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Translate Kaplan Sadock Sinopsis Psikiatri Komprehensif Halaman 721 730 PDF Free
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Table of Contents
Volume I
1 Neural Sciences
1.1 Neural Sciences Introduction and Overview
1.2 Functional Neuroanatomy
1.3 Neural Development and Neurogenesis
1.4 Monoamine Neurotransmitters
1.5 Amino Acids As Neurotransmitters
1.6 Neuropeptides Biology, Regulation, and Role in Neuropsychiatric
Disorders
1.7 Neurotrophic Factors
1.8 Intraneuronal Signaling Pathways
1.9 Basic Electrophysiology
1.10 Genome, Transcriptome, and Proteome
1.11 Psychoneuroendocrinology
1.12 Immune System and Central Nervous System Interactions
1.13 Chronobiology
1.14 Applied Electrophysiology
1.15 Nuclear Magnetic Resonance Imaging Basic Principles and Recent
Findings in Neuropsychiatric Disorders
1.16 Radiotracer Imaging Basic Principles and Exemplary Findings in
Neuropsychiatric Disorders
1.17 Population Genetics and Genetic Epidemiology
1.18 Genetic Linkage Analysis of the Psychiatric Disorders
1.19 Transgenic Models of Behavior
1.20 Basic Science of Sleep
1.21 Appetite
1.22 Neural Basis of Substance Abuse and Dependence
1.23 Future Directions in Neuroscience and Psychiatry
2 Neuropsychiatry and Behavioral Neurology
2.1 Neuropsychiatric Approach to the Patient
2.2 Neuropsychiatric Aspects of Cerebrovascular Disorders
2.3 Neuropsychiatric Aspects of Brain Tumors
2.4 Neuropsychiatric Aspects of Epilepsy
2.5 Neuropsychiatric Aspects of Traumatic Brain Injury
2.6 Neuropsychiatric Aspects of Movement Disorders
2.7 Neuropsychiatric Aspects of Multiple Sclerosis and Other
Demyelinating Disorders
2.8 Neuropsychiatric Aspects of HIV Infection and AIDS
2.9 Neuropsychiatric Aspects of Other Infectious Diseases (Non-HIV)
2.10 Neuropsychiatric Aspects of Prion Disease
2.11 Neuropsychiatric Aspects of Headache
2.12 Neuropsychiatric Aspects of Neuromuscular Disease
2.13 Psychiatric Aspects of Child Neurology
3 Contributions of the Psychological Sciences
3.1 Sensation, Perception, and Cognition
3.2 Extending Jean Piaget's Approach to Intellectual Functioning
3.3 Learning Theory
3.4 Biology of Memory
3.5 Brain Models of Mind
3.6 Neuroscientific Bases of Consciousness and Dreaming
3.7 Normality and Mental Health
4 Contributions of the Sociocultural Sciences
4.1 The Psychiatric Scientist and the Psychoanalyst
4.2 Sociology and Psychiatry
4.3 Sociobiology
4.4 Sociopolitical Trends in Mental Health Care The Consumer/Survivor
Movement and Multiculturalism
5 Quantitative and Experimental Methods in Psychiatry
5.1 Epidemiology
5.2 Statistics and Experimental Design
5.3 Mental Health Services
5.4 Animal Research and Its Relevance to Psychiatry
6 Theories of Personality and Psychopathology
6.1 Classic Psychoanalysis
6.2 Erik H. Erikson
6.3 Other Psychodynamic Schools
6.4 Approaches Derived from Philosophy and Psychology
7 Diagnosis and Psychiatry Examination of the Psychiatric Patient
7.1 Psychiatric Interview, History, and Mental Status Examination
7.2 Interviewing Techniques with the Difficult Patient
7.3 Psychiatric Report, Medical Record, and Medical Error
7.4 Signs and Symptoms in Psychiatry
FUTURE DIRECTIONS
7.5 Clinical Neuropsychology and Intellectual Assessment of Adults
7.6 Personality Assessment Adults and Children
7.7 Neuropsychological and Cognitive Assessment of Children
7.8 Medical Assessment and Laboratory Testing in Psychiatry
7.9 Psychiatric Rating Scales
7.10 Telemedicine, Telepsychiatry, and Online Therapy
8 Clinical Manifestations of Psychiatric Disorders
9 Classification in Psychiatry
9.1 Psychiatric Classification
9.2 International Psychiatric Diagnosis
10 Delirium, Dementia, and Amnestic and Other Cognitive Disorders and
Mental Disorders Due to a General Medical Condition
10.1 Cognitive Disorders Introduction and Overview
10.2 Delirium
10.3 Dementia
10.4 Amnestic Disorders
10.5 Other Cognitive Disorders and Mental Disorders Due to a General
Medical Condition
11 Substance-Related Disorders
11.1 Substance-Related Disorders Introduction and Overview
11.2 Alcohol-Related Disorders
11.3 Amphetamine (or Amphetamine-like)related Disorders
11.4 Caffeine-Related Disorders
11.5 Cannabis-Related Disorders
11.6 Cocaine-Related Disorders
11.7 Hallucinogen-Related Disorders
11.8 Inhalant-Related Disorders
11.9 Nicotine-Related Disorders
11.10 Opioid-Related Disorders
11.11 Phencyclidine (or Phencyclidine-like)related Disorders
11.12 Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
11.13 Anabolic-Androgenic steroid abuse
12 Schizophrenia and Other Psychotic Disorders
12.1 Concept of Schizophrenia
12.2 Schizophrenia Scope of the Problem
12.3 Schizophrenia Genetics
12.4 Schizophrenia Environmental Epidemiology
12.5 Developmental Model of Schizophrenia
12.6 Neuroimaging in Schizophrenia Linking Neuropsychiatric
Manifestations to Neurobiology
12.7 Schizophrenia Neuropathology
12.8 Schizophrenia Clinical Features and Psychopathology Concepts
12.9 Schizophrenia Cognition
12.10 Schizophrenia Sensory Gating Deficits and Translational Research
12.11 Schizophrenia Psychosocial Treatment
12.12 Schizophrenia Somatic Treatment
12.13 Psychiatric Rehabilitation
12.14 Schizophrenia Integrative Treatment and Functional Outcomes
12.15 Schizophrenia Spectrum Pathology and Treatment
12.16 Other Psychotic Disorders
12.16a Acute and Transient Psychotic Disorders and Brief Psychotic
Disorder
12.16b Schizophreniform Disorder
12.16c Delusional Disorder and Shared Psychotic Disorder
12.16d Schizoaffective Disorder
12.16e Postpartum Psychosis
12.16f Culture-Bound Syndromes with Psychotic Features
12.16g Psychosis Not Otherwise Specified
12.16h Treatment of Other Psychotic Disorders
12.17 Schizophrenia and Other Psychotic Disorders Special Issues in Early
Detection and Intervention
13 Mood Disorders
13.1 Mood Disorders Historical Introduction and Conceptual Overview
13.2 Mood Disorders Epidemiology
13.3 Mood Disorders Genetics
13.4 Mood Disorders Neurobiology
13.5 Mood Disorders Intrapsychic and Interpersonal Aspects
13.6 Mood Disorders Clinical Features
13.7 Mood Disorders Treatment of Depression
13.8 Mood Disorders Treatment of Bipolar Disorders
13.9 Mood Disorders Psychotherapy
14 Anxiety Disorders
14.1 Anxiety Disorders Introduction and Overview
14.2 Anxiety Disorders Epidemiology
14.3 Anxiety Disorders Psychophysiological Aspects
14.4 Anxiety Disorders Neurochemical Aspects
14.5 Anxiety Disorders Neuroimaging
14.6 Anxiety Disorders Genetics
14.7 Anxiety Disorders Psychodynamic Aspects
14.8 Anxiety Disorders Clinical Features
14.9 Anxiety Disorders Somatic Treatment
14.10 Anxiety Disorders Cognitive-Behavioral Therapy
15 Somatoform Disorders
16 Factitious Disorders
17 Dissociative Disorders
18 Normal Human Sexuality and Sexual and Gender Identity Disorders
18.1a Normal Human Sexuality and Sexual Dysfunctions
18.1b Homosexuality, Gay and Lesbian Identities, and Homosexual
Behavior
18.2 Paraphilias
18.3 Gender Identity Disorders
18.4 Sexual Addiction
19 Eating Disorders
20 Sleep Disorders
21 Impulse-Control Disorders Not Elsewhere Classified
Volume II
22 Adjustment Disorders
23 Personality Disorders
24 Psychological Factors Affecting Medical Conditions
24.1 History of Psychosomatic Medicine
