Psychopathology
Psychopathology
CADP ArticlesPalgrave Encyclopedia of the Possible, 2022
This entry provides an overview of the field of psychopathology -- including the theoretical and clinical study of an individual's abnormal psychological thoughts, feelings, and behaviors (symptoms) as well as the personal expression of such manifestations. The first section is a general discussion of the field of study, outlining the ongoing concerns for the limits of nomothetic vs expressive, idiographic psychopathologies. A contemporary history of the field is sketched revealing these conflicting approaches and the place of objectivity, subjectivity, and their resolution into simultaneous presence. Then the main theoretical constructs in this history which have risen to prominence are put forward as the structure of current psychopathology. The entry concludes by arguing that the relevant constructs are found in both a foundational manner in Alfred Adler's Individual Psychology and therein they play a synthesizing function in the application of psychotherapy today.
Keywords: Abnormal psychology, Personality disorder, Neurosis, Psychosis
DEFINITION
The traditional etymological structure of "psychopathology" offers an intriguing first sense of the word: psyche / pathos / ology --> the mind's / suffering / under study conditions. The scholarly definition provided by a national psychological association, however, captures two central characteristics that will be covered in this entry:
1. The scientific study of mental disorders, including their theoretical underpinnings, etiology, progression, symptomatology, diagnosis, and treatment. This broad discipline draws on research from numerous areas. The term in this sense is sometimes used synonymously with abnormal psychology;
2. The behavioral or cognitive manifestations of such disorders. The term in this sense is sometimes considered synonymous with mental disorder itself (APA 2015, https://dictionary.apa.org/psychopathology, italics added).
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INTRODUCTION TO CURRENT PSYCHOPATHOLOGY
Correctly implied in the brief definition above, psychopathology is an enormous field of research that assesses thoughts, feelings, emotions, personality, and experiences of individuals, groups, and communities in their abnormal manifestation. Concise categories, however, cannot capture the activity involved in attempting to understand and explain human beings -- well or ill. While categorization of the abnormal is a well-acknowledged phenomenon within the field of psychopathology, persistent efforts to delineate the meanings and objectives of psychopathology without seeing its relationship to mental health are difficult or impossible. To look at behavior and diagnose it as abnormal will have either an acknowledged or unacknowledged concept against which the abnormal is being measured. It is like trying to define one end of a continuum with no awareness of the other end. This problem pervades psychopathology even currently and will be traced through the field's development.
Contemporary psychiatric authors strive to make psychopathology both useful and precise by developing a consensus that promotes the essential functions of psychopathology. The number of functions vary in the literature but typically include at least four proposals for psychopathology's chief purposes: (1) it is descriptive, in that it attends to the phenomenological experience of the person suffering psychopathology; (2) it is clinical in its linking the phenomenological with the classification (nosology) of psychopathologic experience; (3) it is theoretical by stipulating the foundational causes (etiology) of the psychopathologic experience; and (4) it is structural in its efforts to expose the meaningful coherence of psychopathologic experience (e.g., Cutting 2012; Schultze-Lutter et al. 2018; Stanghellini 2009).
Taken together, these specific functions of psychopathology give some breathing space to the main definition's focus on psychopathology as scientific study and behavioral or cognitive manifestations. The study of psychopathology includes explanatory aspects such as nosology and etiology and the behavioral manifestations themselves involve understanding aspects such as empathic observation of the suffering individual and concern for the meaning of the suffering for that individual. Studying the manifestations and observing them within living beings can unearth connections between and among (1) experiences, (2) categorizations, (3) causal foundations, and (4) meanings of psychopathology -- all of which aim at healing the sufferer. In this way, we can say the study and observation of psychopathology generates the possibility of psychotherapy.
This healing possibility, as will be shown below, is implied all along the development of the discipline: from the coining of the term "psychopathology" (Emminghaus 1878), through that term being first comprehensively organized as human maladaptation (Janet 1938), and its direct appeal at understanding along phenomenological lines (Jaspers 1913). Yet, throughout its history, the study and observation approaches have clashed with the experiences of the suffering individual. That is to say, the sufferer has to some degree been neglected in studying the suffering. Up until the present discussion, the "newer and better" nosology attempts have objectively suffered from both reliability and validity issues (Kotov et al. 2018; Ross and Margolis 2019). Subjectively they have been distrusted by the lay public for overlooking the human person for whom they purport to be concerned (Davis 1997; Spiegel 2005).
Study approaches can consider both etiology (source of the psychopathology) and pathogenesis (development of the psychopathology), but when such models are applied wholesale to the workings of the mind, they lead to manageable-enough general classifications of symptoms, but when considering individual, unique human beings normal and abnormal are hard to determine. That is, when the human subject is conceived within a narrow, causal model for diagnosing illness, the model pays little attention to the phenomenology (subjectivity) and teleology (purpose) of the psychopathological experience (see Andreasen 2006). The treatment of mental abnormalities as diagnosable via a medical model that treats physical illnesses has given rise to an ongoing "critique of psychopathology" (Cutting 2012). In his own thoroughgoing critique, Cutting sees philosophical consideration as sine qua non for understanding the suffering individual which for him already involves functional (psychological) and organic (neuropsychological) analyses.
Schultze-Lutter and her colleagues (2018) concur, while expanding considerably the differentiated psychopathology approaches needing to cooperate on "equal footing" if science is "to succeed in understanding the underpinnings and mechanisms of mental disorders." They emphasize not only psychiatry, psychology, neuroscience, and philosophy, but genetics, epidemiology, computer science, and mathematics as well (p. 4), concluding that "contemporary research and clinic in psychiatry do not need less but rather more differentiated psychopathologic approaches in order to develop approaches that integrate professional knowledge and patients' self-experience ... ." (p. 5).
