Theories of Personality and Psychopathology

Psychoanalysis is one of the fundamental principles within psychiatry. It was developed by Sigmund Freud (1856–1939), and although it has advanced far beyond Freud, it can be said that his influence is still strong and pervasive. Psychoanalysis is the bedrock of psychodynamic understanding and forms the fundamental point of reference for a variety of types of therapeutic intervention. It embraces not only psychoanalysis itself but also various forms of psychoanalytically oriented psychotherapies and related therapies involving psychodynamic concepts.

All major psychological theories of personality involve the basic premise that a person’s early psychosocial development shapes what comes later—that the impact of childhood events, beliefs, experiences, and fantasies continue, consciously or unconsciously, throughout life and account for adult behavior.

Freud’s revolutionary contributions to the understanding of the human mind and psyche continue to stimulate, provoke, and challenge students of personality and psychopathology today. His basic tenets of the unconscious mind, psychosexual development, and psychodynamics remain the bedrock of psychoanalytic theory even though many have disagreed with, modified, or expanded on his ideas. No matter how a particular theorist may feel about Freud’s ideas, each must begin with a thorough knowledge of his contributions.

There have been many other psychoanalytic personality theorists with widely varying views on development. These include Alfred Adler (1870–1937), Erik Erikson (1902–1994), Karen Horney (1885–1952), Carl Gustav Jung (1875–1961), Melanie Klein (1882–1960), Harry Stack Sullivan (1892–1949), and Heinz Kohut (1913–1981). Schools of thought, encompassing a variety of different theories, include ego psychology, object relations, self-psychology, and interpersonal psychology, among others. Each approach has its own perspective on personality development and the development of psychopathology.

Students should study the questions and answers below to test their knowledge in this area.

Helpful Hints

Students should know the various theorists, their schools of thought, and their theories.

Karl Abraham
abreaction
Alfred Adler
Franz Alexander
Gordon Allport
analytical process
attention cathexis
birth trauma
Joseph Breuer
cathexis
conscious
defense mechanisms
displacement
dream work
The Ego and the Id
ego functions
ego psychology
Erik Erikson
Eros and Thanatos
Anna Freud
free association
Erich Fromm
fundamental rule
Karen Horney
hypnosis
hysterical phenomena
infantile sexuality
instinctual drives
The Interpretation of Dreams
Carl Gustav Jung
latent and manifest dreams
libido and instinct theories
Abraham Maslow
Adolph Meyer
multiple self-organizations
nocturnal sensory stimuli
object constancy
object relations
parapraxes
preconscious system
pregenital
primary and secondary gains
primary and secondary processes
primary autonomous functions
psychic determinism
psychoanalytic theory
psychodynamic thinking
psychoneurosis
psychosexual development
Otto Rank
reality principle
reality testing
regression
Wilhelm Reich
repetition compulsion
repression
resistance
secondary revision
signal anxiety
Studies on Hysteria
Harry Stack Sullivan
symbolic representation
synthetic functions of the ego
topographic theory
transference
unconscious motivation
wish fulfillment

Questions

Directions

Each question or incomplete statement below is followed by five suggested responses or completions. Select the one that is best in each case.

5.1. Mr. A was a 26-year-old white man who had a history of bipolar I disorder. He was brought in for treatment after not completing the last required course for his advanced degree and being arrested for disturbing the peace. He had consistently lied to his family about where he stood with his coursework and about having skipped an examination that would have qualified him to use his professional degree. He had also not told them that he had been using marijuana almost daily for a number of years and occasionally used hallucinogens. His arrest for disorderly conduct was for swimming naked in an apartment complex in the middle of the night while under the influence of hallucinogens. Mr. A spent most of his time reading and trying to write but compared himself unfavorably with other famous writers, feeling himself to be inferior. (Adapted from Paul C. Mohl, MD, and Adam M. Brenner, MD.)

How would Alfred Adler view Mr. A?

A. Mr. A’s problems are a failure of adaptation to his mental illness and adult life.

B. Mr. A’s rebellion against conformity is a defense against his fear of being away from his mother’s protection and domination.

C. Mr. A uses drugs and psychosis as escapes to maintain some degree of self-esteem.

D. Mr. A has been attempting to move from inferiority to mastery in fantasy rather than in realistic achievement.

E. Mr. A’s process of self-realization has been blocked.

View Answer

5.1. The answer is D

Alfred Adler (1870–1937) posited striving for self-esteem through overcoming a sense of inferiority, which he saw as an inevitable force in the human condition as a result of its extended childhood. As seen from the Alderian point of view, Mr. A has been attempting to make the normal step of moving from inferiority to mastery in fantasy instead of through realistic achievement. He maintains himself in fantasy as a writer while failing at the accomplishments that would enable him to become a writer.

