Exploring Psychological Theories: Freudian Theory

Perhaps Freud’s most influential piece of work in the field of psychology is his theory that divided the mind into the three fundamental components of the psyche, known as the id, the ego and of course the superego. This piece of Freud’s work asserts that the three components of the mind have to compete and opposing desires. Freud’s work argues that the ego is reality-based, the id is rather hedonistic in nature, and the superego is moral and ethical in nature.  Freud argues the development of the strong ego is necessary to keep the id and superego from disregarding reality and consequence to satisfy its own needs. These three fundamental components of the psyche are essential to understand when reviewing some of Freud’s more controversial theories.

Although his Penis Envy theory is quite controversial, Freud’s theory of Psychosexual Development is perhaps his most renowned and disputed theory (Argosy Lectures, 2014). Freud argument in his theory Psychosexual Development asserts that personality development happens through a series of childhood stages he has named oral, anal, phallic, the latent period, and the genital stage (Argosy Lectures, 2014). Freud’s theory asserts during this development period the pleasure-seeking energies of the id are concentrated on certain erogenous areas and fulfilling these needs and passing through the next stage is essential to healthy development (Argosy Lectures, 2014). Admittedly controversial and historically disputed the work of Sigmund Freud’s on psychosexual development was the first of many theories developed with a focus on understanding the phases of development contained within a human lifespan(Argosy Lectures, 2014). Because of Freud’s contribution to psychosexual development has opened the door for many new and contrasting theories to develop, regardless of its accuracy, it has further expanded our insight into human development considerably.

Life and sociocultural factors that significantly contributed to his conclusions were the era in which he was lived, the state of social affairs and human rights during this time, the social class and ethnicity in which he was born to, his own personality, personal experiences and direct social influences during his life such as his parents, two half brothers, a nephew, his wife and children (IEP, 2014). Although born in Frieberg, Moravia in 1856 by the end of 1860 Freud’s family relocated to Vienna (IEP, 2014). Consequently, it was in Vienna where he founded the first Viennese School’ of Psychoanalysis, the psychoanalysis movement and where many other subsequent developments in this field arose (IEP, 2014). Other notable influences on his work directly was Jean Charcot for his use of hypnotism and Josef Breuer for his knowledge of the healing power found in cathartic release through talking therapy (IEP, 2014).  

People disagree with the findings of Freud for a seemingly never-ending list of reasons. Many use the argument that his study methodology was unreliable and his subject sample too limited in scope, resultantly his results are unfalsifiable (Moffat, 2006). Others have indicated he discredited the evidence, even falsified and destroyed data (Moffat, 2006). Another popular argument against Freud was that his work was sexually discriminatory or bias in nature (Cherry, 2013). Donna Stewart, M.D., a professor and chair of women’s health at the University Health Network, asserted this his worked lacked inadequate insight into women’s desires. Although Freud’s view expresses a socially appropriate view for the time, his view that a women’s thoughts and actions are “dominated by their sexual reproductive functions” is a view that is largely bias, inaccurate and likely based on Freud’s own opposition to the women’s emancipation movement (Lehmann, p. 9).

Not surprisingly, despite all the controversy surrounding Freud’s works his famously coined terms “ego”, “Freudian slip” and “penis envy” as well as other theories often are still referred to in general psychology and popular culture every day (Argosy Lectures, 2014). Interestingly, there are a number of concepts that are based in Freudian theory that at first glance to not appear to have anything related to Freudian theory. This is because Freud’s work inspired many great conversations and debates that resulted in new theories and schools of thought being developed, thus expanding the scope of our understanding into human personality development and human behavior through our life span in many ways. An example of this expansion of knowledge is the behaviorism theory. Although behaviorism is a theory that seems so far way from Freudian theory it has arisen as a result of expanding ideas that are partly based on psychoanalytic assumptions about human behavior (Argosy Lectures, 2014).  

References

Cherry, K. (2013). Freud & Women: Freud's Perspective on Women. About Psychology. Retrieved from http://psychology.about.com/od/sigmundfreud/p/freud_women.htm

Lehmann, C. (2001). Women psychiatrists still battle Freud’s view of sexes. Psychiatric News, 36(14), American Psychiatric Association, p. 9.

