The first session of this essay introduces the core assumptions of contemporary structural/ego psychology, including the explanations of key theoretical prepositions of the theory. The second session illustrates the explanation of structural/ego theory in the etiology of pathological symptom formation and character traits, along with the case conceptualization of Freud’s classical case history, the ‘Rat Man’. Last but not the least, the last session provides empirical arguments for the validity of this theoretical-based psychotherapy. Theoretical background Sigmund Freud (1856 -1939) believed that all mental phenomena including dreams, parapraxes, and neurotic symptoms, have unconscious wishes or drives (e.g. sexual and aggressive drives) behind them, and in sexual stages. If these drives are not satisfied, they may seek other outlets, substitute objects or fantasy.
Freud identified childhood development into five psychosexual stages: oral, anal, phallic, and latency and genital stage. In this psychosexual theory, inborn drives are stressed in determining later personality development. To describe the structure of personality, Freud argues that human behavior is the result of interactions among three component parts of the mind: the id, ego, and superego. This theory, known as the structural theory of personality, places great emphasis on the role of unconscious psychological conflicts in shaping behavior and personality. It is stated that conflicts between id, ego may further lead to specific symptom and character formation. In order to protect the ego from unacceptable internal impulses, individuals adopt defense mechanisms to handle these unconscious conflicts. These ego defense mechanisms are concepts of ego psychology. Overall, all these concepts serve as an important foundation in contemporary psychoanalysis. The Structural/Ego Psychology in The Case of ‘Rat Man’ 3 Drive Theory/Psychosexual theory.
Drive theory is based on the principle that organisms are born with certain psychological needs and that tension is created when these needs are not satisfied. Freud proposed that sexual and aggression drives evolve with their physical and psychological maturation throughout childhood development. In psychosexual drive theory, a child is presented with a conflict between inborn drives and social expectations at each stage. Unsuccessful navigation of these internal conflicts will lead to fixations at each stage of development, or regressions to earlier stages, which may form the basis for pathological relationships or character traits in later life. Freud believed that different symptoms arise from different majors of conflicts at different psychosexual stages. Symptoms occurs when some symbolic event triggers the breakdown of individual’s defense of those impulses, leading to a regression to early stages Oral Stage. It lasts from birth to eighteen months of age. The main erotogenic zone is the oral zone and oral sensations include thirst, hunger, swallowing and satiation. The oral drives consist of libidinal (oral eroticism) and aggressive (oral sadism) components.
The functions of biting and spitting are related to oral aggressive characteristics that might include sarcasm, cynicism, or argumentativeness while the functions of eating and holding can be related to the development of later character traits referred to as oral incorporation, which might include the acquiring of knowledge or things. Excessive oral gratifications or deprivations may lead to individual’s excessive dependent on objects for maintenance of self-esteem while successful resolution results in a sense of self-reliance and trust. The Structural/Ego Psychology in The Case of ‘Rat Man’ 4 Anal Stage. Between the ages of about 18 months and 3 years enters the anal stage in which anus is the main erogenous zone. Freud hypothesized that there was both erotic pleasure and aggression over excrement. Feces become the libidinal object as it serves as an agency of pleasure, and defecation is accompanied by a sense of omnipotence.
In this stage, both the loving and aggressive drives aimed at trying to gain control over the sphincter muscles and then over the important objects in their lives. The combination of gratifying and punitive aspects of this interaction can contribute to ambivalence, and this conflicted attitude towards feces could be displaced towards objects. At the anal stage, relationships become dyadic in nature and self-control determines the quality of relationships. The objective of this stage involves the strive for independence and autonomy without excessive shame or self-doubt. Phallic Stage. Lasting from the age of about 3 until 6, the source of sexual gratification shifts to the genital area. There is an unconscious sexual fantasy towards the opposite sex parent in this stage, known as the Oedipus complex.
On the other hand, the threat of castration causes castration anxiety in male and penis envy on girls, which associates guilt over oedipal wishes. In this traumatic event, the child learns to identify with the same-sex parent and eventually developing an erotic preference for the other sex objects. Also, object constancy is achieved at this stage so that the individual can maintain positive emotional attachments to particular object in frustration of needs and wishes. It also means the capacity to tolerate both loving and hostile feelings toward the same object, to maintain a loving relationship with the object under aggressive impulses, and to maintain attachment to specific object under absence circumstances. Successful resolution in this stage results in the formation of The Structural/Ego Psychology in The Case of ‘Rat Man’ 5 sexual identity, curiosity without embarrassment, initiative without guilt, and mastery over inner impulses.
