NEO ANALYTICAL MOVEMENT:

Talks about the criticisms of Freud’s Psychoanalysis.

Psychodynamic ideology = Freud Psychoanalysis + neo analytics

Ramona v Isabella (1994)

Case related to repressed memories.

Ramona was the patient and in the course of treatment recalled memories. Psychoanalysis stresses on childhood
experiences and memories.

2 Parameters influencing the neo analytical movement:

1. Rejection of repression: repressing has an aim attached to it and is motivated forgetting.

2. Motivated unconscious: elements in the unconscious have their own motivations and serves its own goals
which is not recognised by the conscious.

The cognitive unconscious is a part of the personality where we lack control. The neo analytical movement
rejected this idea, it agrees that there is an unconscious mind but rejects the idea of complete autonomy of
that mind. It is simply the elements of the mind we are not conscious of. It was the nature of the
unconscious that was rejected not the existence of it. Even the seemingly negative nature of the unconscious
was rejected. Eg: Automatic actions like walking.
3. The cognitive unconscious is also governed by the rules of conscious reality and conscious experience as
well.

Not all forgetting carries a memory that was anxiety provoking or traumatic in nature.

There is a reverse effect in psychoanalyst’s approach where the patient may believe that there was necessarily a
traumatic event in the past which may lead to the creation of false memories.

There is also a confirmatory bias involved. Pre set notions of the therapist may influence suggestibility and may
result in recovery of memories or creation of them in the client.

Erikson is the one of the chief proponents of the neo analytical movement. Humanistic theorists borrows concepts
from the psychoanalytical theory. It just appeared skewed and deviant when Freud presented it.

1. Ego Psychology: Usually all the concepts are Id centred. Ego psychologists look at the strength and expression of
the ego.

Erikson also talks about stages of development of psychology. There is an unresolved conflict at every stage and on
the way and when it is resolved affects the subsequent stages.

The idea of fixation: if the conflict is not adequately resolved and is fixated in the early stage of development and will
display immature conflict resolution tendencies in the future.

Differences:

1 . Freud proposes that development is over by 5-6 years of age. But Erikson says that development spans out for a
lifetime.

2. Shift from Psychosexual (Freud) conflict to Psychosocial conflicts (Erikson). It’s not about channelling the libido or
psychosexual energy but how social relationships and conflict resolution plays out.

The first stage is Infancy  Freud was specific to the biological mother but Erikson proposed the primary caregiver
Freus said the id, ego and superego develops in the first 3 stages and Erikson’s first three stages correspond with the
same

But for Freud the personality development stops here but Erikson proposes that it carries on.

Adolescence comes with the phase of exploration and is followed by ‘moratorium’ which is a period where there is a
flux and self evaluation happens.

Erikson talks about identity foreclosure which results in the development of an identity that is moralistic and
conventional in nature when an adolescent doesn’t get to explore themselves. Exploration is deemed as necessary
as there is lack od grounding and no basis for why a specific attitude or identity was adopted.

Young adulthood (18 years-35)

Chief conflict of intimacy vs isolation.

Freud and Erikson both support fixation but Freud would say that first 3 stages affect the later stages but Erikson
proposes that it continues throughout all the stages. If Fixation happens early in life it affects conflict resolution in
the later stages. It is desirable to have fixation in a later stage like young adult as the personality has grounded by
them.

Adulthood:

Career and interpersonal relationships reach a level of stability. This is a point where there is stagnation and the
productive period starts. The main virtue is care

Maturity (beyond 50):

After the productive period and Erikson says that this is the time individuals prepare for death.

Rogerian theory also refers to self-theory and talks about how self-concept develops. Roger uses the term IFR
(Internal Frame of reference) is the subjective reality of the individual.

Humanists reject objective reality.

Rogers takes an ahistorical view of the self, because when he talks about the IFR it is about the present and the
present IFR that is independent of the past. What matters is how the present reality is appraised.

What is the self according to Rogers? We are all functioning based on the perception of reality. It is a differentiated
aspect within the phenomenal or perceptual field of an individual which represents the conscious experience of I and
me.

The self-concept can be of two types

1. The real self : what we actually are and we perceive ourselves to be at the current moment.
2. The ideal self : what we strive to be.

There is a congruence between the real self and the ideal self. The level of congruence decides how healthy or
mature an individual is. The greater the congruence, the more mature the individual is. This congruence is not rigid
and evolves with experience. Therapy focuses on maximising this convergence.

