Download The psychodynamic explanation of mental illness

The psychodynamic explanation
of mental illness
Unconscious conflicts
• The assumption of the psychodynamic perspective is that our
behaviour is determined by our unconscious.
• The id and superego are constantly conflicting with each other. If we
give in to our id then we feel guilty for letting our desires get the
better of us. If we always let the superego control us then this can
lead to depression, damaged relationships and even murder.
• The ego is meant to use defence mechanisms to protect us from
these conflicts. These defence mechanisms can often lead to signs
of mental illness.
Defence mechanisms
• Using denial to block a painful truth can often lead to people not
acknowledging that relationships are over, resulting in anxiety and
depression.
• Repressing memories from disturbing experiences in childhood can
lead to unhealthy behaviours in the future.
• The quality of our defence mechanisms is very dependent on
childhood experiences.
• A child who suffers from a parental bereavement may not have the
developed defences to handle a major loss.
• A cold, rejecting mother can lead to a weak ego where the id is out
of control. With the id out of control, the person may not have the
ability to distinguish reality from fantasy.
Treatments – Dream analysis
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The focus of therapy according to the psychodynamic perspective is to resolve the
unconscious conflicts in the mind.
One way that the unconscious is reflected is through dreams.
Freud claimed that dreams contained two parts: 1) the manifest content (what you are
dreaming about); but also 2) the latent content (what the meaning of your dream is).
It is understanding the latent content that will help the therapist to treat the patient.
Dreams are constructed by turning the latent content (for example, a fear of exams)
into manifest content in a dream.
This is achieved through condensation and symbolism – where people and feelings in
the real world are represented in a different way in a dream.
Emotions that you feel in the real world (e.g. fear of failure) are then displaced onto the
manifest content of the dream that seemingly appears unrelated (e.g. fear while falling
in a dream).
The aim of therapy (psychoanalysis) is to reverse this dream-making process so the
patient understands the meaning behind their dream. Once this is achieved the
therapist can make suggests about what the patient needs to do.
Treatments – Free association
• Another way that unconscious conflicts can be found is free
association.
• In free association the patient talks out loud continuously about
everything that comes to mind. This must be done without
processing or editing out anything.
• As Freud felt that 90 % of behaviour is determined by the
unconscious then even the most trivial comments can have a
deeper meaning.
• The role of the therapist is to identify key points the patient says and
make suggestions that the patient can either accept or reject.
• Free association can be carried out either by verbal or written
methods (sometimes writing down something is less embarrassing
than saying it out loud).
Evaluating psychoanalysis
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The are many critics and proponents of psychoanalysis.
Szasz (1990) claims that Freud was a myth maker and falsified stories to
provide evidence of his theories (i.e. Little Hans).
Eysenck (1952) found that patients improved significantly after therapy
whether or not they received psychotherapy.
On the other hand Leichsenring et al. (2004) found that short-term
psychotherapy gave significant improvements to general psychiatric
symptoms, while Tschushke et al. (2007) found that patients had better
outcomes from prolonged psychoanalysis.
Berin and Garfield (1971) also found that 80% of patients benefitted when
they had psychoanalysis compared to other therapies.
However, research comparing psychoanalysis to other therapies like CBT is
limited as investigating long-term impacts of treatments is time consuming
and longitudinal research is yet to be published.
The cognitive neuroscience explanation
of mental illness
What is cognitive neuroscience?
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Rather than simply looking at cognitive factors and biological factors as an
explanation of behaviour, cognitive neuroscience will look at how biological
factors (i.e. a part of the brain) can have an impact on cognitive processes
(e.g. memory).
In terms of mental illness we can use brain imaging techniques such as MRI
or PET scans to identify which areas of the brain are affected by the
disorder and then this helps to understand how these might affect cognitive
processes – which in turn affects behaviour.
For example, someone with low serotonin levels – this can lead to an
impairment in cognition, which results in a depressed mood.
Rather than simply saying that low serotonin levels result in a depressed
mood there is more understanding because the cognition element is also
being recognised.
An explanation of depression
• Neurotropic factors are proteins that aid the growth and survival of
neurons. Brain-derived neurotropic factor (BDNF) are the most
common of these found in the brain.
• Stress is linked to a decrease of BDNF in the hippocampus. The
hippocampus is linked to the hypothalamic-pituitary-adrenal system
(HPA) which controls stress through serotonin.
• If the HPA is not able to cope with the stress, the lack of serotonin
will lead to depression.
• Shrayana (2002) found that increasing BDNF levels in the brain can
act as an anti-depressant in mice.
An explanation of schizophrenia
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Barch (2005) suggested that cognitive deficits associated with
schizophrenia like disturbances in memory can be explained by a neural
deficiency.
A neural deficiency in working memory (an area of the brain that controls
input and output of stimuli, visual, spatial, acoustic and language
production) could lead to some of the symptoms shown by people with
schizophrenia.
Deficits in episodic memory (memory of events that have happened to us)
could also lead to confusion seen in people with schizophrenia.
Cognitive neuroscience is a new psychological area, adding to our
explanation of disorders. It allows for more cognitive-based treatments to be
used that focus on cognitive skills impaired by neural deficiencies.