So, the critical approach to psychopathology prevalent today reveals an interdisciplinary perspective making it far more compatible with the "both/and" orientation of possibility studies. As this article unfolds, it includes appreciation of both the study approach as well as openness to observing the experience of suffering individuals. It attends to etiology but re-emphasizes the utility and benefit of teleology; it recognizes salient pathogeneticists but underscores phenomenological experience and the importance of the individual sufferer.
Following from the definition of psychopathology, both the study of psychopathology for classification purposes and observing and empathizing with the suffering individual are now addressed. The overview of classification concerns is interwoven with the growing possibilities for practical understanding of mental suffering as they emerged from the early frustration of how to apply early psychopathological knowledge to healing endeavors.
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CONTEMPORARY HISTORY OF PSYCHOPATHOLOGY
Psychogenesis vs Phenomenology
Before large organizations began sharing information and gathering it into classification systems, came the initial attempts to explain what was entailed in psychopathic behavior, what separated it from that of everyday lives, and notably, what might be done about it. The first professionally organized attempts at encompassing anomalous behavior was made by the World Health Organization (WHO) at the turn of the 19th to the twentieth century. In 1900 it first developed a taxonomy of illness and causes of death (Zhavoronkov and Bhullar 2015). It was nearly a half century later in 1948 that WHO offered its first definition of health (Huber et al. 2011) -- which was revised in 1984 (World Health Organization (WHO) Definition Of Health -- Public Health). One hundred and twenty years after its inception, WHO is currently developing the 11th edition of its International Classification of Diseases (ICD-11). Notably, the ICD-10 already includes 11 categories into which 200+ distinct mental disorders, psychopathologies, are classified.
At the same time as and alongside classification efforts by the WHO, an attempt was developed for explaining psychopathological behavior with the aim to cure it. In 1902, the budding psychotherapeutic discipline of psychoanalysis came into existence under the guidance of Sigmund Freud [1856-1939]. He gathered with three colleagues to begin discussing a promising treatment for human mental suffering. Suffice it to say for now, that psychoanalysis initially distinguished the severity of mental disorders by a three-way designation: psychosis, neurosis, and perversion (Laplanche and Pontalis 1973). The initial prognoses of such disorders intended to delineate the curability of each and to identify which were amenable to therapeutic (psychoanalytic) intervention (Freud 1910/1957).
Psychopathology's development eventually drew psychologists' attention to differentiating between thoughts, attitudes, and actions that hurt oneself and those that hurt others. The former retained the moniker, psychopathology. George Partridge [1870-1953] worked to clarify the latter issue, harming others, as involving the greater community (Partridge 1930). This evolved as the originally separate discipline of sociopathy (Whitlock 1987).
These early-modern attempts to organize psychopathological disorders are part of a long continuum of human attempts to explain and understand human foible. In a broader context, psychology itself is a name given to the oldest attempts at grasping motivational forces of individuals along with differential aspects that separate humans from other animals. Egyptians, Greeks, and later religions all sought to conceptualize the animating force of humanity. It is from them that designations of the terms "soul" or "psyche" gained philosophical currency. In this, psychology lagged behind the scientific curve in its development even until the eighteenth century, when the natural sciences blossomed. Early psychological understandings of the person, or of nature, were active among that century's philosophers, among whom Immanuel Kant [1724-1804] was exemplary. His was among the early, grand attempts at understanding human motivation. With the influence of his Critique of Pure Reason (1781), psychology would ultimately be considered a scientific undertaking at the close of the eighteenth and beginning of the nineteenth centuries. This was a long and arduous road toward scientific acceptability that would finally be acknowledged with the 1890 publication of Principles of Psychology by William James [1842-1910].
That philosophy first came in the form of the materialistic philosophy of the time, which insisted that everything could be explained by biochemical processes. The brain was considered something of a modified mechanical organ -- not unlike the eye, with its particular functions characterized accordingly. So, the original aim of a scientific psychology came to be the explanation of all behavior by mechanical principles. While of great interest to the growing scientific community, an explanatory approach did little to help understand either healthy or pathological mental life. These two perspectives would struggle with one another throughout the history of psychology.
Objectivity of Scientific Psychopathology
In the early 1800s, as natural science took center stage among intellects of the day and psychology was drafted into a scientific niche, treatment of psychopathological patients was consigned to institutions. Scientific growth of psychology notwithstanding, humane treatment of the individual sufferer would begin in 1793 when Philippe Pinel [1745-1826] was able to enact human reforms for his patients at the Salpetriere and elsewhere in France (Elkes and Thorpe 1967). Certainly, science was making advances on many fronts. Biochemistry could well explain individual activities such as enzyme activity and metabolism yet could not explain the maintenance of integrity -- that the whole precedes its parts. Organisms, it seemed, were a unity whose parts are subordinated to the laws of indwelling purposiveness (Wexberg 1929). For the first time, alongside the etiological (cause-effect) approach, the teleological view (goal-orientation) was reintroduced. Purely mechanistic explanations, while still working somewhat in biology, were not only faltering there but were no longer sufficient in psychology.
It was Gustav Fechner [1801-1887] who first developed a physiology of the senses. His approach was to develop divisions of psychic mechanisms into a catalogue of physiopsychology, namely, sensations, imaginations, feelings-emotions, will-desires, and so on. This was a revolutionary approach to the brain, yet try as they might, scientific attempts to apply this information to the complex behaviors of the mentally ill were failures.