Latency stage. Individual enters the latency period from the ages of 6 to 12. Freud saw latency as a period of unparalleled repression of sexual desires and erogenous impulses. During this period, individuals redirect this repressed libidinal energy into asexual pursuits such as school, athletics, and same-sex friendships. The development goal of this stage involves the consolidation of sex identity with same-sex adults outside the family. Latency is also a period of integrating and consolidating previous attainments in psychosexual development. Fixation at this stage result in a lack of inner controls which hinder personality while successful resolution leads to a sense of industry, autonomous function and initiative without inferiority. Genital stage. The genital stage begins from 12 till young adulthood. Individual’s biological maturation lead to the intensification of libidinal drives.
Conflicts from previous psychosexual development are re-opened, which provide the opportunity for resolution of conflicts so as to achieve a mature sexual identity. The objective of this stage involves an establishment of mature heterosexual object relations, satisfying genital potency and consistent self-identity. Structural Psychology Structural theory proposes that all mental activity is organized around the interaction of three relatively stable and enduring structures or agencies of the mind: the id, the ego, and the superego. Their interaction within the mind generates intrapsychic conflict that might lead to anxiety and even neurotic symptom formation. The Structural/Ego Psychology in The Case of ‘Rat Man’ 6 Freud identified three types of anxiety: reality1 , neurotic2 and moral3 . It is the purpose of the ego and superego to channel psychic energy through drives (cathexes) and restraining forces (anticathexes).
Overall, the structural model provides a useful way to understand neurotic conflict, which can be explained as a conflict between the forces of the id and ego. Id. The id is described as the source of human sexual and aggressive impulses. It is a completely unorganized reservoir of energy that follows the pleasure principle . When only the id is operating, individuals try to find pleasure and avoid pain, which is based on a desire to seek immediate satisfaction Ego. The ego is a coherent system of functions that follows the reality principle. It mediates between the unconscious impulses and external environment, creating a balance between pleasure and pain. It preserves the self by gaining control over the demands of drives either by postponing the satisfaction of impulses or by suppressing their expressions. Ego makes contact with reality and inhibit the instinctual drives representations through carrying out defense mechanisms. The functions and defense mechanisms of the ego will be discussed later in ego psychology. Superego.
The superego is the aspect of personality that holds individual’s internalized moral standards and ideals from both parents and society. It is resulted from the resolution of the Oedipal complex. During conflicts, the superego cooperates with the ego to impose punitive demands on individual with conscience or guilty, whereas it occasionally allies with the Id in cases of regressed reaction. Superego represents two functions: ego ideal4 and conscious5 . In early development, superego tends to be rigid and punitive. The Structural/Ego Psychology in The Case of ‘Rat Man’ 7 It gradually becomes more flexible in its expectations and becomes more tolerant of moral ambiguity along the developmental process. Ego Psychology Contemporary ego psychology emphases that ego is the part of the mind that helps to modulate anxiety by effectively reacting to dangers engendered by internal or relational conflicts as well as the agent responsible for optimal adaptation. Ego mechanisms.
Contemporary Ego psychology focuses on the ego’s normal and pathological development, its management of libidinal and aggressive impulses, and its adaptation to reality. The ego mainly involves in the following functions: reality testing, impulse control, affect regulation, judgement, object relations, thought processes, defensive functioning and synthesis. Reality testing involves the ego’s capacity to distinguish what is occurring in one’s own mind from what is occurring in the external world. Impulse control refers to capacity to withhold aggressive and libidinal drives without immediate discharge through symptoms or behavior until the ego makes sure they meet the standard from superego. Affect regulation prevents painful or unacceptable emotional reactions from entering conscious awareness, or by managing the expression of such feelings in ways that do not disrupt either emotional equilibrium or social relationships.
Self-esteem regulation involves the capacity to maintain a steady and reasonable level of positive self-regard in the face of distressing or frustrating external environment. Judgement involves the capacity to reach “reasonable” conclusions about what is and what is not “appropriate” behavior. Object relations refers to the capacity for mutually satisfying relationship. Mastery refers to the successful resolution at different psychosexual stages the epigenetic view that individuals achieve more advanced levels of ego organization by mastering successive The Structural/Ego Psychology in The Case of ‘Rat Man’ (ID 3103745) 8 developmental challenges. Defense mechanisms. Anxiety develops out of the conflict among id, ego, and superego. Since ego plays an important role in coping with anxiety and channeling the psychic energy, defense mechanisms are adopted to preserve emotional well-being and limit the degree of functional impairment. When the ego perceives anxiety, it responds automatically by evaluating the nature of the danger and reviewing its repertoire of defenses.