Sandor Rado (1890–1972) theorized that cultural factors often cause excessive hedonic control by interfering with the organism’s ability for self-regulation. Rado would have framed Mr. A’s difficulties as failures of adaptation to his mental illness and adult life and as a regression to the hedonic level of adaptation in which pleasure is sought and pain avoided.

Wilhelm Reich (1897–1957) made major contributions to psychoanalysis in the area of character formation and character types. The term character armor refers to the personality’s defenses that serve as resistance to self-understanding and change. Reich might see Mr. A’s rebellion against conformity as a defense against his fear of being away from his mother’s protection and domination. The more Mr. A rebels, the more tightly he binds himself to his mother.

Harry Stack Sullivan (1892–1949) would probably see Mr. A as arrested in childhood. His fear of displeasing his mother led him to give up healthy self-esteem strivings for independence, favoring a distant yet dependent position. Mr. A uses drugs and psychosis as escapes to maintain some degree of self-esteem.

Karen Horney (1885–1952) proposed three separate concepts of the self: the actual self (the sum total of a person’s experience), the real self (the harmonious, healthy person), and the idealized self (the neurotic expectation or glorified image that a person believes he or she should be). From the standpoint of Horney, Mr. A’s process of self-realization has been blocked in all three directions. He has not developed the ability to love and trust; he expresses opposition in an unhealthy way, and he has made self-defeating moves toward independence.

5.2. Adolf Meyer would treat Mr. A by

A. assisting Mr. A in integrating alien parts of himself into his ego complex

B. focusing on the adequate treatment of Mr. A’s mental disorder

C. challenging Mr. A to develop attachments outside of the family

D. encouraging Mr. A to join a support and educational group to better understand and accept his mental illness

E. none of the above

View Answer

5.2. The answer is B

Adolf Meyer (1866–1952) would focus first on the adequate treatment of Mr. A’s mental disorder. Meyer emphasized the interrelationship of symptoms and individual psychological and biological functioning. Controlling biological forces at work to disrupt Mr. A’s life is always a primary goal. Because Mr. A is still dependent on his parents, they are included in the treatment plan and might be seen separately by a social worker. Both Mr. A and his parents are told that failure to control the symptoms of his mental illness could cost him his life and any satisfaction that he might derive from it. Mr. A’s mood swings are stabilized on an appropriate medication. Later, Mr. A would begin the distributive analysis phase of his treatment and would be asked to reflect on the impact of his bipolar I disorder and his avoidance of responsibility in his life.

5.3. A young woman presents to you complaining of lack of energy, trouble sleeping, depression, and hopelessness that has been present for the past year. You diagnose her with major depressive disorder. Which of the following would have been Freud’s explanation of this disorder?

A. Her depression is actually internally directed anger.

B. Her internal good objects have been destroyed by aggression and greed.

C. She never mastered the trust versus mistrust stage of ego development.

D. She is being persecuted by a tormenting internal object.

E. She feels despair that her self-object needs will not be met by others.

View Answer

5.3. The answer is A

Freud originally understood depression as internally directed anger. In his view, the self-reproaches and the loss of self-esteem commonly experienced by depressed patients are directed not at the self but rather at an ambivalently experienced introject. He noted that in some cases, the only way the ego can give up an object is to introject it, so the anger directed at the ambivalently held object takes on the clinical manifestation of the depression.

From the self-psychological point of view associated with Heinz Kohut, depression is related to a sense of despair about getting one’s self object needs met by people in the environment. Melanie Klein suggested that depression is linked to a reactivation of the depressive position; depressed patients are convinced that they have destroyed their internal good objects because of their own aggression and greed. As a result, they feel persecuted by internal bad objects while longing for the lost love objects.

Erikson hypothesized that the depressed patient’s experience of being empty and of being no good is an outgrowth of a developmental derailment. Depression therefore results from failing to develop a basic sense of trust or the virtue of hope. From an object relations perspective, many depressed patients unconsciously experience themselves to be at the mercy of a tormenting internal object that is unrelenting in its persecution of them. In cases of psychosis, that primitive forerunner of the superego may actually be hallucinated as a voice that is unrelentingly critical.

5.4. Lacanian theory

A. places heavy emphasis on linguistics

B. has little place for biology or drives

C. postulates that an individual is embedded in political and societal structure

D. views the analytical process as an effort to recognize alienation from one’s true self

E. all of the above

View Answer

5.4. The answer is E (all)

The French psychoanalyst Jacques Lacan (1901–1981) made a lasting impression on French psychoanalysis as well as on literary and film criticism in academic departments throughout the world. Lacan’s reading of Freud relies heavily on linguistics. The notion that human beings are constituted by language is one of three basic principles endorsed by Lacan. The unconscious is structured like a language that consists only of signifiers; biology and drives have no place in his theory. Second, the ego does not exist as an autonomous structure. A third principle is that an individual is inevitably embedded in political and societal structures that cannot be transcended.