It seemed that Fechner and his disciples could not satisfactorily explain subjective aspects of the individual. His physio-psychology (Fechner 1869/1966) was primarily speculative and remained sterile regarding classification of mental phenomena that helped deal with psychopathological behavior. As important as his Weber-Fechner law was (the observation that just-noticeable differences between two phenomena is in constant proportion of the original stimulus [More formally stated by Fancher 1996, that the stimulus must increase geometrically if the intensity of a sensation is to increase arithmetically]), it had little practical utility for teachers and physicians who needed practical application of psychological information. Further, anecdotal efforts at understanding human nature were attempted, but the available intuitive understanding of human behavior could not produce replicable insight. Some level of organized scientific method was needed, and the scientific, mechanistic explanations of physio-psychology were proving unsuccessful. The sought-after fully-psychological understanding of human behavior was yet to be formulated.
Subjectivity of Scientific Psychopathology
As medical treatment grew in importance, however, so did issues of mental pathology and the stimulus to understand behavior was to come from this newer focus on psychopathology. A small but determined number of researchers produced a shift away from physio-psychology and toward fully psychological explanations for the psychological problems. Jean-Martin Charcot [1825-1893] was experimenting with hypnosis as it related to hysteria -- which was still considered a brain phenomenon. At the same time, Hippolyte Bernheim's [1840-1919] use of "suggestion" -- controversial as it was (see Ellenberger 1970) -- posited the first recognized psychological, non-material motivation for behavior.
Having been a university assistant for Carl Gerhardt [1833-1902], an early leader in pediatrics, Hermann Emminghaus [1845-1904] is responsible for using the term "psychopathology" probably for the first time in his publication of General Psychopathology as an Introduction to the Study of Mental Disorders (1878). Emil Kraeplin [1856-1926] filled the chair of psychiatry that Emminghaus vacated in 1886 and devoted himself to revising the psychopathology classification system current in his day. Kraeplin focused not just on major psychopathological symptoms but to the patterns of symptoms (syndromes). Both Emminghaus and Pierre Janet [1859-1947] broke new territory in understanding developmental aspects of psychopathology. In assembling the first comprehensive explanation of psychopathological behavior (see Ellenberger 1970, pp. 386-394), Janet advanced the first therapeutically workable psychopathology theory. He observed individuals who experienced "splitting of the personality" (dissociation) that he believed was caused by dynamic emotional excitation. He described this as "psychic automatism" -- acts carried out mechanically without awareness. He described it as if the suffering individual were experiencing two souls living in a single body. Thus, he formulated the system in which an "unconscious" state was opposed to a "conscious" state.
Given Emminghaus' coining of the term in 1887, broad use of the term, "psychopathology" is most frequently attributed to Karl Jaspers and his 1913 publication of General Psychopathology. A guide for students, physicians, and psychologists. It was his insistence that suffering individuals be attended to especially in their self-expression of psychopathological experience. "Since we never can perceive the psychic experience of the other in any direct fashion, there has to be an act of empathy. Our chief help in all this comes from the patients' own self-description" (Jaspers 1913/1997, p. 56). At this point in its development, the cause for pathological mental phenomena was no longer seen as related solely to brain mechanics. Rather psychologists were dealing with an "unconscious" which eluded mathematical or chemical proofs. It could best be understood via professional interpretation. Thus, the hypothesis of dissociation between conscious and unconscious grew in favor and displaced consciousness as the primary seat of human behavior.
Wilhelm Dilthey [1833-1911], although considered to be an empiricist by many, brought out the importance of a first-person oriented "understanding psychology." Within the movement to develop a working psychopathology model, his approach opposed the prevalent third-person oriented "explaining psychology" which intended primarily to make the psychopathological conditions graspable and able to be shared and discussed objectively among concerned professionals. Dilthey's intentions were broader -- he aimed to make the findings of mental aberrations understood from the perspective of the clients. Thus, helping professionals could focus on the individual's specific suffering. This was specifically what the physiological, explanatory psychology had not been able to accomplish.
Dilthey represented the shift from solely objective data to a conceptualizing which included phenomenological data. Rather than the once prevailing physiology's focus on only objective material, now subjective experience was cautiously admitted. Knowing that stand-alone physiology had not worked and that a practical/usable psychology was needed, scientific exactitude, explanatory psychology, was by-and-large relinquished.
A culmination of understanding psychology was represented by Edmund Husserl [1859-1938] and his phenomenological approach. His "essential immanence" emphasized the indispensable unity and totality of immediate experience for understanding psychopathology. The consequence being that Fechner's older efforts at cataloguing experiences appeared as artificial divisions.
Also at that time, biological science was evolving away from materialism as the pure physiology model of nineteenth century. So, while psychology's original aim was to explain all mental activity by mechanical principles -- with its failure on the physiological level -- biochemistry as the familiar partner of mechanistic physiology began pointing in another, relativistic-biologic direction. Escaping this irrelevance, biochemistry better and better differentiated living from dead matter and, as a result, scientific interest turned to investigating living material. These investigations produced questions more fundamental to human life; those about organic material and about its biological phenomena, for example the process of regeneration in nature (e.g., tapeworm survival after vivisection) and the healing process in general. What grew to be a revolution in biology joined phenomenology in conceptualizing organisms as unities. As Smuts (1926) had conjectured philosophically and Goldstein (1934/1963) contended neurologically, maintenance of the integrity of the whole cannot be deduced biochemically. Each tissue and every organ seem to follow a law of the total organism.