Moffat, L. (2006). Acknowledge Freud’s Mistakes. Worker’s Liberty. Retrieved from http://www.workersliberty.org/node/6472

The Internet Encyclopedia of Philosophy. (2014) Sigmund Freud. Internet Encyclopedia of Philosophy. Retrieved from http://www.iep.utm.edu/freud/

Dissociative Identity Disorder: Research Concerning Etiology, Treatment, and Diagnosis

Dissociative Identity Disorder, formerly called Multiple Personality Disorder is a disorder in which the persons suffers from a disturbance in normal integrative functions of memory, identity, and consciousness. The DSM-IV-TR (2012) has classified Dissociative Identity Disorder under the following criteria: “The presence of two or more distinct identities or personality states that recurrently take control of the person’s behavior, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self with an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness” (American Psychological Association, 2012, Butcher, 2009, p.292). This disturbance is “not caused by physiological effects of a substance like blackouts or chaotic behavior during Alcohol Intoxication or a general medical condition like complex partial seizures” (American Psychological Association, 2012; Butcher, 2009, p. 2009). Lastly, in children, these “symptoms are not attributable to imaginary playmates or other fantasy play” (American Psychological Association, 2012).

Current research of Dissociative Identity Disorder has focused on understanding the memory disturbances, clinical features, best treatment and as always proving the etiological validity of the diagnosis. The etiological validity of the diagnosis has been of particular interest to researchers because this diagnosis has historically been discounted as not-real because of a controversy surrounding its pathology. Spano’s (1994) suggested the sociocognitive model of Dissociative Identity Disorder, that suggested this disorder is constructed iatrogenically through therapists and maintained by clients who enact social roles. However, most, if not all, of the current research, discredits the sociocognitive model of Dissociative Identity Disorder and supports the trauma models which suggests that development of did nearly always occurs in the face of early trauma and childhood abuse (International Society for the Study of Trauma and Dissociation, 2011).  In fact, the data supports the validity of three different trauma models.

The Four Factor Model

The Four Factor Model suggests that the following for factors precede the development of Dissociative Identity Disorder: the child has the capacity for dissociation, the experiences that overwhelm the child’s non-dissociative coping capacity, there is secondary structuring of Dissociative Identity Disorder  in which alternate identities with individualized characteristics such as names, ages, genders; and there is a lack of soothing and restorative experiences rendering the child isolated or abandoned and need to create ways of managing distress on their own (International Society for the Study of Trauma and Dissociation, 2011).

Structural Dissociation Model

The Structural Dissociation Model of development in Dissociative Identity Disorder supports that this disorder develops as a result of the failure to integrate aspects of personality, including ideas and functions, following traumatizing events. In this model, the whole personality system is first divided into two parts including the “apparently normal part of the personality” dedicated to daily functioning and an “emotional part of the personality” dedicated to defense i.e psychobiological functions of survival in response to life threat, such as fight/flight (International Society for the Study of Trauma and Dissociation, 2011). This theory suggests that chronic traumatization, neglect, and/or child abuse can lead to “secondary structural dissociation and the emergence of additional emotional parts of the personality” (International Society for the Study of Trauma and Dissociation, 2011).

Developmental Model

In the Developmental Model of Dissociative Identity Disorder, this disorder is thought to begin in childhood when early attachment needs are not met, childhood integration does not occur and personalities states do not integrate into one continuously unified personality state (International Society for the Study of Trauma and Dissociation, 2011). Attachment to primary caregivers is a biologically programmed need and attachment style is an important factor in childhood development and the development of relationships later in life (Howell, 2011, p.89-104). Healthy attachment occurs when the primary caregiver and the child form a secure bond. A secure bond is formed when the caregiver responds to the babies needs in a way that soothes him or her and keeps the baby happy and safe, thus the baby develops a feeling that their caregiver is a secure base which they can leave to explore and then return to when distressed (Howell, 2011, p.89-104). However, when the child forms a bond because this caregiver is the only source of the attachment and the relationship must be preserved, even in the face of abuse, a disorganized attachment is often the result (Howell, 2011, p.89-104).

No one is born with a unified sense of self or personality this is created through linking behavioral and personality states (Simeon, 2008). A sense of a unified identity develops from experience in childhood when behavior states become linked over time and grouped together in sequences that flow effortlessly (Howell, 2011). For proper integration and identity development, this linking of behavioral and personality states must occur (Howell, 2011). For this linking to occur, the child must have a secure attachment that responds to the child in such a way that the child begins to create an internal singular representation of themselves (Howell, 2011). In the face of severe ongoing trauma and neglect which is repeated consistently throughout early childhood and other important developmental stages integration or the development of a unified sense of identity is delayed (Howell, 2011).

