Ego Development and Psychopathology

David Ausubel

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138509436
• eBook ISBN: 9781351292221
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Ego Development and Psychopathology presents an original theoretical underpinning for classification and interpretation of the major mental disorders, one based largely on the author's clinical experience. Ausubel's central thesis is that the most significant and crucial factors predisposing persons to mental disorders are critical developmental defects that arise at vital transitional phases of ego development. He sees both normal and pathological personality functioning as most cogently explained in terms of an individual's ego structure at a given point in the life cycle.

Ausubel relates his developmental theory to the phenomenology and related clinical problems of psychiatric diagnosis. He classifies mental disorders in terms of their developmental history. Such factors, in his opinion, offer the most precise delineation of etiological, functional, and phenomenological similarities and differences among the various psychiatric syndromes. He provides an overview of ego development, as well as major variants of the norm. He also discusses development of conscience and moral values, as well as psychopathological considerations that follow from deficiencies, defects, failure, and distortions in ego development. He examines at length classification of mental disorders, such as anxiety states, psychotic depression and mania, schizophrenia, autism, antisocial and narcissistic personality disorders, and defense mechanisms.

Ausubel is careful to point out that ego development is not the only significant determinant of normal and aberrant personality. Genetic predispositions, situational stress, and sociocultural factors must always be taken into consideration since mental disorder is always a product of multiple causality. However, he believes ego development is by far the most critical factor, and hence offers the most for classification of mental illness. This intriguing study will be of interest to professionals as well as educated and concerned practitioners in the fields of psychology, psychiatry, psychoanalysis, child psychotherapy, and social work.

II

Clinical Applications

4

General Psychopathology

In this chapter I shall attempt a systematic application of the dynamics of ego development to the pathogenesis of the behavior disorders. What is needed now is a more formal classification of these disorders so that the relationships of the various diagnostic categories to their developmental matrices and to each other can be more readily appreciated.

The proposed system of classification is based on the assumption that developmental factors in ego formation represent the most salient and critical factors in the etiology of personality and behavioral psychopathology, and account most meaningfully for the differences in onset, symptomatology, and prognosis that hold for the recognized clinical entities. This by no means rules out the importance of other interpersonal, cultural, or situational factors, or of other aspects of personality development. By definition, however, classification in science aims at defining relationships between phenomenological entities in terms of the most prepotent factors responsible for their evolution and with the least possible degree of overlapping categories.

The Ego-Development Approach

The principal theoretical implication of naturalistic ego psychology for the psychopathology of the mental disorders is that both normal and aberrant personality, that is, largely ego, functioning, can be most cogently understood and explained in terms of an individual’s ego structure and development at any given point in his or her life cycle. More specifically, because ego structure in large measure reflects how, and in what manner, he or she had traversed the two critical transitional phases of ego development, namely, the ego devaluation (satellization) and desatellization crises described above, it behooves the psychopathologist to pay scrupulous attention to patients’ ego development. This is why detailed attention was devoted to the three principal stages of ego development, to their determinants and developmental outcomes, and to the implications of these outcomes both for current and later, normal and impaired, ego functioning and development, as well as for current and later vulnerability to particular kinds of mental disorder.

In other words, the hypothesized most significant and critical factors predisposing individuals to various mental disorders, in my view, are developmental defects (i.e., complete or partial deficiencies, failure, distortion) that arise at crucial transitional phases of ego development. This does not imply in the least that these above causal factors are simply determinative, but rather that they interact with genie, temperamental, and coping predispositions; with the individual’s degree of exposure and resistance to stress; and with his adjustive and adaptive reactions to situational vicissitudes. Mental disorders, like all complex behavioral and social phenomena, are obviously a product of multiple causality. I choose to classify them in terms of their developmental history and outcomes largely because these factors, in my opinion, have the greatest discriminating power in delineating etiological, functional, and phenomenological similarities and differences among the various clinical psychiatric syndromes, as well as exhibit greater explanatory power than the causal factors implicated in other possible classificatory schemes.

