, mean a great deal of pain and suffering to the schizophrenic. His resistance against frustration is easily exhausted.
Once he reaches his limit of endurance, he escapes the unbearable reality of his present life by attempting to reestablish the autistic, delusional world of the infant, but this is impossible because the content of his delusions and hallucinations are naturally coloured by the experiences of his whole lifetime.
How do these developments influence the patient’s attitude toward the analyst and the analyst’s approach to him?
Due to the very damage and the succeeding chain of frustrations which the schizophrenic undergoes before finally giving in to illness, he feels extremely suspicious and distrustful of everyone, particularly of the psychotherapist ho approaches him with the intent of intruding into his isolated world and personal life. To him the physician’s approach means the threat of being compelled to return to the frustrations of real life and to reveal his inadequacy to meet them or, - still worse – a repetition of the aggressive interference with his initial symptoms and peculiarities which he has encountered in his previous environment.
The founder of phenomenology, German philosopher Edmund Husserl, introduced the term in his book Ideen zu einer reinen Phänomenolgie und phänomenologischen Philosophie (1913; Ideas: A General Introduction to Pure Phenomenology, 1931). Early followers of Husserl such as the German philosopher Max Scheler, influenced by his previous book, Logische Untersuchungen (two volumes, 1900 and 1901, Logical Investigations, 1970), claimed that the task of phenomenology is to study essences, such as the essence of emotions. Although Husserl himself never gave up his early interest in essences, he later held that only the essences of certain special conscious structures are the proper objects of phenomenology. As formulated by Husserl after 1910, phenomenology is the study of the structures of consciousness that enable consciousness to refer to objects outside itself. This study requires reflection on the content of the mind to the exclusion of everything else. Husserl called this type of reflection the phenomenological reduction. Because the mind can be directed toward nonexistent as well as real objects, Husserl noted that phenomenological reflection does not presuppose that anything that has recently come into existence, but rather amounts to a "bracketing of existence" - that is, setting aside the question of the real existence of the contemplated object.
Freud’s first published work, "On Aphasia," appeared in 1891, it was a study of the neurological disorder in which the ability to pronounce words or to name common objects is lost as a result of organic brain disease. His final work in neurology, an article, "Infantile Cerebral Paralysis," was written in 1897 for an encyclopaedia only at the insistence of the editor, since by this time Freud was occupied largely with psychological rather than physiological explanations for mental illnesses. His subsequent writings were devoted entirely to that field, which he had named psychoanalysis in 1896.
Pierre Janet (1859-1947), the French psychologist, born and educated in Paris, he taught philosophy (1881-98) but was also interested in neurology and psychology, which he studied under Jean Martin Charcot. Janet did important pioneer work on the scientific treatment of neuroses and hysteria; his investigations of hypnosis as an aid to understanding the mind and the diagnosis of its disorders greatly influenced the early work of another pupil of Charcot, Sigmund Freud. Among Janet's works are "Neuroses" (1898; trans. 1909), "Major Symptoms of Hysteria" (1907; trans. 1920), and "Principles of Psychotherapy" (1924).
Freud’s new orientation was heralded by his collaborative work on hysteria with the Viennese physician Josef Breuer. The work was presented in 1893 in a preliminary paper and two years later in an expanded form under the title "Studies on Hysteria." In this work the symptoms of hysteria were ascribed to manifestations of undischarged emotional energy associated with forgotten psychic traumas. The therapeutic procedure involved the use of a hypnotic state in which the patient was led to recall and reenact the traumatic experience, thus discharging by catharsis the emotions causing the symptoms. The publication of this work marked the beginning of psychoanalytic theory formulated on the basis of clinical observations.
During the periods from 1895 to 1900 Freud developed many of the concepts that were later incorporated into psychoanalytic practice and doctrine. Soon after publishing the studies on hysteria he abandoned the use of hypnosis as a cathartic procedure and substituted the investigation of the patient’s spontaneous flow of thoughts, called ‘free association’, to reveal the unconscious mental processes at the root of the neurotic disturbance.
In his clinical observations Freud found evidence for the mental mechanisms of repression and resistance. He described repression as a device operating unconsciously to make the memory of painful or threatening events inaccessible to the conscious mind. Resistance is defined as the unconscious defence against awareness of repressed experiences in order to avoid the resulting anxiety. That to probe the unconscious mind, Freud developed the psychotherapy technique of free association. In free association, the patient reclines and talks about thoughts, wishes, memories, and whatever else comes to mind. The analyst tries to interpret these verbalizations to determine their psychological significance. In particular, Freud encouraged patients to free associate about their dreams, which he believed were the ‘royal road to the unconscious’. According to Freud, dreams are disguised expressions of deep, hidden impulses. Thus, as patients recount the conscious manifest content of dreams, the psychoanalyst tries to unmask the underlying latent content - what the dreams carries or attemptively communicates (as an idea) that something is held of a measurable understanding to mean and give to expression of something potentially understood in the mind.
He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech. Dream analysis led to his discoveries of infantile sexuality and of the so-called Oedipus complex, which constitutes the erotic attachment of the child for the parent of the opposite sex, together with hostile feelings toward the other parent. In these years he also developed the ‘theory of transference’, the processes by which emotional attitudes, established originally toward parental figures in childhood, are transferred in later life to others. The end of this period was marked by the appearance of Freud’s most important work, "The Interpretation of Dreams" (1899). Here Freud analysed many of his own dreams recorded in the 3-year period of his self-analysis, begun in 1897. This work expounds all the fundamental concepts underlying psychoanalytic technique and doctrine.
Freud introduced his new theory in The Interpretation of Dreams (1889), the first of 24 books he would write. The theory is summarized in Freud’s last book "An Outline of Psychoanalysis" published in 1940, after his death. In contrast to Wundt and James, for whom psychology was the study of conscious experience, Freud believed that people are motivated largely by unconscious forces, including strong sexual and aggressive drives. He likened the human mind to an iceberg: The small tip that floats on the water is the conscious part, and the vast region beneath the surface comprises the unconscious. Freud believed that although unconscious motives can be temporarily suppressed, they must find a suitable outlet in order for a person to maintain a healthy personality.
Realization of these modes of operation in unconscious mental processes made possibly the understanding of such previously incomprehensible psychological phenomena as dreaming. Through analysis of unconscious processes, Freud saw dreams as serving to protect sleep against disturbing impulses arising from within and related to early life experiences. Thus, unacceptable impulses and thoughts, called the latent dream content, are transformed into a conscious, although no longer immediately comprehensible, experience called the manifest dream. Knowledge of these unconscious mechanisms permits the analyst to reverse the so-called dream work, that is, the process by which the latent dream is transformed into the manifest dream, and through dream interpretation, to recognize its underlying meaning.
In 1902 Freud was appointed a full professor at Vienna University. This honour was granted not in recognition of his contributions but as a result of the efforts of a highly influential patient. The medical world still regarded his work with hostility, and his next writings, "The Psychopathology of Everyday Life" (1904) and "Three Contributions to the Sexual Theory" (1905), only increased this antagonism. As a result Freud continued to work virtually alone in what he termed ‘splendid isolation’.
By 1906, however, a small number of disciples and followers had gathered around Freud, including the Austrian psychiatrists William Stekel and Alfred Adler, the Austrian psychologist Otto Rank, the American psychiatrist Abraham Brill, and the Swiss psychiatrist’s Eugen Bleuler and Carl Jung. Other notable associates, joined the circle in 1908, as well, the Hungarian psychiatrist Sándor Ferenczi and the British psychiatrist Ernest Jones.
Austrian doctor Sigmund Freud spent many hours refining his theories in this study within his home in Vienna, Austria. Freud pioneered the use of clinical observation to treat mental disease. The publication of The Interpretation of Dreams in 1899 detailed his technique of isolating the source of psychological problems by examining a patient’s spontaneous stream of thought.
Increasing recognition of the psychoanalytic movement made possibly the formation in 1910 of a worldwide organization called the International Psychoanalytic Association. As the movement spread, gaining new adherents through Europe and the US, Freud was troubled by the dissension that arose among members of his original circle. Most disturbing was the defection from the group of Adler and Jung, each of whom developed a different theoretical basis for disagreement with Freud’s emphasis on the sexual origin of neurosis. Freud met these setbacks by developing further his basic concepts and by elaborating his own views in many publications and lectures.
After the onset of World War I Freud devoted little time to clinical observation and concentrated on the application of his theories to the interpretation of religion, mythology, art, and literature. In 1923 he was stricken with cancer of the jaw, which necessitated constant, painful treatment in addition to many surgical operations. Despite his physical suffering he continued his literary activity for the next 16 years, writing mostly on cultural and philosophical problems.
When the Germans occupied Austria in 1938, Freud, a Jew, was persuaded by friends to escape with his family to England. He died in London on September 23, 1939.
Freud created an entirely new approach to the understanding of human personality by his demonstration of the existence and force of the unconscious. In addition, he founded a new medical discipline and formulated basic therapeutic procedures that in modified form are applied widely in the present-day treatment of neuroses and psychoses. Although never accorded full recognition during his lifetime, Freud is generally acknowledged as one of the great creative minds of modern times.
Among his other works are Totem and Taboo (1913), Ego and the Id (1923), New Introductory Lectures on Psychoanalysis (1933), and Moses and Monotheism (1939).
The ego, the term occurring in psychoanalysis, that designates its term as denoting the central part of the personality structure that deals with reality and is influenced by social forces. According to the psychoanalytic theories developed by Sigmund Freud, the ego constitutes one of the three basic provinces of the mind, the other two, being the id and the superego. Formation of the ego begins at birth in the first encounters with the external world of people and things. The ego learns to modify behaviour by controlling those impulses that are socially unacceptable. Its role is that of a mediator between unconscious impulses and acquired social and personal standards.
In philosophy, ego means the conscious self or "I." It was viewed by some philosophers, notably the 17th-century Frenchman René Descartes and the 18th-century German Johann Gottlieb Fichte, as the sole basis of reality; they saw the universe as existing only in the individual's knowledge and experience of it. Other philosophers, such as the 18th-century German Immanuel Kant, proposed two forms of the ego, one perceiving and the other thinking.
As well, the term id was oriented into psychoanalytic theory, one of the three basic elements of personality, the others being the ego and the superego. The id can be equated with the unconscious of common usage, which is the reservoir of the instinctual drives of the individual, including biological urges, wishes, and affective motives. The id is dominated by the pleasure principle, through which the individual is pressed for immediate gratification of his or her desires. In strict Freudian theory the energy behind the instinctual drives of the id is known as the libido, a generalized force, basically sexual in nature, through which the sexual and psychosexual nature of the individual finds expression.
Also, the Superego, in psychoanalytic theory is one of the three basic and most fundamental constituents of the mind, the others being the id and the ego. As postulated by Sigmund Freud, the term designates the element of the mind that, in normal personalities, automatically modifies and inhibits those instinctual impulses or drives of the id that tend to produce antisocial actions and thoughts.
According to psychoanalytic theory, the superego develops as the child gradually and unconsciously adopts the values and standards, first of his or her parents, and later of the social environment. According to modern Freudian psychoanalysts, the superego includes the positive ego, or conscious self-image, or ego ideal, that each individual develops.
Psychoanalysis, is the name applied to a specific method of investigating unconscious mental processes and to a form of psychotherapy. The term refers, as well, to the systematic structure of psychoanalytic theory, which is based on the relation of conscious and unconscious psychological processes.
