Psychoanalysis Individuals and Systems

Psychoanalysis:Individuals and Systems

Psychoanalysis:Individuals and Systems

Backin 1923, Sigmund Freud originally coined “TheEgo and the Id,” also known as the structural theory (Berzoff etal, p. 48). Having witnessed much unimaginable destruction and theaftermath of the war between 1918 and 1936, Freud’s perspective hada profoundly deep effect on human nature (Berzoff et al, p. 62). Hisarticulation of the three structures: the id, ego, and superego,relies heavily on the disposition of the unconscious sexual andaggressive desires repressed as the prime motivator to much of thehuman behaviors (Berzoff, p. 48). At the core of the self, the egoresides in managing the tension and balancing the conflicts withinthe self (id, ego, and superego). Freud’s contemporaries such asAnna Freud, Feinz Hartmann and Erik Erikson have further developedthe structural theory, ego functioning, and ego defense mechanism torefine the idea of ego psychology recognizing various strengths ofthe ego in its executive and synthesizing elements (Berzoff,pp. 63-64). The structural theory has laid the foundation of personality andrefinement of the ego psychology, ego defense, and self-psychologyamong other psychodynamic-based theories. The three distinctivefunctions and roles of the id, ego, and superego will be explored inthe context of a client suffering from a persistent mental illnessfor nearly thirty years.

Carol(assumed name) was a college-aged single female Korean-Americanstudent who during her Sophomore year traveledto Wales and Oxford, England on an art exchange program with a smallgroup of faculty and colleagues. Shortly upon her return to the U.S,she became a client at the university’s health center in duringmid-1980’s for several months after experiencing a mental breakdownand her inability to function as a student. Her initial diagnosiswas vaguely labeled as chemical imbalance. With greater maladaptivebehavior, she was diagnosed with an acute depression andschizoaffective disorder. Within a year, she had dropped out of theuniversity unable to cope with daily task and eventually moved backhome. As Carol’s symptoms of catatonic affect, auditoryhallucination, social isolation, and erratic behaviors escalated, thefamily caring for her sought out psychiatrists, medications,hospitalization, and spiritual guidance from the community. However,almost thirty years have gone by without much significantimprovement. Over the last year, the client has refused to takeroutine medications both oral or injection, declined to attendtherapy sessions, threw out all of her personal and householdbelongings, and verbally displayed homicidal tendencies. Therefore,the family had to make a decision to involuntarily admit Carol to theemergency room which subsequently led to being a resident at anursing home for around-the-clock monitoring due to the mental healthinsurance policy. After being in the nursing home for over a year,the client has stabilized without homicidal or suicidal ideations,and is voluntarily taking medications. Although she continues toexperience auditory hallucination and catatonic behaviors, she hasshown no interest in therapy, social connection outside of family,personal hygiene, and overall quality of life. The only motivator inher life appears to be food.

Client

Carolwas born asa second child out of four siblings into a conservative Christianfamily in South Korea. Unfortunately, her father passed away at theage of four, so she grew up in a single-parent home until her familyimmigrated to the U.S. at the age of twelve. This ushered in severalchallenges with language, racial discrimination, and adjustment inthe late 1970’s. Nonetheless, Carol grew to be relatively happywith self-confidence and was socially adaptive. She excelled inartistic abilities throughout her junior high and high school yearsfor which she has received several awards, scholarship, andexhibitions. Those accolades have led her to university andeventually studying abroad in the U.K. during her Sophomore year. Upon her return to the U.S, she was unable to continue her artprogram due to her inability to cope with the significant digitalchanges and emotional strain manifested in a mental breakdown. Itappeared that something traumatic happened with her professor whilein the U.K., but the exact details are unclear due to the therapistand client confidentiality. However, the family suspects that shewas either raped by the professor or found herself in an unfortunatesituation where an abortion took place while studying abroad evidenceby an urgent request to mom one day to wire a specific amount moneyand the subsequent verbiage displayed throughout her self-talk anderratic behaviors. Throughout the years of being at home, Carolgained a lot of weight and has been unsuccessful in maintainingstable part-time jobs, being in a church choir (which she loved beinga part of), and any social relationships outside of her familydespite taking antipsychotic medicine, monthly injections andtherapy. Carol seem to have lost any desire to improve upon herquality of life and over the last year and a half, she have withdrawncompletely from taking any medicine, therapy, self-care, andsocialization. This has led her to being more isolated with poorpersonal hygiene, and being a “slave” to the auditoryhallucination in expressing words of harming someone, excessiveswearing to others, and disregard for any personal and communalproperty. More specially, on few occasions, she spoke in her nativelangue of killing someone and she threw out every single personalitems from her passport and driver’s license to clothing andtoiletries all meticulously rapped in making tape and highly tiedplastic bags. Therefore, the family admitted Carol involuntarily tothe emergency room and today she is a resident at a nursing home tobe cared for around the clock. Initially, she has refused help fromall professionals (psychiatrist, social worker, nurses, podiatrist,internist, etc.) and did not engage in any conversation however,after one year, she is showing incremental sign of compliance withmedicine, minimal self-care, and basic conversation on a need basis. She has dropped some weight, but remains healthy overall withexception of auditory hallucination and lack of interest in life. Her favorite pass time is eating therefore, food serves as animportant incentive in getting her to do sometime (e.g. taking ashower, participating in a group therapy or art session).

