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Psychopathology As Adaptive Development Along Distinctive Pathways

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Psychopathology As Adaptive Development Along Distinctive Pathways Development and Psychopathology, 9 (1997), 749±779 Copyright 1997 Cambridge University Press Printed in the United States of America Psychopathology as adaptive development along distinctive pathways KURT W. FISCHER, CATHERINE AYOUB, ILINA SINGH, GIL NOAM, ANDRONICKI MARAGANORE, AND PAMELA RAYA Harvard Graduate School of Education Abstract Contrary to the standard assumption that psychopathology stems from developmental immaturity (retardation, fixation, regression), people diagnosed with psychopathology typically develop along distinctive pathways in which they build complex, advanced skills. These pathways are based on adaptation to trauma, such as maltreatment, or to problems in affective±cognitive regulation, such as those in autism. They do not fit normative developmental frameworks. Research has characterized several types of distinctive pathways, especially those arising from maltreatment; they are marked by normal developmental complexity but distinctive affective±cognitive organization. In one study sexually abused depressed adolescent girls admitted for treatment in a mental hospital described themselves-in-relationships with age-appropriate, complex developmental levels equal to those of both nonabused depressed girls and other adolescents. At the same time, they showed a powerful negativity bias contrasting with the positivity biases of other girls. Many of them produced dramatic switches in affective±cognitive organization across assessments contrasting with the similar organization showed by other girls. In another study toddlers from maltreating families showed a consistent negativity bias in play and representations of interactions. We show how to portray these distinctive developmental pathways through the example of Hidden Family Violence, in which people dissociate their private violent world from their public, good-citizen world. In psychopathology people develop along dis- mature, complex, high-level skills. Instead of tinctive pathways that progress gradually to being developmentally delayed, retarded, or complex, mature forms. Contrary to common regressed, they are developmentally different conceptions in psychology and psychiatry, (Calverley, Fischer, & Ayoub, 1994; Fischer & most people with psychopathology are not de- Pipp, 1984; Robins & Rutter, 1990). velopmentally immature, but instead they The distinctive pathways of psychopathol- have taken a different pathway. People with ogy arise from people's personal histories of borderline disorder, depression, sociopathy, trauma or from other problems in emotion± obsessive±compulsive disorder, autism, multi- cognition regulation, and they show great di- ple personality, or schizophrenia have devel- versity (Fischer & Ayoub, 1994; Herman, oped along a specific pathway toward psycho- 1992; Noam, 1986). Along these alternative pathology. In that pathway they develop pathways, people develop richly complex, so- phisticated skills for adapting to their trauma Funds for research support were provided by Mr. and or regulation problemsÐskills that also pro- Mrs. Frederick P. Rose, Harvard University, NICHD, and the Spencer Foundation. The authors thank Rosemary duce their psychopathology. The false appear- Calverley and Bruce Kennedy, as well as Nancy Cole, ance of developmental immaturity arises from Jane Haltiwanger, Helen Hand, Susan Harter, Louise Sil- assessments based on conventional frame- vern, and Michael Westerman for their contributions to works for development that do not capture the research described in this paper. these people's strange and distinctive patterns. Address correspondence and reprint requests to: Kurt W. Fischer, Harvard University Graduate School of Edu- Traditional attempts to normalize diversity cation, Roy E. Larsen Hall, Appian Way, Cambridge, into one universal developmental pathway se- MA 02138. riously distort the variability of development. 749 750 K. W. Fischer et al. To detect the pathways of pathology, re- Traditional views in clinical psychology searchers and practitioners need to begin from and psychiatry assume that psychopathology each individual's perspective and life history, involves developmental immaturity, resulting not from conventional frames for develop- from fixation, regression, or retardation (Freud, ment. A dynamic, embodied framework be- 1923/1961, 1936/1966). The assumption that gins not with a decontextualized analysis of psychopathology is based in developmental development but with a specific ªperson-in- immaturity has been elaborated extensively in contextº as the fundamental unit of analysis ego psychology (Blanck & Blanck, 1974; (Fischer, 1980; Fischer & Bidell, 1997; Gott- Hartmann, 1939), object