The techniques of psychoanalysis and much of the psychoanalytic theory based on its application were developed by Sigmund Freud. His work concerning the structure and the functioning of the human mind had far-reaching significance, both practically and scientifically, and it continues to influence contemporary thought.
Of Freud’s three basic personality structures - id, ego, and superego - only the id is totally unconscious. The first of Freud's innovations was his recognition of unconscious psychiatric processes that follow laws different from those that govern conscious experience. Under the influence of the unconscious, thoughts and feelings that belong together may be shifted or displaced out of context; two disparate ideas or images may be condensed into one; thoughts may be dramatized in the form of images rather than expressed as abstract concepts; and certain objects may be represented symbolically by images of other objects, although the resemblance between the symbol and the original object may be vague or farfetched. The laws of logic, indispensable for conscious thinking, do not apply to these unconscious mental productions.
Recognition of these modes of operation in unconscious mental processes made possibly the understanding of such previously incomprehensible psychological phenomena as dreaming. Through analysis of unconscious processes, Freud saw dreams as serving to protect sleep against disturbing impulses arising from within and related to early life experiences. Thus, unacceptable impulses and thoughts, called the latent dream content, are transformed into a conscious, although no longer immediately comprehensible, experience called the manifest dream. Knowledge of these unconscious mechanisms permits the analyst to reverse the so-called dream work, that is, the process by which the latent dream is transformed into the manifest dream, and through dream interpretation, to recognize its underlying meaning.
A basic assumption of Freudian theory is that the unconscious conflicts involve instinctual impulses, or drives, that originate in childhood. As these unconscious conflicts are recognized by the patient through analysis, his or her adult mind can find solutions that were unattainable to the immature mind of the child. This depiction of the role of instinctual drives in human life is a unique feature of Freudian theory.
According to Freud's doctrine of infantile sexuality, adult sexuality is an end-product of a complex process of development, beginning in childhood, involving a variety of body functions or areas (oral, anal, and genital zones), and corresponding to various stages in the relation of the child to adults, especially to parents. This distinguishes the oedipus Complex, in psychoanalysis, a son’s largely unconscious sexual attraction toward his mother accompanied by jealousy toward his father. The terminological distinction of the oedipus complex, derived from the Greek legend of Oedipus, was first used in the late 1800's by Austrian psychiatrist Sigmund Freud, the founder of psychoanalysis. Freud thought that the Oedipus complex was the most important event of a boy’s childhood and had a great effect on his subsequent adult life. Freud claimed that in nearly all cases the boy represses the desire for his mother and the jealousy toward his father. As a result of this unconscious experience, Freud believed, a boy with an Oedipus complex feels guilt and experiences strong emotional conflicts. Freud thought that girls go through a similar experience, in which they are attracted to their father and surmount the disconfirming antagonistic attitude toward their mother. He called this the Electra complex. According to Freud, if a woman remains under the influence of the Electra complex, she is likely to choose a husband with characteristics similar to those of her father.
Of crucial importance is the so-called Oedipal period, occurring at about four to six years of age, because at this stage of development the child for the first time becomes capable of an emotional attachment to the parent of the opposite sex that is similar to the adult's relationship to a mate; the child simultaneously reacts as a rival to the parent of the same sex. Physical immaturity dooms the child's desires to frustration and his or her first step toward adulthood to failure. Intellectual immaturity further complicates the situation because it makes children afraid of their own fantasies. The extent to which the child overcomes these emotional upheavals and to which these attachments, fears, and fantasies continue to live on in the unconscious greatly influences later life, especially ‘loves’ relationships.
The conflicts occurring in the earlier developmental stages are no less significant as a formative influence, because these problems represent the earliest prototypes of such basic human situations as dependency on others and relationship to authority. Also, basic in moulding the personality of the individual is the behaviour of the parents toward the child during these stages of development. The fact that the child reacts, not only to objective reality, but also to fantasy distortions of reality, however, greatly complicates even the best-intentioned educational efforts.
The effort to clarify the bewildering number of interrelated observations uncovered by psychoanalytic exploration led to the development of a model of the structure of the psychic system. Three functional systems are distinguished that are conveniently designated as the id, ego, and superego.
The first system refers to the sexual and aggressive tendencies that arise from the body, as distinguished from the mind. Freud called these tendencies Triebe, which literally means "drives," but which is often inaccurately translated as "instincts" to indicate their innate character. These inherent drives claim immediate satisfaction, which is experienced as pleasurable; the id thus is dominated by the pleasure principle. In his later writings, Freud tended more toward psychological rather than biological conceptualization of the drives.
How the conditions for satisfaction are to be brought about is the task of the second system, the ego, which is the domain of such functions as perception, thinking, and motor control that can accurately assess environmental conditions. In order to fulfill its function of adaptation, or reality testing, the ego must be capable of enforcing the postponement of satisfaction of the instinctual impulses originating in the id. To defend itself against unacceptable impulses, the ego develops specific psychic means, known as defence mechanisms. These include repression, the exclusion of impulses from conscious awareness; projection, the process of ascribing to others one's own unacknowledged desires; and reaction formation, the establishments of a pattern of behaviour directly opposed to a strong unconscious imperative necessarily in need for or required to employ of its relief. Such defence mechanisms are put into operation whenever anxiety signals a danger that the original unacceptable impulses may reemerge.
An id impulse becomes unacceptable, not only as a result of a temporary need for postponing its satisfaction until suitable reality conditions can be found, but more often because of a prohibition imposed on the individual by others, originally the parents. The totality of these demands and prohibitions constitutes the major content of the third system, the superego, the function of which is to control the ego in accordance with the internalized standards of parental figures. If the demands of the superego are not fulfilled, the person may feel shame or guilt. Because the superego, in Freudian theory, originates in the struggle to overcome the Oedipal conflict, it has a power akin to an instinctual drive, is in part unconscious, and can give rise to feelings of guilt not justified by any conscious transgression. The ego, having to mediate among the demands of the id, the superego, and the outside world, may not be strong enough to reconcile these conflicting forces. The more the ego is impeded in its development because of being enmeshed in its earlier conflicts, called fixations or complexes, or the more it reverts to earlier satisfactions and archaic modes of functioning, known as regression, the greater is the likelihood of succumbing to these pressures. Unable to function normally, it can maintain its limited control and integrity only at the price of symptom formation, in which the tensions are expressed in neurotic symptoms.
A cornerstone of modern psychoanalytic theory and practice is the concept of anxiety, which institutes appropriate mechanisms of defence against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the object's love, the danger of retaliation and punishment, and, finally, the hazard of reproach by the superego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations - different forms of an adaptive integration that the ego tries to achieve through more or less successfully reconciling the different conflicting forces in the mind.
Various psychoanalytic schools have adopted other names for their doctrines to indicate deviations from Freudian theory.
Swiss psychiatrist Carl Jung began his studies of human motivation in the early 1900's and created the school of psychoanalysis known as analytical psychology. A contemporary of Austrian psychoanalyst Sigmund Freud, Jung at first collaborated closely with Freud but eventually moved on to pursue his own theories, including the exploration of personality types. According to Jung, there are two basic personality types, extroverted and introverted, which alternate equally in the completely normal individual. Jung also believed that the unconscious mind is formed by the personal unconscious (the repressed feelings and thoughts developed during an individual’s life) and the collective unconscious (those feelings, thoughts, and memories shared by all humanity).
Carl Gustav Jung, one of the earliest pupils of Freud, eventually created a school that he preferred to call analytical psychology. Like Freud, Jung used the concept of the libido; however, to him it meant not only sexual drives, but a composite of all creative instincts and impulses and the entire motivating force of human conduct. According to his theories, the unconscious is composed of two parts, as the personal unconscious, which contains the results of the individual's entire experience, and the collective unconscious, the reservoir of the experience of the human race. In the collective unconscious exist a number of primordial images, or archetypes, common to all individuals of a given country or historical era. Archetypes take the form of bits of intuitive knowledge or apprehension and normally exist only in the collective unconscious of the individual. When the conscious mind contains no images, however, as in sleep, or when the consciousness is caught off guard, the archetypes commence to function. Archetypes are primitive modes of thought and tend to personify natural processes in terms of such mythological concepts as good and evil spirits, fairies, and dragons. The mother and the father also serve as prominent archetypes.
An important concept in Jung's theory is the existence of two basically different types of personality, mental attitude, and function. When the libido and the individual's general interest are turned outward toward people and objects of the external world, he or she is said to be extroverted. When the reverse is true, and libido and interest are centred on the individual, he or she is said to be introverted. In a completely normal individual these two tendencies alternate, dominating, but usually the libido is directed mainly neither in one direction nor of the other; as a result, two personality types are recognizable.
The Jungian concepts in the term ‘complex’, was an acceptable group of repressed ideas that shape an individual’s response to think, feel, and act in a certain habitual pattern. Swiss psychiatrist Carl Jung, who originally coined the term complex, derived it from the Latin word complexus, meaning interweaving or braiding. Jung stated that a complex is a "grouping of psychic elements about emotionally toned contents," adding that it "consists of a nuclear element and a great number of secondarily constellated associations." The components of a complex may be present in consciousness or in the unconscious. Conflicts, frustrations, and threats to personal security encountered during infancy are then repressed into the unconscious, where they remain dormant, but not forgotten. These unconscious memories will govern an individual’s response to emotional conflict even into adult life, as the original trauma and its associated effect patterns thinking and behaviour to meet the new conflict.
The Oedipus and Electra complexes as described by Sigmund Freud, and the inferiority complex as described by Alfred Adler, have been influential concepts within the context of psychoanalytic theory
Jung rejected Freud's distinction between the ego and superego and recognized a portion of the personality, somewhat similar to the superego, that he called the persona. The persona consists of what a person appears to be to others, in contrast to what he or she actually is. The persona is the role the individual chooses to play in life, the total impression he or she wishes to make on the outside world.
Austrian psychologist and psychiatrist Alfred Adler, after leaving the university he studied and was associated with Sigmund Freud, the founder of psychoanalysis. In 1911 Adler left the orthodox psychoanalytic school to found a neo-Freudian school of psychoanalysis. After 1926 he was a visiting professor at Columbia University, and in 1935 he and his family moved to the United States.
In his analysis of individual development, Adler stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include "The Theory and Practice of Individual Psychology" (1918) and "The Pattern of Life" (1930).
Adler’s analysis of individual development stressed the sense of inferiority, rather than sexual drives, as the motivating force in human life. According to Adler, conscious or subconscious feelings of inferiority (to which he gave the name inferiority complex), combined with compensatory defence mechanisms, is the basic cause of psychopathological behaviour. The function of the psychoanalyst, furthermore, is to discover and rationalize such feelings and break down the compensatory, neurotic will for power that they engender in the patient. Adler's works include "The Theory and Practice of Individual Psychology" (1918) and "The Pattern of Life" (1930).
Alfred Adler, another of Freud's pupils, differed from both Freud and Jung in stressing that the motivating force in human life is the sense of inferiority, which begins as soon as an infant is able to comprehend the existence of other people who are better able to care for themselves and cope with their environment. From the moment the feeling of inferiority is established, the child strives to overcome it. Because inferiority is intolerable, the compensatory mechanisms set up by the mind may get out of hand, resulting in self-centred neurotic attitudes, overcompensations, and a retreat from the real world and its problems.