The Major Differential Factor: Satellizer versus Nonsatellizer

Broadly speaking then with certain notable exceptions, most persons can be divided into two main groups in terms of ego development outcomes and susceptibility or vulnerability to the various mental disorders, namely, satellizers and nonsatellizers. This, of course, should hardly come as a surprise to anyone who is familiar with the tremendous ego changes that accompany satellization. If these changes characterize the personality functioning of the satellizer, then the absence of these same changes in a nonsatellizer should be equally conspicuous and determinative, making this dichotomous pair of contrasting opposites a natural basis for a psychopathological classification.

Because of the incomparably attractive features of satellization for the child’s self-esteem, namely, guaranteed intrinsic feelings of adequacy and security related to his derived status as a satellizer, the great mental health hazard confronting satellizers is failure to undergo ego maturation or desatellization under those familial and/or cultural conditions fostering exaggerated satellization—that is, intensifying it unduly or overextending it in time. The principal disorders of ego maturation (desatellization) that emerge under these conditions are: (1) early, insidiously developing Process Schizophrenia in individuals with schizoid and introverted temperaments (hedonistic and narcissistic gratification in fantasy); and (2) Inadequate and Immature Personality Disorders—hedonistic and narcissistic gratification in reality (acting out of motivationally immature drives and impulses).

Corresponding to the major underlying ego development defects in satellizers (i.e., oversatellization; failure to desatellize or to undergo ego maturation) that gives rise to such psychopathology as Process Schizophrenia and Inadequate Personality Disorder are the following comparable indications of such general underlying psychopathology in nonsatellizers as lack of derived status, low intrinsic security and self-esteem, inordinate need for earned status and volitional independence, and unrealistically high and tenacious aspirations for achievement.

Some of the more specific mental disorders in nonsatellizers that follow from the latter predisposing factors include: ego hypertrophy or anxiety disorders¹ (contributing, for example, to the rejected nonsatellizer’s impaired self-esteem, which is inherent in the childhood rejection scenario itself, is his long history of defeat of his unrealistically high and tenacious aspirations for achievement and for compensatory earned status); disorders that serve as defenses against anxiety or guilt, for example, phobias, delusions, hypochondriasis, obsessions, compulsions, dissociative disorders; and complications of anxiety, for example, Reactive Schizophrenia, agitated and retarded depression,² and Mania.

As stated above, nonsatellizers generally do not manifest failure in ego maturation at adolescence because they do not satellize to begin with and, thus, do not have to desatellize, and also because they have been striving continuously for high current academic and future vocational status throughout childhood and adolescence. However, teenagers, especially girls, who are paradoxically subjected by parents to increased (rather than reduced) restrictions at adolescence, often react vindictively against their parents by repudiating and sabotaging the goals of adult ego maturation. Thus, they unexpectedly develop a form of psychopathology that is phenotypically (clinically) indistinguishable from clinical Inadequate and Immature Personality Disorder, although having a very atypical genotypic (nonsatellizing) history in childhood.

The latter defense mechanisms referred to above may be conceptualized as follows: (1) rationalization—providing good or acceptable (but not always credible or plausible) reason(s) to justify or make tolerable unacceptable attitudes, motives, feelings, or behavior; (2) minimization—an attempt to justify, or make more acceptable intrinsically unacceptable behavior by understating its consequences, frequency, severity, significance, and so forth ; (3) displacement—transferring the source or target of a negative emotion, such as fear or hostility, from its original source or target to a less disturbing and more acceptable substitute; (4) reaction formation—the development of conscious, socially acceptable activity that is diametrically opposite to its repressed counterpart that is inaccessible to awareness; (5) dissociation—the splitting off (segregation) from consciousness of certain memories or mental sequences from the main body of consciousness which then function independently and are inaccessible to the latter, and vice versa; (6) projection—a defense mechanism in which anxiety, feelings of guilt or inadequacy, and unacceptable ideas or motives are disowned by attributing them to others.