At this point in psychopathology's development the default for understanding maladaptive mental symptoms was no longer physio-psychological a la Fechner and other like-minded objectivists. Rather than brain malfunction, it was conjectured mental symptomology that might have its own meaning and purpose -- at least to that organism. Psychopathologists were drawn to inquire under what circumstance maladaptive symptoms make sense. Taking a lead from the newly invigorated biological sciences by speaking of "organism unity," psychopathologists began to conjecture about unity within the personality. Still, "dissociative states" (Janet) and "psychic conflicts" (Freud) remained inexplicable and stood as a seeming contradiction of a unified personality. However, the more that was learned about biochemistry, the clearer it became that human behavior, normal and abnormal, would not be solved by finding a physicochemical formulae for organic activities.
Biochemistry, ultimately, could explain neither corporal nor mental vitality. If dreams and neurotic symptoms were not the result of biochemistry (i.e., imperfect brain functions), the question of "purpose" -- something following an internal guide toward a discernable end -- gained importance. Three influential psychologists more or less simultaneously offered their understanding of human purposive activity and its unique, phenomenological manifestation in individuals: from the depth psychological vantage point Alfred Adler [1870-1937], in his Individual Psychology (i.e., individual from German [and Latin] individuum implying an indivisible entity) posited an unconscious, fictional goal as the unifying element (Adler 1912/2002); from the individualistic developmental perspective Wilhelm Stern [1871-1938], within his Personalistic Psychology (Stern 1938) posited that the teleological nature of the individual accounted for the individual's differences from other individuals; and Kurt Goldstein [1878-1965], from a psychopathological emphasis via his comprehensive, systems focus on "the organism" (Goldstein 1934/1963) illustrated the purposiveness of behavior as individual organisms striving toward actualization of the organism's nature.
Objectivity vs Subjectivity in Scientific Psychopathology
Yet, the general acceptance of the phenomenological would occur only after struggling with and digesting such subjective phenomena as "dissociations" and "psychic conflicts." The upshot of greater attention to such occurrences, however, did not immediately increase a search for understanding. Instead, it seemed to reinvigorate the explanatory impulse, for an objective psychological science. Early interaction of behavioral psychology, in the form of reflex theory, made its claim to objectivity by ignoring the subjective and claiming it simply did not exist. Enter Ivan Pavlov [1849-1936] and Vladimir Bekhterev [1857-1927], professional competitors on a theory of conditioned reflex, and Edward Thorndike [1874-1949] who adapted the reflex theorists' notions and principles to learning theory. Even the response notations among these major influencers (P R = perception followed by reaction; S R = stimulus followed by response) ignored the human, subjective factor (S O R = stimulus followed by organism followed by response).
John Watson [1878-1958] incorporated such themes into his broader development of behaviorism and a comparative method of applying to humans what had been applied to animals. The behaviorist researchers and theoreticians carried out classical observations and experiments with a pledge to ignore or deny the subjective side of the results. This drive for objectified psychology and its therapeutic application culminated in Burrhus Frederic Skinner [1904-1990] and the behavior modification phenomenon. To provide ascendancy to an objective psychology, behavior modification asserted objective reasons for subjective phenomena it tracked, largely explaining such phenomena as self-deception (Skinner 1948, 1971). The effort held sway in psychology and psychopathology for several decades, but also provoked resistance that set a perpetual stage for a new subjective approach to psychology.
By his own standards, if not by those of behaviorism, Sigmund Freud also lent a hand of sorts to the quest for an objective psychology. He came to explain subjective behavior by developing several of what he considered "objective criteria" among his psychoanalytic concepts. He reworked Janet's dissociation of personality to be understood as the expression of the personality within that individual's conscious and unconscious systems (Wexberg 1929). This system freed Freud to focus more on the content of therapeutic observations, rather than gathering the content together in categorical forms. By seeking causes within the unconscious content (patients' expressions), he believed he had established laws of explaining how abnormal outward, conscious conduct derived from unconscious activity of the mind. In this sense, for the first time, a framework of psychopathology (qua psychoanalysis) was able to provide psychologically determined explanations for psychological occurrences. For example, "slips of the tongue" (a categorical form of psychic activity) were no longer explained by brain fatigue but were seen as linked to painful or unpleasant memories (the content of specific psychic activity). Freud believed he had found the bridge between subjective and objective psychology. He likely maintained this belief even as his later writings became more speculative and narrative -- exemplified by his Moses and Monotheism (Freud 1964/1939). Therefore, it was only in the last decade of the nineteenth and dawning of the twentieth centuries that wholly psychological interventions, rather than physiological interpolations, were applied to dealing therapeutically with psychopathological behavior (Ellenberger 1970).
Thus, the nucleus of the dynamic individual was found in psychological movement which could produce mental activity to accomplish some purpose of the individual. This is the undisputed, noncontroversial contribution of Freud -- despite many controversial positions he took on the etiology of psychopathological behavior over his long career of developing psychoanalysis (Sulloway 1979). As the subjective-objective groundwork took root, the first half of the twentieth century gave rise to the flourishing of three grand theories of psychopathology and psychotherapy: Psychoanalysis (Freud); Individual Psychology (Adler) and Analytic Psychology (Carl Gustav Jung [1875-1961]). All of these stayed intact and operative despite technological advances (Munroe 1955), an onslaught against phenomenology initiated by behaviorism, the rise of evidence-based medical and psychological standards of practice, as well as the contemporary burgeoning of neurobiology and neuropsychology following "the decade of the brain" (Jones and Mendell 1999).
