Psychoanalytic Theory • Sigmund Freud (1856-1939) • Vienna, Austria Psychodynamic Theories • Studied Medicine at University of Vienna of Health and Illness • 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 Freud’s Theory of Personality The Id • True psychic reality • Id, Ego & Superego • Contains instinctual • Three aspects of urges most internal (neurotic) conflict • Source of desire for immediate gratification • This conflict is almost always • No values, ethics, or repressed logic • Obeys the pleasure principle The Superego The Ego • Arises out of resolution of the • The Executive Function Oedipal conflict • Organized & Rational • Values & Ideals of Society • Defers Gratification • As conveyed by parents • Mediates between • Punished behavior becomes Id Conscience • • Superego • Rewarded behavior becomes Ego-Ideal • Outer World • Obeys the reality principle Generation of Anxiety Defense Mechanisms • Sublimation • Id presents ego with an unacceptable wish • Manifesting an • Ego perceives danger associated with unacceptable impulse expression of the wish in socially acceptable ways • Superego reinforces danger perceptions Violence - Surgery • Defenses are mounted against the wish • Denial • Balance is struck between wish and defense • • Very commonly used Defense Mechanisms Wish-Defense Compromise • Repression • Involuntary forgetting of a painful feeling or experience • Reaction Formation • Takes many forms • Expression of unacceptable impulses as directly • Symptom opposite attitudes and behaviors Character trait • Disturbing sexual urges ! extreme prudishness • Character style • Intellectualism • • Maintaining focus away from the emotional • Inhibition aspects of experience Early Psychosomatic Medicine After Freud • 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 Modern Theories Legacy of Freud • 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 Modern Applications Psychodynamics • Type A Behavior Pattern Risk factor for heart disease • Repression remains prominent as an explanation for • physical and psychological distress • Components • Repression can lead to active suppression of strong Time urgency emotional expression • Orderliness • Changes in immune function • • Discrepancy between self-reports of distress & • Hostility physiological state • Irritability with interruptions • Hyperalertness Modern Applications Modern Applications • Type A Behavior Pattern: • Type A Behavior Pattern Evidence is mixed • Anger & Hostility • “Type A increases appear to be most exposure to important potential triggers, rather than Predictive • materially affecting relationship between the process of hostility and atrial atherosclerosis…” fibrillation in men (Eaker et al., 2004) • Gallacher et al., 2003 Modern Applications Critiques of PA/PD Theory Deterministic & Pessimistic • Scriptotherapy • Motivation & behavior determined by Pennebaker, 1995; Smyth et al., 1999 • • mostly unconscious processes Disclosure relieves the anxiety and physical • Personality fixed at puberty stress of repression • Emphasis on sexual and aggressive urges • Interventions using writing about traumatic • experiences • Anxiety is inevitable • Immune function and symptoms decreased • Constructs difficult to measure in asthma & rheumatoid arthritis • Not a good predictor of behavior.