24.2 Gastrointestinal Disorders
24.3 Obesity
24.4 Cardiovascular Disorders
24.5 Respiratory Disorders
24.6 Endocrine and Metabolic Disorders
24.7 Psychocutaneous Disorders
24.8 Musculoskeletal Disorders
24.9 Stress and Psychiatry
24.10 Psycho-Oncology
24.11 Consultation-Liaison Psychiatry
25 Relational Problems
26 Additional Conditions That May Be a Focus of Clinical Attention
26.1 Malingering
26.2 Adult Antisocial Behavior, Criminality, and Violence
26.3 Borderline Intellectual Functioning and Academic Problem
26.4 Other Additional Conditions That May Be a Focus of Clinical
Attention
27 Culture-Bound Syndromes
28 Special Areas of Interest
28.1 Psychiatry and Reproductive Medicine
28.2 Premenstrual Dysphoric Disorder
28.3 Genetic Counseling
28.4 End-of-Life and Palliative Care
28.5 Death, Dying, and Bereavement
28.6 Physical and Sexual Abuse of Adults
28.7 Survivors of Torture
28.8 Alternative and Complementary Health Practices
28.9 Military and Disaster Psychiatry
28.10 Famous Named Cases in Psychiatry
29 Psychiatric Emergencies
29.1 Suicide
29.2 Other Psychiatric Emergencies
30 Psychotherapies
30.1 Psychoanalysis and Psychoanalytic Psychotherapy
30.2 Behavior Therapy
30.3 Hypnosis
30.4 Group Psychotherapy and Combined Individual and Group
Psychotherapy
30.5 Family Therapy and Couple Therapy
30.6 Cognitive Therapy
30.7 Interpersonal Psychotherapy
30.8 Dialectical Behavior Therapy
30.9 Intensive Short-Term Dynamic Psychotherapy
30.10 Other Methods of Psychotherapy
30.11 Evaluation of Psychotherapy
30.12 Combined Psychotherapy and Pharmacology
31 Biological Therapies
31.1 General Principles of Psychopharmacology
31.2 Pharmacokinetics and Drug Interactions
31.3 Drug Development and Approval Process in the United States
31.4 Medication-Induced Movement Disorders
31.5 α2-Adrenergic Receptor Agonists Clonidine and Guanfacine
31.6 β-Adrenergic Receptor Antagonists
31.7 Anticholinergics and Amantadine
31.8 Anticonvulsants
31.9 Antihistamines
31.10 Barbiturates and Similarly Acting Substances
31.11 Benzodiazepine Receptor Agonists and Antagonists
31.12 Bupropion
31.13 Buspirone
31.14 Calcium Channel Inhibitors
31.15 Cholinesterase Inhibitors and Similarly Acting Compounds
31.16 Dopamine Receptor Antagonists (Typical Antipsychotics)
31.17 Lithium
31.18 Mirtazapine
31.19 Monoamine Oxidase Inhibitors
31.20 Nefazodone
31.21 Opioid Receptor Agonists Methadone, Levomethadyl, and
Buprenorphine
31.22 Opioid Receptor Antagonists Naltrexone and Nalmefene
31.23 Selective Serotonin Norepinephrine Reuptake Inhibitors
31.24 Selective Serotonin Reuptake Inhibitors
31.25 Serotonin-Dopamine Antagonists (Atypical or Second-Generation
Antipsychotics)
31.26 Sympathomimetics and Dopamine Receptor Agonists
31.27 Thyroid Hormones
31.28 Trazodone
31.29 Tricyclics and Tetracyclics
31.30 Electroconvulsive Therapy
31.31 Neurosurgical Treatments and Deep Brain Stimulation
31.32 Other Pharmacological and Biological Therapies
31.33 Drug Augmentation
31.34 Reproductive Hormonal Therapy Theory and Practice
32 Child Psychiatry
32.1 Introduction and Overview
32.2 Normal Child Development
32.3 Normal Adolescence
33 Psychiatric Examination of the Infant, Child, and Adolescent
34 Mental Retardation
35 Learning Disorders
35.1 Reading Disorder
35.2 Mathematics Disorder
35.3 Disorder of Written Expression and Learning Disorder Not Otherwise
Specified
36 Motor Skills Disorder Developmental Coordination Disorder
37 Communication Disorders
37.1 Expressive Language Disorder
37.2 Mixed Receptive-Expressive Disorder
37.3 Phonological Disorder
37.4 Stuttering
37.5 Communication Disorder Not Otherwise Specified
38 Pervasive Developmental Disorders
39 Attention-Deficit Disorders
39.1 Attention-Deficit/Hyperactivity Disorder
39.2 Adult Manifestations of Attention-Deficit/Hyperactivity Disorder
40 Disruptive Behavior Disorders
41 Feeding and Eating Disorders of Infancy and Early Childhood
42 Tic Disorders
43 Elimination Disorders
44 Other Disorders of Infancy, Childhood, and Adolescence
44.1 Reactive Attachment Disorder of Infancy and Early Childhood
44.2 Stereotypic Movement Disorder of Infancy
44.3 Disorders of Infancy and Early Childhood Not Otherwise Specified
45 Mood Disorders in Children and Adolescents
45.1 Depressive Disorders and Suicide in Children and Adolescents
45.2 Early-Onset Bipolar Disorders
46 Anxiety Disorders in Children
46.1 Obsessive-Compulsive Disorder in Children
46.2 Posttraumatic Stress Disorder in Children and Adolescents
46.3 Separation Anxiety Disorder and Other Anxiety Disorders
46.4 Selective Mutism
47 Early-Onset Schizophrenia
48 Child Psychiatry Psychiatric Treatment
48.1 Individual Psychodynamic Psychotherapy
48.2 Short-Term Psychotherapies for the Treatment of Child and
Adolescent Disorders
48.3 Cognitive-Behavioral Psychotherapy for Children and Adolescents
48.4 Group Psychotherapy
48.5 Family Therapy
48.6 Pediatric Psychopharmacology
48.7 Partial Hospital and Ambulatory Behavioral Health Services
48.8 Residential and Inpatient Treatment
48.9 Community-Based Treatment
48.10 Psychiatric Treatment of Adolescents
49 Child Psychiatry Special Areas of Interest
49.1 Psychiatric Aspects of Day Care
49.2 Adoption and Foster Care
49.3 Child Maltreatment
49.4 Children's Reaction to Illness and Hospitalization
49.5 Psychiatric Sequelae of HIV and AIDS
49.6 Child or Adolescent Antisocial Behavior
49.7 Dissociative Disorders in Children and Adolescents
49.8 Identity Problem and Borderline Disorders in Children and
Adolescents
49.9 Adolescent Substance Abuse
49.10 Forensic Child and Adolescent Psychiatry
49.11 Ethical Issues in Child and Adolescent Psychiatry
49.12 School Consultation
49.13 Prevention of Psychiatric Disorders in Children and Adolescents
49.14 Neuroimaging in Child and Adolescent Psychiatry
49.15 Child Mental Health Services Research
49.16 Impact of Terrorism on Children
50 Adulthood
51 Geriatric Psychiatry
51.1 Overview
51.2 Assessment
51.3 Psychiatric Disorders of Late Life
51.4 Treatment of Psychiatric Disorders
51.5 Health Care Delivery Systems
51.6 Special Areas of Interest
52 Hospital and Community Psychiatry
52.1 Public and Community Psychiatry
52.2 Health Care Reform
52.3 Role of the Psychiatric Hospital in the Treatment of Mental Illness
52.4 Psychiatric Rehabilitation
53 Psychiatric Education
53.1 Graduate Psychiatric Education
53.2 Examining Psychiatrists and Other Professionals
53.3 An Anthropological View of Psychiatry
54 Ethics and Forensic Psychiatry
54.1 Clinical-Legal Issues in Psychiatry
54.2 Ethics in Psychiatry
54.3 Correctional Psychiatry
55 Psychiatry Past and Future
55.1 History of Psychiatry
55.2 World Aspects of Psychiatry
55.3 Future of Psychiatry
Back of Book
Appendices
Drugs Used in Psychiatry
Color Plates
Index
the defensive functions of the ego. The mechanism that may serve defensive
purposes from one point of view may simultaneously serve adaptive purposes
when viewed from another perspective. Thus, in the obsessive-compulsive person,
intellectualization may serve important inner needs to control drive impulses, but
by the same token, from another perspective, the intellectual activity itself may
serve highly adaptive functions in dealing with the complexities of external
reality.