The self is configurational in nature.

Rogers used a Venn Diagram to represent ideal and real self.

How does the self develop in the first place?

When an organism is created, there is no self it is created through experience. The phenomenal field plays a role. A
non being exists when an organism is created. It’s a unitary all encompassed field at the time of birth with no sense
of the self.

The creation and surfacing of organismic value in process. There is an understanding that the self needs to grow and
develop. It encourages processes and experiences that aid self-actualisation.

The third aspect is the process of socialisation. Socialisation has 4 aspects

1. The need for positive regard

Socialisation marks the interaction between two or more different organisms. There is differentiation of the
self as there is more interaction. When there is a realisation that there is the self and other organisms then
there is a social need for positive regard which is the need to be evaluated positively by others in the
environment. The organismic value in process is replaced by this need for positive regard. The natural self
takes a backseat and the imposed self gains dominance. It is reciprocal in nature. It hinders the experiences
of people.

2. Need for positive self-regard

It is learnt in nature and surfaces from the internalisation of externally imposed systems. The way on e
values themselves is not determined by actualisation but by the regard imposed on an individual externally.
The greater the need of self-regard more the incongruence. Conditions of worth are the positive attitudes
that we expect from those in the environment and act according to this external environment to gain
positive regard. The behaviour of the individual gets contingent on the behaviour and expectations of those
around.

3. Conditions of worth
Imposed expectations are conditions of worth. Conditional positive regard is when an individual meets a
specific criteria that is not determined by actualisation. Rogers compares conditions of worth with blinders
on a horse because these conditions of worth are detrimental for the individual. This will result in
discrepancy between the self and experiences and this lack of congruency and discomfort manifests itself in
the form of anxiety.

4. Unconditional positive regard

When one is truly in touch with oneself. There are no conditions imposed on the individual. Accepting and
respecting the child irrespective of who the child is with discipline and reasonable expectations. Disciplining
the act rather than who the child is. 100% lack of conditionality and complete unconditionality cannot exist
as there can never be complete congruence between the current and realised self.

Selective perception of threat: Rogers

An individual is constantly selectively perceiving. The conditions of worth result in a certain construct of what the
self-constitutes and hence this affects the perception by selectivity. There is discomfort when there is a perception of
threat and selective perception and manifests itself as an emotional response which is anxiety.

Eg: In postpartum psychosis and depression, a mother was trying to drown her child and was charged with attempt
to murder. Psychiatric tests suggested that at that point of time auditory hallucinations were found that made her
perform the act despite no psychiatric history. The humanistic approach would explain this as a woman who went
through a stressful pregnancy but was socialised to believe that she was the caretaker of the chid and the conditions
of worth were imposed on this mother. She was ambitious and hence she was naturally inclined to have a
professional career but these conditions of worth imposed to be a mother would have manifested itself into this
psychosis. There was a complete detachment in the ‘self’ and the experiences of this woman. Her end purpose may
not be to kill the child but to end this mothering role and conditions imposed on her.
Defence mechanisms according to Humanism

1. Perceptual distortion
Distorting the reality in a way that it is in accordance with the selective perception and self-concept.
2. Denial
To completely deny the existence the experiences which are incongruent with our self-concept.

Defence mechanisms work when then the congruence is not much. But they help us cope with the perceived threat.
Compulsive use of defence mechanisms leads to neurotic conditions.

ANXIETY DISORDERS:

It is recognised by the DSM 5.

1. Phobic disorders
2. Panic disorders
3. Generalised anxiety disorder
4. Separation anxiety disorder
5. Selective mutism

Obsessive compulsive disorders have been moved out of Anxiety related disorders in 2013 and now there is a new
head as ‘Obsessive Compulsive and related conditions’ in DSM 5.

Until DSM 4 point 4 and 5 were under childhood related conditions and brought under Anxiety disorders because
separation anxiety disorder is seen in adults too.

There was a change in Panic disorder, Panic disorder was called ‘Panic disorder with or without Agoraphobia’. These
two have been detached that both don’t tend to occur together at all times so Panic disorder is the one put under
Anxiety disorder.

PTSD (read about it) (diagnosis and symptoms)

Aetiology (causes) of PTSD:

First condition is the experience of a traumatic event and this is a causal factor for PTSD.

Greater the trauma caused, the greater the chance that PTSD develops.