Adler laid particular stress on inferiority feelings arising from what he regarded as the three most important relationships: those between the individual and work, friends, and loved ones. The avoidance of inferiority feelings in these relationships leads the individual to adopt a life goal that is often not realistic and frequently is expressed as an unreasoning will to power and to all others are influenced by the dominant ascendancy leading to every type of antisocial behaviour from bullying and boasting to political tyranny. Adler believed that analysis can foster a sane and rational "community feeling" that is constructive rather than destructive.
Austrian psychologist and psychotherapist Otto Rank worked with Sigmund Freud, the founder of psychoanalysis, before developing his own theories about mental and emotional disorders. Rank believed that an individual’s neurotic tendencies could be linked to the traumatic experience of birth.
Otto Rank, introduced a new theory of neurosis, attributing all neurotic disturbances to the primary trauma of birth. In his later writings he described individual development as a progression from complete dependence on the mother and family, to a physical independence coupled with intellectual dependence on society, and finally to complete intellectual and psychological emancipation. Rank also laid great importance on the will, defined as "a positive guiding organization and integration of self, implementing its use in the constant critical creativites as well as that it inhabits and controls the instinctual drives."
American psychoanalyst and social philosopher Erich Fromm stressed the importance of social and economic factors on human behaviour. His focus was a departure from a traditional psychoanalysis, which emphasized the role of the subconscious. In the 1969 essay for Collier’s Year Book, Fromm presents various explanations for human violence. He argues that violence cannot be controlled by imposing stronger legal penalties, but rather by creating a more just society in which people connect with other as humans and are able to control their own lives.
Later noteworthy modifications of psychoanalytic theory include those of the American psychoanalyst’s Erich Fromm, Karen Horney, and Harry Stack Sullivan. The theories of Fromm lay particular emphasis on the concept that society and the individual is not separate and opposing forces, that the nature of society is determined by its historic background, and that the needs and desires of individuals are largely formed by their society. As a result, Fromm believed, the fundamental problem of psychoanalysis and psychology is not to resolve conflicts between fixed and unchanging instinctive drives in the individual and the fixed demands and laws of society, but to bring about harmony and an understanding of the relationship between the individual and society. Fromm also stressed the importance to the individual of developing the ability to fully use his or her mental, emotional, and sensory powers.
Horney worked primarily in the field of therapy and the nature of neuroses, which she defined as of two types: situation neuroses and character neuroses. Situation neuroses arise from the anxiety attendant on a single conflict, such for being faced with a difficult decision. Although they may paralyse the individual temporarily, making it impossible to think or act efficiently, such neuroses are not deeply rooted. Character neuroses are characterized by a basic anxiety and a basic hostility resulting from a lack of love and affection in childhood.
Sullivan believed that all development can be described exclusively in terms of interpersonal relations. Character types as well as neurotic symptoms are explained as results of the struggle against anxiety arising from the individual's relations with others, including security measures of which a system is maintained for the purpose of allaying anxiety.
An important school of thought is based on the teachings of the British psychoanalyst Melanie Klein. Because most of Klein's followers worked with her in England, this has come to be known as the English school. Its influence, nevertheless, is very strong throughout the European continent and in South America. Its principal theories were derived from observations made in the psychoanalysis of children. Klein posited the existence of complex unconscious fantasies in children under the age of six months. The principal source of anxiety arises from the threat to existence posed by the death instinct. Depending on how concrete representations of the destructive forces are dealt within the unconscious fantasy life of the child, two basic early mental attitudes result that Klein characterized as a "depressive position" and a "paranoid position." In the paranoid position, the ego's defence consists of projecting the dangerous internal object onto some external representative, which is treated as a genuine threat emanating from the external world. In the depressive position, the threatening object is introjected and treated in fantasy as concretely retained within the person. Depressive and hypochondriacal symptoms result. Although considerable doubt exists that such complex unconscious fantasies operate in the minds of infants, these observations have been of the utmost importance to the psychology of unconscious fantasies, paranoid delusions, and theory concerning early object relations.
Scottish physician William Cullen coined the term neurosis near the end of the 18th century to describe a wide variety of nervous behaviours with no apparent physical cause. Austrian psychoanalyst Sigmund Freud and his followers popularized the word in the late 19th and early 20th centuries. Freud defined neurosis as one class of mental illnesses. In his view, people became neurotic when their conscious mind repressed inappropriate fantasies of the unconscious mind.
Until 1980 neuroses appeared as a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals. Neurosis encompassed a variety of mental illnesses, including Dissociative disorders, anxiety disorders, and phobias.
In the psychoanalytic model, neurosis differs from a psychosis, another general term used to describe mental illnesses. Individuals with neuroses can function at work and in social situations, whereas people with psychoses find it quite difficult to function adequately. People with neuroses do not grossly distort or misinterpret reality as those with psychoses do. In addition, neurotic individuals recognize that their mental functioning is disturbed while psychotic individuals usually do not. Most mental health professionals now use the term psychosis to refer to symptoms such as hallucinations, delusions, and bizarre behaviour.
Psychosis, the mental illness in which a person loses contact with reality and has difficulty functioning in daily life. Psychotic symptoms can indicate severe mental illnesses, such as schizophrenia and bipolar disorder (manic-depressive illness). Unlike people with fewer severe psychological problems, psychotic individuals do not usually recognize that their mental functioning is disturbed.
Once, again, a psychosis, is categorized as a mental illness in which a person loses contact with reality and has difficulty functioning in daily life. Psychotic symptoms can indicate severe mental illnesses, such as schizophrenia and bipolar disorder (manic-depressive illness). Unlike people with fewer severe psychological problems, psychotic individuals do not usually recognize that their mental functioning is disturbed.
Mental health professionals generally divide psychotic symptoms into three broad types: hallucinations, delusions, and bizarre behaviour. Hallucinations refer to hearing, seeing, smelling, feeling, or tasting something when nothing in the environment actually caused that sensation. For example, a person experiencing an auditory hallucination might hear a voice calling their name even though no one else is actually present. A delusion is a false belief held by a person that appears obviously untrue to other people in that person’s culture. For example, a man may believe that Martians have implanted a microchip in his brain that controls his thoughts. Bizarre behaviour refers to behaviour in a person that is strange or incomprehensible to others who know the person. For example, hoarding unused scraps of tin because of their ‘magical properties’ would be a type of bizarre behaviour.
Psychosis can occur in a number of mental illnesses. These include schizophrenia and schizophrenia-related disorders, bipolar disorder, paranoid personality disorder, and delusional disorder. Less common, psychotic symptoms occur in major depression Dissociative disorders, and post-traumatic stress disorder.
Psychotic symptoms can also result from substance abuse. Stimulants, such as cocaine and amphetamines, can cause psychotic symptoms, especially if taken in high doses or over long periods of time. Hallucinogenic substances, such as lysergic acid diethylamide (LSD), mescaline and phencyclidine (PCP), can cause psychosis. Alcohol and marijuana can occasionally cause psychotic symptoms as well. Individuals with alcoholism may experience psychotic symptoms, especially hallucinations, as they withdraw from alcohol use. Alcohol dependence over a long period of time can result in Korsakoff’s psychosis, a syndrome that may include psychotic symptoms and an inability to form new memories. Certain medical conditions can also cause psychosis. Syphilis, especially if untreated for many years, can lead to psychosis. Brain tumours can also lead to psychotic symptoms.
Treatment of psychotic symptoms usually involved taking antipsychotic drugs, and called neuroleptics. Common Antipsychotic drugs include chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), trifluoperazine (Stelazine), clozapine (Clozaril), haloperidol (Haldol), olanzapine (Zyprexa), and risperidone (Risperdal). These medications can help reduce psychotic symptoms and prevent symptoms from returning. However, they can also cause severe side effects, such as muscle spasms, tremors, and tardive dyskinesia, a permanent condition marked by uncontrollable lip smacking, grimacing, and tongue movements. Psychotic symptoms in individuals with bipolar disorder may respond to other types of medication, including lithium, carbamazepine (Tegretol), and valproate (Depakene).
Psychotic symptoms that occur as a result of substance abuse usually disappear gradually after the person stops using the substances. Physicians sometimes use Antipsychotic medications temporarily to treat these individuals. Physicians have not discovered any effective treatments for Korsakoff’s psychosis. Psychotic symptoms resulting from medical conditions often disappear after treatment of the underlying medical problem.
Neurophysiology, speaking seriously is the study of how nerve cells, or neurons, receives and transmits information. Two types of phenomena are involved in processing nerve signals: electrical and chemical. Electrical events propagate a signal within a neuron, and chemical processes transmit the signal from one neuron to another neuron or to a muscle cell.
A neuron is a long cell that has a thick central area containing the nucleus; it also has one long process called an ‘axon’ and one or more short, bushy processes called ‘dendrites’. Dendrites receive impulses from other neurons. (The exceptions are sensory neurons, such as those that transmit information about temperature or touch, in which the signal is generated by specialized receptors in the skin.) These impulses are propagated electrically along the cell membrane to the end of the axon. At the tip of the axon the signal is chemically transmitted to an adjacent neuron or muscle cell.
Like all other cells, neurons contain charged ions, potassium and sodium (positively charged) and chlorine (negatively charged). Neurons differ from other cells in that they are able to produce a nerve impulse. A neuron is polarized - that is, it has an overall negative charge inside the cell membrane because of the high concentration of chlorine ions and low concentration of potassium and sodium ions. The concentration of these same ions is exactly reversed outside the cell. This charge differential represents stored electrical energy, sometimes referred to as membrane potential or resting potential. The negative charge inside the cell is maintained by two features. The first is the selective permeability of the cell membrane, which is more permeable to potassium than sodium. The second feature is sodium pumps within the cell membrane that actively pump sodium out of the cell. When depolarization occurs, this charge differential across the membrane is reversed, and a nerve impulse is produced.
Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charges within the cell from negative too irrefutable positivity, and charged to ion concentrations, for triggering similar reactions along the membrane, propagating the nerve impulse. After a brief period called the refractory period, during which the ionic concentration returned to resting potential, the neuron can repeat this process.
Nerve impulses travel at different speeds, depending on the cellular composition of a neuron. Where speed of impulse is important, as in the nervous system, axons are insulated with a membranous substance called ‘myelin’. The insulation provided by myelin maintains the ionic charge over long distances. Nerve impulses are propagated at specific points along the myelin sheath; these points are called the nodes of Ranvier. Examples of myelinated axons are those in sensory nerve fibres and nerves connected to skeletal muscles. In non-myelinated cells, the nerve impulse is propagated more diffusely.
When the electrical signal reaches the tip of an axon, it stimulates small presynaptic vesicles in the cell. These vesicles contain chemicals called neurotransmitters, which are released into the microscopic space between neurons (the synaptic cleft). The neurotransmitters subjoin of abounding deliberations to particularly specific receptors on the surface of the adjacent neuron their adherence of fastening or affix by a state of being firmly attached to the receptor or something that causes the adjacent cell to depolarize and propagate an action potential of its own.
The duration of a stimulus from a neurotransmitter is limited by the breakdown of the chemicals in the synaptic cleft and the reuptake by the neuron that produced them. Formerly, each neuron was thought to make only one transmitter, but recent studies have shown that some cells progress of two or more.