Object Relationships
The capacity for mutually satisfying relationships is one of the fundamental
functions to which the ego contributes, although self–other relationships are more
properly a function of the whole person, the self, of which the ego is a functional
component. Significance of object relationships and their disturbance—for normal
psychological development and a variety of psychopathological states—were fully
appreciated relatively late in the development of classic psychoanalysis. The
evolution in the child's capacity for relationships with others, progressing from
narcissism to social relationships within the family and then to relationships
within the larger community, is related to this capacity. Development of object
relationship may be disturbed by retarded development, regression, or
conceivably by inherent genetic defects or limitations in the capacity to develop
object relationships or impairments and deficiencies in early caretaking
relationships. The development of object relationships is closely related to the
concomitant evolution of drive components and the phase-appropriate defenses
that accompany them.
Defensive Functions of the Ego
As was pointed out previously, in his initial psychoanalytic formulations and for a
long time thereafter, Freud considered repression to be virtually synonymous with
defense. More specifically, repression was directed primarily against the impulses,
drives, or drive representations and, particularly, against direct expression of the
sexual instinct. Defense was thus mobilized to bring instinctual demands into
conformity with demands of external reality. With development of the structural
view of the mind, the function of defense was ascribed to the ego. Only after
Freud had formulated his final theory of anxiety, however, was it possible to study
the operation of the various defense mechanisms in light of their mobilization in
response to danger signals.
Thus, a systematic and comprehensive study of ego defenses was only presented
for the first time by Anna Freud. In her classic monograph The Ego and the
Mechanisms of Defense, she maintained that everyone, whether normal or
neurotic, uses a characteristic repertoire of defense mechanisms but to varying
degrees. On the basis of her extensive clinical studies of children, she described
their essential inability to tolerate excessive instinctual stimulation and discussed
processes whereby the primacy of such drives at various developmental stages
evoked anxiety in the ego. This anxiety, in turn, produced a variety of defenses.
With regard to adults, her psychoanalytic investigations led her to conclude that,
although resistance was an obstacle to progress in treatment to the extent that it
impeded the emergence of unconscious material, it also constituted a useful
source of information concerning the ego's defensive operations.
Genesis of Defense Mechanisms
In the early stages of development, defenses emerge as a result of the ego's
struggles to mediate pressures of the id and the requirements and strictures of
outside reality. At each phase of libidinal development, associated drive
components evoke characteristic ego defenses. Thus, for example, introjection,
denial, and projection are defense mechanisms associated with oral-incorporative
or oral-sadistic impulses, whereas reaction formations, such as shame and disgust,
usually develop in relation to anal impulses and pleasures. Defense mechanisms
from earlier phases of development persist side by side with those of later periods.
When defenses associated with pregenital phases of development tend to
predominate in adult life over more mature mechanisms, such as sublimation and
repression, the personality retains an infantile cast.
Classification of Defenses
The defenses used by the ego can be categorized according to a variety of
classifications, none of which is all inclusive or takes into account all of the
relevant factors. Defenses may be classified developmentally, for example, in
terms of the libidinal phase in which they arise. Thus, denial, projection, and
distortion are assigned to the oral stage of development and to the correlative
narcissistic stage of object relationships. Certain defenses, however, such as
magical thinking and regression, cannot be categorized in this way. Moreover,
certain basic developmental processes, such as introjection and projection, may
also serve defensive functions under certain specifiable conditions.
The defenses have also been classified on the basis of the particular form of
psychopathology with which they are commonly associated. Thus, the obsessional
defenses include isolation, rationalization, intellectualization, and denial;
however, defensive operations are not limited to pathological conditions. Finally,
the defenses have been classified as to whether they are simple mechanisms or
complex, in which a single defense involves a combination or composite of
simple mechanisms. Table 6.1-2 gives a brief classification and description of
some of the basic defense mechanisms most frequently used and most thoroughly
investigated by psychoanalysts.
Table 6.1-2 Classification of Defense Mechanisms
Narcissistic Defenses
Immature Defenses
Neurotic Defenses
Controlling The excessive attempt to manage or regulate events or objects
in the environment in the interest of minimizing anxiety and
solving internal conflicts.
Displacement Involves a purposeful, unconscious shifting from one object to
another in the interest of solving a conflict. Although the
object is changed, the instinctual nature of the impulse and its
aim remain unchanged.
Dissociation A temporary but drastic modification of character or sense of
personal identity to avoid emotional distress; it includes fugue
states and hysterical conversion reactions.
Externalization A general term, correlative to internalization, referring to the
tendency to perceive in the external world and in external
objects components of one's own personality, including
instinctual impulses, conflicts, moods, attitudes, and styles of
thinking. It is a more general term than projection, which is
defined by its derivation from and correlation with specific
introjects.
Inhibition The unconsciously determined limitation or renunciation of
specific ego functions, singly or in combination, to avoid
anxiety arising out of conflict with instinctual impulses,
superego, or environmental forces or figures.
Intellectualization The control of affects and impulses by way of thinking about
them instead of experiencing them. It is a systematic excess of
thinking, deprived of its affect, to defend against anxiety
caused by unacceptable impulses.
Isolation The intrapsychic splitting or separation of affect from content
resulting in repression of either idea or affect or the
displacement of affect to a different or substitute content.
Rationalization A justification of attitudes, beliefs, or behavior that might
otherwise be unacceptable by an incorrect application of
justifying reasons or the invention of a convincing fallacy.
Reaction formationThe management of unacceptable impulses by permitting
expression of the impulse in antithetical form. This is
equivalently an expression of the impulse in the negative.
Where instinctual conflict is persistent, reaction formation can
become a character trait on a permanent basis, usually as an
aspect of obsessional character.
Repression Consists of the expelling and withholding from conscious
awareness of an idea or feeling. It may operate either by
excluding from awareness what was once experienced on a
conscious level (secondary repression) or by curbing ideas and
feelings before they have reached consciousness (primary
repression). The “forgetting” of repression is unique in that it
is often accompanied by highly symbolic behavior, which
suggests that the repressed is not really forgotten. The
important discrimination between repression and the more
general concept of defense has been discussed.
Sexualization The endowing of an object or function with sexual
significance that it did not previously have, or possesses to a
lesser degree, to ward off anxieties connected with prohibited
impulses.
Mature Defenses
Adapted from Vaillant GE. Adaptation to Life. Boston: Little, Brown; 1977;
Semrad E. The operation of ego defenses in object loss. In: Moriarity DM, ed. The
Loss of Loved Ones. Springfield, IL: Charles C. Thomas; 1967; and Bibring GL,
Dwyer TF, Huntington DS, Valenstein AA: A study of the psychological principles
in pregnancy and of the earliest mother-child relationship: Methodological
considerations. Psychoanal Stud Child. 1961;16:25.
Synthetic Function
The synthetic function of the ego refers to the ego's capacity to integrate various
aspects of its functioning. It involves the capacity of the ego to unite, organize,
and bind together various drives, tendencies, and functions within the personality,
enabling the individual to think, feel, and act in an organized and directed manner.
Briefly, the synthetic function is concerned with the overall organization and
functioning of the ego in the self-system and consequently must enlist the
cooperation of other ego and nonego functions in its operation.
Although the synthetic function subserves adaptive functioning in the ego, it may
also bring together various forces in a way that, although not completely adaptive,
is an optimal solution for the individual in a particular state at a given moment or
period of time. Thus, the formation of a symptom that represents a compromise of
opposing tendencies, although unpleasant in some degree, is nonetheless
preferable to yielding to a dangerous instinctual impulse or, conversely, trying to
stifle the impulse completely. Hysterical conversion, for example, combines a
forbidden wish and the punishment for it into a physical symptom. On
examination, the symptom often turns out to be the only possible compromise
under the circumstances.
Autonomy of the Ego
Although Freud only referred to “primal, congenital ego variations” as early as
1937, this concept was greatly expanded and clarified by Hartmann. Hartmann
advanced a basic formulation about development that the ego and id differentiate
from a common matrix, the so-called undifferentiated phase, in which the ego's
precursors are inborn apparatuses of primary autonomy. These apparatuses are
rudimentary in nature, present at birth, and develop outside the area of conflict
with the id. This area Hartmann referred to as a “conflict-free” area of ego
functioning. He included perception, intuition, comprehension, thinking,
language, certain phases of motor development, learning, and intelligence among
the functions in this conflict-free sphere. Each of these functions,
P.722
P.723
Oral Stage
Anal Stage
Urethral Stage
Definition This stage not explicitly treated by Sigmund Freud but serves as
transitional stage between anal and phallic stages. It shares some
characteristics of anal phase and some from subsequent phallic
phase.
Description Characteristics of the urethral phase often subsumed under phallic
phase. Urethral erotism, however, refers to pleasure in urination as
well as pleasure in urethral retention analogous to anal retention.