PTSD over a period of time, it was cleared that chronic sub traumatic experiences can also lead to PTSD and its not
necessary that a single experience causes it.

There is no criteria to decide what the traumatic experience could be as it varies from person to person. Eg: parental
discord, lower classes and financial troubles, child abuse etc.

A number of studies have been done on war veterans and soldiers. 2/3rd of them developed PTSD but the rest didn’t.
Some individuals develop it while some don’t and the reason is that simple exposure to the trauma is not the
deciding factor to determine if an individual will develop PTSD.

The reason is psychological + Physiological vulnerability in an individual varies in individuals. Some individuals are
more prone.

Vulnerabilities are simply psychological and biological pre dispositions.

Genetically some individuals are more vulnerable with the gene transfer which leads to mental disorders. Individuals
who have developed PTSD if they had an underlying anxious personality, or dependent in nature etc in general make
it conditions that are correlates of PTSD. It is likely that someone in the family had a mental condition.
Genes do not always trigger the manifestation of a disorder but trigger a certain environmental seeking behaviour is
determined by the genes and the gene environment interaction creates a situation which makes the individual more
prone to developing the disorder.

Psychological vulnerabilities:

A study was conducted by Basoglo and they studies the development of PTSD in victims of violence in Turkey. They
categorized the sample into two categories based on their history of activism and gatherings which were subject to
violence. The other set was the group of people who had no history of exposure to any kind of violence. Basoglo
compared there two groups of people as there was a lack of preparedness in the second group which made them
more likely to develop PTSD.

The first group did not develop PTSD because there was voluntary exposure and there was a built up resilience to
PTSD. It is the control one has over the trauma experienced is what determines the resilience to PTSD.

Psychological vulnerabilities are linked with biological vulnerabilities. Studies show that children subject to abuse in
childhood had a higher level of HPA System (Hypothalamus, Pituitary, Adrenal Cortex) and is dysfunctional with a
chronically higher level. Cortisol once released sends negative feedback to the hypothalamus when there is threat in
the environment. Hence, the trauma experienced by children creates a certain level of biological vulnerabilities along
with the psychological impact.

Research says that experience of some basic trauma is required to build up resilience and builds familiarity to higher
levels of cortisol and is required but when the trauma is extreme then It becomes dysfunctional.

After tests on rats, moderate exposure to trauma can alleviate the trauma and build resilience. Rats exposed to
human handling is deemed as a moderate trauma and the trauma alleviates after being in the safe space while rats
permanently separated from its parents made it more prone to developing trauma

Social Support Mechanisms

If there is a strong social support system it makes the individual more psychologically resilient.

Biologically and physiologically social support systems have an impact in development of resilience.

Eg: early separation from the parent figure can result in damage in the Hippocampus, higher HPA and chronic
anxiety. Social separation affects the size of the hippocampus (associated with learning and memory and selective
amnesia) and areas regulating emotions. There Is an alteration in the way the brain functions and leads to
physiological effects such as fear conditioning (always feeling afraid), learning and memory gets affected. These
alterations increase the chances in individuals to develop PTSD.

The problem solving strategy that an individual tends to apply is (a) Task oriented coping (b) Emotional coping
strategies.

Task oriented coping mechanism is a better approach adopted by individuals suffering from PTSD than the emotional
coping strategies. Emotional coping strategy is more internally driven and the kind of coping style determines the
proneness to the development of PTSD.

There is a personal pre disposition that an individual has and that also determines the form in which PTSD manifests
itself.

APPROACH TO DEAL WITH PTSD:

First line of treatment is Catharsis and giving ample space to the individual to express themselves. This catharsis and
the process of reexposure enables the individual to experience the trauma again but perceiving it in a therapeutic
sense. It is the process of converting the trauma into therapy and re-introduction to that trauma but with better
control and re guided which helps the person allay the feelings of negativity associated with it. It could be actual re
exposure or imagined re exposure. There needs to be caution in the practice of Catharsis as well as an initial and one
session catharsis can result in an overflow of emotions that ultimately may do more damage than good.
How has PTSD been used in context of law:

In criminal cases, as a defence PTSD is used in both civil and criminal cases especially for prisoners of war and
veterans. Insanity plea for PTSD has been granted in a very small number of cases. In criminal cases the defence has
not been very successful but in claim of damages and other civil cases compensation and in general there has been
more success.