CaseAnalysis: Linking Id, Ego and Superego with Schizophrenia

StructuralTheory: Id

Accordingto Freud’s structural theory, the Id is the driving force forpleasure, as primarily unconscious. It is the source of instinctualdemands and impulses for immediate satisfaction of an individual’sprimitive needs. According to Freudian theory, these primitive needsseek immediate satisfaction as provided in the pleasure principle.These needs are overtly expressed and modified by Superego and Egoand (Freud, 2013, p.46).

StructuralTheory: Ego

Accordingto Freudian theory, the ego is the accessible, preconscious orconscious part of an individual’s psychic apparatus. The egorepresents subjective common sense and reason. It is part of anindividual’s personality that is recognized as “I” orexperienced as oneself. The ego plays the important function ofReality Testing. It reaches out to the world in order to see whetherwhat is conceptualized by an individual can be confirmed. However,this can only be achieved when the Ego become autonomous andsubstantially get disengaged from the inner conflict occurringbetween Superego and the Id (Freud, 2013, p.54).

Inview of Freud (2013, p.68) as an individual grows up, the ego (i.e.,the sense of being or self-image) implements measures aimed atensuring that such an individual constructs meaning of the day-to-dayhappenings and experiences. The Ego is not something that people havewhen they are born rather it is part of who they are. It plays therole of analytic function in people’s mind including consciousmemory and reasoning. It constantly and always engages in organizingand reorganizing anything and everything it feels, sees, senses,tastes, hears and touches. It makes meaning out of experiences. Thisway, it creates and recreates an individual’s viewpoint. Anindividual relies on this viewpoint to approach issues in daily life.The Ego works to make the world-view out of conflicting informationencountered in the day-to-day life. The theory of Ego development wasdeveloped by Jane Loevinger. The emphasis of this theory is on thematuring conscience and gradual internalization of existing socialrules. Jane’s SCT (Sentence Completion Test) cover a wide range ofEgo functions: conceptual complexity, interpersonal relations andmoral development. The development theory proposed by Loevingerposits that people often progress through a range of stages. Thesestages reflect levels of Ego maturity and cognitive complexity.Loevinger believed that the functioning of the Ego influences howindividuals interpret and perceive interpersonal relations andpersonal experiences. Loevinger identified nine levels of Egodevelopment broadly categorized into Post-conventional, Conventionaland Pre-conventional. The pre-conventional level includes infancy,impulsive, and self-protective (Freud, 2011, p.75). The modelpresupposes that infants are born without any Ego with their sense ofbelonging undifferentiated with the real world around them. Theseinfants are also pre-social. Their communication is limited occurringat the perceptual stage. At the infancy stage, the Ego development isaligned with Piaget’s Sensory level of Cognitive Development. Theworld is dominantly represented through kinesthetic senses. Onthe other hand, the impulsive mode is associated with children whoare less than one year. These children are less aware of whatdistinguishes self and others. They are generally impulsive in theirbehaviors. However, they are curbed by punishments, rewards andrestraints. The child sees other people from the point of view ofwhat they can offer. It is primarily a present-centered causation andorientation, which is restricted to only things that are physical.This stage is characterized by children lacking sense ofresponsibility especially with regard to psychological causation. Itis at this stage that the development of the Ego aligns with theCognitive development logical intuitive stage. The subjectsdominantly represent the world via auditory senses. At theself-protective stage, an individual realizes and develops theawareness that other individuals have their perspectives. However,this sense of self is very limited. The individuals label anyanything that is incongruent with their desires as bad. On thecontrary, they label anything that is congruent with their owndesires as “good”. There exists little capacity for real empathyor introspection. The self-protective individual is egocentric. Forthis case, such an individual is largely amoral. This stage marks thestart of anticipation of punishments and rewards. Also marks thestart of self-control. It is the beginning of opportunistic hedonism.This is the Ego development stage which aligns with Cognitivedevelopment Low Concrete Operational stage.

