COMMENTARY
Proposed models of psychodynamics and its therapeutic paradigm in Indian context
Swapanjit Sarma
Postgraduate Trainee, Department of Psychiatry, Gauhati Medical College Hospital, Guwahati, Assam, India
Abstract
The four basic psychodynamic theories are drive theory, ego psychology, object relations and self psychology. Constancy principle is withdrawal from excessive stimuli and discharge of accumulated excitation. Psychic energy is a purely quantitative capacity for work. Four basic assumptions in topographical model are psychological determinism, unconscious psychological processes, unconscious psychological conflicts and psychological energies. Topographical model is a dynamic “reflex arc.” There are three structures of psychic apparatus—id, ego and superego. Functions of ego include mounting of defenses – the signal anxiety. Defense mechanisms are under the administrative control of ego, modalities of handling “id” pressure and external reality. Transference is usually ubiquitous in all human relationship. Real relation is the realistic and genuine aspect of the therapeutic relationship. Technical aspects are free association, resistance and interpretation. Western emphasis on autonomy and independence as opposed to Eastern interdependence in familial context was forwarded by Neki in 1977. According to the Indian heritage of psychodynamics, the psychic apparatus consists of manas (mind/perception), buddhi (intellect) and ahamkara (ego/self-consciousness). Emphasis was on honest self-appraisal. Existential psychotherapy is a concept of Rao in 1990 and according to him classical psychoanalysis is the most unsuitable for Indian population. Understanding of ethnical and cultural impacts upon individual and community psychology is of paramount importance.
Sarma S. Proposed models of psychodynamics and its therapeutic paradigm in Indian context. Dysphrenia. 2012;3(1):80-2. Epub 2011 November 9.
Keywords: Manas. Buddhi. Ahamkara. Classical psychoanalysis. Culture.
Correspondence: raak84@gmail.com
Received on 29 October 2011. Accepted on 9 November 2011.
What is psychodynamics?
Psychodynamics is the theory and systematic study of the psychological forces that underlie human behaviour, specially the dynamic relations between conscious motivation and unconscious motivation (Stedman's Medical Dictionary 2006). The four basic psychodynamic theories are drive theory (Sigmund Freud), ego psychology (Freud, Heinz Hartmann, Carl Jung), object relations (Freud, Melanie Kleine, Ronald Fairbairn), and self psychology (Heinz Kohut).
Theoretical evolution of Freudian psychodynamics
In "Project for a Scientific Psychology" (1897), Freud describes mental functioning as a "reflex apparatus". Constancy principle is withdrawal from excessive stimuli and discharge of accumulated excitation. Some other principles are pleasure-unpleasure principle and reality principle. Nirvana principle is the tendency for lowest energy state.
Psychic energy and instinctual drives (German – Trieb)
Psychic energy is a purely quantitative capacity for work. Instinctual drives impose this demand for work on the mind. Instincts are psychical representation of stimuli originating from within the organism reaching the mind as a measure of the demand made upon mind for its work towards gratification. The two types are libido (mental manifestation of sexual instincts) and ego instinct (narcissistic instinct which leads to self preservation). Aggression as a separate instinct was a later concept. In "Beyond The Pleasure Principle" (1920), Freud extended the inherent duality of the instinctual theory to the final biological principles i.e. life instinct as eros and death instinct as thanatos.
Topographical model
The classic case of "Anna O" conceives the idea of repressed wishes and earlier traumatic memory where primary defense is repression. Conscious is neutral psychic energy i.e. attention cathexis. Unconscious is countercathexis, manifests as resistance. Four basic assumptions in topographical model are psychological determinism, unconscious psychological processes, unconscious psychological conflicts (root of psychoneurotic difficulties), and psychological energies (drive cathexis) which is displaceable and transformable quantity of energy primarily associated with the affect.
Dynamics of topographical model
It is a dynamic "reflex arc". Perceptual or sensory end is conscious. Intermediate region is unconscious storehouse of memories. Motor end is closely related to the preconscious. Topographic regression is reversal of "flow of energy" as in sleep / dreaming and external frustration / neurosis.
Structural model
There are three structures of psychic apparatus as distinguished by their functions. Id is pleasure principle and primary process thinking. Ego is reality principle and secondary process thinking that mediates between instincts and the outside world. Superego is ego ideal and "heir" of the Oedipus complex.
Functions of ego
Control and regulation of the instinctual drives, mounting of defenses – the signal anxiety, sense of reality, reality testing, adaptation, object relationship, synthetic function, and autonomy of the ego.
Defense mechanisms
They are under the administrative control of ego, modalities of handling "id" pressure and external reality. There’re specific defenses in each stage of development e.g. narcissistic defenses are projection, denial, and distortion. Immature defenses are acting out, blocking, hypochondriasis, introjection, passive aggression, projection, regression, schizoid fantasy, and somatization. Neurotic defenses are controlling, displacement, dissociation, externalization, inhibition, intellectualization, isolation, rationalization, reaction formation, repression, and sexualization. Mature defenses are altruism, anticipation, asceticism, humour, sublimation, and suppression.
Psychosexual development and object relationship
They are concepts of infantile sexuality and "fixation". Oral stage is 12 – 18 months, anal stage 18 months – 3 years, urethral stage is transitional stage, phallic stage 3 – 6 years, latency stage 6 – 11 to 13 years, and genital stage 13 yrs and beyond.