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SUMMARY OF THE HISTORY OF PSYCHOPATHOLOGY
Once the long wait for applied, effective psychologically pertinent interventions was ended, the would-be practitioners -- physicians, clergy, educators, and other professional helpers -- had at their disposal an approach to relieving the suffering shaped by psychopathological thoughts, feelings, and behavior. The long wait involved its own dynamics, fostering the evolution of a puzzling number of old and new psychopathological anomalies and the ability to address current issues (e.g., "war neurosis") in new ways. It was not just the therapeutic techniques that changed, but the nomenclature surrounding such maladies. Dementia praecox, neurasthenia, hysteria, and the like all developed more specificity as the therapeutic interventions (medicinal and interpersonal) were found incrementally more effective.
By mid-twentieth century the booming psychotherapeutic response linked to the improvement of psychopathology saw the rise of other theories (e.g., humanism, cognitive-behavioral therapy) and still later, over 200 separate approaches to treat the most frequently occurring maladies of the given decade. Remarkably few of the theories and techniques developed their own expansive theories about the nature of the human being. What anthropologies existed -- Freud's psycho-sexual approach, Adler's psycho-social approach, and Jung's psycho-spiritual approach -- addressed the most varied human characteristics, articulate human development over the evolution of the species, and could be applied with the intention of healing the widest variety of maladaptive behavior encountered today. Each of the 200+ newer approaches rely on one or the other of the three foundational psychopathological-psychotherapeutic models for their basic outlook on which is constructed the new, specific technique addressing the problems at hand (see Ehrenwald 1976).
Questions arise about the actual theoretical characteristics of today's therapy models and whether they utilize anthropologies that are a combination of the grand three or are otherwise constituted. This is a complex enquiry that touches on the entry's opening concern about scientific study and behavioral or cognitive manifestations. Still, the most important issue for the field of possibility studies -- shared by the major critiques of the psychodynamic approaches (Munroe 1955; Glover 1950; Holt 1989; Jacoby 1975) -- is the ability of any theory to synthesize a vast amount of current scholarship about the nature of psychopathology, to provide a coherent understanding of it, while maintaining an eye toward individual healing. This concern is addressed in the following section.
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THEORETICAL CONSTRUCTS OF CURRENT PSYCHOPATHOLOGY
What then are the philosophical/theoretical characteristics that form a basis of existing psychopathology and psychotherapy? What can be gleaned from the previous perusal of history? There are at least four broad characteristics that prevail today and have been part of the development of psychopathology since Emminghaus', Jaspers', and Janet's insisting that the experience of the suffering individual be the focus of any system that aims to explain and understand such mental suffering. Alongside these characteristics -- phenomenology, holism, teleology, and social embeddedness -- there is a striking absence (avoidance?) of what is meant by mental health. The common characteristics will be described here before offering evidence of their ubiquity in today's therapeutic milieu which by-and-large, despite current psychopathology practices, subscribes to a model of wellness in providing psychotherapy.
Phenomenology has been brought forward as a necessary condition for a valid psychopathology throughout this entry. Due primarily to the influence of Karl Jaspers, psychopathology and psychotherapy today focus on the structures of individual experience, or consciousness -- both in its aberration and its healing. Literally, phenomenology concentrates on things as they appear in the patient's experience and provides meaning to things within that experience. This definition alludes to other closely related psychopathological strata, such as the subjective nature of one's own mental activity giving rise to an individual experience rather than one that is shared or communal, with little adherence to or awareness of an external, objective truth; an idiographic approach to life which gives credence first to the subjective nature of uniqueness over and against a generalizable outlook being considered preeminent; and an existential starting point of the experience, viewing the human subject not merely as thinking, but as a living (thinking, feeling, and acting) and vulnerable human individual.
Holistic experiencing of reality is another characteristic of current psychopathology/psychotherapy assessment and interaction. The originator of the concept of holism, Jan Smuts (1926) described the holistic perspective as life consisting of various interacting systems (e.g., physical, biological, social) each of which are whole and function unto themselves. Simultaneously they are also part of larger interactive wholes that join force to accomplish activities which the separate systems cannot attain.
Teleology, once disregarded as merely a philosophical perspective, is appreciated in psychopathology as an understanding of behavior as a function of its end, purpose, or goal. Within psychopathology it contrasts with etiology which references the psychogenetic cause of a malady. Teleology and etiology are understood today to be inseparable aspects of how a sickness starts and what course it naturally runs. The advantage of a psychological understanding of teleology is that it provides consideration of the cost-benefit ratio of so-called secondary outcomes that manifest in the psychopathologic experience. At the same time, the future orientation emphasizes the possibility for healing within that future -- and so is coupled to issues of wellness.
Social embeddedness of individuals is being newly affirmed in neurological imaging, notwithstanding the subjective and individual experience of life. Now given credence in interpersonal neurobiology as the "mirror neuron" system is studied and understood, being wired for connection with others (Siegel 2020) helps grasp what is regularly manifested in family and community structures. Allusions have been made throughout history of the dignity of the human person in fellowship with others that it is not tenable to postulate society as if it confronts the individual. The individual is social being; individual human life and species life are not different things (Adler 1994).
While these four characteristic ways for perceiving reality contrast mightily with the perceptions of the pathologically suffering individual, it is by utilizing such an outlook that the therapist or pathologist can locate the sufferer within coordinates that simultaneously provide a structure for the extent of the illness, conjecture about the perceptual model used by the patient, as well as offer a way back to relative health. The four characteristics represent a therapeutic confluence of healing factors that finally gained traction in the earlier history of psychopathology. And while the distinction between categorizing and observing became clear enough, the co-equal importance of each characteristic is only now being recognized, nearly a century after the impetus of therapeutic interventions for healing psychopathological conditions.