relations theory lieb, 1992; Lerner, 1991; Noam, 1990). Peo- (Kernberg, 1976; Mahler, Pine, & Bergman, ple build their own development through their 1975), and self psychology (Kohut, 1971). activities in important contexts and relation- The more severe the disorder, the more imma- ships. There is no single ªnaturalº progression ture the person is assumed to be. Westen of cognitive±emotional development followed (1989) provides a helpful critique of the im- by all human beings. maturity assumption in object relations theory In our research, evaluation of cognitive± and self psychology. emotional development uses assessment in- This assumption has been dramatically struments that start from people's own per- overthrown in recent years for schizophrenia, spectives and include multiple contexts to even though a few decades ago this disorder detect the natural variability in people's re- was widely assumed to involve severe devel- sponses. This research shows that troubled opmental immaturity (Benes, 1995; Murray & preschool children and adolescents produce Lewis, 1987; Weinberger, 1987). The current complex adaptations, not developmentally im- consensus on schizophrenia is that it does not mature ones. We describe key characteristics emerge until adolescence or early adulthood of several distinctive pathological pathways, and is a problem of relatively mature develop- especially those associated with child mal- ment, not a fixation or regression to primitive treatment or with autism. Children subjected developmental stages. Despite this change in to abuse develop adaptations characterized by beliefs about schizophrenia, the develop- pervasive negativity of core self-representa- mental immaturity of most other psychopath- tions and powerful skills for switching and ology continues to be taken for granted in dissociating cognitive±emotional organizations clinical theory and practice. across contexts and moods. Children with au- Contrary to the false impression of imma- tism develop adaptations strongly shaped by turity provided by traditional analyses, the de- their problems in interpreting feelings and re- velopmental levels involved in pathology are lationships. These pathways progress to high typically the same as those in normal develop- skill levels that are age appropriate, but they ment. That is, the complexity of cognitive are not the pathways that are typically as- skills in pathological patterns of interaction is sessed in clinical or educational settings. similar to the complexity in nonpathological patterns in people of the same age. The mech- anisms by which a person coordinates or iso- Psychopathology Involves Developmental lates domains of activity may differ in patho- Adaptation, Not Delay logical patterns, but the cognitive complexity Most psychopathology involves development does not differ. For example, a girl who has to high levels of complexity, with skills been repeatedly abused by her parents will of- adapted to trauma and regulation problems ten adapt through avoidance, denial, and de- (such as anomalous emotional or cognitive personalization. With development and in- processing in autism or depression) rather creasingly sophisticated capacities, she will than to the normative environment that is as- construct increasingly complex, sophisticated sumed in traditional analyses. Processes of skills to sustain those defenses. In fact, devel- dissociation and splitting provide especially opmental advances sometimes put a person at clear examples of the adaptive and complex greater risk of psychopathology, as when nature of development of psychopathology. higher stages of ego development in adoles- Psychopathology as distinctive development 751 cence seem to produce greater risk of depres- sion and suicide (Noam, Paget, Valiant, Borst, & Bartok, 1994). With developing defenses, a person who has been abused may appear erratic and un- predictable with others, self-focused, emo- tionally volatile, and rigid in her beliefs. From her own perspective, however, she is con- structing sophisticated skills for sustaining herself in the face of abuse. In traumatized children, behaviors often described as erratic include shifting between approach and avoid- ance strategies in dealing with adults (Cic- chetti, 1991; Crittenden, 1988). These strate- gies make sense for her because the same adults that nurture her also abuse her. The combination of approach and avoidance strat- egies are part of her self-protective dance. In much psychopathology, people keep in- Figure 1. Developmental web. formation separate that in normal develop- ment would be integrated. For example, while most adults can integrate positive and nega- tive interactions with parents, adults who have itations of traditional conceptions of develop- been maltreated may dissociate or split posi- ment (Fischer & Bidell, 1997). Description
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