A few important cases are:

1. Albertson Inc v Board of Workers compensation of Appeals (1982) (Cal.)

In this case damages were granted to an employee of a bakery for PTSD when the manager exuded derogatory
behaviour. The stress reaction is what is the main point and not necessarily a clinical diagnosis of a disorder per se.

2. Egeland v City of Minneapolis (1984)

A police officer sued the state department for claim for damages because the stress of the job caused a physiological
and psychological stress reaction. The stress caused ulcers and physiological disabilities and emotional distress in
terms of psychological disability. The claim was granted for only the physiological damage. The psychological one
was rejected because before entering the job and the police officer had knowledge that this was a high stress job.

The distinction drawn by the court between the physical and psychological distress caused is invalid according to the
psychological standpoint. This becomes problematic from a psycho legal standpoint. Another question was that what
constitutes as a valid stressor to go ahead legally.

According to the DSM the stress should be outside the range of normal experiences and in DSM IV this phrase was
removed. From the psychological standpoint it was welcome but in the legal view it was problematic because there
was a lack of definition for what constitutes a stressor and was recognized in

3. Means v Baltimore County

In this judgement the change in the DSM was recognised and it was said that any mental or occupational pressure
that causes distress and mental stress or disease can constitute a valid stressor. But again there was no clear cut
definition to define the same.

Another identified problem was that the causal link between the stressor and the psychological stress was not easy
to establish.

MOOD DISORDERS:

Most common type of disorder and gender differences play a major role. Women are two times more likely to
develop them. The moods experienced and its nature may be the same by people but the determining factor is the
severity and duration. In mood disorders there is no objectivity in diagnosis unlike disorders like Schizophrenia.
Dysfunctionality of the individual which is the determining factor to test severity. Mood disorders are always
episodic in nature. These episodes are separated by phases of normalcy.

There are 3 sub types

(A) Unipolar disorders (here there is fluctuation b/w normalcy and low) (mania can never occur and has only
depression)
This has a depressive spectrum
1. Persistent Depressive Disorder (PDD)
2. Major Depressive Disorder (MDD)
(B) Mixed Episodes
 Mood disorders are always episodic in nature. These episodes are separated by phases of normalcy. When the
manic phase and normal phase has very less gap or occur simultaneously which results in confusion and co
existence of the effects. These are mixed episodes.

(C) Bipolar (Manic depressive spectrum) (there is extreme highs/ elation and extreme low)
1. Bipolar

Fugue: it was listed in DSM 4 and was merged with dissociative amnesia in DSM 5. It implies amnesia as well as the
movement away from the original place of residence. One forgets autobiographical history, forgets their history and
starts living life as a different person.

It can last for a few days, a few weeks and even a few years. The fugue state may break and recovers their original
memory and has amnesia pertaining to the fugue state. It encompasses amnesia and defence Mechanism by
supressing. This is dissociative amnesia so there is only localised and episodic memory that has been forgotten.

Procedural memory remains intact along with semantic memory but memory pertaining to identity is forgotten.

DID:

It was known as multiple personality disorder. Till DSM 3 it was known as this and from DSM 4 it was changed to DID.
The reason it was changed was that there was a misconception relation to what it meant and was perceived as
having multiple personalities. There must be two distinct personalities. There is a complete difference in cognition,
behaviour etc.

The affect, the behaviour and the cognition (The A,B,C) are completely different in nature. These distinct
personalities are called alters and the original identity is called the “host” personality.

Sybil is a famous case.

Alters can also take the form of animals and even skill set may vary in each identity.

One explanation for the change in skillset and how in some cases people know different languages is collective
consciousness proposed by Carl Jung.

In most cases the host doesn’t know about the alters, the alters may have some knowledge about the host.

Ross has suggested 4 pathways to disassociation.

1. The pathway of childhood abuse: if the child faces trauma and due to lack of protection and develops a
protective system which results in the development of an alter which is the protector of the host.
2. Pathway of childhood neglect: accompanied by a companion. The alter serves the role of a companion.
3. Factitious pathway: the individual misusing the concept to attain some means. The individual is falsifying the
image oof DID to get some benefit.
4. Iatrogenic pathway: it is medicine induced which results in some disassociation. Side effects of heavy
medication and treatment.

De personalisation disorder:

There Is a transition in the name. In DSM 5 it was changed to de personalisation and de realisation disorder. There
is a loss of the sense of the self. They feel different and don’t feel like themselves. The body starts feeling different.
In severe cases the individual has a complete detachment from oneself and sees himself performing acts in a third
person perspective. It is a pure defence mechanism.
In de realisation there is difference in a way perception functions. There is an intangible, impalpable feeling to how
the external world is seen. Objects may appear more intangible and fuzzy. It could be a result of singular or chronic
trauma. Disassociation is seen as psychotic breakdown.

