There are three broad categories in psychopathology: defects, deficits, and conflicts. To illustrate this point, let me give you examples of driving a car: If you have a problem with your eyesight, it is a defect; no amount of driving lessons will help―you have to get glasses. However, if you have good eyesight, and you don’t know how to drive, it is a deficit―it can be corrected by training. On the other hand, if you have good eyesight and are well trained to drive, but you have a fear of driving or are ambivalent, and thus cannot make a decision about whether you should drive to visit your mother-in-law, then that is a conflict―neither eyeglasses nor any amount of driving lessons will help.
Similarly, in the makeup of the mind, there can be defects of thinking that characterize schizophrenia or of affect in manic-depressive psychoses; there can be deficits that result in personality or self disorders; and there can be conflicts that cause neuroses. It is possible, of course, that their manifestations occur separately, simultaneously, or successively, not only combine with but compound each other. For example, as F. Pine says, detachment as an early developmental deficit may represent failure of attachment, or as later developmental conflict may reflect defensive avoidance of interpersonal contact.
M.N. Eagle has suggested that the two sources of psychopathology can easily overlap, insofar as developmental deficiencies frequently interfere with the capacity to deal with conflict, while unresolved conflicts in turn often trigger developmental regressions or arrests. Furthermore, one cannot proceed with the next stage of development without proper mourning of the last, says S. Roth (this is postdepression depression).
Psychotherapy primarily deals with conflicts and deficits. Patients with neuroanatomical, physiological, or chemical defects can be given psychotherapy for their deficits and/or conflicts, or even for coping with their defects―but not for defects per se. Although psychotherapy for the defects themselves is generally considered inappropriate and ineffective, Eric Kandel’s pioneering research has begun to suggest a different conclusion. Genetic work with sea snails, which explores the neurophysiology and biochemistry of psychological phenomena, is clearly demonstrating the integration of psychology and neurobiology on a molecular level.
His studies of social and sensory deprivation, of sensitization and habituation “training” processes, and even of the development of anxiety have become phylogenetic models for comparable biological mechanisms in humans. His findings during conditioning, of both structural and functional changes in synaptic transmission (e.g., changes in neurotransmitter release and enzyme levels), are striking, and go a long way toward welding the long-standing mine-body split that has plagued the psychiatric field since its inception.
These explorations also reveal that genetically determined pathways can be interrupted, as well as restored, by learning. By demonstrating how psychological disturbances reflect neuronal and synaptic changes, he has further proposed that treatment with psychotherapy can, in fact, act on these biochemical events―that the alteration in synaptic functions produced by external phenomena can allay anxiety or impact upon other neurotic conditions.
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T. Byram Karasu, M.D. is the author of The Psychotherapist as Healer