Similar issues of performance and control are related to urethral
functioning. Urethral functioning may also have sadistic quality,
often reflecting persistence of anal sadistic urges. Loss of urethral
control, as in enuresis, may frequently have regressive significance
that reactivates anal conflicts.
Objectives Issues of control and urethral performance and loss of control. Not
clear whether or to what extent objectives of urethral functioning
differ from those of anal period.
Pathological Predominant urethral trait is competitiveness and ambition, probably
traits related to compensation for shame due to loss of urethral control.
This may be start for development of penis envy, related to feminine
sense of shame and inadequacy in being unable to match male
urethral performance. Also related to issues of control and shaming.
Character Besides healthy effects analogous to those from anal period, urethral
traits competence provides sense of pride and self-competence based on
performance. Urethral performance is area in which small boy can
imitate and try to match his father's more adult performance.
Resolution of urethral conflicts sets stage for budding gender
identity and subsequent identifications.
Phallic Stage
Definition Phallic stage begins sometime during 3rd yr and continues until
approximately end of 5th yr.
Description Phallic phase characterized by primary focus of sexual interests,
stimulation, and excitement in genital area. Penis becomes organ of
principal interest to children of both sexes, with lack of penis in
females being considered as evidence of castration. Phallic phase
associated with increase in genital masturbation accompanied by
predominantly unconscious fantasies of sexual involvement with
opposite-sex parent. Threat of castration and related anxiety
connected with guilt over masturbation and oedipal wishes. During
this phase, oedipal involvement and conflict are established and
consolidated.
Objectives To focus erotic interest in genital area and genital functions. This
lays foundation for gender identity and serves to integrate residues
of previous stages into predominantly genital-sexual orientation.
Establishing oedipal situation essential for furtherance of subsequent
identifications serving as basis for important and enduring
dimensions of character organization.
Pathological Derivation of pathological traits from phallic-oedipal involvement
traits are sufficiently complex and subject to such a variety of
modifications so that it encompasses nearly the whole of neurotic
development. Issues, however, focus on castration in males and
penis envy in females. Patterns of identification developed from
resolution of oedipal complex provide another important focus of
developmental distortions. Influence of castration anxiety and penis
envy, defenses against them, and patterns of identification are
primary determinants of the development of human character. They
also subsume and integrate residues of previous psychosexual stages
so that fixations or conflicts deriving from preceding stages can
contaminate and modify oedipal resolution.
Character Phallic stage provides foundations for emerging sense of sexual
traits identity, of a sense of curiosity without embarrassment, of initiative
without guilt, as well as a sense of mastery not only over objects and
people in environment but also over internal processes and impulses.
Resolution of the oedipal conflict gives rise to internal structural
capacities for regulation of drive impulses and their direction to
constructive ends. This internal source of regulation is the superego,
based on identifications derived primarily from parental figures.
Latency Stage
Genital Stage
Definition Genital or adolescent phase extends from onset of puberty from 11–
13 yrs of age until young adulthood. Current thinking tends to
subdivide this stage into preadolescent, early adolescent, middle
adolescent, late adolescent, and even postadolescent periods.
Description Physiological maturation of systems of genital (sexual) functioning
and attendant hormonal systems leads to intensification of drives,
particularly libidinal drives. This produces a regression in
personality organization, which reopens conflicts of previous stages
of psychosexual development and provides opportunity for
reresolution of these conflicts in context of achieving a mature
sexual and adult identity. Often referred to as a second individuation.
Objectives Primary objectives are ultimate separation from dependence on and
attachment to parents and establishment of mature, nonincestuous,
heterosexual object relations. Related are achievement of mature
sense of personal identity and acceptance and integration of adult
roles and functions that permit new adaptive integrations with social
expectations and cultural values.
Pathological Pathological deviations due to inability to achieve successful
traits resolution of this stage of development are multiple and complex.
Defects can arise from whole spectrum of psychosexual residues
because developmental task of adolescence is in a sense a partial
reopening and reworking and reintegrating of all of these aspects of
development. Previous unsuccessful resolutions and fixations in
various phases or aspects of psychosexual development produce
pathological defects in the emerging adult personality.
Character Successful resolution and reintegration of previous psychosexual
traits stages in adolescent genital phase set stage normally for fully mature
personality with capacity for full and satisfying genital potency and
a self-integrated and consistent sense of identity. This provides basis
for capacity for self-realization and meaningful participation in areas
of work, love, and in creative and productive application to
satisfying and meaningful goals and values.
P.727
infant first begins to grasp this fact of experience. In the beginning, an infant
cannot distinguish between its own lips and its mother's breasts, nor does an infant
initially associate satiation of painful hunger pangs with presentation of the
extrinsic breast. Because the infant is aware only of its own inner tension and
relaxation and is unaware of the external object, longing for the object exists only
to the degree that the disturbing stimuli persist, and longing for satiation remains
unsatisfied in the absence of the object. When the satisfying object finally
appears, and the infant's needs are gratified, longing also disappears. Gradually,
but also rather quickly, the infant becomes aware of the mother herself, in addition
to her breast, as a need-satisfying object.
ORAL PHASE AND OBJECTS
This experience of unsatisfied need, together with the experience of frustration in
the absence of the breast and need-satisfying release of tension in the presence of
the breast, forms the basis of the infant's first awareness of external objects. This
first awareness of an object, then, in the psychological sense, comes from longing
for something that is already familiar and for something that actually gratified
needs in the past but is not immediately available in the present. Thus, it is
basically the infant's hunger in this view that in the beginning compels recognition
of the outside world. The first primitive reflex reaction to objects, putting them
into the mouth, then becomes understandable. This reaction is consistent with the
modality of the infant's first recognition of reality, judging reality by oral
gratification, that is, whether something will provide relaxation of inner tension
and satisfaction (and should thereby be incorporated, swallowed) or whether it
will create inner tension and dissatisfaction (and consequently should be spit out).
Early in this interaction, the mother serves an important function, that of
empathically responding to the infant's inner needs in such a manner as to become
involved in a process of mutual regulation, which maintains the homeostatic
balance of the infant's physiological needs and processes within tolerable limits.
Not only does this process keep the child alive, but it sets a rudimentary pattern of
experience within which the child can build elements of a basic trust that promote
reliance on the benevolence and availability of caretaking objects. Consequently,
the mother's administrations and responsiveness to the child help to lay the most
rudimentary and essential foundation for subsequent development of object
relations and the capacity for entering the community of human beings.
As differentiation between the limits of self and object is gradually established in
the child's experience, the mother becomes acknowledged and recognized as the
source of gratifying nourishment and, in addition, as source of the erotogenic
pleasure the infant derives from sucking on the breast. In this sense, she becomes
the first love object. The quality of the child's attachment to this primary object is
of the utmost importance, as developmental and attachment theorists have
demonstrated. From the oral phase onward, the whole progression in
psychosexual development, with its focus on successive erotogenic zones and
emergence of associated component instincts, reflects the quality of the child's
attachment to the crucial figures in the environment as well as the strength of
feelings of love or hate, or both, toward these important people. If a
fundamentally warm, trusting, secure, and affectionate relationship has been
established between mother and child during the earliest stages of the child's
career, then at least theoretically, the stage is set for development of trusting and
affectionate relationships with other human objects during the course of life.
ANAL PHASE AND OBJECTS
During the oral stage of development, the infant's role is not altogether passive
because, caught up as it is in a process of mutual interaction, the infant makes its
own contribution to eliciting certain responses from the mother. The activity,
however, is more or less automatic and dependent on such physiological factors as
level of activity, irritability, or responsiveness to stimuli. Generally speaking,
however, the infant's control over the mother's feeding responses is relatively
limited. Consequently, the primary onus remains on the mother to gratify or
frustrate the demands of the infant.
In the transition to the anal period, however, this picture changes significantly.
The child acquires a greater degree of control over behavior and particularly over
sphincter function. Moreover, for the first time during this period, demands are
placed on the child to relinquish some aspect of freedom by reason of expectations
to accede to parental demands to use the toilet for evacuation of feces and urine.
However, the primary aim of anal eroticism is enjoyment of the pleasurable
sensations of excretion. Somewhat later, stimulation of the anal mucosa through
retention of the fecal mass may become a source of even more intense pleasure.
Nonetheless, at this stage of development, the demand is placed on the child to
regulate gratification, to surrender some portion of the gratification at the parent's
wish, or to delay gratification according to a schedule established by the parent's
wishes. It can be readily seen that one of the important aspects of the anal period,
therefore, is that it sets the stage for a contest of wills over when, how, and on
what terms the child achieves gratification.
