Psychoanalytic Theory. Psychodynamic Theories of Health and Illness. Freud s Theories. Charcot Treating Hysteria

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1 Psychoanalytic Theory Psychodynamic Theories of Health and Illness Sigmund Freud ( ) Vienna, Austria Studied Medicine at University of Vienna Specialized in Neurology Not well differentiated from Psychiatry Trained with Charcot in Paris Hypnotist Specialized in hysterics Charcot Treating Hysteria Freud s Theories Unconscious events influence psychic life Unconscious & Conscious forces determine: Mental Events Experiences Behavior Many physical symptoms are caused by psychological conflicts

2 Freud s Theory of Personality Id, Ego & Superego Three aspects of most internal (neurotic) conflict This conflict is almost always repressed The Superego Arises out of resolution of the Oedipal conflict Values & Ideals of Society The Id As conveyed by parents Punished behavior becomes Conscience Rewarded behavior becomes Ego-Ideal True psychic reality Source of desire for immediate gratification No values, ethics, or logic Obeys the pleasure principle Contains instinctual urges The Ego The Executive Function Organized & Rational Defers Gratification Mediates between Id Superego Outer World Obeys the reality principle

3 Generation of Anxiety Id presents ego with an unacceptable wish Ego perceives danger associated with expression of the wish Superego reinforces danger perceptions Defenses are mounted against the wish Balance is struck between wish and defense Defense Mechanisms Sublimation Manifesting an unacceptable impulse in socially acceptable ways Violence - Surgery Denial Very commonly used Defense Mechanisms Repression Involuntary forgetting of a painful feeling or experience Reaction Formation Expression of unacceptable impulses as directly opposite attitudes and behaviors Disturbing sexual urges! extreme prudishness Intellectualism Maintaining focus away from the emotional aspects of experience Wish-Defense Compromise Takes many forms Symptom Character trait Character style Inhibition

4 Early Psychosomatic Medicine After Freud Modern Theories Kobasa: Health & Hardiness Pennebaker & O Heeron: Stress & Coping Peterson & Seligman: Learned Helplessness Spiegel: Emotional Disclosure and Health Temoshok: Type C Personality and Cancer Stoicism, niceness, perfectionism, conventionality Emotional repression Helplessness-hopelessness Deutsch (1922, 1924) Psychodynamic processes affect life in 2 ways Behavioral Direct effects on organ systems Franz Alexander (1943) Psychosomatic specificity Repressed emotions linked to specific physical symptoms Legacy of Freud

5 Psychodynamics Repression remains prominent as an explanation for physical and psychological distress Repression can lead to active suppression of strong emotional expression Changes in immune function Discrepancy between self-reports of distress & physiological state Modern Applications Type A Behavior Pattern Risk factor for heart disease Components Time urgency Orderliness Hostility Irritability with interruptions Hyperalertness Modern Applications Type A Behavior Pattern Anger & Hostility appear to be most important Predictive relationship between hostility and atrial fibrillation in men (Eaker et al., 2004) Modern Applications Type A Behavior Pattern: Evidence is mixed Type A increases exposure to potential triggers, rather than materially affecting the process of atherosclerosis Gallacher et al., 2003

6 Modern Applications Scriptotherapy Pennebaker, 1995; Smyth et al., 1999 Disclosure relieves the anxiety and physical stress of repression Interventions using writing about traumatic experiences Immune function and symptoms decreased in asthma & rheumatoid arthritis Critiques of PA/PD Theory Deterministic & Pessimistic Motivation & behavior determined by mostly unconscious processes Personality fixed at puberty Emphasis on sexual and aggressive urges Anxiety is inevitable Constructs difficult to measure Not a good predictor of behavior

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