In view of Freud, all individuals are born within a sense of Ego. Forthis reason, only enmeshment exists without the “I”. People areborn when they are still enmeshed and attached with their mothers.They do have the capability to distinguish themselves from others. Asthey encounter reality, the develop more of the sense of self.Gradually as people grow up, and interact with others and the world,they have to work through Ego development stages. This way, peoplebecome autonomous beings with inner-directed human beings. Thisprocess is called individuation (Freud, 2013, p.84).

Hartmann cited in Feud (2011, p.78) identifies the autonomous Ego aszone free of conflict and a zone free from conflict or war betweenthe Id and the Superego. This zone contains an autonomous system ofdrives that is derived from an individual’s self-preservation. Anautonomous Ego is represented as a conflict-free area ofconsciousness. The consciousness within this area or sphere has anidentity. It can interact with the real world independent of theinfluences of the Superego and Id. However, a weak Ego is driven bythe Shadow. It runs wild and it not under the control of theSuperego. It is not the way to achieve valuable creativity. It is theroute to psychosis, mania, or hypomania (Freud, 2013, p.92).

Thestrength of the Ego is the power, ability and determination to facethe realty as it is. It is the ability to accept that reality existsand to use our own rational, emotional, and cognitive-behavioralskills to deal with the reality (Freud, 2013, p.114). The Egostrength may also refer to individual inner personal strength thatenables them to tolerate frustrations and stress and to effectivelydeal with reality as it appears without assuming the infantiledefense mechanisms. An individual with a strong Ego has the abilityto tolerate difficult situations. Such an individual has the abilityto cope with the situation and look at it from a realistic point ofview and provide the solution to it. As such, the Ego strength helpsan individual to develop some sense of self and to develop greaterresources and skills to handle realities (Freud, 2011, p.74).

StructuralTheory: Superego

TheSuperego is part of an individual’s personality. It influencesself-criticism, self-observation and other reflective activities.Parental introjects are located in this part of the mind. However,the Superego is not the same as the Conscience. Its frame ofreference is morality. It involves inhibitions and injunctions thatare derived from the past (Freud, 2011, p.96). The superego alsoincludes unconscious elements. Conventionally, conscience can becontained within the Superego. Nonetheless, morality of Superego maybe replaced by the autonomous Conscience when one develops ethicalawareness (Kendra, 2013). The Superego serves as the restrictiveparent during pre-logical phase of Ego development. However, unlessnormal development becomes interfered with, control moves fromSuperego to Ego as an individual is able to attain the successfulcognitive maturity stages (Freud, 2013, p.83). With greaterself-awareness and greater freedom from constraints of Superego,cognitive process plays a significant role in expanding anddeveloping one’s sense of morality. This culminates to the searchof Universal Ethical System. An individual approaches thepost-conventional stage of ego at which Spiritual and Moraldevelopment occurs. At this stage, Ego gradually overcomes theSuperego. However, there is a stage at which the Superego plays apassive role. At this stage, an individual operates stops operatingon a Superego Morality instead acts on the Ego Morality. Afully-actualized individual has overcome the Superego and gained EgoAutonomy (Freud, 2013, p.118).