PHALLIC PHASE AND OBJECTS
The passage from anal to phallic phase marks not only the transition from pre-
oedipal to beginnings of the oedipal level of development but also marks
completion of the work of separation individuation and, in the normal course of
development, achievement of object constancy. The oedipal situation evolves
during the period extending from the third to the fifth year in children of both
sexes.
Oedipus Complex
In the normal course of development, the so-called pregenital phases are regarded
as primarily autoerotic. Primary gratification derives from stimulation of
erotogenic zones, whereas the object serves a significant, although secondary and
instrumental, role. A fundamental shift begins to take place in the phallic phase in
which the phallus becomes the primary erotogenous zone for both sexes, thus
laying a foundation for and initiating a shift of libidinal motivation and intention
in the direction of objects. The phallic phase sets the stage for the fundamental
task of finding a love object, a dynamic that moves to another level of progression
in establishing love relations of the oedipal period and beyond to more mature
adult object choices and love relationships. The phallic period is also 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. 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.
Castration Complex
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 situation 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, but unlike the boy, the little girl was already castrated, and as a result,
she turned to her father as bearer of the penis out of a sense of disappointment
over her own lack of a penis. The little girl was thus more threatened by a loss of
love than by actual castration fears.
P.729
“During the first few weeks of extrauterine life, a stage of absolute primary
narcissism, marked by the infant's lack of awareness of a mothering agent,
prevails. This is the stage we have termed normal autism. It is followed by a stage
of dim awareness that need satisfaction cannot be provided by oneself, but comes
from somewhere outside the self.… The task of the autistic phase is the
achievement of homeostatic equilibrium of the organism within the new
extramural environment, by predominantly somatopsychic physiological
mechanisms.”
To the external observer, newborn infants seem to relate to their mothers in a
condition of unique dependence and responsiveness. This relationship is, however,
at least at first, purely biological based on physiological reflexes and ordered to
the fulfillment of basic biological needs. It is only as babies' egos begin to
develop, along with the organization of perceptual capacities and memory traces,
which allow for the initial differentiation of self and object, that infants can be
said to experience something outside of themselves, to which they can relate, as
satisfying their inner needs. This dawning awareness of the external object is a
most significant state in the psychological development of children and involves
not only cognitive and perceptual developments but also goes hand in hand with
the organization of rudimentary infantile drives and affects in relation to emerging
object experiences.
The emergence of the psychological need-satisfying relationship to the object or
part-object occurs during the oral phase of libidinal development. It should be
noted, however, that the notion of the oral phase of development and the concepts
of need-satisfying relationships are not equivalent. The oral phase is primarily
concerned with libidinal development and stresses predominance of the oral zone
as the main erotogenic zone. The concept of the need-satisfying relationship,
however, is not concerned directly with issues of drive development but, rather,
with the characteristics of object involvement and object relationship.
Symbiotic Phase
This awareness signals the beginning of normal symbiosis “in which the infant
behaves and functions as though he and his mother were an omnipotent system—a
dual unity within one common boundary.” The symbiotic phase is described as a
“hallucinatory or delusional somatopsychic omnipotent fusion with the
representation of the mother and, in particular, the delusion of a common
boundary between two physically separate individuals.” These boundaries become
temporarily differentiated only in the state of “affect hunger” but disappear again
as a result of need gratification. Only gradually does the child form more stable
part-images of the mother such as breasts, face, or hands. Consequently, the object
is recognized as separate from the self only at moments of need so that, once the
need is satisfied, the object ceases to exist—from the infant's (subjective) point of
view—until a need again arises. Moreover, from the infant's perspective, the
relationship is not to a specific object (or part-object) but rather to a function of
the object satisfying the need and to the pleasure accompanying that function. It is
only when the specific object—that is, the whole object—becomes as important to
the child as the need-satisfying function that it performs that one can regard the
child's development as moving beyond the level of need-satisfying relationships
toward the attainment of object constancy.
Thus, it is useful to distinguish between need satisfaction as a stage of
development in object relationships, related to but not synonymous with the oral
phase of libidinal development, and need satisfaction as a determinant in object
relationships at every level of development. The satisfaction of various kinds of
psychological needs continues to play a role at all levels of object relatedness, but
the satisfaction of such needs cannot be used as a distinguishing characteristic of
the specific stage of need-satisfying object relationships. As objects become
increasingly differentiated in the child's experience, their representations achieve
increasing psychological complexity and value in a context of increasingly
complex and subtle needs for a variety of input from objects. Development of
object constancy implies a constant relationship to a specific object, but within
that relationship, the wish for satisfaction of needs and the actual satisfaction of
those needs may still be a significant component of the object relationship.
Separation and Individuation
HATCHING
During this period, the child with effort gradually differentiates out of the
symbiotic matrix. The first behavioral signs of such differentiation seem to arise at
approximately 4 or 5 months of age at the high point of the symbiotic period. The
first stage of this process of differentiation is described as “hatching” from the
symbiotic orbit:
In other words, the infant's attention, which during the first months of symbiosis
was in large part inwardly directed, or focused in a coenesthetic vague way within
the symbiotic orbit, gradually expands through the coming into being of
outwardly directed perceptual activity during the child's increasing periods of
wakefulness. This is a change of degree rather than of kind, for during the
symbiotic stage the child has certainly been highly attentive to the mothering
figure. But gradually that attention is combined with a growing store of memories
of mother's comings and goings, of “good” and “bad” experiences; the latter were
altogether unrelievable by the self, but could be “confidently expected” to be
relieved by mother's ministrations.
PRACTICING
As the child's differentiation and separation from the mother gradually increase,
there is a move to the second or “practicing” subphase of separation–
individuation. The practicing period can be usefully divided into an early
practicing period and a practicing period proper. The early practicing phase begins
with the infant's earliest ability to move physically away from the mother by
locomotion, that is, crawling, creeping, climbing, and assuming an upright sitting
position. Moving away from the safe protective orbit of the mother has its risks
and uncertainties, however. In the early practicing phase, there is frequently a
pattern of visually “checking back to mother” or even crawling or paddling back
to her to touch or hold on as a form of “emotional refueling.”
The practicing period proper is characterized by the attainment of free upright
locomotion. It is marked by three interrelated developments that contribute to the
continuing process of separation and individuation. These are (1) rapid bodily
differentiation from the mother, (2) establishment of a specific bond with her, and
(3) growth and functioning of autonomous ego-apparatuses in close connection
and dependence on the mothering figure.
RAPPROCHEMENT
As this testing of the freedom of individuation proceeds, by approximately the
middle of the second year of life, the child enters the third subphase of
rapprochement:
He now becomes more and more aware, and makes greater and greater use, of his
physical separateness. However, side by side with the growth of his cognitive
faculties and the increasing differentiation of his emotional life, there is also a
noticeable waning of his previous imperviousness to frustration, as well as a
diminution of what has been a relative obliviousness to his mother's presence.
Increased separation anxiety can be observed: at first this consists mainly of fear
of object loss, which is to be inferred from many of the child's
P.731
Hubungan objek
Klasifikasi pertahanan
Fungsi sintetis
Meskipun fungsi sintetis merupakan fungsi adaptif dalam ego, juga dapat
menyatukan berbagai kekuatan dengan cara yang meskipun tidak benar-benar
adaptif, adalah solusi optimal bagi individu dalam keadaan tertentu pada saat atau
periode waktu yang diberikan. Dengan demikian, pembentukan gejala yang
merupakan kompromi dari kecenderungan menentang, meskipun tidak
menyenangkan dalam beberapa derajat, lebih baik untuk menyerah pada dorongan
insting yang berbahaya atau sebaliknya mencoba menahan dorongan sepenuhnya,
konversi histeris, misalnya, menggabungkan keinginan terlarang dan hukuman
untuk itu menjadi gejala fisik. Pada pemeriksaan, gejala sering menjadi satu-
satunya kemungkinan kompromi dalam situasi.
Otonomi ego
Meskipun Freud hanya disebut “primal, bawaan variasi ego” pada awal
1937, konsep ini sangat diperluas dan diperjelas oleh Hartmann. Hartmann
menguatkan formulasi dasar tentang pengembangan perbedaan dari matriks umum
antara ego dan id yang disebut fase dibedakan, dimana prekursor ego adalah
aparat bawaan otonomi primer. Aparat yang belum sempurna di alam, hadir pada
saat lahir, dan berkembang di luar wilayah konflik dengan id. Daerah ini disebut
Hartmann sebagai daerah “bebas konflik” dari ego berfungsi. Dia termasuk
persepsi, intuisi, pemahaman, pemikiran, bahasa, fase-fase tertentu dari
perkembangan motorik, belajar, dan intelijen di antara fungsi-fungsi dalam
lingkup bebas konflik. Namun, masing-masing fungsi mungkin juga terlibat
dalam konflik sekunder dalam proses pembangunan. Sebagai contoh, jika agresif,
impuls kompetitif mengganggu dorongan untuk belajar, mereka dapat
menimbulkan reaksi defensif. Penghambatan pada bagian dari ego, sehingga
mengganggu operasi bebas konflik dari fungsi-fungsi ini.
