Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life

CHAPTER 3. A Structural Approach to Understanding Psychopathology

3 A STRUCTURAL APPROACH TO UNDERSTANDING PSYCHOPATHOLOGY OBJECT RELATIONS THEORY and Self Psychology link psychopathology to adverse conditions in the childhood home that inhibit the maturation of key structures in the psyche. The immaturity of these structures, along with the disintegration and disharmony among them that is the result of ongoing abuse and neglect by parents, makes normal functioning impossible . The structural approach to understanding psychological dysfunction has greatly increased our understanding of the identity and self-esteem problems that trouble modern man, and that so severely afflict children who grow up in alcoholic homes. The unique contributions of this perspective are probably best understood by comparing it to classical notions concerning the etiology of psychopathology. Freud's Topographical Division of the Mind The psychic topography proposed by Freud in 1923 is a part of the bedrock of professional and popular psychology. The concept of an interplay between id, ego, and superego is so deeply A Structural Approach to Understanding Psychopathology 15 embedded in our notions about the structure and function of the human mind that it now not only dictates the clinical posture of psychoanalysts, but must surely also exert subtle and not-sosubtle influences on the behavior of a generation of other mental health professionals, many of whom may have had only the most rudimentary exposure to Freud's original works. Freud's attempt to differentiate a set of psychical agencies had, as an integral component, the idea of a conflict among these agencies. He saw the id as a chaotic entity, filled with energy from the instincts and found it to be inevitably opposed to the interests of the superego, which is founded upon internalizations of parental prohibitions, demands, and judgments. Although Freud's view of the ego was a complex one that changed over time, he saw it mainly as a representative of the whole person, responsible for mediating between the pressures exerted by the id and the superego. He believed that the ego has certain functions at its disposal which enable it to perform the critical and difficult task of assuring the individual a reasonable degree of safety and pleasure in the world. He thought that these ego functions include reality-oriented operations such as the capacity for rational thought, and the ability to perceive and act upon stimuli, and that they also enable the individual to perform certain defensive maneuvers against unpleasant realities and troublesome instinctual demands. Since the ego plays such a prominent role in assuring the survival of the individual, Freud's immediate followers, as well as more contemporary analytic thinkers, have been most interested in refining and extending this concept. They have investigated the nature of ego development as well as the range of ego functions, and have tried to identify and describe important structures within the ego. Freud originally described the ego as a part of the id which develops in response to the individual's perceptions of the external world and its demands that the expression of the instincts be subdued and modified (Freud [1923] 1962). Freud also 16 Children ofAlcoholism thought that the individual's perception of bodily sensations plays a crucial role in ego formation; that, in fact, the ego could be regarded as "a mental projection" ofthe body's surface (Freud [1923] 1962, 16 footnote 1.) The idea of the ego as a ((projection" into the psyche of bodily sensations and other aspects of external reality has served as a wellspring for certain analytic thinkers who have studied the ego and other aspects of psychic structure and have tried to describe the process by which they are formed. In their investigation of the important external realities that influence the development of psychic structure, many of these theorists have emphasized the human realities that the individual encounters during infancy and childhood; that is, they have been interested in the relationship between the psyche and its "objects." The Development of Psychic Structure: Object Relations Theories Freud used the term ((object" to refer to the individual upon whom a sexual or aggressive drive is discharged (Freud [1915] 1959, 65). The idea that an object can be more than an external phenomenon, that it can actually come to reside within the psyche and alter the condition of the ego, was advanced somewhat later, in 1917, when Freud discussed the psychology of melancholia . Here, he proposed that the "shadow of the object" can fall upon the ego (Freud [1917...