Developmental Levels of Personality Organization
Developmental Levels of Personality Organization
This chapter focuses on what many analysts have seen as the maturational issues embedded in a person's character-the unfinished or impeded business of early psychological development: what Freud called fixation and what later analysts called developmental arrest. In much analytic writing about personality, it has been assumed that the earlier the developmental obstacle, the more disturbed the person. This belief is a great oversimplification and in some ways is simply wrong. But for purposes of introducing a way to think about character that can be clinically helpful, I lay out the traditional overview as well as more recent efforts to account for general differences in psychological health and personality structure.
Historically, analysts have conceived of a continuum of overall mental functioning, from more disturbed to healthier. They have explicitly or implicitly construed individual personality as organized at a particular developmental level and structured by the individual's characteristic defensive style. The first dimension conceptualizes a person's degree of healthy psychological growth or pathology (psychotic, borderline, neurotic, "normal"); the second identifies his or her type of character (paranoid, depressive, schizoid, etc.).
A close friend of mine, a man with no experience in psychotherapy, who cannot imagine why anyone would go into a field where one spends hour upon hour listening to other people's problems, was trying to understand my interest in writing this book. "It's simple for me," he commented. "I have just two categories for people: (1) nuts and (2) not nuts." I responded that in psychoanalytic theory, which assumes that everyone is to some degree irrational, we also have two basic attributions: (1) How nuts? and (2) Nuts in what particular way? As I mentioned in Chapter two, although contemporary analysts conceive the phases through which young children pass in less drive-defined ways than Freud did, many of their theories continue to reflect his conclusion that current psychological preoccupations reflect infantile precursors, and that interactions in our earliest years set up the template for how we later assimilate experience.
Conceptualizing someone's unmet developmental challenges can help in understanding that person. Interestingly, the same three phases of early psychological organization keep reappearing in psychoanalytic developmental theories: (1) the first year and a half to two years (Freud's oral phase), (2) the period from eighteen to twenty-four months to about three years (Freud's anal phase), and (3) the time between three or four and about six (Freud's oedipal period). The approximateness of these ages reflects individual differences; the sequence seems to be the same whether a child is precocious or late blooming. Many theorists have discussed these phases, variously emphasizing drive and defense, ego development, or images of self and other that characterize them. Some have stressed behavioral issues of the stages, others have addressed cognition, still others the child's affective maturation.
Many scholars have critiqued stage theories in light of infant research, which has illuminated far more competence in early infancy than most developmental models assume and connects difficulties to parental attachment behaviors rather than presumed developmental phases. Analysts of a postmodern bent point out that models of "normal development" contain implicit cultural prescriptions, inevitably contributing to images of an in-group that is fine and an out-group that is not. Despite these limitations, I think that some notion of expectable psychological stages will survive in our conceptual formulations, as there is something that invites clinical empathy in the idea that we all go through a similar process of growth. In the following, I draw mostly on the ideas of Erikson, Mahler, and Fonagy to explicate the developmental aspect of psychoanalytic diagnosis.
It has never been empirically demonstrated that people with a lot of "oral" qualities have more severe degrees of psychopathology than those with central dynamics that earlier analysts would have regarded as either anal or oedipal, even though Freud's naming of the first three stages of development by these inferred drive concepts has a lot of intuitive appeal and correlates to some degree with type of personality (depressive people at any level of health or pathology tend to manifest orality; the preoccupations of compulsive people are notoriously anal-whether or not their compulsivity causes them major problems).
Yet there is substantial clinical commentary and increasing empirical research, supporting a correlation between, on the one hand, one's level of ego development and self-other differentiation, and, on the other, the health or pathology of one's personality. To a certain extent this correlation is definitional and therefore tautological; that is, assessing primitive levels of ego development and object relations is like saying an interviewee is "sick," whereas seeing someone as obsessive or schizoid is not necessarily assigning pathology. But this way of conceptualizing psychological wellness versus disturbance according to categories from ego psychology and the later relational theories has profound clinical implications across different character types. A brief history of psychoanalytic attempts to make diagnostic distinctions between people based on the extent or "depth" of their difficulties rather than their type of personality follows.
HISTORICAL CONTEXT: DIAGNOSING LEVEL
HISTORICAL CONTEXT: DIAGNOSING LEVEL
OF CHARACTER PATHOLOGY
Before the advent of descriptive psychiatry in the nineteenth century, certain forms of mental disturbance that occurred with any frequency in what was considered the "civilized world" were recognized, and most observers presumably made distinctions between the sane and the insane, much as my nonpsychological friend distinguishes between "nuts" and "not nuts." Sane people agreed more or less about what constitutes reality; insane people deviated from this consensus.
Men and women with hysterical conditions (which included what today would be diagnosed as posttraumatic problems), phobias, obsessions, compulsions, and nonpsychotic manic and depressive symptoms were understood to have psychological difficulties that fall short of complete insanity. People with hallucinations, delusions, and thought disorders were regarded as insane. People we would today call antisocial were diagnosed with "moral insanity" but were considered mentally in touch with reality. This rather crude taxonomy survives in the categories of our legal system, which puts emphasis on whether the person accused of a crime was able to assess reality at the time of its commission.