Otonomi primer
Dengan diperkenalkannya fungsi otonom utama, Hartmann memberikan
derivasi genetik independen untuk setidaknya sebagian dari ego, sehingga
membentuk sebagai sebuah dunia yang independen dari organisasi psikis yang
tidak benar-benar tergantung pada dan berasal dari naluri. Ini adalah wawasan
sangat penting karena meletakkan dasar bagi doktrin muncul otonomi ego dan
berarti bahwa analisis perkembangan ego harus mempertimbangkan yang sama
sekali baru dari variabel cukup terpisah dari mereka yang terlibat dalam
pengembangan insting.
Otonomi sekunder
Hartmann mengamati bahwa pola bebas konflik yang berasal dari struktur
ekonomi primer dapat diperbesar dan fungsi lebih lanjut bisa ditarik dari dominasi
pengaruh drive. Ini adalah konsep Hartmann otonomi sekunder. Dengan demikian,
mekanisme yang muncul awalnya dalam pelayanan pertahanan terhadap dorongan
naluriah mungkin dalam waktu menjadi struktur yang independen, sehingga
dorongan drive yang hanya memicu aparat automatisasi. Dengan demikian, alat
dapat datang untuk melayani fungsi selaint fungsi defensif asli, misalnya, adaptasi
atau sintesi. Hartmann menyebut penghapusan ini mekanisme tertentu dari
pengaruh drive sebagai proses perubahan fungsi.
PERTAHANAN NARSISTIK
Proyeksi Mengamati dan bereaksi terhadap impuls batin
yang tidak dapat diterima dan turunannya seolah-
olah mereka berada di luar diri sendiri. Pada tingkat
psikotik, hal ini mengambil bentuk delusi jujur
tentang realitas eksternal, biasanya persekutori, dan
termasuk persepsi perasaan sendiri di lain dengan
akting berikutnya pada persepsi (delusi psikotik
paranoid). Impuls mungkin berasal dari identitas
Denial
atau superego (halusinasi saling tuduh).
PERTAHANAN IMATUR
Acting out Ekspresi langsung dari keinginan tak sadar atau
dorongan dalam tindakan untuk menghindari
menjadi sadar akan pengaruh yang menyertainya.
Fantasi bawah sadar, yang melibatkan objek, yang
tinggal di luar impulsif dalam perilaku, sehinga
memuaskan dorongan lebih dari larangan itu. Pada
tingkat kronis, bertindak melibatkan menyerah
Blocking pada dorongan untuk menghindari ketegangan yang
dihasilkan dari penundaan ekspresi.
Sebuah hambatan, biasanya bersifat sementara, dari
dampat terutama, tapi mungkin juga pikiran dan
Hipokondriasis
impuls. Hal ini dekat dengan represi dalam efeknya
namun memiliki komponen ketegangan yang
timbul dari penghambatan impuls, pengaruh atau
pemikiran.
PERTAHANAN NEUROTIK
Controlling Upaya yang berlebihan untuk mengelola atau
mengatur peristiwa atau objek dalam lingkungan
untuk kepentingan mengurangi kecemasan dan
menyelesaikan konflik internal.
DEFENSIF MATUR
Altruisme Layanan perwakilan tetapi konstruktif dan naluriah
memuaskan kepada orang lain. Ini harus dibedakan
dari penyerahan altruistik, yang melibatkan
penyerahan gratifikasi langsung atau kebutuhan
insting mendukung pemenuhan kebutuhan orang
lain sehingga merugikan diri, dengan kepuasan
perwakilan hanya yang diperoleh melalui
introyeksi.
Superego
Asal usul dan fungsi dari superego yang terkait dengan orang-orang dari
ego, tetapi mereka mencerminkan perubahan-perubahan perkembangan yang
berbeda. Secara singkat, superego adalah yang terakhir dari komponen struktural
untuk mengembangkan sehinggal analisis Freud dari resolusi kompleks oedipal.
Hal ini berkaitan dengan perilaku moral didasarkan pada pola perilaku sadar
dipelajari pada tahap awal pengembangan pregenital. Sering, superego
berpartisipasi dalam konflik neurotik dengan bersekutu dirinya dengan ego dan
dengan demikian memaksakan tuntutan dalam bentk perasaan hati nurani atau
rasa bersalah. Kadang bagaimanapu, superego dapat bersekutu dengan id melawan
ego. Hal ini terjadi dalam kasus reaksi kemunduran, dimana fungsi dari superego
dapat menjadi seksual sekali lagi atau mungkin terjadi menjadi meresap dengan
agresi, mengambil sebuah kualitas primitif (biasanya anal) pengrusakan.
Perkembangan sejarah
Dalam sebuah makalah yang ditulis pada tahun 1896, Freud digambarkan
gagasan obsesif sebagai celaan diri sendiri yang muncul kembali dari penindasan
dan yang selalu berhubungan dengan beberapa tindakan seksual yang dilakukan
dengan senang hati di masa kanak-kanak. Kegiatan ini menyiratkan diskusi awal
Freud adalah mimpi, yang mengendalikan adanya sensor yang tidak mengizinkan
ide-ide yang tidak dapat diterima untuk memasuki kesadaran atas dasar moral. Dia
pertama kali membahas konsep lembaga kritik diri khusus pada tahun 1914,
menunjukkan bahwa keadaan hipotesis kesempurnaan narsis ada pada anak usia
dini, pada tahap ini, anak memiliki ideal sendiri, sebagai anak tumbuh teguran dari
orang lain dan otokritik dikombinasikan untuk menghancurkan citra sempurna.
Untuk mengimbangi narsisme ini hilang atau untuk memulihkan itu, anak proyek
sebelum dia baru ideal atau ego ideal. Pada titik ini, Freud menyarankan bahwa
aparat psikis mungkin masih komponen struktural lain, badan khusus yang
tugasnya adalah untuk mengawasi ego, untuk memastikan itu berukuran hingga
ego ideal, konsep super ego berkembang dari formulasi ini dari sebuah lembaha
ego ideal dan pemantauan kedua untuk memastikan pelestariannya.
Pada tahun 1923, namun dalam ego dan id konsep Freud tentan superego
berfungsi bahwa ini adalah superego yang mewakili ego ideal serta hati nurani. Ia
juga menunjukkan bahwa operasi dari superego terutama sadar. Dengan demikian,
pasien yang didominasi oleh perasaan yang amat bersalah jauh lebih kasar pada
tingkat bawah sadar daripada yang mereka lakukan secara sadar. Fakta bahwa rasa
bersalah yang ditimbulkan oleh superego mungkin mereda dengan penderitaaan
atau hukuman yang jelas dalam kasus neurosis yang menunjukkan kebutuhan
sadar untuk hukuman, dalam karya-karya selanjutnya, Freud menguraikan
hubungan antara ego dan superego. Perasaan bersalah tersebut dianggap milik
ketegangan antar dua lembaga ini, dan kebutuhan untuk hukuman adalah ekspresi
ketegangan yang terjadi.
Asal-usul superego
Cukup dimengerti permusuhan pada anak dapat diterima oleh orang tua
dan kenyataanya, menjadi tidak dapat diterima untuk seorang anak. Selain itu,
eksplorasi seksual anak dan kegiatan masturbasi sendiri apabila orangtua
menegaskan hal itu merupakan suatu ancaman pengebirian. Akibatnya ia
berpaling dari situasi oedipal dan keterlibatan emosional dan memasuki periode
laten perkembangan psikososial. Ekspresi seksual ini terjadi pada masa kanak-
kanak.
Anak-anak perempuan ketika mereka menjadi sadar akan fakta bahwa
mereka tidak memiliki penis, Freud menunjukkan adanya kecemasan tentang
pengebirian yang merupakan kompleks eodipus. Berakir pada masa anak laki-laki,
pada anak perempuan hal itu adalah faktor pemicu utaman. Pada tahap latensi,
bahwa anak perempuan biasanya memainkan peran sebagai seorang istri dan anak
laki-laki memainkan peran sebagai seorang ayah. Mereka menyatakan hubungna
mereka ke dalam suatu hubungan yang ada dalam khayalan mereka.