For much of the developmental history of psychopathology, describing and explaining the problem was seen as disconnected from the intention of understanding; objective observation was seen as superior to subjective experience, the former was considered a scientific necessity while the latter was often considered a scientific nicety. Freud became an unwitting bridge between the objective and subjective approaches to human well-being. He believed himself to be firmly on the side of objectivity. He was, by James' (1907) formulation, "tough-minded," an empiricist and materialistic psychologist. For MacKinnon and Maslow (1951), "Freud rested squarely on 19th century scientific theory in his reductionism, his tendency to analyze, to dissect, to dichotomize" (p. 642). He, nonetheless, set forward the conditions under which an understanding of the mind involved more than measurable conscious cognitive activity. This was the door through which it became possible to bypass physiology and to psychologically understand psychopathology.
Ironically, it was Adler, Freud's first defecting colleague, whose temperament and theorizing was better prepared to embrace objective and subjective psychology simultaneously. His holistic "both/and" position better fit James' formulation (1907) of the "tender-minded" psychologist who was both idealistic and monistic in his outlook on an integrated reality. But defectors from Freud's school of psychoanalysis did not fare well -- a story that takes up volumes of history and psychology texts starting with Freud (1914) himself.
The salient point here is that in the development of psychopathology, the only two individuals who developed grand anthropological and psychopathological theories that remain today -- besides Freud himself -- were his first two dissenters, Adler and Jung. Neither originally intended to modify psychoanalysis; both believed the depth perspective allowed for different conceptualizations of the psyche. Historically, each found their theories developing while collaborating with Freud, yet both had initiated their views separate from him (Ellenberger 1970): Jung in an esoteric direction, Adler in the direction of social psychology. The distinctions among the "triple star" of psychodynamic practitioners cannot be overstressed, but here the Ansbachers' (1964) helpful overview will suffice.
Regarding Freud's field of inquiry -- the vast context from which he viewed psychopathological issues -- was based in human physiology. From here, he looked "into" the individual and sought to grasp the function of instincts as an intrapsychic issue. Adler, by contrast, contextualized psychopathology from an organic perspective: the individual (indivisible, holistic) organism was a complete functioning whole whose unified functioning occurred within the larger "organic" setting of culture. This viewpoint assumed that transactions between and among the individuals would provide evidence of both individual and communal psychopathology. Jung, for his part, was interested in what he considered a vast spiritual context where symbolism -- mental/spiritual and archeological -- could point to connections among peoples, and perhaps yield evidence of collective psychopathology.
From Freud's physiological field of inquiry, conflict became his frame of reference. Whether great or modest, all is in conflict: the death instinct conflicts with the life instinct; the superego conflicts with society; and, most fundamentally, consciousness conflicts with unconsciousness.
Adler's inquiry from within an organically interconnected field made his frame of reference the problem of cooperation within the community -- from social inclusion to social exclusion. Jung's intangible field of symbolism made his frame of reference similarly nonmaterial as he concerned himself with the impenetrable mysteries of life, the esoteric, and arcane.
Not surprisingly, the methodologies applied by the three facilitated their arrival at altogether disparate findings about the resolution of psychopathological issues. Freud emphasized that the conflictual human journey within society could be accomplished only by embracing the reality principle, a conscious containment of personal pleasures so that a modicum of harmony can rise among individuals and communities. Adler conjectured that the evolutionary impulse that brought the human organism together with others for protection and survival had progressed along a continuum starting from parent/child affection and extending to appreciation for and participation in community. He believed this feeling for community (Gemeinschaftsgefuhl), wherein both the individual and the community find mutual benefit, needed developing in all individuals. Jung saw the way to stable mental health by means of the lifelong individuation process -- a conscious effort of uniting the personal and collective unconscious to become aware of one's place in the largest context.
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ADLERIAN THOUGHT AND CURRENT PSYCHOPATHOLOGY
It may be clear from this comparison that in practical application the three systems are not equally parsimonious. Determining their application in the psychopathology sphere, Adler's was undoubtedly -- and deceptively -- simpler. Ignored or criticized for being simply ego psychology (Freud, 1914) it is, nonetheless, Adler's Individual Psychology which most expresses the outlook on psychopathology today with its phenomenological, teleologic, holistic, socially focused, wellness orientation. The largely unacknowledged infiltration of Adler's thought into current psychotherapy practices today has been outlined in the opening essays of Heinz and Rowena Ansbachers' three compilations of Adler's works (1956, 1964, 1978). [Note: These texts, prior to the publishing of The Collected Clinical Works of Alfred Adler (2002-2006), were the most accessible means to Adler's theory by English-speaking professionals.] They were not alone in their finding. Henri Ellenberger (1970), historian of psychiatry, contended, "It would not be easy to find another author from which so much has been borrowed from all sides without acknowledgment than Alfred Adler" (p. 645).
This not only pertains to current psychotherapeutics but was already underway upon the separation of Freud and Adler. As far back as 1917, when Adler's opus magnus, The Neurotic Character, was translated into English the actual development of therapeutic interventions strongly favored Adler's interpretation of psychopathology despite using Freud's nomenclature in psychotherapy generally (see Shon & Mansager, 2019). And it was an early follower of Freud, Fritz Wittels (1939) who determined that the neo-Freudians could properly be called neo-Adlerians. Ansbacher and Ansbacher (1956) identified nine prominent neo-Freudians whose position could be described as "stressing social relations rather than biological factors, the self rather than the id and the superego, the striving for self-actualization rather than the sex instinct, and the present situation rather than early experiences" (p. 16).