The signals conveying everything that human beings sense and think, and every motion they make, follows nerve pathways in the human body as waves of ions (atoms or groups of atoms that carries electric charges). Australian physiologist Sir John Eccles discovered many of the intricacies of this electrochemical signalling process, particularly the pivotal step in which a signal is conveyed from one nerve cell to another. He shared the 1963 Nobel Prize in physiology or medicine for this work, which he described in the 1965 Scientific American article.
Sir John Eccles writes: The first step in trying to understand the brain is to examine its structure in order to discover the components from which it is built and how they are related to one another. After that one can attempt to understand the mode of operation of the simplest components. These two modes of investigation - the morphological and the physiologica - have now become complementary. In studying the nervous system with today's sensitive electrical devices, however, it is all too easy to find physiological events that cannot be correlated with any known anatomical structure. Conversely, the electron microscope reveals many structural details whose physiological significance is obscure or unknown.
At the close of the past century the Spanish anatomist Santiago Ramóny Cajal showed how all parts of the nervous system are built up of individual nerve cells of many different shapes and sizes. Like other cells, each nerve cell has a nucleus and a surrounding cytoplasm. Its outer surface consists of numerous fine branches - the dendrites - that receive nerve impulses from other nerve cells, and one relatively long branch - the axon - that transmits nerve impulses. Near its end the axon divides into branches that terminate at the dendrites or bodies of other nerve cells. The axon can be as short as a fraction of a millimetre or as long as a metre, depending on its place and function. It has many of the properties of an electric cable and is uniquely specialized to conduct the brief electrical waves called nerve impulses. In very thin axons these impulses travel at less than one metre per second; in others, for example in the large axons of the nerve cells that activate muscles, they travel as fast as 100 metres per second.
The electrical impulse that travels along the axon ceases abruptly when it comes to the point where the axon's terminal fibres make contact with another nerve cell. These junction points were given the name "synapses" by Sir Charles Sherrington, who laid the foundations of what is sometimes called synaptology. If the nerve impulse is to continue beyond the synapse, it must be regenerated afresh on the other side. As recently as 15 years ago some physiologists held that transmission at the synapse was predominantly, if not exclusively, an electrical phenomenon. Now, however, there is abundant evidence that transmission is effectuated by the release of specific chemical substances that trigger a regeneration of the impulse. In fact, the first strong evidence showing that a transmitter substance acts across the synapse was provided more than 40 years ago by Sir Henry Dale and Otto Loewi.
It has been estimated that the human central nervous system, which of course includes the spinal cord as well as the brain itself, consists of about 10 billion nerve cells. With rare exceptions each nerve cell receives information directly in the form of impulses from many other nerve cells - often hundreds - and transmits information to a like number. Depending on its threshold of response, a given nerve cell may fire an impulse when stimulated by only a few incoming fibres or it may not fire until stimulated by many incoming fibres. It has long been known that this threshold can be raised or lowered by various factors. Moreover, it was conjectured some 60 years ago that some of the incoming fibres must inhibit the firing of the receiving cell rather than excite it. The conjecture was subsequently confirmed, and the mechanism of the inhibitory effect has now been clarified. This mechanism and its equally fundamental counterpart - nerve-cell excitation.
A neuron is a long cell that has a thick central area containing the nucleus, it also has one long process called an axon and one or more short, bushy processes called dendrites. Dendrites receive impulses from other neurons. (The exceptions are sensory neurons, such as those that transmit information about temperature or touch, in which the signal is generated by specialized receptors in the skin.) These impulses are propagated electrically along the cell membrane to the end of the axon. At the tip of the axon the signal is chemically transmitted to an adjacent neuron or muscle cell.
Like all other cells, neurons contain charged ions: potassium and sodium (positively charged) and chlorine (negatively charged). Neurons differ from other cells in that they are able to produce a nerve impulse. A neuron is polarized - that is, it has an overall negative charge inside the cell membrane because of the high concentration of chlorine ions and low concentration of potassium and sodium ions. The concentration of these same ions is exactly reversed outside the cell. This charge differential represents stored electrical energy, sometimes referred to as membrane potential or resting potential. The negative charge inside the cell is maintained by two features. The first is the selective permeability of the cell membrane, which is more permeable to potassium than sodium. The second feature is sodium pumps within the cell membrane that actively pump sodium out of the cell. When depolarization occurs, this charge differential across the membrane is reversed, and a nerve impulse is produced.
Depolarization is a rapid change in the permeability of the cell membrane. When sensory input or any other kind of stimulating current is received by the neuron, the membrane permeability is changed, allowing a sudden influx of sodium ions into the cell. The high concentration of sodium, or action potential, changes the overall charges within the cell from negative too positively in finding the local change in ion concentration, which triggers similar reactions along the membrane, propagating the nerve impulse. After a brief period called the ‘refractory period’, during which the ionic concentration returned to resting potential, the neuron can repeat this process.
When the electrical signal reaches the tip of an axon, it stimulates small presynaptic vesicles in the cell. These vesicles contain chemicals called neurotransmitters, which are released into the microscopic space between the synaptic cleft. The neurotransmitters attach to specialized or specific receptors on the surface of the adjacent neuron. This stimulus causes the adjacent cell to depolarize and propagate an action potential of its own. The duration of a stimulus from a neurotransmitter is limited by the breakdown of the chemicals in the synaptic cleft and the reuptake by the neuron that produced them.
If to say, that Roderick MacKinnon, born in 1956, is the American biomedical researcher and co-winner of the 2003 Nobel Prize in chemistry for his discoveries involving ion channels. The pores that govern the passage of molecules into and out of cells, in that of every second in each of the billions of cells in the human body, millions of ions, such as potassium and sodium, shuttles back and forth through these special portals in the cellular membrane. This action underlies a range of physiological processes, including muscle contraction and the communication of impulses between nerve cells. MacKinnon and his colleagues were the first to show the detailed structure of one type of ion channel.
Born in 1956, MacKinnon grew up in Burlington, Massachusetts, outside Boston. He earned his bachelor’s degree in biochemistry from Brandeis University in Waltham, Massachusetts, in 1978, and his medical degree from Tufts University School of Medicine in Boston in 1982. After beginning a career in medicine, MacKinnon turned to biomedical research. Postdoctoral fellowships at Harvard University in Cambridge, Massachusetts, and Brandeis ultimately led to a professorship in the Department of Neurobiology at Harvard Medical School in 1989. In 1996 MacKinnon moved to Rockefeller University in New York City, where he became a professor of molecular Neurobiology and biophysics.
To study an ion channel - in this case, a particular cellular protein involved in the transport of potassium - MacKinnon chose a difficult method known as X-ray crystallography. This method involves forming the protein into a crystal and then using X rays to determine the protein’s structure. Many scientists doubted that the approach would work, but in 1998 MacKinnon and his team achieved success, presenting a detailed three-dimensional picture of the potassium channel.
In subsequent research, MacKinnon and his colleagues discovered more about the chemical workings of ion channels. This work helped to explain, for example, how such a pore permits the passage of millions of potassium ions per second while largely blocking the passage of sodium ions. Increased knowledge of these protein pores will be important for the design of future drugs because the malfunctioning of ion channels has been linked to heart disease and cystic fibrosis, among other illnesses.
In addition to the Nobel Prize, MacKinnon has been honoured with the 1999 Albert Lasker Basic Medical Research Award. He shared the Nobel Prize with American biologist Peter Agre, who, in separate research, discovered the molecular channel through which cells transport water.
When a neuron is in its resting state, its voltage is about -70 millivolts. An excitatory neurotransmitter alters the membrane of the postsynaptic neuron, making it possible for ions (electrically charged molecules) to move back and forth across the neuron’s membranes. This flow of ions makes the neuron’s voltage rise toward zero.. At one end of a nerve cell to the other by means of an electrical impulse. When it reaches the terminal end of a nerve cell, the impulse triggers tiny sacs called presynaptic vessicles to release their contents, chemical messengers called neurotransmitters. The neurotransmitters float across the synapse, or gap between adjacent nerve cells. When they reach the neighbouring nerve cell, the neurotransmitters fit into specialized receptor sites much as a key fits into a lock, causing that nerve cell to "fire," or generate an electric message-carrying impulse. As the message continues through the nervous system, the presynaptic cell absorbs the excess neurotransmitters, and repackages them in presynaptic vessicles in a process called neurostransmitter reuptake. If enough excitatory receptors have been activated, the postsynaptic neuron responds by firing, generating a nerve impulse that causes its own neurotransmitter to be released into the next synapse. An inhibitory neurotransmitter causes different ions to pass back and forth across the postsynaptic neuron’s membrane, lowering the nerve cell’s voltage to -80 or -90 millivolts. The drop in voltage makes it less likely that the postsynaptic cell will fire.
If the postsynaptic cell is a muscle cell rather than a neuron, an excitatory neurotransmitter will cause the muscle to contract. If the postsynaptic cell is a gland cell, an excitatory neurotransmitter will cause the cell to secrete its contents.
While most neurotransmitters interact with their receptors to create new electrical nerve impulses that energize or inhibit the adjoining cell, some neurotransmitter interactions do not generate or suppress nerve impulses. Instead, they interact with a second type of receptor that changes the internal chemistry of the postsynaptic cell by either causing or blocking the formation of chemicals called second messenger molecules. These second messengers regulate the postsynaptic cell’s biochemical processes and enable it to conduct the maintenance necessary to continue synthesizing neurotransmitters and conducting nerve impulses. Examples of second messengers, which are formed and entirely contained within the postsynaptic cell, include cyclic adenosine monophosphate, diacylglycerol, and inositol phosphates.
Once neurotransmitters have been secreted into synapses and have passed on their chemical signals, the presynaptic neuron clears the synapse of neurotransmitter molecules. For example, acetylcholine is broken down by the enzyme acetylcholinesterase into choline and acetate. Neurotransmitters like dopamine, serotonin, and GABA is removed by a physical process called reuptake. In reuptake, a protein in the presynaptic membrane acts as a sort of sponge, causing the neurotransmitters to reenter the presynaptic neuron, where they can be broken down by enzymes or repackaged for reuse.
Neurotransmitters are known to be involved in a number of disorders, including Alzheimer’s disease. Victims of Alzheimer’s disease suffer from loss of intellectual capacity, disintegration of personality, mental confusion, hallucinations, and aggressive - even violent - behaviour. These symptoms are the result of progressive degeneration in many types of neurons in the brain. Forgetfulness, one of the earliest symptoms of Alzheimer’s disease, is partly caused by the destruction of neurons that normally release the neurotransmitter acetylcholine. Medications that increase brain levels of acetylcholine have helped restore short-term memory and reduce mood swings in some Alzheimer’s patients.
Neurotransmitters also play a role in Parkinson disease, which slowly attacks the nervous system, causing symptoms that worsen over time. Fatigue, mental confusion, a mask-like facial expression, stooping posture, shuffling gait, and problems with and speaking is among the difficulties suffered by Parkinson victims. These symptoms have been partly linked to the deterioration and eventual death of neurons that run from the base of the brain to the basal ganglia, a collection of nerve cells that manufacture the neurotransmitter dopamine. The reasons why such neurons die are yet to be understood, but the related symptoms can be alleviated. L-dopa, or levodopa, widely used to treat Parkinson disease, acts as a supplementary precursor for dopamine. It causes the surviving neurons in the basal ganglia to increase their production of dopamine, thereby compensating to some extent for the disabled neurons.
