Compare and Contrast the Psychoanalytic and Biogenic Perspectives of Psychopathy, with Respect to Phobia etiology and Treatment Psychopathy.

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Compare and Contrast the Psychoanalytic and Biogenic Perspectives of Psychopathy, with Respect to Phobia etiology and Treatment

Psychopathy, or abnormal psychology is the term used for the study of ‘illnesses related to the mind’, and so includes the etiology and treatment of schizophrenia, obsessive-compulsive disorders and phobias etc. In general it can be seen to encompass any mentally or behaviourally disordered state in which proper psychological functioning is disordered or interfered with. It is not a simple, clear cut science by any means, as it is still in very experimental stages, with much of that which it encompasses still lying outside proper human understanding. The result of this is that within the field of psychopathy many different perspectives exist, with each approaching the various disorders from very different angles and proposing different etiology and treatment. The perspectives include humanistic (or learning model), behavioural, biogenic and psychoanalytic, each based around the perspectives they relate to in other areas of psychology. To get the best understanding of psychopathy in such a small review as this, it is best to look at the two most disparate fields; biogenics and psychoanalysis.

The biogenic model of psychopathy is focussed on the biological aspects of any given mental disorder, rather than any psychological factors. It was first employed when it was noticed that strokes and general brain damage would often lead to personality and behavioural disorders. The conclusion was that the roots of mental disorders were the results of malfunctioning of the brain such as the electrical activity and its circuitry. As a result, when a clinician tries to resolve such problems, he will look for biological contributors and biological treatments. The psychoanalytic model, on the other hand, can be found at the opposite end of the psychological spectrum. It works on the grounds that any disorder (behavioural or mental) is the result of internal conflicts within the subject. It was adopted when early patients who suffered from apparent disorders such as the inability to use their legs were often seen to be alleviated of their problems under hypnosis. It directly stems from the Freudian psychoanalytic theory, and so is seen to adopt many of the features therein, including the existence of the unconscious being a priori, and a strong emphasis on childhood experience.

To be able to accurately assess and compare these two very different approaches, it will prove beneficial at times (especially over the psychoanalytic model) to focus on one particular area of psychopathy as a sort of case study. ‘Phobias’ is the best candidate as it is generally regarded as the best understood so far, with much known regarding etiology and treatment and little trouble found in diagnosis. Freud created the psychoanalytic account of phobias in 1909 in a groundbreaking case known as the ‘Little Hans’ study. In the ‘Little Hans’ case study, Freud’s patient was a five year old boy who had a fear of horses intense enough to prevent him from leaving his home. The case history began when the boy was four and he witnessed one of his father’s horses fall in the street and violently flail its legs in an attempt to stand back up. The boy claimed that he feared that this situation could repeat itself and would result in the horse biting him. Freud did not talk to the boy directly, but instead instructed the father on a line of questioning to follow, and then studied the results. The questions that the father asked Hans eventually resulted in him admitting that he often harboured resentment and ill will towards his father, as well as jealousy over the relationship his father had with his mother. As Hans slowly overcame his phobia, he had a dream of plumber giving him a larger penis. Freud interpreted this as the boy overcoming his fear of castration and beginning to identify with his father.

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Most psychoanalytic accounts of phobias since have been based on this, such as Odier (1956) and Arieti (1979). As a result of this case, Freud stated that there were five stages to phobia etiology and treatment, and these stages can be seen to directly effect his earlier work on personality stages (in particular the Oedipal complex, and all resultant issues). In the first stage the phobic is seen to be in love with and sexually attracted to the parent of the opposite sex. The second stage is that the phobic resultantly becomes jealous of the parent of the same sex (seeing them as a rival for the other parent’s affections) and wishes to kill and supersede them. The result of this is the third stage, in which the phobic becomes fearful that the father wishes to castrate them in retaliation (male) or suffers from penis envy (female). The fourth stage is that the conscious mind of the phobic finds the situation unacceptable and so cannot deal with the anxiety caused directly. The anxiety is therefore projected onto another, innocent object which becomes the focus of the phobia (be it an animal, situation or inanimate object). In the fifth and final stage, Freud believes that the phobia is alleviated when the subject recognises the underlying unconscious conflict.