This is the borderline situation between psychosis and neurosis and if de realisation is left untreated it may result in
symptoms like hallucination etc.

Charlott D. ( 19 year old girl and went through a separation and she has experienced de personalisation and de
realisation ) (The therapist described it as experiencing spells in which her mind left her body and went to a strange
place and has had 4 episodes of the feeling of travelling during these episodes. Her arms and legs were not attached
to her body and other people seemed zombie like, this is a description of de realisation.)

SOMATOFORM DISORDERS:

Now it is called somatic symptom and related disorders (DSM 5).

There were 5 major conditions that were recognized in DSM IV but in DSM 5 there are 4

1. Somatic symptom disorder: It is a mergence of somatoform and pain disorder

2. Body dysmorphic disorders have been shifted to OCD.
3. Factitious disorders is a new condition that was added under DSM 5.

Somatic symptom disorder: it requires one or more somatic and bodily symptoms in an individual. Somatoform
symptoms results in bodily and physiological symptoms due to psychological causes and distress. It causes distress to
an individual and marked by excessive thoughts, behaviour and feelings associated with these somatic symptoms.
They can take specific forms such as resulting in excessive thinking pertaining to these somatic symptoms. A
symptoms or a set of symptoms need not be constantly present but the individual is constantly in a state of being
symptomatic for a period of at least 6 months.

There is a specifier that along with these symptoms there is predominant pain. This means that the individual is
constantly experiencing pain.

DSM 5 says that psychological pain is a universality and even if there is physiological pain there is always the factor
of psychological pain involved.

Eg: Aana O’s condition

2. Illness Anxiety disorder: it involves individuals who are pre occupied with their health concerns. There is no
physiological symptom per se but the individual is convinced that there is some underlying physical illness.
THERE IS A PRE OCCUPATION With the physiological health in the individual and this hampers the other areas of
functioning of the individual. Even reassurances fail to the convince the individual that there is something wrong.
There is also a high consumption of Over the counter drugs and there is excessive engagement in health related
magazines etc and feels that they are experiencing symptoms. There was a change in the nomenclature because
this describes it better.
3. Conversion disorder  now its called Functional neurological symptom disorder.

One or more symptoms of altered motor or sensory activity. This reflects an underlying neurological condition. The
neural system is not functioning the way its supposed to. The second requirement is failed to be accounted for an
underlying cause. It doesn’t fit into any medical condition per se and hampers the functionality of the individual. This
can take the form of sensory functions in an individual like tingling in the arms and body of the individual, blindness
for example but the medical tests may not show any problem yet the person may not be able to see. Paralysis in case
of motor functions.

Asteasia- Abasia which is marked by wobbly walking movements of the individual. This is a hampered motor function
if the individual. The medical test would show that everything is intact yet the individual may not be able to walk.
There is usually a marked lack of concern which an individual shows to his/her condition. This is because the
psychological distress in channelised into their physiological symptom so there is no residual anxiety left in the
individual which results in this lack of concern. Over a period of time if there is physiological dysfunctionality it may
manifest into an actual degeneration and deformity.

The third aspect is the selective nature of the symptom. Ex: In the case of Asteasia- Abasia when a person has
conversion disorder they may be normal while lying down without wobbly legs but this will not be the case when
they are walking.

The last aspect is that under hypnosis the individual regains control over the dysfunctionality and the symptoms tend
to vanish.

4. Factitious disorder: it implies a condition in which an individual fabricates a physiological symptom from the
standpoint of getting external benefits. Even when the external benefits are cut off the symptoms persist
because the end goal is then to obtain the concern of others. It is not the same as voluntary faking and the
individual is purposefully doing it, the individual has no control over it and is unable to control such behaviour.
Ex: Deliberately adding blood to a urine sample to show that there was some underlying problem despite there
being no such problem.

5. Malingering: It is not a disorder as recognized by the DSM but in as conditions that might be of clinical interest. It
is a condition where an individual falsifies physical symptoms for external gains and is a case of persistent deceit.
If it becomes a consistent pattern in an individual then this deceptive behaviour becomes a problem. Lying to
escape a criminal conviction with persistent deceit is malingering too.