Many other effective drugs have been shown to act by influencing neurotransmitter behaviour. Some drugs work by interfering with the interactions between neurotransmitters and intestinal receptors. For example, belladonna decreases intestinal cramps in such disorders as irritable bowel syndrome by blocking acetylcholine from combining with receptors. This process reduces nerve signals to the bowel wall, which prevents painful spasms.
Other drugs block the reuptake process. One well-known example is the drug fluoxetine (Prozac), which blocks the reuptake of serotonin. Serotonin then remains in the synapse for a longer time, and its ability to act as a signal is prolonged, which contributes to the relief of depression and the control of obsessive-compulsive behaviours.
Neurotransmitters are released into a microscopic gap, called a synapse, that separates the transmitting neuron from the cell receiving the chemical signal. The cell that generates the signal is called the presynaptic cell, while the receiving cell is termed the postsynaptic cell.
After their release into the synapse, neurotransmitters combine chemically with highly specific protein molecules, termed receptors, that are embedded in the surface membranes of the postsynaptic cell. When this combination occurs, the voltage, or electrical force, of the postsynaptic cell is either increased (excited) or decreased (inhibited).
When a neuron is in its resting state, its voltage is about -70 millivolts. An excitatory neurotransmitter alters the membrane of the postsynaptic neuron, making it possible for ions (electrically charged molecules) to move back and forth across the neuron’s membranes. This flow of ions makes the neuron’s voltage rise toward zero. If enough excitatory receptors have been activated, the postsynaptic neuron responds by firing, generating a nerve impulse that causes its own neurotransmitter to be released into the next synapse. An inhibitory neurotransmitter causes different ions to pass back and forth across the postsynaptic neuron’s membrane, lowering the nerve cell’s voltage to -80 or -90 millivolts. The drop in voltage makes it less likely that the postsynaptic cell will fire.
If the postsynaptic cell is a muscle cell rather than a neuron, an excitatory neurotransmitter will cause the muscle to contract. If the postsynaptic cell is a gland cell, an excitatory neurotransmitter will cause the cell to secrete its contents.
While most neurotransmitters interact with their receptors to create new electrical nerve impulses that energize or inhibit the adjoining cell, some neurotransmitter interactions do not generate or suppress nerve impulses. Instead, they interact with a second type of receptor that changes the internal chemistry of the postsynaptic cell by either causing or blocking the formation of chemicals called second messenger molecules. These second messengers regulate the postsynaptic cell’s biochemical processes and enable it to conduct the maintenance necessary to continue synthesizing neurotransmitters and conducting nerve impulses. Examples of second messengers, which are formed and entirely contained within the postsynaptic cell, include cyclic adenosine monophosphate, diacylglycerol, and inositol phosphates.
Once neurotransmitters have been secreted into synapses and have passed on their chemical signals, the presynaptic neuron clears the synapse of neurotransmitter molecules. For example, acetylcholine is broken down by the enzyme acetylcholinesterase into choline and acetate. Neurotransmitters like dopamine, serotonin, and GABA is removed by a physical process called reuptake. In reuptake, a protein in the presynaptic membrane acts as a sort of sponge, causing the neurotransmitters to reenter the presynaptic neuron, where they can be broken down by enzymes or repackaged for reuse.
Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can make it difficult in holding down a job, or go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.
The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralysed by paranoia - the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People whom experience episodes of mania may engage in reckless sexual behaviour or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.
Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.
Experiences of mental illness often differ to be unlike or distinct in nature as it depends on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. And yet, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of the new cases of schizophrenia involve catatonia, a behavioural condition in which a person maintains a bizarre statue-like posture for hours or days. This condition is rare in Europe and North America.
Schizophrenia, is a very severe mental illness characterized by a variety of symptoms, including loss of contact with reality, bizarre behaviour, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. Usually only some of these symptoms occur in any one person. The term schizophrenia comes from Greek words meaning "split mind." However, contrary to common belief, schizophrenia does not refer to a person with a split personality or multiple personality. For a description of a mental illness in which a person has multiple personalities, to observers, schizophrenia may seem like madness or insanity, but persons with schizophrenia have disturbed, frightening thoughts and may have trouble telling the difference between real and unreal experiences.
Perhaps more than any other mental illness, schizophrenia has a debilitating effect on the lives of the people who suffer from it. A person with schizophrenia may have difficulty telling the difference between real and unreal experiences, logical and illogical thoughts, or appropriate and inappropriate behavioural interactions whose appropriations are to express of the objectifying descriptions upon the cases to act of having or having to carry of a definite direction, resisting upon those forms that exploit the contribution in weights of others, or sustain without the adequate issues for which exists or going together without conflict or incongruity, which are accorded to the agreeing conditions, that are disinherently limited. Schizophrenia seriously impairs a person’s ability to work, go to school, enjoy relationships with others, or take care of oneself. In addition, people with schizophrenia frequently require hospitalization because they pose a danger to themselves. About 10 percent of people with schizophrenia commit suicide, and many others attempt suicide. Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives. Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Schizophrenia also carries an enormous cost to society. People with schizophrenia occupy about one-third of all beds in psychiatric hospitals in the United States. In addition, people with schizophrenia account for at least 10 percent of the homeless population in the United States. The National Institute of Mental Health has estimated that schizophrenia costs the United States tens of billions of dollars each year in direct treatment, social services, and lost productivity.
Approximately 1 percent of people develop schizophrenia at some time during their lives. Experts estimate that about 1.8 million people in the United States have schizophrenia. The prevalence of schizophrenia is rather being one than another or more, regardless of sex, race, and culture. Although women are just as likely as men to develop schizophrenia, women tend to experience the illness to a lesser extent than is severely, with fewer hospitalizations and better social functioning in the community.
Schizophrenia usually develops in late adolescence or early adulthood, between the ages of 15 and 30. Much less common, schizophrenia develops later in life. The illness may begin abruptly, but it usually develops slowly over months or years. Mental health professionals diagnose schizophrenia based on an interview with the patient in which they determine whether the person has experienced specific symptoms of the illness.
Symptoms and functioning in people with schizophrenia tend to vary over time, sometimes worsening and other times improving. For many patients the symptoms gradually become less severe as they grow older. About 25 percent of people with schizophrenia become symptom-free later in their lives.
A variety of symptoms characterize schizophrenia. The most prominent include symptoms of psychosis - such as delusions and hallucinations - as well as bizarre behaviour, strange movements, and disorganized thinking and speech. Many people with schizophrenia do not recognize that their mental functioning is disturbed.
Delusions are false beliefs that appear obviously untrue to other people. For example, a person with schizophrenia may believe that he is the king of England when he is not. People with schizophrenia may have delusions that others, such as the local police or the FBI are plotting against them or spying on them. They may believe that aliens are controlling their thoughts or that their own thoughts are being broadcast to the world so that other people can hear them.
People with schizophrenia may also experience hallucinations (false sensory perceptions). People with hallucinations see, hear, smell, feel, or taste things that are not really there. Auditory hallucinations, such as hearing voices when no one else is around, are especially common in schizophrenia. These hallucinations may include, in and around two or more voices conversing with other, voices that continually comment on the person’s life, or voices that command the person to do something.
People with schizophrenia often behave bizarrely. They may talk to themselves, walk backward, laugh suddenly without explanation, make funny faces, or masturbate in public. In rare cases, they maintain a rigid, bizarre pose for hours on end. Alternately, they may engage in constant random or repetitive movement, such that the actions justified, the dynamical situation has proven current to the motional services in moderation that include the primary presence of its operateness.
People with schizophrenia sometimes talk in incoherent or nonsensical ways, which may commonly suggest of an impounding distinction the impact to cause confused or disorganized thinking? In conversation they may eradicably jump from subject to subject or string together loosely associated phrases. They may combine words and phrases in meaningless ways or make up new words. In addition, they may show poverty of speech, in which they talk less and more slowly than other people, fail to answer questions or reply only briefly, or suddenly stop talking in the middle of speech.
Another common characteristic of schizophrenia is social withdrawal. People with schizophrenia may avoid others or act as though others do not exist. They often show decreased emotional expressiveness. For example, they may talk in a low, monotonous voice, avoid eye contact with others, and display a blank facial expression. They may also have difficulties experiencing pleasure and may lack interest in participating in activities.
Other symptoms of schizophrenia include difficulties with memory, attention span, abstract thinking, and planning ahead. People with schizophrenia commonly have problems with anxiety, depression, and suicidal thoughts. In addition, people with schizophrenia are much more likely to abuse or become dependent upon drugs or alcohol than other people. The use of alcohol and drugs often worsens the symptoms of schizophrenia, resulting in relapses and hospitalizations.
Schizophrenia appears to result not from a single cause, but from a variety of factors. Most scientists believe that schizophrenia is a biological disease caused by genetic factors, an imbalance of chemicals in the brain, structural brain abnormalities, or abnormalities in the prenatal environment. In addition, stressful life events may contribute to the development of schizophrenia in those who are predisposed to the illness.
Research shows that the more genetically related a person is to someone with schizophrenia, the greater the risk that person has of developing the illness. For example, children of one parent with schizophrenia have a 13 percent chance of developing the illness, whereas children of two parents with schizophrenia have a 46 percent chance of developing the disorder.
Mental health professionals do not rely on psychotherapy to treat schizophrenia, a severe mental illness. Drugs are used to treat this disorder. However, some psychotherapeutic techniques may help people with schizophrenia learn appropriate social skills and skills for managing anxiety. Another severe mental illness, bipolar disorder (popularly called manic depression), is treated with drugs or a combination of drugs and psychotherapy.
Some evidence suggests that schizophrenia may result from an imbalance of chemicals in the brain called neurotransmitters. These chemicals enable neurons (brain cells) to communicate with other. Some scientists suggest that schizophrenia result from excess activity of the neurotransmitter dopamine in certain parts of the brain or from an abnormal sensitivity to dopamine. Support for this hypothesis comes from Antipsychotic drugs, which reduce psychotic symptoms in schizophrenia by blocking brain receptors for dopamine. In addition, amphetamines, which increase dopamine activity, intensify psychotic symptoms in people with schizophrenia. Despite these findings, many experts believe that excess dopamine activity alone cannot account for schizophrenia. Other neurotransmitters, such as serotonin and norepinephrine, may play important roles as well.
Brain imaging techniques, such as magnetic resonance imaging and positron-emission tomography, have led researchers to discover specific structural abnormalities in the brains of people with schizophrenia. For example, people with chronic schizophrenia tend to have enlarged brain ventricles (cavities in the brain that contains cerebrospinal fluid). They also have a smaller overall volume of brain tissue compared to mentally healthy people. Other people with schizophrenia show abnormally low activity in the frontal lobe of the brain, which governs abstract thought, planning, and judgment. Research has identified possible abnormalities in many other parts of the brain, including the temporal lobes, basal ganglia, thalamus, hippocampus, and superior temporal gyrus. These defects may partially explain the abnormal thoughts, perceptions, and behaviours that characterize schizophrenia.
Evidence suggests those factors in the prenatal environment and during birth can increase the risk of a person later developing schizophrenia. These events are believed to affect the brain development of the fetus during a critical period. For example, pregnant women who have been exposed to the influenza virus or who have poor nutrition have a slightly increased chance of giving birth to a child who later develops schizophrenia. In addition, obstetric complications during the birth of a child - for example, delivery with forceps - can slightly increase the chances of the child later developing schizophrenia.