It then employs defenses that have been effective in managing a similar threat earlier in life. Usually, the danger that is defended against or the activated protective mechanisms happen unconsciously. When these defense mechanisms are used infrequently, they serve an adaptive value in reducing stress. However, it becomes pathological if the ego defense mechanisms are used frequently as the individual develops a style of avoiding reality. Some of the important defense mechanisms are illustrated in Figure 1. The relationship between ego defense mechanisms and etiology formation will further be discussed in this essay. The ‘Rat man’ case To understand how structural/ego psychology explain the etiology of pathological symptom formation and character traits, Freud’s clinical case of an obsessive-compulsive patient, known as the ‘Rat Man’, is illustrated in this essay.
Case presentation The case study of ‘Rat Man’ presented how Freud applied psychoanalysis in the one-year treatment of an obsessive‑compulsive6 patient. Freud commented this is a successful treatment, which led to “the complete restoration of the patient’s personality and removal of his inhibitions” through psychoanalysis. The Structural/Ego Psychology in The Case of ‘Rat Man’ 9 The patient, Ernst Lanzer, suffered from obsessional thoughts and behaviors since childhood was 29 years old when he first entered treatment with Freud. His obsessive symptoms had worsened over the past 4 years, few years since his father’s death, who had never approved of his marriage to his lady. Ernst’s chief presenting problems included the fears that something might happen to the two people he loved – his father and the lady whom he loved and wished to marry. This “Great obsessive fear” occurred since Ernst heard the brutal punishment of putting wild rats over back of the victim so that they would eat their way into the anal, which led to an obsession to the obsessive story of returning money.
Ernst also claimed several fantasies about murder and suicide, and developed a number of compulsive irrational behavior patterns. He had reported compulsive impulses such as an impulse to cut his throat with a razor, or a sudden wish to jump down a steep precipice. In his daily life, Ernst would be involved in compulsive behaviors such as counting and even praying to ward off the possible evil. He also believed that his mere thinking of evilness would eventually lead to torture of his lady and father despite the fact that he had already died During the treatment, Freud believed that the patient’s current symptoms kept him from suffering the reality dilemma in which he had to choose between his lady and the one assigned by his mother. Moreover, these obsessive symptoms helped him ward off the anxiety to express anger and aggressive impulses that was repressed by the patient who regarded himself as a ‘criminal’.
Frustration in infantile sexuality, as well as the death of the patient’s sister in early age, resulted in the patient’s ‘omnipotent’ destructive belief that formed part of the phantasies, verbal associations and symbolic meanings in which the patient was trapped. The Structural/Ego Psychology in The Case of ‘Rat Man’ 10 Etiology formation From structural/ego psychology perspective. Structural/ego psychology emphases the role of instinct psychic energy in the lifelong development of adaptive personality. It is believed that individuals move through the oral to phallic psychosexual stages in the accomplishment of stage-appropriate developmental tasks along with different id-ego conflicts. Etiology formation refers to the formation of symptom and pathological character traits. Symptom formation. Symptoms are regarded as the ego’s adaptive effort to prevent conflicts entering into the conscious. Therefore, symptom formation protects the psychic apparatus from annihilation and prevents subtotal regression to a primitive and chaotic state.
When large amounts of psychic energy become fixated around the conflicts in oral to phallic psychosexual stages, there will be a predisposition of symptom formation in later life. With sufficient defenses, the earlier conflict will be successfully repressed, whereas insufficient defenses cause the ego to adopt further defenses to repress the conflict and restore the equilibrium. However, if the defense fails again, individual psyche will regress to earlier point of fixated energy so as to gather sufficient defenses at that earlier psychosexual stage to resolve original conflict. This mechanism starts from the phallic until enough defenses are mobilized to ward off the perceived threat. As a result, symptoms develop as a compromise formation to prevent subtotal regression of psychic apparatus, to allow the superego to punish for expression and to defend the impulses from being conscious. Neurotic symptoms are characterized by the regress to phallic stage, while psychotic symptoms refer to the regression to pre-phallic stage, showing a manifestation of severe oral/anal symptoms.