While there is not much mention of Adler among the psychoanalytic community at present, when the object relations theory of personality (Fairbairn 1954; Kernberg 1995) largely displaced the latent sexuality focus within psychoanalysis with a relational emphasis, even psychoanalytic authors could recognize Adler's social focus as an originating influence (see Borden 2015). Already in the 1960s, the humanistic psychology movement -- as "third force" in psychology's development after psychoanalysis and behaviorism -- became increasingly influential. It was then that Adler's understanding of human nature could be differentiated from the development of psychoanalysis (Maslow 1962) and be seen as a major influence on humanism itself. At the same time other theorists (see Rotter 1962) recognized Adler's contribution and summarized the obvious alignment of psychopathology and psychotherapy away from Freud and toward Adler's understanding: away from explaining behavior based on instincts, and toward a stress on the necessity and benefits of communal interaction (social embeddedness); away from considering sexual drive as a primary human determinant, and toward a more organismic understanding of a future-oriented human being (holism and teleology); away from the view of the person as amoral and therapy as a zone of "value free neutrality," and toward a view of the person as at least capable of being an autonomous moral agent and recognition of the tacit influence that values play in psychopathology assessment and psychotherapy (phenomenology and social responsibility). These shifts were strong and consistent enough to withstand applied scrutiny and criticism from the psychoanalytic community (Kernberg 2011), and reliably evident in the current psychotherapies that The Journal of Individual Psychology (JIP) regularly and effectively provided comparisons of psychopathology theory and clinical practice within its pages.
Beyond the proponents of object relations and self-psychology who emphasized the relational nature of humans (e.g., Kernberg, Kohut), and the humanistic psychologies who flourished in the presentation of growth potential (e.g., Rogers, Maslow), Heinz Ansbacher, an early editor of the JIP, and subsequent JIP authors have made evident the early and persistent connection of psychotherapeutic development with Individual Psychology:
Interpersonalists offered a primary alternative to the intrapersonal nature of psychoanalysis (e.g., Sullivan); feminists championed equality of sexes opposing Freud's contention that anatomy is destiny (e.g., Horney); social psychologies emphasized the context of larger interactions as not solely contentious as Freud did (e.g., Fromm); existential psychologies re-presented the mode of being as the subjective and phenomenological aspect of human integrity (e.g., May, Yalom); family and systems approaches addressed holistically intertwined interactions and transactions (e.g., Satire, Manuchin); the cognitive behavioral approaches (Ellis, Beck) developed a plethora of techniques for restructuring one's phenomenological, subjective outlook on reality (e.g., Ellis, Beck); constructivist theory has again brought forward the subjective impact in a wholly postmodern manner (e.g., Kelly, Berger, Luckmann); somatosensory approaches restate the holistic connections of the human being and its social interactions (e.g., Lavine); family constellations work with the positive-negative energy within systemic family bonds (e.g., Hellinger); emotion-focused therapy emphasizes the security of emotional bonding (e.g., Johnson); while polyvagal theory accentuates the social engagement system and the social embeddedness of the individual (e.g., Porges); and, interpersonal neurobiology presents social connections as hardwired into the human system (e.g., Siegel).
These instances of Adler's structural influence on both psychopathology and psychotherapy arguably have become most apparent within the Positive Psychology movement today and its developing impact on optimal health (Watts and Ergüner-Tekinalp 2017). Seligman and Csikszentmihalyi (2000) have inspired a commanding amount of quantitative and qualitative research which gives credence to its declaration of being the declared school which offers an alternative to the causal-medical model of psychopathology today (Kobau et al. 2011). Its own growing research findings have convincingly established that "negative" inquiry and approach to human behavior no longer have complete dominance within the field. This has been clarified in contemporary critiques so that the issue is less one of positive/negative and more of causal/teleological inquiry (Wright 2014; Lazarus 2003).
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FOUNDATIONAL STRENGTH OF ADLER'S INDIVIDUAL PSYCHOLOGY
Hopefully, the main philosophical underpinnings that are found though this entry's previous history-taking and current manifestation of psychopathology are now clear. Questions that remain are less about how the four constructs are presented in various psychotherapeutic approaches -- since they appear in all of them -- than about the extent to which each one is exhibited in each therapeutic methodology. Especially regarding current psychotherapies, the issue of resolving suffering begs the question: Within the whole of any given approach (psychopathology or psychotherapy), in what combination ("quantity" or "ratio") do the constructs appear?
It is in answer to this pivotal question that Alfred Adler again comes to the fore; not because he was the originator of any of these concepts or the first to include any one of them in his approach, but because his style of thinking -- indeed his entire style of living (see Hoffman 1994), seamlessly intertwined these perceptive schemata into a unique vision and understanding of humanity.
Adler was not the only theoretician or practitioner to address issues of phenomenology. As we have seen, others thought along these lines as well. Adler was not the first or only physician to holistically conceptualize his patients' suffering. Characteristically, Adler acknowledged his debt to Jan Smuts for Smuts' original conceptualization of the term, but other of his contemporaries were thinking along these lines. Of course, the teleological perspective is at least as old as Aristotle (Johnson 2005), and Adler was among a group of physicians who took their cues from organic life which could be seen restoring itself to a seemingly "planned" end-state long before DNA was hypothesized. Finally, the most noticeable battle in the psychodynamic outlook had to do with social embeddedness: was personal psychopathology an inwardly oriented or an outwardly oriented event? Adler was not alone in this arena either, nor can he be seen solely as Freud's adversary. The individual for Adler did not represent a dualistic, potentially antagonistically dynamic being. Instead, the two orientations -- inward and outward -- existed together, influencing one another, one taking ascendance if needed depending on the circumstances.