Cukup dimengerti, permusuhan ini pada bagian dari anak tidak dapat
diterima kepada orang tua dan, pada kenyataannya, akhirnya menjadi tidak dapat
diterima untuk anak juga. Selain itu, eksplorasi seksual anak dan kegiatan
masturbasi sendiri mungkin bertemu dengan orang tua tidak disukai, yang bahkan
mungkin ditegaskan oleh ancaman nyata atau tersirat pengebirian. Ancaman ini
dan di atas semua, pengamatan anak itu bahwa perempuan dan anak perempuan
kurang penis meyakinkan dia tentang realitas pengebirian. Akibatnya, ia berpaling
dari situasi oedipal dan keterlibatan emosional dan memasuki periode laten
perkembangan psikoseksual. Dia renounces ekspresi seksual dari fase kekanak-
kanakan.
Introjections ini dari kedua orang tuanya menjadi bersatu dan membentuk
semaca endapan di dalam diri, yang kemudian dihadapkan isi lainnya dari jiwa
sebagai superego. Indikasi dengan orang tua didasarkan pada perjuangan untuk
menindas tujuan insting yang ditujukan kepada mereka, dan itu upaya ini
penolakan yang memberi superego karakter melarang. Hal ini untuk alasan ini
juga, bahwa hasil superego, untuk seperti sebagian besar dan introyeksi dari
superegos orang tua sendiri. Namun, karena superego berkembang sebagai akibat
dari represi dari keinginan naluriah, itu memiliki hubungan dekat dengan id
daripada ego sendiri. Asal usulnya lebih internal: ego berasal ketingkat yang lebih
besar dalam kaitannya dengan dunia luar dan perwakilan internal.
Fokus kedua menarik baru-baru ini telah menjadi kontribusi drive dan
lampiran objek dibentuk pada periode pra-oedipal untuk pengembangan superego.
Ini pregenital (terutama anal) prekursor superego umumnya diyakini memberikan
beberapa kualitas yang sangat kaku, ketat dan agresif dari superego. Kualitas ini
berasal dari proyeksi drive sadis anak sendiri dan konsep primitif keadilan
berdasarkan pembalasan, yang disebabkan oleh orang tua selama periode ini.
Penekanan keras terhadap kebersihan mutlak dan kepatutan yang kadang-kadang
ditemukan pada individu yang sangat kaku dan obesif neurotis didasarkan sampai
batas tertentu pada sfinter ini moralitas periode anal. Salah satu hasil dari
perkembagan ini adalah bahwa hubungan antara dinamika oedipal dan
pengembangan superego telah diencerkan secara signifikan dalam arti bahwa
prekursor superego pra-oedipal dan fungsi superego pra-oedipal lebih baik
dipahami di satu sisi, dari integrasi postoedipal, terutama dengan fungsi ego, disisi
lain, telah memodifikasi pemahaman fungsi superego.
Tabel 6,1-3 menggambarkan gambaran tentang pandangan saat ini, kurang lebih
tentatif , pada perkembangan psikoseksual.
Tahap Oral
________________________________________
Ciri-ciri karakter resolusi Sukses dari hasil tahap lisan dalam kapasitas untuk
memberikan dan menerima dari orang lain tanpa
ketergantungan Karakter ciri-ciri resolusi Sukses dari hasil
tahap lisan dalam kapasitas untuk memberikan dan
menerima dari orang lain tanpa ketergantungan yang
berlebihan atau iri hati, kapasitas untuk bergantung pada
orang lain dengan rasa percaya serta dengan rasa
kemandirian dan kepercayaan diri. Karakter Oral sering
berlebihan dan memerlukan orang lain untuk diberikan
kepada mereka dan menjaga mereka dan sering sangat
tergantung pada orang lain untuk menjaga harga diri.
________________________________________
Tahap Anal
________________________________________
Keterangan Periode meluas sekitar 1-3 tahun usia, ditandai dengan intensifikasi
dikenali dari drive agresif dicampur dengan komponen libidinal di impuls sadis.
Akuisisi kontrol sfingter sukarela terkait dengan meningkatnya pergeseran dari
pasif ke aktivitas. Konflik kontrol anal dan perjuangan dengan orang tua lebih
mempertahankan atau mengeluarkan kotoran di toilet training menimbulkan
peningkatan ambivalensi bersama dengan perjuangan lebih pemisahan,
individuasi, dan kemandirian. Erotisme anal mengacu kenikmatan seksual dalam
fungsi anal, baik dalam mempertahankan kotoran berharga dan menghadirkan
mereka sebagai hadiah yang berharga untuk orang tua. Sadisme anal mengacu
ekspresi keinginan agresif terhubung dengan pemakaian tinja sebagai senjata
ampuh dan destruktif. Keinginan ini sering ditampilkan dalam fantasi bom atau
ledakan.
Ciri-ciri karakter resolusi Sukses dari fase anal memberikan dasar bagi
pengembangan otonomi pribadi, kapasitas untuk
kemerdekaan dan inisiatif pribadi tanpa rasa bersalah,
kapasitas untuk perilaku diri menentukan tanpa rasa malu
atau keraguan diri, kurangnya ambivalensi dan kapasitas
untuk kerjasama bersedia tanpa baik hasrat keinginan yang
berlebihan atau diri pengecilan atau kalah.
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Tahap uretra
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Tujuan Isu kontrol dan kinerja uretra dan hilangnya kontrol. Tidak
jelas apakah atau sejauh mana tujuan dari uretra fungsi
berbeda dari periode anal.
Ciri patologis uretra Dominan sifat adalah daya saing dan ambisi,
mungkin terkait dengan kompensasi malu karena hilangnya
kontrol uretra. Hal ini dapat mulai untuk pengembangan
penis iri, terkait dengan rasa feminin malu dan tidak
mampu di tidak mampu untuk mencocokkan kinerja uretra
laki-laki. Juga terkait dengan masalah kontrol dan
mempermalukan.
Ciri-ciri karakter Selain efek sehat analog dengan orang-orang dari periode
anal, kompetensi uretra memberikan rasa bangga dan self-
kompetensi berdasarkan kinerja. Kinerja uretra adalah area
di mana anak kecil dapat meniru dan mencoba untuk
mencocokkan kinerja yang lebih dewasa ayahnya. Resolusi
uretra bertentangan set panggung untuk pemula identitas
gender dan identifikasi selanjutnya.
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Tahap phallic
________________________________________
Definisi tahap Phallic dimulai sekitar tahun tahun ke-3 dan terus
sampai kira-kira akhir tahun ke-5.
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Tahap Latensi
________________________________________
Ciri patologis Bahaya di masa laten dapat timbul baik dari kurangnya
pengembangan kontrol dalam atau kelebihan mereka.
Kurangnya kontrol dapat menyebabkan ketidakmampuan
untuk cukup menghaluskan energi dalam kepentingan
pembelajaran dan pengembangan keterampilan; kelebihan
kontrol batin, bagaimanapun, dapat menyebabkan
penutupan dini perkembangan kepribadian dan elaborasi
dewasa sebelum waktunya sifat karakter obsesif.
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Tahap Genital
________________________________________
Saat lahir, tanggapan bayi terhadap stimulasi eksternal relatif menyebar dan tidak
terorganisir. Meski begitu, penelitian eksperimental baru pada neonatus telah
mengindikasikan, bayi cukup responsif terhadap rangsangan eksternal, dan pola-
pola respon yang cukup kompleks dan relatif terorganisir, bahkan tak lama setelah
lahir. Bahkan neonatus dari beberapa jam usia merespon selektif terhadap
rangsangan novel dan menunjukkan preferensi yang luar biasa untuk kompleks,
dibandingkan dengan sederhana, pola stimulasi. Tanggapan bayi terhadap
rangsangan berbahaya dan menyenangkan juga relatif dibedakan. Meski begitu,
sensasi kelaparan, dingin, dan nyeri menimbulkan ketegangan dan kebutuhan
yang sesuai untuk mencari bantuan dari rangsangan yang menyakitkan. Pada awal
kehidupan, namun, bayi tidak merespon secara khusus untuk benda-benda sebagai
objek. Sebuah tingkat tertentu perkembangan aparat persepsi dan kognitif yang
diperlukan, serta tingkat yang lebih besar dari diferensiasi sensorik kesan dan
integrasi pola kognitif, sebelum bayi dapat membedakan antara tayangan milik
sendiri dan orang-orang yang berasal dari objek-objek eksternal. Akibatnya,
pengamatan dan kesimpulan berdasarkan data yang diperoleh dari 6 bulan
pertama kehidupan harus ditafsirkan dalam konteks fungsi kognitif anak sebelum
diferensiasi diri objek.