Roleof Ego, Id, and Superego in Caro’s Schizophrenic condition

FromFraud’s psychodynamic approach, it can be argued that Carol hadunresolved conflict between the Superego, Ego and Id. This conflictrepressed into unconsciousness. In view ofFreud (2013, p.88)this conflict caused regression to earlier psychosexual developmentstages. It leads to abnormalities experienced by individuals withschizophrenia as observed in Carol’s case. According to Freud,regression and fixation may indicate that an individual’s Ego isnot developed fully. This way, the Superego or the Id may dominatethe individual. The weak Ego makes a person to lack the necessarysound basis in reality. From the psychodynamic point of view, mostschizophrenic individuals experience regression or fixation while intheir early psychosexual stages of development largely due to thevery harsh childhood environments. In fact, Freud associatesschizophrenia with issues within an individual’s sub-consciousmind. Freud emphasized that harsh experiences may cause an individualto regress to his/her childlike state (i.e., a stage before the fullformation of the Ego). In view of Freud(2013, p.121) thischildhood state is responsible for the symptoms experienced by Carolincluding Grandeur and delusions. Similarly, Silber(2014, p.1) citing Freudlinks schizophrenia to primary narcissism (early oral stage). Freud(2011, p.132)claims that during primary narcissism, an individual’s Id is notdelinked from the Ego. For this reason, a person with schizophreniadoes not operate in accordance with the reality principle. This makesthe person to lose touch with reality since the Ego is touted as therational part of an individual’s mind. This may explain thesymptoms of schizophrenia displayed by Carol namely delusions,grandeur etc.

Fromthe psychodynamic approach, Carol’s schizophrenia condition mayhave occurred following the disintegration of ego. As suggested byBellak (2008, p.57)it is the job of Carol’s ego to manage her Id’s impulses. The egowas supposed to strike a balance between moral restriction imposed bythe superego and the demands of her Id.

Again,the advocators of the Freudian explanation link abnormal upbringingto weak and fragile ego. In line with this argument, Carol’schallenging upbringing may be linked to her schizophrenic condition.Carolwas raised in a single-parent home following the dead of her fatherat age four. Her single mother later immigrated to the U.S. at theage of twelve. Again, she is reported to have experienced severalchallenges with language, racial discrimination, and adjustment inthe late 1970’s. This challenging and difficult upbringing and thepassing on of the father may have contributed to Carol’s weak andfragile ego which has been associated with limited ability to containan individual’s Id’s desires. In view of Freud(2011, p.154)the weak and fragile ego may break part of an individual’s Ego inits attempt to manage the Id and leave the Id in full control of anindividual’s psyche. When this happened, an individual losescontact with real world reality as observed in Carol’s case. Bellak(2008)explains that the when an individual with schizophrenia loses contactwith the real world reality, he also lacks the ability to distinguishbetween fantasies, reality and their desires, and between themselvesand others. Such an individual is bound to regress to the “primarynarcissism” state. The individual also gets in a state similar tothat of the newborn infant. While in the “primary narcissism” theindividual is dominated with animal instincts. This is demonstratedby the individual’s incapability to organize his/her behavior.Indeed, Carolis reported to have lost any desire to improve upon her quality oflife and over the last one year and a half, she withdrew completelyfrom taking any medicine, therapy, self-care, and socialization. Shebecame unsuccessful in maintaining stable part-time jobs, being in achurch choir (which she loved being a part of), and any socialrelationships outside of her family despite taking antipsychoticmedicine, monthly injections and therapy.

Again,it is suggested that when an individual loses contact with the realworld reality, she or he is dominated by hallucinations due to thelack of the ability to distinguish between world reality andimaginations. This was evident in Carol’s case. Carolis said to have increasingly become isolated with poor personalhygiene, and being a “slave” to the auditory hallucination inexpressing words of harming someone, excessive swearing to others,and disregard for any personal and communal property. On fewoccasions, she spoke in her native langue of killing someone and shethrew out every single personal item from her passport and driver’slicense to clothing and toiletries all meticulously rapped in makingtape and highly tied plastic bags.

Conclusion

Carol’sschizophrenic condition can be explained using Freud’s structuraltheory: Id, Ego, and superego. Fromthe psychodynamic approach, Carol’s schizophrenia condition couldhave occurred as a result of the disintegration of ego. It isacknowledged that the job of Carol’s ego is to manage her Id’simpulses. The ego was supposed to strike a balance between moralrestriction imposed by the superego and the demands of her Id.

References

Bellak,L. (2008). Schizophrenia: A Review of the Syndrome. Logos Press.

Freud,S. (2010). The Ego and the Id. New York, NY: Pacific PublishingStudio.

Freud,S. (2013). The Ego and the Id. New York, NY: CreateSpace IndependentPublishing Platform.

Freud,S. (2011). The Ego and the Id. New York, NY: Read Books.

Kendra,C. (2013). The Conscious and Unconscious Mind (The Structure of theMind According to Freud). Retrieved on 3rd Nov 2016 fromhttp://psychology.about.com/od/theoriesofpersonality/a/consciousuncon.htm(accessed 10 12, 2013).

Silber,S. (2014). Schizophrenia. New York, NY: Palgrave Macmillan.