A child has the natural ability to separate many of their feelings and memories from consciousness (Howell, 2011). This innate ability allows children in the face of abuse to escape to a the fantasy world and create alternate states (Howell, 2011). In the face of ongoing neglect and trauma, these alternate states can endure the abuse or neglect while the child maintains attachment. Sadly, if this pattern of abuse and attachment continues through development these dissociated parts (most commonly referred to as alters) can develop a sense of self, accompanied by their own memories, state of consciousness, biophysical characteristics, and manifest their own speech mannerisms, physical behavior, handwriting, somatic manifestations of the disease, sense of body, sense of history (Howell, 2013). Commonly terminology to describe alters includes describing them by their function or characteristic, i.e. hosts, children alter, abuser alters, differently gendered alters, animal alters, manager alters, inner-self helpers, protector alter, caretakers alters and abuser alters (Howell, 2011).

Dissociative states are a normal response to trauma and stress found in all humans across all cultures and studies indicate that the etiology models of DID that explain the symptom patterns found in Dissociative Identity Disorder patient that include chronic childhood trauma have validity for the entire human race (Ross & Ness, 2010). Dissociative Identity Disorder differs from simple dissociative states because the dissociated states develop a sense of self and identity and there are dissociative barriers or an amnesic boundary between the fragmented states of self-called alters (Dissociative Identity Disorder, 2013). Interestingly, research demonstrates these different alters show variable “visual acuity, medication responses, allergies, plasma glucose levels in diabetic patients, heart rate, blood pressure readings, galvanic skin response, muscle tension, laterality, immune function, electroencephalography and evoked potential patterns, functional magnetic resonance imaging activation, and brain activation and regional blood flow using single-photon emission computed tomography and positron emission tomography with switches” (International Society for the Study of Trauma and Dissociation, 2011, p. 121).

While this sounds as though it may appear dramatic in easy to spot this actually contrary to the truth, in fact, less than 6%  of the population with Dissociative Identity Disorder will present so obviously (International Society for the Study of Trauma and Dissociation, 2011).  More likely they will not appear in and the overdramatized histrionic presentation that is often presented in the media, instead, the person will likely be “intellectualized, obsessive, introversive, with an avoidant and/or self-defeating personality profile with co-morbid disorders both dissociative and post-traumatic symptoms, as well as many apparently non-trauma-related issues such as depression, substance abuse, eating disorders and anxiety” (Jewels, 2013). The symptoms displayed can be categorized more accurately in three major groups’ straight forward dissociative symptoms, Schneiderian first-rank symptoms, and psychotic-like dissociative symptoms (Dell, 2006). Straight forward dissociative symptoms include “amnesia, voices, conversion, self alteration, derealization, depersonalization, flashbacks, trances, identity confusion and awareness of alters” (Dell, 2006). Schneiderian first-rank symptoms include “voices arguing, voices commenting, thought withdrawal, thought insertion, made impulses, made feelings and made actions” (Dell, 2006). Lastly, Psychotic-like dissociative symptoms including both “auditory hallucinations and visual hallucinations” are also commonly reported by these patients (Dell, 2006).

Tragically, the classification of the DSM-IV-TR barely touches many of the important factors associated with making a diagnosis of Dissociative Identity Disorder such as causation and etiology, terminology, functional dynamics, symptomatology and most importantly non-observable symptoms such as state-dependent amnesia, conversion symptoms, self-alteration, derealization, depersonalization, flashbacks, trances, identity confusion, awareness of alters, voices, thought withdrawal and insertion, made impulses, feelings and actions and nonpsychotic auditory and visual hallucinations (Dell, 2006). Accurate diagnosis of this disorder can be done with diagnostic tools such as the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ-20), and the Structured Clinical Interview for Dissociative Disorders (SCID-D), as well as, through patient self-reports and clinician observation (International Society for the Study of Trauma and Dissociation, 2011). Sadly, despite diagnostic availability often these patients spend 11.9 years seeking treatment before they receive an accurate diagnosis (International Society for the Study of Trauma and Dissociation, 2011). Misdiagnosis for a Dissociative Identity Patient really is tragic because treatment can significantly reduce symptoms and with integration therapy helps the patient form a more unified and functioning sense of self.