The following definitions apply to specific mental disorders that also defend against anxiety or guilt: Phobia—displacement of the source of fear or anxiety from an unidentifiable or irremediable object or situation to a more identifiable and tangible situation that can be more readily avoided; (2) Hypochondriasis—a chronic condition in which one is morbidly preoccupied with one’s own physical or mental health and believes that one is suffering from a grave bodily disease, but without demonstrable organic or pathophysiological findings; (3) Conversion Hysteria—a neurotic condition in which unconscious conflict, or the psychosocial threat ordinarily causing anxiety, induces gross functional deficits in the special senses or in the voluntary musculature (i.e., paralysis); (4) obsession—an intrusive, unwanted idea or emotion that tends to persist and monopolize the center stage of consciousness, thus preventing the entrance of other threatening ideas or emotions; (5) compulsion—an unwanted, insistent, repetitive, intrusive, irresistible impulse to do something which is against the will or moral norms of the individual, and which is also socially unacceptable—failure to perform the act in question gives rise to overt anxiety; and (6) Mania—an affective state of elation, euphoria, and unwarranted feelings of extreme well-being, characterized also by expansiveness, grandiosity, pressure of speech, loquacity, flight of ideas, hyperactivity, and diminished need for sleep.

In both Process Schizophrenia and Inadequate and Immature Personality Disorders, generally occurring in satellizers, it will be recalled that ego devaluation, as well as preliminary (childhood) maturation and attenuation of infantile ego attributes, take place normally. That is, these children are generally accepted and intrinsically valued by parents (although some are also treated in an overpermissive, overprotected, overdominated, or underdominated manner) and hence undergo normal early satellization. Preliminary increments in executive independence, sense of responsibility, and frustration tolerance occur normally during childhood and are implicitly internalized on the basis of personal loyalty. But presumably because of genie predispositions, various temperamental qualities, and, particularly, because of certain pervasive parent attitudes (e.g., overprotection, overindulgence, overpermissiveness, underdomination, or overdomination), normal ego maturation (desatellization) fails to take place. Introverted and schizoid children with this type of personality structure are, thus, extremely vulnerable to Process Schizophrenia, whereas extroverted children tend to become Inadequate and Immature personalities strongly predisposed toward seeking drug-induced euphoria.

The underlying developmental history and psychopathology in Infantile Autism and childhood Schizophrenia, on the other hand, are markedly different despite basic similarities in parent child-rearing attitudes and in gross clinical appearance to Process Schizophrenia. Unlike Process Schizophrenia and Inadequate and Immature Personality Disorder, however, ego devaluation and satellization do not occur in Infantile Autism probably because of a potent, genically determined incapacity for relating emotionally to others—not because of rejection or extrinsic valuation by parents. In these latter disorders the basic psychopathology is not failure to desatellize, since this eventuality pertains to a future developmental task that will not be encountered yet for several years, but rather the failure to satellize in the first place, presumably because of a relatively rarely occurring difficulty in (or incapacity for) relating emotionally to others, or in exhibiting normal attachment behavior. This can be best explained on the basis of prepotent genie predispositions, coupled both with secondary disturbance of communication skills and with bizarre behavior reflective of the absence of normal manifestations of attachment and of corresponding patterns of communication.

Very similar underlying psychopathology is typically found in undersocialized Conduct Disorder (especially in the aggressive subgroup) and in Antisocial Personality Disorder. In these latter disorders, for the most part, the principal locus of the developmental deficit lies in the absence of internalized moral values and/or of moral obligations to conform their conduct to such values by exercising appropriate behavioral restraints.