Dalam bulan-bulan pertama kehidupan, bayi manusia yang jauh lebih berdaya
daripada mamalia muda lainnya. Ketidakberdayaan mereka terus untuk jangka
waktu lebih lama daripada di spesies lain. Mereka tidak bisa bertahan hidup
kecuali mereka dirawat, dan mereka tidak dapat mencapai bantuan dari
ketidakseimbangan menyakitka fisiologis dalam tanpa bantuan benda eksternal.
Hubungan objek dari jenis yang paling primitif hanya mulai dibentuk ketika bayi
pertama mulai memahami fakta ini pengalaman. Pada awalnya, bayi tidak bisa
membedakan antara bibir sendiri dan payudara ibunya, juga tidak bayi awalnya
mengasosiasikan kejenuhan dari rasa lapar yang menyakitkan dengan presentasi
dari payudara ekstrinsik. Karena bayi menyadari hanya ketegangan batin sendiri
dan relaksasi dan tidak menyadari objek eksternal, kerinduan untuk objek ada
hanya untuk tingkat bahwa rangsangan yang mengganggu bertahan, dan
kerinduan untuk kenyang tetap tidak puas dengan tidak adanya objek. Ketika
objek memuaskan akhirnya muncul, dan kebutuhan bayi bersyukur, kerinduan
juga menghilang. Secara bertahap, tetapi juga lebih cepat, bayi menjadi sadar ibu
sendiri, di samping payudaranya, sebagai objek kebutuhan-memuaskan.
Sebagai diferensi antara batas diri dan objek secara bertahap didirikan
pada pengalaman anak, ibu menjadi diakui dan diakui sebagai sumber makanan
dan memuaskan, disamping itu, sebagai sumber kesenangan erotogenic bayi
berasal dari mengisap payudara. Dalam hal ini, ia menjadi objek cinta pertama.
Kualitas keterikatan anak untuk objek utama ini adalah yang paling penting,
sebagai teori perkembangan dan lampiran telah menunjukkan. Dari fase lisan dan
seterusnya, seluruh kemajuan dalam perkembangan psikoseksual, dengan focus
pada zona erotogenic berturu-turut dan munculnya naluri komponen terkait,
mencerminkan kualitas keterikatan anak dengan angka penting dalam lingkungan
serta kekuatan persasaan cinta atau benci, atau keduanya, terhadap orang-orang
penting. Jika hubungan fundamental hangat, percaya, aman, dan penuh kasih
sayang telah dibentuk antara ibu dan anak selama hidup tahap awal karir anak,
maka setidaknya secara teoritis, panggung diatur untuk pengembangan hubungan
saling percaya dan penuh kasih sayang dengan objek manusia lainnya selama
perjalanan hidup.
FASE PHALLIC DAN OBJEK Bagian dari anak ke phallic tanda fase
tidak hanya transisi dari pra-oedipal ke awal dari tingkap oedipal perkembangan
tetapi juga menandai selesainya pekerjaan pemisahan individuasi dan, dalam
kegiatan normal pembangunan, mencapai objek keteguhan. Situasi oedipal
berkembang selama periode memanjang dari ketiga untuk tahun kelima pada
anak-anak dari kedua jenis kelamin.
Ini gambaran yang agak sederhana dari resolusi kompleks oedipus jauh
lebih kompleks dalam perjalanan sebenarnya pembangunan. Biasanya, cinta anak
itu untuk ibunya tetap menjadi kekuatan yang dominan selama periode
perkembangan seksual infantil. Hal ini diketahui, bagaimanapun, bahwa cinta
tidak bebas dari beberapa campuran permusuhan dan bahwa hubungan anak
dengan kedua orang tua adalah untuk beberapa derajat ambivalen. Anak itu juga
mencintai ayahnya, dan pada saat ia telah frustasi oleh ibunya, ia mungkin
membencinta dan berpaling darinya untuk mencari kasih sayang dari ayahnya.
Tidak diragukan lagi, untuk beberapa derajat, dia mencintai dan membenci kedua
orangtuanya pada saat yang sama. Selain itu, dalil Freud secara dasarnya biseksual
sifat libido memperumit masalh ini lebih lanjut.di satu sisi, anak itu ingin
memiliki ibunya dan membunuh saingannya. Di sisi lain, ia juga mencintai
ayahnya dan mencari persetujuan dan kasih sayang darinya, sedangkan ia sering
bereaksi terhadap ibunya dengan permusuhna, terutama ketika tuntutan pada
suami mengganggu eksklusivitas dari hubungan ayak-anak. kompleks oedipus
negatif mengacu pada situasi-situasi di mana cinta anak itu untuk ayahnya
mendominasi atas cinta untuk ibu, dan ibu yang relatif dibenci sebagai elemen
yang mengganggu dalam hubungan ini.
Penolakan gadis itu lampiran pra-oedipal dia ibu tidak bisa memuaskan
dijelaskan sebagai akibat dari karakteristik ambivalen atau agresif hubungan ibu-
anak, untuk elemen yang sama dipengaruhi hubungan antara laki-laki dan sosok
ibu. Freud dikaitkan faktor pencetus penting untuk perbedaan anatomi antara-
khusus jenis kelamin penemuan gadis itu dari dia kurang penis selama periode
phallic. Sampai saat ini, eksklusif perbedaan konstitusional dan tergantung pada
variasi dalam sikap orangtua dalam berhubungan dengan anak perempuan
dibandingkan anak laki-laki, pengembangan gadis kecil itu paralel dengan anak
kecil.
Tahap autis
Tahap simbiosis
Sinyal kesadaran ini awal simbiosis normal "di mana bayi berperilaku dan
fungsi seolah-olah ia dan ibunya adalah sistem-kesatuan ganda mahakuasa dalam
satu batas umum." Tahap simbiosis digambarkan sebagai "halusinasi atau delusi
fusi mahakuasa somatopsychic dengan representasi ibu dan, khususnya, khayalan
batas umum antara dua individu yang terpisah secara fisik. "Batas-batas ini
menjadi sementara dibedakan hanya dalam keadaan" mempengaruhi kelaparan
"tapi hilang lagi sebagai akibat dari kebutuhan pemuasan. Hanya secara bertahap
tidak membentuk anak lebih stabil bagian-gambar ibu seperti payudara, wajah,
atau tangan. Akibatnya, objek diakui sebagai terpisah dari diri hanya pada saat-
saat kebutuhan sehingga, setelah kebutuhan puas, objek tidak lagi ada-dari
(subjektif) titik bayi pandang-sampai lagi kebutuhan muncul. Selain itu, dari
perspektif bayi, hubungan ini tidak ke objek tertentu (atau bagian-objek)
melainkan untuk fungsi dari objek memuaskan kebutuhan dan kesenangan yang
menyertai fungsi itu. Hanya ketika tertentu objek-yaitu, seluruh objek-menjadi
penting untuk anak sebagai fungsi kebutuhan-memuaskan bahwa ia melakukan
yang satu dapat menganggap perkembangan anak sebagai bergerak melampaui
tingkat hubungan kebutuhan-memuaskan menuju pencapaian yang dari objek
keteguhan.
Penggarisan
Selama periode ini, anak dengan usaha secara bertahap membedakan dari
matriks simbiosis. Tanda-tanda perilaku pertama diferensiasi tersebut tampaknya
muncul di sekitar 4 atau 5 bulan usia pada titik tinggi dari periode simbiosis.
Tahap pertama dari proses diferensiasi digambarkan sebagai "menetas" dari orbit
simbiosis:
Pelatihan
Masa berlatih yang tepat ditandai dengan pencapaian gerak tegak gratis.
Hal ini ditandai oleh tiga perkembangan yang saling terkait yang berkontribusi
pada proses terus pemisahan dan individuasi. Ini adalah (1) cepat diferensiasi
tubuh dari ibu, (2) pembentukan ikatan khusus dengan dia, dan (3) pertumbuhan
dan fungsi otonom ego-aparat dalam hubungan dekat dan ketergantungan pada
sosok keibuan.
Persesuaian
Dia sekarang menjadi lebih dan lebih sadar, dan membuat yang lebih besar
dan lebih besar digunakan, keterpisahan fisiknya. Namun, berdampingan dengan
pertumbuhan fakultas kognitif dan diferensiasi meningkatkan kehidupan
emosionalnya, ada juga memudarnya terlihat dari imperviousness sebelumnya
frustrasi, serta berkurangnya apa yang telah terlupa relatif terhadap kehadiran
ibunya . Peningkatan pemisahan kecemasan dapat diamati: pada awalnya ini
terutama terdiri dari rasa takut kehilangan objek, yang akan disimpulkan dari
banyak anak