Although scientists favour a biological cause of schizophrenia, stress in the environment may affect the onset and course of the illness. Stressful life circumstances - such as growing up and living in poverty, the death of a loved one, an important change in jobs or relationships, or chronic tension and hostility at home - can increase the chances of schizophrenia in a person biologically predisposed to the disease. In addition, stressful events can trigger a relapse of symptoms in a person who already has the illness. Individuals who have effective skills for managing stress may be less susceptible to its negative effects. Psychological and social rehabilitation can help patients develop more effective skills for dealing with stress.
Although there is no cure for schizophrenia, effective treatment exists that can improve the long-term course of the illness. With many years of treatment and rehabilitation, significant numbers of people with schizophrenia experience partial or full remission of their symptoms.
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have. Antipsychotic drugs (also called neuroleptics) are the most frequently used medications for treatment of schizophrenia. Psychological and social rehabilitation programs may help people with schizophrenia function in the community and reduce stress related to their symptoms. Treatment of secondary problems, such as substance abuse and infectious diseases, is also an important part of an overall treatment program.
Serotonin, neurotransmitter, or chemical that transmits messages across the synapses, or gaps, between adjacent cells, in among the many functions, serotonin is released from blood cells called platelets to activate blood vessel constriction and blood clotting. In the gastrointestinal tract, serotonin inhibits gastric acid production and stimulates muscle contraction in the intestinal wall. Its functions in the central nervous system and effects on human behaviour - including mood, memory, and appetite control - have been the subject of a great deal of research. This intensive study of serotonin has revealed important knowledge about the serotonin-related cause and treatment of many illnesses.
Serotonin is produced in the brain from the amino acid tryptophan, which is derived from foods high in protein, such as meat and dairy products. Tryptophan is transported to the brain, where it is broken down by enzymes to produce serotonin. In the process of neurotransmission, serotonin is transferred from one nerve cell, or neuron, to another, triggering an electrical impulse that stimulates or inhibits cell activity as needed. Serotonin is then reabsorbed by the first neuron, in a process known as reuptake, where it is recycled and used again or converted into an inactive chemical form and excreted.
While the complete picture of serotonin’s function in the body is still being investigated, many disorders are known to be associated with an imbalance of serotonin in the brain. Drugs that manipulate serotonin levels have been used to alleviate the symptoms of serotonin imbalances. Some of these drugs, known as selective serotonin reuptake inhibitors (SSRIs), block or inhibit the reuptake of serotonin into neurons, enabling serotonin to remain active in the synapses for a longer period of time. These medications are used to treat such psychiatric disorders as depression; obsessive-compulsive disorder, in which repetitive and disturbing thoughts trigger bizarre, ritualistic behaviours; and impulsive aggressive behaviours. Fluoxetine (more commonly known by the brand name Prozac), is a widely prescribed SSRI used to treat depression, and more recently, obsessive-compulsive disorder.
Drugs that affect serotonin levels may prove beneficial in the treatment of nonpsychiatric disorders as well, including diabetic neuropathy (degeneration of nerves outside the central nervous system in diabetics) and premenstrual syndrome. Recently the serotonin-releasing agent dexfenfluramine has been approved for patients who are 30 percent or more over their ideal body weight. By preventing serotonin reuptake, dexfenfluramine promotes satiety, or fullness, after eating less food.
Other drugs serve as agonists that react with neurons to produce effects similar to those of serotonin. Serotonin agonists have been used to treat migraine headaches, in which low levels of serotonin cause arteries in the brain to swell, resulting in a headache. Sumatriptan is an agonist drug that mimics the effects of serotonin in the brain, constricting blood vessels and alleviating pain.
Drugs known as antagonists bind with neurons to prevent serotonin neurotransmission. Some antagonists have been found effective in treating the nausea that typically accompanies radiation and chemotherapy in cancer treatment. Antagonists are also being tested to treat high blood pressure and other cardiovascular disorders by blocking serotonin’s ability to constrict blood vessels. Other antagonists may produce an effect on learning and memory in age-associated memory impairment.
Antipsychotic medications, developed in the mid-1950's, can dramatically improve the quality of life for people with schizophrenia. The drugs reduce or eliminate psychotic symptoms such as hallucinations and delusions. The medications can also help prevent these symptoms from returning. Common Antipsychotic drugs include risperidone (Risperdal), olanzapine (Zyprexa), clozapine (Clozaril), quetiapine (Seroquel), haloperidol (Haldol), thioridazine (Mellaril), chlorpromazine (Thorazine), fluphenazine (Prolixin), and trifluoperazine (Stelazine). People with schizophrenia usually must take medication for the rest of their lives to control psychotic symptoms. Antipsychotic medications appear to be less effective at treating other symptoms of schizophrenia, such as social withdrawal and apathy.
Antipsychotic drugs help reduce symptoms in 80 to 90 percent of people with schizophrenia. However, those who benefit often stop taking medication because they do not understand that they are ill or because of unpleasant side effects. Minor side effects include weight gain, dry mouth, blurred vision, restlessness, constipation, dizziness, and drowsiness. Other side effects are more serious and debilitating. These may include muscle spasms or cramps, tremors, and tardive dyskinesia. Newer drugs, such as clozapine, olanzapine, risperidone, and quetiapine, tend to produce fewer of these side effects. However, clozapine can cause agranulocytosis, a significant reduction in white blood cells necessary to fight infections. This condition can be fatal if not detected early enough. For this reason, people taking clozapine must have weekly tests to monitor their blood.
Because many patients with schizophrenia continue to experience difficulties despite taking medication, psychological and social rehabilitation is often necessary. A variety of methods can be effective. Social skills training help people with schizophrenia learn specific behaviours for functioning in society, such as making friends, purchasing items at a store, or initiating conversations. Behavioural training methods can also help them learn self-care skills such as personal hygiene, money management, and proper nutrition. In addition, cognitive-behavioural therapy, a type of psychotherapy, can help reduce persistent symptoms such as hallucinations, delusions, and social withdrawal.
Family intervention programs can also benefit people with schizophrenia. These programs focus on helping family members understand the nature and treatment of schizophrenia, how to monitor the illness, and how to help the patient make progress toward personal goals and greater independence. They can also lower the stress experienced by everyone in the family and help prevent the patient from relapsing or being rehospitalized.
Because many patients have difficulty obtaining or keeping jobs, supported employment programs that help patients find and maintain jobs are a helpful part of rehabilitation. In these programs, the patient works alongside people without disabilities and earns competitive wages. An employment specialist (or vocational specialist) helps the person maintain their job by, for example, training the person in specific skills, helping the employer accommodate the person, arranging transportation, and monitoring performance. These programs are most effective when the supported employment is closely integrated with other aspects of treatment, such as medication and monitoring of symptoms.
Some people with schizophrenia are vulnerable to frequent crises because they do not regularly go to mental health centres to receive the treatment they need. These individuals often relapse and face rehospitalization. To ensure that such patients take their medication and receive appropriate psychological and social rehabilitation, assertive community treatment (ACT) programs have been developed that deliver treatment to patients in natural settings, such as in their homes, in restaurants, or on the street.
People with schizophrenia often have other medical problems, so an effective treatment program must attend to these as well. One of the most commonly associated problems is substance abuse. Successful treatment of substance abuse in patients with schizophrenia requires careful coordination with their mental health care, so that the same clinicians are treating both disorders at the same time.
The high rate of substance abuse in patients with schizophrenia contributes to a high prevalence of infectious diseases, including hepatitis B and C and the human immunodeficiency virus (HIV). Assessment, education, and treatment or management of these illnesses is critical for the long-term health of patients.
Other problems frequently associated with schizophrenia include housing instability and homelessness, legal problems, violence, trauma and post-traumatic stress disorder, anxiety, depression, and suicide attempts. Close monitoring and psychotherapeutic interventions are often helpful in addressing these problems.
Certain personality traits may also directively lead to stress-related disorders. The so-called Type A personality, characterized by competitive, hard-driving intensity, is common in American society. Although early studies suggested a link between Type A behaviour and coronary heart disease, most studies since the 1980s have failed to find such a relationship. However, research has consistently demonstrated that people who show a high level of hostility, anger, and cynicism - often components of Type A behaviour - have a higher risk of coronary heart disease than people without these traits.
Several other psychiatric disorders are closely related to schizophrenia. In schizoaffective disorder, a person shows symptoms of schizophrenia combined whether mania or severe depression. Schizophreniform disorder refers to an illness in which a person experiences schizophrenic symptoms for more than one month but fewer than six months. In schizotypal personality disorder, a person engages in odd thinking, speech, and behaviour, but usually does not lose contact with reality
The occurring personality disorders, disorders in which one’s personality results in personal state of being agitated with doubt or mental conflict as unconcernedly a crazed derangement or significantly inflicting something that gives rise to the defragmentation of the social or working function, such that of every person has a personality — that is to say, a characteristic way of thinking, feeling, behaving, and relating to others. Most people experience at least some difficulties and problems that result from their personality. The specific point at which those problems justify the diagnosis of a personality disorder is controversial. To some extent the definition of a personality disorder is arbitrary, reflecting as well as professional judgments about the person’s degree of dysfunction, needs for change, and motivation for change.
The occurring personality disorders involve behaviour that deviates from the norms or expectations of one’s culture. However, people who digress from cultural norms are not necessarily dysfunctional, nor are people who conform to cultural norms necessarily healthy. Many personality disorders represent extreme variants of behaviour patterns that people usually value and encourage. For example, most people value confidence but not arrogance, agreeableness but not submissiveness, and conscientiousness but not perfectionism.
Because no clear line exists between healthy and unhealthy functioning, critics question the reliability of personality disorder diagnoses. A behaviour that seems deviant to one person may seem normal to another depending on one’s gender, ethnicity, and cultural background. The personal and cultural biases of mental health professionals may influence their diagnoses of personality disorders.
An estimated 20 percent of people in the general population have one or more personality disorders. Some people with personality disorders have other mental illnesses as well. About 50 percent of people who are treated for any psychiatric disorder have a personality disorder.
Mental health professionals rarely diagnose personality disorders in children because their manner of thinking, feeling, and relating to others does not usually stabilize until young adulthood. Thereafter, personality traits usually remain stable. Personality disorders often decrease in severity as some person ages.
People with antisocial personality disorder act in a way that disregards the feelings and rights of other people. Antisocial personalities often break the law, and they may use or exploit other people for their own gain. They may lie repeatedly, act impulsively, and get into physical fights. They may mistreat their spouses, neglect or abuse their children, and exploit their employees. They may even kill other people. People with this disorder are also sometimes called sociopaths or psychopaths. Antisocial behaviour in people less than 18 years old is called conduct disorder.
Antisocial personalities usually fail to understand that their behaviour is dysfunctional because their ability to feel guilty, remorseful, and anxious is impaired. Guilt, remorse, shame, and anxiety are unpleasant feelings, but they are also necessary for social functioning and even physical survival. For example, people who are found in their deficiency, such as their ability to feel anxious will often fail to anticipate actual dangers and risks. They may take chances that other people would not take.
Antisocial personality disorder affects about 3 percent of males and 1 percent of females. This is the most heavily researched personality disorder, in part because it costs society the most. People with this disorder are at high risk for premature and violent death, injury, imprisonment, loss of employment, bankruptcy, alcoholism, drug dependence, and failed personal relationships.