There are three main areas over which criticisms arise in Freud’s psychoanalytic theory of phobia etiology and treatment. The first is that the little Hans account, and others like it are based almost entirely on case history, and all the theoretical inferences made are not very well qualified. Secondly, when this particular psychoanalytic therapy is used to cure phobias, the levels of success are far from constant. Moreover, even when the treatment is successful, it often takes years of gradual progress, and does not appear to result from a sudden recognition of internal conflicts. In the case of little Hans, the overcoming of the phobia was smooth and gradual and did not seen to arise from his sudden understanding of this theory which he was probably too young to comprehend the implications of anyway. This discrediting of Freud’s conclusions is furthered by more recent research (Holmes, 1935 and MacFarland, Allen and Honzik, 1954) which shows that children of ages two to six years can often develop sudden fears of animals that decline with age (as their common sense grows). Finally, many sceptics argue that the original theory is only supported due to response guidance by Freud. In the Hans case, Hans initially denied having any sort of fear or hatred for his father, and only finally agreed after being subjected to a series of leading questions. When his age is taken into account, as well as the fact that his father was administering the questions, it is highly possible that he only agreed because he was led to believe it was the correct answer.

In light of many of these and of other criticisms, a number of post-Freudians have modified this psychoanalytic theory of phobias. They follow the belief that the phobia is the result of anxiety over personally unacceptable conflicts being projected onto other objects. They also believe, however, that this conflict can stem from any number of personal aspects, and does not have to be the direct result of the rather tenuous Oedipal complex. Thus the treatment is that the repressed conflict must be brought to the surface through free association exercises and/or dream analysis (and other such traditional psychoanalytic practices). The patient must then be made to re-experience the phobic situation from which they suffer while being shown that the fear is unnecessary and illogical. This is recognised by the practitioners to be a slow and gradual process, taking much patience and effort.

When it comes to looking at the biogenic perspective of psychopathy, it is much more difficult to apply it to phobia etiology and treatment, as there is very little that it directly suggests for such a case. Instead, it is perhaps better to take a more general view of biogenic etiologies and treatments, and understand that each could be seen to apply to phobias, if the case was deemed relevant (or in many cases severe) enough. As previously explained, the etiology involved in the biogenic perspective is very clear cut. Any behavioural or mental deviance from the norm is seen to result from some malfunction of the brain itself. The treatments involved on the other hand are much more diverse, ranging in both style and severity.

The first, and least severe corrective measure that can be taken is psychopharmacology or drug therapy. This is the subscription of various chemicals that are designed to in some way alter the human biochemistry, and in biogenics there are four categories; antiolytics, Neuroleptics, antidepressants and antimanics. Antiolytics is the category term for depressants and minor tranquillisers (such as Valium). They are mainly prescribed to reduce anxiety or depression without the need for hospitalisation. Neuroleptics are major tranquillisers that are used mainly to calm severely disturbed individuals. Their effect and us is such that they have gone a long way to replacing ‘strait jackets’. Instead of inhibiting certain chemical reactions in the brain (as seen with the antiolytics) they actually block certain neural receptors (such as dopamine receptors) completely. The more severe effects of these drugs mean that they can often lead to side effects such as blurred vision, reduction in white blood cell production and uncontrollable shaking. Antidepressants (such as Prozac) are stimulants, which are used to treat depression, anxiety, agoraphobia etc. they work by temporarily increasing the supply of noradrenaline and seratonin to the brain. Again, the nature of the drug means that they can often lead to harsh side effects with continued use, such as heart problems and even brain haemorrhages. Antimanics are used to control severe, bipolar mental disorders such as bouts of mania or severe depression. Side effects can include weight gain, tremors, dry mouth, impaired memory and kidney disease. Drug therapy is particularly relevant to this discussion as it is the only one of the biogenic therapies generally used to deal with phobias, although they are not particularly useful with specific phobias. Anti anxiety drugs (tranquillisers) can be administered just before or during a phobic situation to induce calm and relaxation (as well as drowsiness and lethargy). As such a person who has a phobia of flying may take such drugs to help him take a flight. The problem with psychopharmacology in this and all other conditions is that it is only a short term solution, it deals with immediate symptoms but does not effect the underlying cause. Moreover, even if the drug itself is not addictive, the patient can often become dependant on it to continually alleviate the symptoms from which he suffers.