Adler's contribution was this solid positioning in the liminal place despite the cognitive dissonance engendered; and it led quickly and effectively to his ostracization among the original psychoanalytic community. By occupying a position on both sides of a boundary, he enlivened perceptions of humankind. Here, the internal dynamic of the individual is set within socially embedded circumstances -- with each boundary continually, and vigorously, influencing the other. This typical stance of his prevailed regarding pathological cause and effect as well. Both the starting point (cause), what Adler understood as the exogenous factor of a given psychopathology, and its ending point (effect) were relative to one another, to the individual and to the circumstance. In practice, this relativity did not result in ambiguous diagnoses. Rather, it was comprehensively decisive for the phenomenal individual. This is precisely the benefit of Adler's synthesizing approach to the unique possibility in psychopathological expression. He insisted on a distinction between the general and the specific diagnoses. The general diagnosis -- which all nosology seeks to provide -- focuses on categorical and systematic presentations of the symptomology. Current efforts to personalize such symptom-based nosology (Schultze-Lutter et al. 2018) remains bound in the general and cannot go directly in a healing direction. Only by including simultaneously the circumstances surrounding the individual, as well as the person's internal dynamic, can a specific diagnosis be rendered: a diagnosis which by its phenomenological focus, potentially reveals the unique healing procedure.
By its etiological orientation, the general diagnosis is not designed to heal but to provide the conditions under which the healing regimen can be determined and implemented. On the other hand, by its teleological orientation, the specific diagnosis focuses on the individual interacting with its environment (expansively understood), and presents the possible distortions of thinking, feeling, and interacting and suggests their purpose -- all of which are included in the healing process. In this context, teleology can be seen to have differentiated meanings regarding psychopathology. As "end" it can refer to the effect which follows a causal incident; and in this sense it is a relative end. Teleology can also reference the normal course an illness runs until it is finished, and death occurs, or health is restored as the final end. But from the phenomenological, holistic, teleologic, socially embedded perspective, it can also be the intended end which was conceived in some fashion from the outset. Such "intentionality" will have to be addressed below, but for now we have provided the warrant for Adler's Individual Psychology being considered as especially suited for presenting the contribution of possibility studies visa vie psychopathology. What is left is for the authors to highlight two of Adler's clinical concepts to demonstrate some positioning of the possible. This will be done by addressing how Adler's anthropology construed movement toward wellness within psychopathology.
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SUMMARY: SYNTHESIZING POSSIBILITIES OF CURRENT PSYCHOPATHOLOGY
In this section, the traditional concentrations of psychopathology -- both the assessment of thoughts, feelings, emotions, personality, as well as the resulting experiences -- are introduced under Adler's construct of expressive, dynamic, psychological movement (Stein 2014; Stern 2010). Adler conceived of organic life generally as movement from a minus position(-) to a plus position (+), from a state of incompleteness to a striving for completion.
For Adler, our human experience of life, meaning the psychic life, flows from the organic life and the striving from minus to plus. He famously described this movement as striving from a felt inferiority to a fictional superiority. Both concepts of inferiority and superiority were generally neutral except in the valuation (feeling tone) of the individual. Thus, the movement toward superiority over challenges in life was frequently termed "mastery" or conquering the adversity. When one's striving movement aimed at becoming superior to another individual, however, it was usually termed "power over" the other. In this way the impetus to move, to strive, was stimulated by the sense of inferiority. This understanding of the innate power-distribution of humanity became a truncated cliche about Adler's method among detractors within the psychoanalytic schools (Jones 1955).
In fact, Adler's theory continued to develop after leaving Freud. It was likely due to his treating frontline soldiers during the First World War that Adler began to think of the direction of the impetus to overcome one's inferiority feelings. In the years just after the Great War, Adler posited an innate potential, the possibility, of a given direction being established for movement from the minus to the plus. He conceived this as one's relative interest in being socially embedded, or being socially interested in one's surroundings. For Adler (1918), a dual dynamic of motion and direction parsimoniously represented the basic human striving found in human interactions of all kinds. When the stimulated direction was toward, for, or with others Adler, from a utilitarian viewpoint, identified such action on the useful, helpful, or contributing side of life -- one had an adequate feeling for community (Gemeinschaftsgefuhl). When the movement was away from, against, or left out others, he concluded they were useless to, unhelpful for, or detracting from the commonweal. This level of one's social interest was inadequate to sustain real benefit for the community or the existential wellbeing of the individual.
Such striving or movement was part of Adler's overall construction of a general diagnostic continuum along which psychopathology and wellness could be located. He did not describe the two as opposite one another, but in relationship by means of their force (derived from the depth of the inferiority feeling) and direction (relative amount of social interest). Socially interested striving accounted for cohesive communal living, while the striving that lacks social interest manifest as more self-bound and would be used when pitting one individual or group against the other. From this construction, psychopathologic expressions -- whether activities, thoughts, or feelings -- remain the focus. But, for Adler, wellness could for the first time be understood in terms beyond "that from which" pathology deviates.
From what has been explored here, movement and social interest have emerged as the synthesizing clinical constructs for the four salient characteristics of psychopathology -- phenomenology, holism, teleology, and social embeddedness. Categorization of symptoms can be accomplished by conceptualizing the motion as "frozen," but categorization cannot in itself offer a perception of the living, moving entity. Movement is phenomenologically personal and idiosyncratic, and its relationship to wellness embraces all aspects of life. Interacting waves of movement from others advance toward a goal as "forward" in the direction life takes -- and where possibility lies. In order to see the movement within a frozen symptom, the phenomenal individual is considered as part of the holistic milieu in which the self-motivation to escape feeling inferior (by striving for a goal of superiority) embeds the individual to some degree in relationship to others.
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CROSS-REFERENCES
Creative Development; Divergent Thinking; Insight; Interdisciplinary; Malevolent Creativity; Open Mindedness; Perspective Taking; Possible in Psychology; Postmodernism
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