People with borderline personality disorder experience intense emotional instability, particularly in relationships with others. They may make frantic efforts to avoid real or imagined abandonment by others. They may experience minor problems as major crises. They may also express their anger, frustration, and dismay through suicidal gestures, self-mutilation, and other self-destructive acts. They tend to have an unstable self-image or sense of self.
As children, most people with this disorder were emotionally unstable, impulsive, and often bitter or angry, although their chaotic impulsiveness and intense emotions may have made them popular at school. At first they may impress people as stimulating and exciting, but their relationships tend to be unstable and explosive.
About 2 percent of all people have borderline personality disorder. About 75 percent of people with this disorder are female. Borderline personalities are at high risk for developing depression, alcoholism, drug dependence, bulimia, Dissociative disorders, and post-traumatic stress disorder. As many as 10 percent of people with this disorder commit suicide by the age of 30. People with borderline personality disorder are among the most difficult to treat with psychotherapy, in part because their relationship with their therapist may become as intense and unstable as their other personal relationships.
Avoidant personality disorder is social withdrawal due to intense, anxious shyness. People with Avoidant personalities are reluctant to interact with others unless they feel certain of the likened impact, which they fear for being criticized or rejected. Often they view themselves as socially inept and inferior to others.
Dependent personality disorder involves severe and disabling emotional dependency on others. People with this disorder have difficulty making decisions without a great deal of advice and reassurance from others. They urgently seek out another relationship when a close relationship ends. They feel uncomfortable by themselves.
People with histrionic personality disorder constantly strive to be the centres of attention. They may act overly flirtatious or dress in ways that draw attention. They may also talk in a dramatic or theatrical style and display exaggerated emotional reactions.
People with narcissistic personality disorder have a grandiose sense of self-importance. They seek excessive admiration from others and fantasize about unlimited success or power. They believe they are special, unique, or superior to others. However, they often have very fragile self-esteem.
Obsessive-compulsive personality disorder is characterized by a preoccupation with details, orderliness, perfection, and control. People with this disorder often devote excessive amounts of time toward working and individual productivity and fail to take time for leisure activities and friendships. They tend to be rigid, formal, stubborn, and serious. This disorder differs from obsessive-compulsive disorder, which often includes more bizarre behaviour and rituals.
People with paranoid personality disorder feel constant suspicion and distrust toward other people. They believe that others are against them and constantly look for evidence to support their suspicions. They are hostile toward others and react angrily to perceived insults.
Schizoid personality disorder involves social isolation and a lack of desire for close personal relationships. People with this disorder prefer to be alone and seem withdrawn and emotionally detached. They seem indifferent to felicitation or criticism from other people.
People with schizotypal personality disorder engage in odd thinking, speech, and behaviour. They may ramble or use words and phrases in unusual ways, and they may believe they have magical control over others. They feel very uncomfortable with close personal relationships and tend to be suspicious of others. Some research indications to bare procedures in the disorder which is less severe form of schizophrenia.
Many psychiatrists and psychologists use two additional diagnoses. Depressive personality disorder is characterized by chronic pessimism, gloominess, and cheerlessness. In passive-aggressive personality disorder, a person passively resists completing tasks and chores, criticizes and scorns authority figures, and seems negative and sullen.
Personality disorders result from a complex interaction of inherited traits and life experience, not from a single cause. For example, some cases of antisocial personality disorder may result from a combination of a genetic predisposition to impulsiveness and violence, very inconsistent or erratic parenting, and a harsh environment that discourage feelings of empathy and warmth but rewards exploitation and aggressiveness. Borderline personality disorder may result from a genetic predisposition to impulsiveness and emotional instability combined with parental neglect, intense marital conflicts between parents, and repeated episodes of severe emotional or sexual abuse. Dependent personality disorder may result from genetically based anxiety, an inhibited temperament, and overly protective, clinging, or neglectful parenting.
The pervasive and chronic nature of personality disorders makes them difficult to treat. People with these disorders often fail to recognize that their personality has contributed to their social, occupational, and personal problems. They may not think they have any real problems despite a history of drug abuse, failed relationships, and irregular employment. Thus, therapists must first focus on helping the person understand and become aware of the significance of their personality traits.
People with personality disorders sometimes feel that they can never change their dysfunctional behaviour because they have always acted the same way. Although personality change is exceedingly difficult, sometimes people can change the most dysfunctional aspects of their feelings and behaviour.
Therapists use a variety of methods to treat personality disorders, depending on the specific disorder. For example, cognitive and behavioural techniques, such as role playing and logical argument, may help alter a person’s irrational perceptions and assumptions about himself or herself. Certain psychoactive drugs may help control feelings of anxiety, depression, or severe distortions of thought. Psychotherapy may help people to understand the impact of experiences and responsibilities. These programs appear to help some people, but it is unclear how long their beneficial effects last.
The appropriate treatment, most people can recover from mental illness and return to normal life. Even those with persistent, long-term mental illnesses can usually learn to manage their symptoms and live productive lives.
In most societies mental illness carries a substantial stigma, or mark of shame. The mentally ill, were at most, blamed for their own ill’s, blamed for bringing it upon their own illnesses, and others may see them as victims of bad fate, religious and moral transgression, or witchcraft. Such stigma may keep families from acknowledging that a family member is ill. Some families may hide or overprotect a member with mental illness - keeping the person from receiving potentially effective care - or they may reject the person from the family. When magnified from individuals to a whole society, such attitudes lead to underfunding of mental health services and terribly inadequate care. In much of the world, even today, the mentally ill, were chained, shackled and caged, or hospitalized in filthy, brutal institutions. Yet attitudes toward mental illness have improved in many areas, especially owing to a heralded breed and advocacy for the mentally ill.
Mental illness creates enormous social and economic costs. Depression, for example, affects some 500 million people in the world and results in more time lost to disability than such chronic diseases as diabetes mellitus and arthritis. Estimating the economic cost of mental illness is complex because there are direct costs (actual medical expenditures), indirect costs (the cost to individuals and society due to reduced or lost productivity, for example), and support costs (time lost to care of family members with mental illnesses).
Another method of estimating the cost of mental illness to society measures the impact of premature deaths and disablements. Research by the World Health Organization and the World Bank estimated that in 1990, among the world’s population aged 15 to 44 years, depression accounted for more than 10 percent of the total burden attributable to all diseases. Two other illnesses, bipolar disorder and schizophrenia, accounted for another 6 percent of the burden. This research has helped governments recognize that mental illnesses constitute a far greater challenge to public health systems than previously realized.
No universally accepted definition of mental illness exists. In general, the definition of mental illness depends on a society’s norms, or rules of behaviour. Behaviours that violate these norms are considered signs of deviance or, in some cases, of mental illness.
The variation in behavioural norms does not mean, however, that definitions of mental illness are necessarily incompatible across cultures. Many behaviours are recognized throughout the world for being indicative of mental illness. These include extreme social withdrawal, violence to oneself, hallucinations (false sensory perceptions), and delusions (fixed, false ideas).
Another way of defining mental illness is based on whether a person’s behaviours are maladaptive - that is, whether they cause a person to experience problems in coping with common life demands. For example, people with social phobia may avoid interacting with other people and experience problems at work as a result. Critics note that under this definition, political dissidents could be considered mentally ill for refusing to accept the dictates of their government.
Mental illness affects people of all ages, races, cultures, and socioeconomic classes. The prevalence of mental illness refers to what degree or to the greater extent do peoples experience of a mental illness during a specified time period.
Psychosomatic Illness, illness that has no basic physical or organic cause but appears to be the result of psychological conditions, such as stress, anxiety, and depression. Such illnesses reflect the general belief that the mind is capable of strongly affecting bodily reactions, and that a person’s mental condition can actually cause changes in the chemistry of the body, thereby creating physical illness. In cases of psychosomatic illness, a marked change in the body can often be readily detected.
The most effective treatment for psychosomatic disorders takes account into both the physical and the emotional aspects of the disease. The physical symptoms usually cannot be cured until the person’s psychological environment has improved. For instance, a business executive working under severe pressure may develop ulcers. Although medicine and a special diet can improve this condition, if the person fails to cut down on work or learn relaxation techniques, he or she will probably continue to suffer from the disease and may even develop additional psychosomatic illnesses. In more serious cases of psychosomatic illness, doctors may recommend that the patient undergo some form of psychotherapy in addition to treatment for the physical aspects of the illness.
Depression can take several other forms. In bipolar disorder, sometimes called manic-depressive illness, a person’s mood swings back and forth between depression and mania. People with seasonal affective disorder typically suffer from depression only during autumn and winter, when there are fewer hours of daylight. In dysthymia, people feel depressed, have low self-esteem, and concentrate poorly most of the time - often for a period of years - but their symptoms are milder than in major depression. Some people with dysthymia experience occasional episodes of major depression. Mental health professionals use the term clinical depression to refer to any of the above forms of depression.
Major depression, the most severe form of depression, affects from 1 to 2 percent of people aged 65 or older who are living in the community (rather than in nursing homes or other institutions). The prevalence of depression and other mental illnesses is much higher among elderly residents of nursing homes. Although most older people with depression respond to treatment, many cases of depression among the elderly go undetected or untreated. Research indicates that depression is a major risk factor for suicide among the elderly in the United States. People over age 65 in the United States have the highest suicide rate of any age group.
Generally, the overall prevalence rates of mental illnesses between men and women are similar. However, men have much higher rates of antisocial personality disorder and substance abuse. In the United States, women suffer from depression and anxiety disorders at about twice the rate of men. The gender gap is even wider in some countries. For example, in China, women suffer from depression at nine times the rate of men.
Mental illness is becoming an increasing problem for two reasons. First, increases in life expectancy have brought increased numbers of certain chronic mental illnesses. For example, because more people are living into old age, more people are suffering from dementia. Second, a number of studies provide evidence that rates of depression are rising throughout the world. The reasons may be related to such factors as economic change, political and social violence, and cultural disruptions. While some have questioned these findings, dramatic increases in the numbers of refugees and people dislocated from their homes by economic forces or civil strife are associated with great increases in a variety of mental illnesses for those populations. According to the United Nations High Commissioner for Refugees, the number of refugees worldwide increased from 2.5 million in 1971 to 13.2 million in 1996, peaking at 17 million in 1991.
A number of mental illnesses - such as depression, anxiety disorders, schizophrenia, and bipolar disorder - occur worldwide. Others seem to occur only in particular cultures. For example, eating disorders, such as anorexia nervosa (compulsive dieting associated with unrealistic fears of fatness), occurs mostly between girls and women in Europe, North America, and Westernized areas of Asia, whose cultures view thinness as an essential component of female beauty. In Latin America, people who are met with directly (as through participation or observation) in having known the intimacy or inward practices that are acquainted or familiar with or versed of something based on the personal exposure seem as been awarded of an experience, perhaps, an experience overwhelming of some causal reason to fright after a dangerous or traumatic event is said to have sustained (fright), an illness in which their soul has been frightened away. In some societies of West Africa and elsewhere, brain fatigue describes individuals (usually students) who experience difficulties in concentrating and thinking, as well as physical symptoms of pain and wearing out.