The second type of therapy involved in biogenics is Electro-Convulsive Therapy (E.C.T.). In this procedure, a series of electrical shocks are applied to the temporal region of the brain to alter brain synapse patterns and therefore stop the impulses which cause depression, schizophrenia and other such disorders. It is seen to have an immediate effect and an 80% success rate where drugs have failed. Although it is believed that that this therapy works by causing the release of noradrenaline which effects seratonin and dopamine levels, and other similar biochemical changes, it is not known for certain. Moreover, it is not always successful, not always of long term effect, and can lead to permanent memory loss and brain damage.

The final type of biogenic therapy in use is psychosurgery, which involves physically tampering with and often removing parts of the brain. It is used to permanently destroy specific connections in the brain with the aim of disrupting psychotic thoughts and impulses in patients. Techniques include lobotomies, lobectomies and cauterisations. This is a last step measure that is now replaced where possible by psychopharmacology, as there is no great understanding in how it works, no major consistency in the results, and the process is irreversible. Moreover, the side effects of the procedure include apathy, partial paralysis, permanent memory and general brain damage, and can even lead to death. Although all of the biogenic treatments come with associated risks and can seem very dangerous, they are only ever administered where they can be perceived as the lesser of two evils, i.e. where the effects and risks are relatively less than the current suffering of the patient.

Both the psychoanalytic and biogenic perspectives of psychopathy, then, can be seen to be less than perfect. There are many who would claim that it is debatable that psychotherapy has any real benefits whatsoever, and that those ‘successes’ seen so far could have been totally unrelated to the therapy which the individual was undergoing. Biogenics is also criticised by many for being the practice of ‘scientific guesswork’, and for being unethical, as most often the patients are in no objective state to give consent to such treatments. It has to be remembered, however, both perspectives are still in their relative infancy, and both have still enjoyed a relative amount of success. Also, these two are not (as previously mentioned) the only two perspectives on psychopathy available. Perhaps then to get a full understanding of the mature of mental and behavioural problems these perspectives need to be researched further, or possibly even combined to some extent.

References (Primary):

1) Atkinson, R.L., Atkinson, R.C., Smith, E.E., Benn, D.J., Nolen-Hoeksema, S. (Eds.) (1999) Hilgard’s Introduction to Psychology, Harcourt Brace.

Gleitman, H. (1995) Gleitman Psychology, Norton Publishing.
Gross, R.D. & Humphreys P. (1993) Psychology: the Science of Mind and Behaviour, Hodder & Stoughton.
Wallerstein, R.S. (1975) Psychotherapy and Psychoanalysis, International Universities Press, Inc.
Corsini, R.J. & Wedding, D. (1995) Current Psychotherapies, F.E. Peacock.
Dryden, W. (1996) Handbook of Individual Therapies, SAGE Publications

References (Secondary):

Freud, S. (1909) Notes Upon a Case of Obssesional Neurosis.
Odier, C. (1956) Anxiety and Magical Thinking, International Universities Press.
Arieti, S. (1979) New Views on Psychodynamics of Phobias, American Journal of Psychotherapy No.33.
MacFarland, J.W., Allen, L. and Honzik, N.P. (1954) A Developmental Study of the Behavioural Problems of Normal Children Between 21 Months and 14 Years, University of California Press.