Treatment that is given with a focus on relieving dissociative symptoms is effective in reducing a range of symptoms associated with dissociative disorders including dissociation, depression, posttraumatic stress disorder, distress, and suicidality (Brand, Classen, McNary & Zaveri, 2009). Effective therapy for these patients often includes phase-oriented treatment plans starting with phase one establishing safety, stabilization, and symptom reduction (International Society for the Study of Trauma and Dissociation, 2011, p.135). The focus of early treatment is helping the patient understand, accept, and access the alternate identities that play an active role in their current lives will help the patient develop internal cooperation and increase co-consciousness (International Society for the Study of Trauma and Dissociation, 2011, p.139). In phase two, the therapeutic focus is on confronting, working through, and integrating traumatic memories (International Society for the Study of Trauma and Dissociation, 2011, p.135) The later stages of therapy are focused on identity integration and rehabilitation (International Society for the Study of Trauma and Dissociation, 2011, p.135).

Dissociative identity disorder has been closely linked to early childhood abuse, trauma memories and disorganized attachment patterns that delay the normal process of normal personality development and memory integration in early childhood. Dissociative Identity Disorder is a challenging mental health disorder to recognize and treat because of multiple causative factors and confusing symptomatology. It is important for those who are working in the field to be aware of the etiology of Dissociative Identity Disorder, the symptoms and presenting a presentation, current diagnostic tools, terminology, and treatment for this disorder because this disorder is often misdiagnosed or left undiagnosed and untreated. Treatment of this disorder mainly consists of psychotherapy geared at relieving dissociative symptoms and the integration of dissociated memories and personality states. This treatment is unique to this group of patients and medication alone will not relieve the dissociative symptoms, which is why an accurate diagnosis is vital to symptom reduction and treatment.   

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References

American Psychiatric Association (2000-06). Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc. pp. 526–529. ISBN 978-0-89042-024-9. Retrieved from DOI:10.1176/appi.books.9780890423349.

Brand, Classen, McNary, Zaveri. (2009) A Review of Dissociative Disorders Treatment Studies Journal of Nervous & Mental Disease Volume 197 - Issue 9 - pp 646-654. Retrieved from doi: 10.1097/NMD.0b013e3181b3afaa.

Butcher. (2009). DSM-IV-TR Dissociative Identity Disorder  Abnormal Psychology, 14^th Edition. Pearson Learning Solutions. VitalBook file

Dell P. (2006). "A new model of dissociative identity disorder". Psychiatric Clinic North America. Retrieved from http://www.copingwithdissociation.com/Dell_2006_ANewModelofDID1.pdf#

Dissociative Identity Disorder. (2013). Dissociative Identity Disorder: Etiology. Dissociative Identity Disorder.org. Retrieved from http://www.dissociative-identity-disorder.org/

Gillig, P, M. (2009). Dissociative Identity Disorder A Controversial Diagnosis. Psychiatry Edgmont 6(3): 24–29. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2719457/

Gleaves, D, H. (1996). The Sociocognitive Model of Dissociative Identity Disorder: A Reexamination of the Evidence. Texas A&M University. American Psychological Association, Inc. Retrieved from https://www.ptsdforum.org/c/gallery/-pdf/1-41.pdf

Howell E. (2011). Understanding and Treating Dissociative Identity Disorder. New York: Routledge. ISBN 0415994969.

International Society for the Study of Trauma and Dissociation (2011) Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12:2, 115-187 retrieved from http://dx.doi.org/10.1080/15299732.2011.537247

Jewels, K. (2012). An Examination of the Evidence: Misdiagnosis and Dissociative Identity Disorder. A Literature Review on Dissociative Identity Disorder. Retrieved from http://www.kaytjewels.com/2013/05/dissociative-identity-disorder.html

 Ross C, & Ness L. (2010). Symptom Patterns in Dissociative Identity Disorder Patients and the General Population. Journal of Trauma & Dissociation.11(4): 458-468. Abstract. Retrieved from  DOI:10.1080/15299732.2010.495939

Simeon D. (2008). Dissociative Identity Disorder: Patient's Reference. Merck.com. Merck Manual for Health Care Professionals. Retrieved from http://www.merckmanuals.com/professional/psychiatric_disorders/dissociative_disorders/dissociative_identity_disorder.html