Most mental health professionals in the United States use the Diagnostic and Statistical Manual of Mental Disorders(DSM), a reference book published by the American Psychiatric Association, as a guide to the different kinds of mental illnesses. The foundation, known as DSM-IV, describes more than 300 mental disorders, behavioural disorders, addictive disorders, and other psychological problems and groups them into broad categories. This describes some of the major categories, including anxiety disorders, mood disorders, schizophrenia and other psychotic disorders, personality disorders, cognitive disorders, Dissociative disorders, somatoform disorders, factitious disorders, substance-related disorders, eating disorders, and impulse-control disorders. Mental health professionals in many other parts of the world use a different classification system, the International Classification of Diseases (ICD), published by the World Health Organization.
The DSM and ICD are both categorical systems of classification, in which each mental illness is defined by its own unique set of symptoms and characteristics. In theory, each disorder should possess diagnostic criteria that are independent of from each one and another, just as tuberculosis and lung cancer are discrete diseases. Yet symptoms of many mental disorders overlap, and many people - such as those who experience both depression and severe anxiety - show symptoms of more than one disorder at the same time. For these reasons, some mental health professionals advocate a dimensional system of classification. In contrast to the categorical approach, which sees mental disorders as qualitatively distinct from normal behaviour, a dimensional system views behaviour as falling along a continuum of normality, with some behaviours considered more abnormally than others. In a dimensional system, diagnoses do not describe discrete diseases but rather portray the relative importance of an array of symptoms.
Mood disorders, also called affective disorders, create disturbances in a person’s emotional life. Depression, mania, and bipolar disorder are examples of mood disorders. Symptoms of depression may include feelings of sadness, hopelessness, and worthlessness, as well as complaints of physical pain and changes in appetite, sleep patterns, and energy level. In mania, on the other hand, an individual experiences an abnormally elevated mood, often marked by exaggerated self-importance, irritability, agitation, and a decreased need for sleep. In bipolar disorder, also called manic-depressive illness, a person’s mood alternates between extremes of mania and depression.
Bipolar disorder is a mental illness that causes mood swings. In the manic phase, a person might feel ecstatic, self-important, and energetic. But when the person becomes depressed, the mood shifts to extreme sadness, negative thinking, and apathy. Some studies indicate that the disease occurs at unusually high rates in creative people, such as artists, writers, and musicians. But some researchers contend that the methodology of these studies was flawed and their results were misleading. In the October 1996 Discover Magazine article, anthropologist Jo Ann C. Gutin presents the results of several studies that explore the link between creativity and mental illness.
People with schizophrenia and other psychotic disorders lose contact with reality. Symptoms may include delusions and hallucinations, disorganized thinking and speech, bizarre behaviour, a diminished range of emotional responsiveness, and social withdrawal. In addition, people who suffer from these illnesses experience and inability function operates in one or more important areas of life, such as social relations, work, or school.
Personality disorders are mental illnesses in which one’s personality results in personal distress or a significant impairment in social or work functioning. In general, people with personality disorders have poor perceptions of themselves or others. They may have low self-esteem or overwhelming narcissism, poor impulse control, troubled social relationships, and inappropriate emotional responses. Considerable controversy exists over where to draw the distinction between a normal personality and a personality disorder.
Cognitive disorders, such as delirium and dementia, involve a significant loss of mental functioning. Dementia, for example, is characterized by impaired memory and difficulties in such functions as speaking, abstract thinking, and the ability to identify familiar objects. The conditions in this category usually result from a medical condition, substance abuse, or adverse reactions to medication or poisonous substances.
Dissociative disorders involve disturbances in a person’s consciousness, memories, identity, and perception of the environment. Dissociative disorders include amnesia that has no physical cause; Dissociative identity disorders, in which a person has what more is less, such are the considerations in having two or more distinct personalities that alternate in their control of the person’s behaviour; depersonalization disorder, characterized by a chronic feeling of being detached from one’s body or mental processes; and Dissociative fugue, an episode of sudden departure from home or work with an accompanying loss of memory. In some parts of the world people experience Dissociative states as ‘possession’, is that by a god or ghost instead of separate personalities, insofar as many societies, a trance and possession states are normal parts of cultural and religious practices, as well as, to what they are, and not too considered for Dissociative disorders.
Somatoform disorders are characterized by the presence of physical symptoms that cannot be explained by a medical condition or another mental illness. Thus, physicians often judge that such symptoms result from psychological conflicts or distress. For example, in conversion disorder, also called hysteria, a person may experience blindness, deafness, or seizures, but a physician cannot find anything wrong with the person. People with another somatoform disorder, hypochondriasis, constantly fear that they will develop a serious disease and misinterpret minor physical symptoms as evidence of illness.
Substance-related disorders result from the abuse of drugs, side effects of medications, or exposure to toxic substances. Many mental health professionals regard these disorders as behavioural or addictive disorders rather than as mental illnesses, although substance-related disorders commonly occur in people with mental illnesses. Common substance-related disorders include alcoholism and other forms of drug dependence. In addition, drug use can contribute to symptoms of other mental disorders, such as depression, anxiety, and psychosis. Drugs associated with substance-related disorders include alcohol, caffeine, nicotine, cocaine, heroin, amphetamines, hallucinogens, and sedatives.
Eating disorders are conditions in which an individual experience severe disturbances in eating behaviours. People with anorexia nervosa have an intense fear about gaining weight and refuse to eat adequately or maintain a normal body weight. People with bulimia nervosa repeatedly engage in episodes of binge eating, usually followed by self-induced vomiting or the use of laxatives, diuretics, or other medications to prevent weight gain. Eating disorders occur mostly among young women in Western societies and certain parts of Asia.
People with impulse-control disorders cannot control an impulse to engage in harmful behaviours, such as explosive anger, stealing (kleptomania), setting fires (pyromania), gambling, or pulling out their own hair (trichotillomania). Some mental illnesses - such as mania, schizophrenia, and antisocial personality disorder - may include symptoms of impulsive behaviour.
People have tried to understand the causes of mental illness for thousands of years. The modern era of psychiatry, which began in the late 19th and early 20th centuries, has witnessed a sharp debate between biological and psychological perspectives of mental illness. The biological perspective views mental illness in terms of bodily processes, whereas psychological perspectives emphasize the roles of a person’s upbringing and environment.
These two perspectives are exemplified in the work of German psychiatrist Emil Kraepelin and Austrian psychoanalyst Sigmund Freud. Kraepelin, influenced by the work in the mid-1800's of German psychiatrist Wilhelm Griesinger, believed that psychiatric disorders were disease entities that could be classified like physical illnesses. That is, Kraepelin believed that the fundamental causes of mental illness lay in the physiology and biochemistry of the human brain. His classification system of mental disorders, first published in 1883, formed the basis for later diagnostic systems. Freud, on the other hand, argued that the source of mental illness lay in unconscious conflicts originating in early childhood experiences. Freud found evidence for this idea through the analysis of dreams, free association, and slips of speech.
This debate has continued into the late 20th century. Beginning in the 1960's, the biological perspective became dominant, supported by numerous breakthroughs in psychopharmacology, genetics, neurophysiology, and brain research. For example, scientists discovered many medications that helped to relieve symptoms of certain mental illnesses and demonstrated that people can inherit a vulnerability to some mental illnesses. Psychological perspectives also remain influential, including the Psychodynamic perspective, the humanistic and existential perspectives, the behavioural perspective, the cognitive perspective, and the Sociocultural perspective.
Psychiatry has increasingly emphasized a biological basis for the causes of mental illness. Studies suggest a genetic influence in some mental illnesses, such as schizophrenia and bipolar disorder, although the evidence is not conclusive.
Clinical depression is one of the most common forms of mental illness. Although depression can be treated with psychotherapy, many scientists believe there are biological causes for the disease. In the June 1998 Scientific American article, neurobiologist Charles B. Nemeroff reports upon the connection between biochemical changes in the brain and depression.
Scientists have identified a number of neurotransmitters, or chemical substances that enable brain cells to communicate with other, that appears important in regulating a person’s emotions and behaviour. These include dopamine, serotonin, norepinephrine, gamma-amino butyric acid (GABA), and acetylcholine. Excesses and deficiencies in levels of these neurotransmitters have been associated with depression, anxiety, and schizophrenia, but scientists have yet to determine the exact mechanisms involved.
Research shows that the more genetically related a person is to someone with schizophrenia, the greater the risk that person has of developing the illness. For example, children of one parent with schizophrenia have a 13 percent chance of developing the illness, whereas children of two parents with schizophrenia have a 46 percent chance of developing the disorder.
Advances in brain imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have enabled scientists to study the role of brain structure in mental illness. Some studies have revealed structural brain abnormalities in certain mental illnesses. For example, some people with schizophrenia have enlarged brain ventricles (cavities in the brain that contains cerebrospinal fluid). However, this may be a result of schizophrenia rather than a cause, and not all people with schizophrenia show this abnormality.
A variety of medical conditions can cause mental illness. Brain damage and strokes can cause loss of memory, impaired concentration and speech, and unusual changes in behaviour. In addition, brain tumours, if left to grow, can cause psychosis and personality changes. Other possible biological factors in mental illness include an imbalance of hormones, deficiencies in diet, and infections from viruses.
In the late 19th century Viennese neurologist Sigmund Freud developed a theory of personality and a system of psychotherapy known as psychoanalysis. According to this theory, people are strongly influenced by unconscious forces, including innate sexual and aggressive drives.
The Psychodynamic perspective views mental illness as caused by unconscious and unresolved conflicts in the mind. As stated by Freud, these conflicts arise in early childhood and may cause mental illness by impeding the balanced development of the three systems that constitute the human psyche: the id, which comprises innate sexual and aggressive drives; the ego, the conscious portion of the mind that mediates between the unconscious and reality; and the superego, which controls the primitive impulses of the id and represents moral ideals. In this view, generalized anxiety disorder stems from a signal of unconscious danger whose source can only be identified through a thorough analysis of the person’s personality and life experiences. Modern Psychodynamic theorists tend to emphasize sexuality less than Freud did and focus more on problems in the individual’s relationships with others.
Both the humanistic and existential perspectives view abnormal behaviour as resulting from a person’s failure to find meaning in life and fulfill his or her potential. The humanistic school of psychology, as represented in the work of American psychologist Carl Rogers, views mental health and personal growth as the natural conditions of human life. In Rogers’s view, every person possesses a drive toward self-actualization, the fulfilment of one’s greatest potential. Mental illness develops when a person’s condition by some circumstantial environment interferes with this drive. The existential perspective sees emotional disturbances as the result of a person’s failure to act authentically - that is, to behave in accordance with one’s own goals and values, rather than the goals and values of others.
The pioneers of behaviourism, American psychologist’s John B. Watson and B. F. Skinner, maintained that psychology should confine itself to the study of observable behaviour, rather than explore a person’s unconscious feelings. The behavioural perspective explains mental illness, as well as all of human behaviour, as a learned response to, malaria, and infection’s stimuli. In this view, rewards and punishments in a person’s environment shape that person’s behaviour, for example, a person involved in a serious car accident may develop a phobia of cars or the generalized fear to all forms of transportation.
The cognitive perspective holds that mental illness result from problems in cognition - that is, problems in how a person reasons, perceives events, and solves problems. American psychiatrist Aaron Beck proposed that some mental illnesses - such as depression, anxiety disorders, and personality disorders - result from a way of thinking learned in childhood that is not consistent with reality. For example, people with depression tend to see themselves in a negative light, exaggerate the importance of minor flaws or failures, and misinterpret the behaviour of others in negative ways. It remains unclear, however, whether these kinds of cognitive problems actually cause mental illness or merely represent symptoms of the illnesses themselves.