Satellizing individuals who fail to undergo normal personality maturation in adolescence, however, are typically protected against Neurotic Anxiety and hence against its defenses and complications as well, because of their strong intrinsic feelings of adequacy and security, which is a product of the derived status they enjoy. Thus, they tend to feel adequate simply because they have had the experience of being accepted and intrinsically valued for themselves, irrespective of their prior or current level or capacity for achievement. Paradoxically, their self-esteem is also unnaturally high because of a poorly developed self-critical faculty. Because of this severe maturational defect or failure, however, they become functionally inadequate adults, incapable of acquiring both adult motivational and volitional status, as well as the personality traits necessary for their implementation.

Exceptions to the Satellizer-Nonsatellizer Dichotomy

The chief exceptions to this rule linking the genesis of Neurotic Anxiety to nonsatellization are: (1) high susceptibility to Separation Anxiety of Childhood and to Neurotic Anxiety in grossly overprotected and over-dependent satellizing children; and (2) vulnerability of satellizing children to anxiety disorders and depression following loss of a parent or parents because of death or divorce.

Contrariwise, failure to undergo ego maturation is quite rare in nonsatellizing children inasmuch as satellization does not occur in the first place. In a very real sense the goals of desatellization and ego maturation can, therefore, be said to be accomplished in advance, since there is obviously no need for a nonsatellizer to desatellize.

The reverse of this latter situation, as indicated above—later reactive maturational failure in nonsatellizers, resulting in motivational immaturity and inadequacy with respect to both ego-status and ego-maturity goals—occurs relatively frequently in adolescents following the paradoxical parental imposition of more restrictive discipline to which the latter react with both passive and active sabotage of these goals.

These latter three conditions, therefore, constitute the principal exceptions to the dichotomy of satellizers and nonsatellizers with respect to the categories of mental disorder associated respectively with each member of the dichotomy.

Determinants of Mental Disorder³

At this point it would be helpful to relate the developmental approach adopted in this book to the more general context of psychopathological determinants implicated in mental disorder. If we are to adhere to the general proposition that any complex psychopathological mental and/or behavioral outcome must be considered a summated resultant of various influences impinging upon an individual’s psychological field, what are the relevant variables that should be considered in assessing the possibility that he may or may not develop a behavior disorder or a particular type of behavior disorder?

The following is a list of the principal factors that should be taken into account: (1) genetic predisposition as determined by a single dominant gene, two recessive genes, or polygenes; (2) inadequacy of constitutional defense factors (based on multifactorial genetic patterns) that do not provide sufficient resistance to mental disease; (3) the objective magnitude of the adjustive stress or deprivation confronting the individual; (4) predispositions arising from aberrant ego development, for example, lack of ego devaluation or maturation; (5) frustration tolerance, that is, the degree of frustration an individual can withstand before succumbing to either disruption of performance ability, loss of self-esteem, or lowering of aspirational level; (6) various subjective factors that determine to what extent deprivation will be interpreted, or reacted to, as frustration, that is, general level of prestige aspiration, specific ego involvement in a given activity, capacity for selective ego disinvolvement; (7) the self-critical faculty, that is, the ability or tendency to evaluate oneself more or less severely; (8) introversion-extroversion; (9) previous mode of adjustment to stress, that is, canalized types of adjustive mechanisms employed, and at what level of integration; (10) accessibility of motivations, attitudes, and emotions to consciousness, degree of insight into adjustive techniques; (11) level of energy or stamina; (12) complexity of personality organization; (13) level of neurophysiological irritability as influenced by fatigue, emotion, sleep deprivation, hormonal balance, and so forth; (14) level of resistance to stress situations in terms of reacting with somatic dysfunction (adrenocortical sufficiency); (15) tolerance for anxiety, guilt, ambiguity, and inconsistency; and (16) level of intelligence and problem-solving ability.

One reason why ego development is the central organizing factor in the etiology of behavior disorder (as has been shown in the preceding chapters) is because it crucially affects so many of the other important etiological factors, for example, level of prestige aspiration, self-critical faculty, introversion-extroversion, frustration tolerance, tolerance for anxiety and guilt, and so forth.

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Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Dedication
• Dedication
• Preface
• I Ego Development
• II Clinical Applications
• Index