Lacan thrived on being unorthodox. He denied the significance of diagnoses, rules, or established schools of thought. He saw the analytical process as an effort to recognize the alienation from one’s true self. Analysis was also designed to bring out underlying structures and contexts in the unconscious.

5.5. The Oedipus complex as described by Freud involves all of the following except

A. adult sexuality

B. rivalries

C. anal phase

D. intense love relationships

E. both mother and father

View Answer

5.5. The answer is C

The phallic period (not anal phase), during which the Oedipus complex emerges, is a critical phase of development for the budding formation of the child’s own sense of gender identity—as decisively male or female—based on the child’s discovery and realization of the significance of anatomical sexual differences. Adult sexual adjustment is said to rely on the attachment to one parent and the identification with the other. The events associated with the phallic phase also set the stage for the developmental predisposition to later psychoneuroses. Freud used the term Oedipus complex to refer to the intense love relationships, together with their associated rivalries, hostilities, and emerging identifications, formed during this period between the child and parents.

5.6. The work of Anna Freud, daughter of Sigmund Freud, included all of the following except

A. contributions to child psychoanalysis

B. development of modern ego psychology

C. studies on the function of the ego in personality development

D. contradictions to her father’s claims about psychosexual development

E. expansion on individual defense mechanisms

View Answer

5.6. The answer is D

Anna Freud (1895–1982) was not known to have contradicted her father’s claims on psychosexual development. Anna Freud, the daughter of Sigmund Freud, ultimately made her own set of unique contributions to psychoanalysis. Whereas her father focused primarily on repression as the central defense mechanism, Anna Freud greatly elaborated on individual defense mechanisms, including reaction formation, undoing, introjection, identification, projection, turning against the self, reversal, and sublimation. She was also a key figure in the development of modern ego psychology in that she emphasized that there was “depth in the surface.” In other words, the defenses marshaled by the ego to avoid unacceptable wishes from the id were in and of themselves complex and worthy of attention. Up to that point, the primary focus had been on uncovering unconscious sexual and aggressive wishes. She also made seminal contributions to the field of child psychoanalysis and studied the function of the ego in personality development.

5.7. According to Freud, the Oedipus complex is resolved through

A. the castration complex

B. the acting out of symbolic rivalries

C. moving on to the genital stage of development

D. the realization of one’s gender identity

E. identification with the opposite-sex parent

View Answer

5.7. The answer is A

There is some differentiation between the sexes in the pattern of development. Freud explained the nature of this discrepancy in terms of genital differences. Under normal circumstances, he believed that, for boys, the Oedipal complex was resolved by the castration complex. Specifically, the boy had to give up his strivings for his mother because of the threat of castration—castration anxiety. In contrast, the Oedipus complex in girls was also evoked by reason of the castration complex. Unlike in boys, little girls are already castrated, and as a result, they turn to their fathers as bearers of the penis out of a sense of disappointment over their own lack of penises. Little girls are thus more threatened by a loss of love than by actual castration fears.

5.8. Erikson differs from Freud by his placing greater emphasis on

A. interpersonal relationships

B. cultural factors in development

C. instinctual drives

D. psychosexual development

E. object relations

View Answer

5.8. The answer is B

Erikson’s work concentrated on the effects of social, cultural, and psychological factors in development. Although Erikson acknowledged the important role of sexuality, it was less central to his theory. The concepts of instinctual drives and psychosexual development are essential parts of Freud’s theories, not Erikson’s. Object relations, which refer not to interpersonal relationships but to the interactions of internalized constructs of external relationships, is the central idea in object relation psychology.

5.9. You have a 72-year-old patient who has been very concerned with her appearance ever since you met her. She has had three facelifts, never leaves the house without makeup, and refuses to allow her grandchildren to call her “grandmother.” Which of the following of Erikson’s stages is this woman having difficulty mastering?

A. Narcissistic

B. Generativity versus stagnation

C. Egocentric

D. Identity versus role confusion

E. Integrity versus despair

View Answer

5.9. The answer is E

Erikson’s theory of psychosocial development centers around eight stages of ego development. Integrity versus despair is the last of the stages and takes place between age 65 years and death. If this stage is successfully mastered, the individual arrives at a peaceful acceptance of his or her own mortality without losing interest in life. The patient in this case, however, is clearly having difficulties with this stage as she attempts to deny the passage of time and refuses to prepare for this endpoint of the life cycle. A person in a stage of despair is unconsciously fearful of death and lives in basic self-contempt.

Generativity versus stagnation

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