Object relations
In oral phase, no breast causes frustration while mother's breast leads to satisfaction; nonavailability in hunger leads to self – external object differentiation. In anal stage, autonomy in toilet training occurs. As a result of ego not being developed fully, there is huge amount of ambivalence. In urethral stage, sense of autonomy is strengthened which develops competitiveness and ambition. In phallic stage, there are Oedipus complex / Electra complex and castration complex with resultant resolution of the Oedipus complex and development of superego, love object develops. Negative Oedipus complex is excessive internalization of the father and the child in turn may hate his mother. In latency stage and genital stage, there is elaboration of object relationships towards internalization of role models, teachers, spiritual guru, and more mature interpersonal relationship.
Further development of object relations theory
Erik Erikson further advances the theory beyond adolescence to death. Melanie Klein proposed concepts of part objects and whole objects. Projective identification is projection of one's intolerable past experiences or emotions unto another person; the recipient in turn behaves laden with the experience. According to Ronald Fairbairn, object relations are the capacity and function of the ego. The libido or instincts were regarded as essentially object seeking. Ego is present from birth and "as a whole", only during development it gets split into self and object due to early bad experiences in object–relations.
Further evolution of ego psychology
Heinz Hartmann considered that "ego" and "id" develops from a common matrix. "Conflict free area" is outside "id". Ego has primary autonomous functions. Secondary autonomy means that conflict free sphere can be enlarged to withdraw more functions from the dominations of "id".
Carl Jung's psychodynamics
The psychic apparatus consists of conscious, personal unconscious, and collective unconscious. Superficial rim is conscious. Middle rim of personal unconscious contains complexes – unconscious ideas associated with particular set of emotionally laden experiences. Deeper rim of collective unconscious contains archetypes – inherited capacity to initiate and carry out behaviours typical of all human beings, regardless of race and culture. Ego is also a complex.
Self psychology
Proposed by Heinz Kohut, self representation is a subordinate function of the ego. Self is seen as object and an object of an individual's inner experiences. Self as agent, a source of psychic integration and activity, is more in line with Freudian structural theory of ego. Origin of self in primary narcissism leads to grandiose self and idealized parental imago. Grandiose self ultimately leads to ambition, self esteem, and self confidence. Idealized parental imago ultimately merges with the evolving ego–ideal. In self objects, concept of the "self– worth" is reflected back by empathetic and caregiving others, most significantly mother, those who bolster one's positive attitude towards self.
Basic concepts in psychoanalysis
Analytic situation is the framework or setting in which the analysis occurs. Analytic process is process of the actual conduct of analysis. Analytic relation consists of transference / counter-transference, therapeutic alliance, and real relation. Transference is the displacement of feelings originally experienced toward significant people in one's childhood, usually parents, onto the person of the therapist. Transference is usually ubiquitous in all human relationship. Transference can manifest as a therapeutic relationship, as a substitute pathology e.g. transference neurosis and narcissistic transference, or as a general phenomenon. While libidinal transference is positive transference reactions, aggressive transference are negative transference reactions. There may be transference neurosis and transference psychosis. According to Kohut, narcissistic transference is the root of nontransference. Countertransference refers to the analyst's unconscious emotional needs, wishes, and conflicts that are evoked by the patient, brought into the analytic situation, and influence, usually negatively, the analyst's objective judgement and reason. Therapeutic alliance is task oriented collaboration between therapist and patient in which the therapist's aims are to form an alliance with the conscious adult ego of the patient and to encourage the patient to be a scientific partner in the exploration of his or her problems. Real relation is the realistic and genuine aspect of the therapeutic relationship.
Technical aspects
They are free association, resistance, and interpretation which is a method used by the analyst to help the patient understand his / her resistance to spontaneous self-awareness and further advancing the analysis.
Therapeutic paradigm in Indian context
Historical perspective
"The concept of repression" was given by Girindrasekhar Bose in 1921. There were theory of opposite wishes and theory of primary femininity i.e. resolution of castration complex. Indian Psychoanalytic Society was formed in Calcutta in 1922. The trend was on decline after World War 2.
Points of disagreement
They were concept of infantile sexuality and Western concept of religious experience as psychopathology, compromise, and reaction formation. Western emphasis on autonomy and independence as opposed to eastern interdependence in familial context was forwarded by Neki in 1977. There was social distance between the doctor and patient. Verma in 1982 advocated religious belief in rebirth and guilt associated with misdeeds in past. Family influence in decision making was another point of disagreement.
Indian heritage of psychodynamics
The psychic apparatus consists of manas (mind / perception), buddhi (intellect), and ahamkara (ego / self-consciousness). Bhagawat Gita is considered as the great book of psychotherapy. Therapeutic model emphasized on cognitive therapy. Emphasis was on honest self-appraisal.
New therapeutic paradigms
Neki in 1977 proposed "guru–chela" relationship. Paradigms for illiterate populations were given by E. M. Hoch through psycho-drama, role of "pirs" and "faquirs".
Recommendations
Neki recommended family therapy, at least one or two sessions with family in other forms of therapies. Short term supportive therapy was formulated by Verma and Ghosh in 1976. Existential psychotherapy is a concept of Rao in 1990 and according to him classical psychoanalysis is the most unsuitable for Indian population.
Conclusion
Since Freud, ways to explain dynamic interactions in human mind has travelled a long distance. Integrated approach considering realms of intrapsychic conflicts, intersubjective and relational, and behavioural approaches are widening the scope of psychotherapy. Understanding of ethnical and cultural impacts upon individual and community psychology is of paramount importance in devising more acceptable therapeutic interventions.
Further Reading
Gelder MG, Andreasen NC, Lopez-Ibor JJ Jr, Geddes JR, editors. New oxford textbook of psychiatry, 2nd ed. Oxford: Oxford University Press; 2009.
Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock's comprehensive textbook of psychiatry, 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
Indian J Psychiatry.
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