Situated Psychopathology

This special section on theories of psychopathology provides an opportunity to collect the emergent, cross-cutting scholarship that is challenging traditional approaches to understanding mental illness. Here, we appraise the state of theory in the field and emphasize the pitfalls of working in the context of overly flexible, unchallenged, and essentially unchallengeable theoretic models, such as the biopsychosocial model, which we argue has become the de facto theoretic model for our field. We further posit that theoretic shortcomings are contributing to the often-referenced pessimism regarding our progress in understanding and treating mental illness, and introduce the charge of the authors of the papers in this section to articulate novel, falsifiable theories of psychopathology. We briefly touch on the intertwined issue of how to define psychopathology and discuss a key issue raised by the array of papers comprising the section, namely how to conceptualize the spatiotemporal boundaries of complex causal systems. We then use this schematic for understanding how these theories relate to each other and to the vanilla biopsychosocial model they are vying to replace. Ultimately, it is our belief and hope that progress in theoretic thinking will catalyze faster progress in research and improvements to and novel developments in clinical prevention and intervention efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Back to table of contents Previous article Next article Book ReviewFull AccessEgo Development and PsychopathologyDaniel D. Storch,, M.D.Daniel D. Storch,Search for more papers by this author, M.D.Published Online:1 Jun 1998https://doi.org/10.1176/ps.49.6.844AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This is a hard book to read. The nearly 300 pages are densely written, with no relief offered by case studies or illustrations, and only three tables. However, the author, as he promises, presents a "coherent, self-consistent, and comprehensive" theory of psychopathology and relates it to the current descriptive classification of psychiatric diagnoses. His is a developmental theory with ego preeminent. The central thesis of the book is that "the most significant and critical factors predisposing persons to various mental disorders are critical developmental defects . . . that arise at critical phases of ego development."The book is divided into two main sections. The first part, Ego Development, expounds the theory. The normal progression is that the ego becomes omnipotent in the infant. In solving "the crisis of ego devaluation," the ego of the child "satellizes" (subordinates itself) to the parents and then others in authority, such as teachers. Then the ego must "desatellize" in preadolescence and adolescence in response to the individual's need for "emancipation from the home and preparation to assume the role of a volitionally independent adult in society."The second part, Clinical Applications, is a bit easier to read. The author proceeds to discuss each of the "major"DSM-IVpsychiatric diagnoses within the context of his theory. Anxiety states fit best. Neurotic anxiety, the prototypical disorder, is "a form of developmental anxiety (occurring usually in a nonsatellizing individual with a history of failure in ego devaluation) in which the essential source of the threat to self-esteem arises from a severely impaired sense of adequacy." Other diagnoses follow. For example, depression, mania, reactive (as opposed to process) schizophrenia (schizophreniform disorder), and delusional disorders are the "four basic kinds of 'psychotic' complications" of neurotic anxiety.Ego Development and Psychopathologyincludes interesting clinical points and observations. The need for moral values is repeated. Parents and therapists should lead the way. Parents should not be "overpermissive"; therapists cannot ignore the question of moral judgment. "Behavior and ethics are inextricably bound together." Delinquency is a "moral problem."The author is not afraid of controversy. For example, he takes our culture to task for not providing children with opportunity for socially responsible participation and for discrepancies between "the professed (official) moral ideology" and "the simultaneous overvaluation of aggressiveness, prestige, and success at any price."The book jacket identifies David Ausubel as distinguished professor emeritus at the Graduate School and University Center of the City University of New York, evaluating psychiatrist for the Catholic Archdiocese of New York, and also in private practice. The book "is addressed chiefly to . . . the primary diagnosticians and therapists of mentally ill individuals." The author also hopes other intellectuals will be interested.I admit I am a pragmatic eclectic in my approach and concrete in my thinking. In reading a book such as this, I find my own psychological-mindedness exercised and stretched and, correspondingly, my work with patients showing more insight, with better results and mutual satisfaction. In summary, the book was hard to read, requiring time and serious study, but worth the effort.Dr. Storch is clinical associate professor of psychiatry at the University of Maryland School of Medicine in Baltimore and medical director of the Riverwood Center of the Howard County Health Department in Columbia, Maryland.by David P. Ausubel; New Brunswick, New Jersey, Transaction Publishers, 1996, 301 pages, $49.95 FiguresReferencesCited byDetailsCited byNone Volume 49Issue 6 June 1998Pages 844-844 Metrics History Published online 1 June 1998 Published in print 1 June 1998

In recent years there has been considerable discussion and controversy concerning the concepts of mental health and mental illness. The controversy has centered around the problem of providing criteria for an adequate conception of mental health and illness, as well as difficulties in specifying a clear and workable system for the classification, understanding, and treatment of psychological and emotional disorders. In this paper I shall examine a cluster of these complex and important issues, focusing on attempts to define ‘mental health’ and ‘mental illness’; diverse factors influencing the ascription of the predicates ‘is mentally ill’ and ‘is mentally healthy’; and some specific problems concerning these concepts as they appear in various theories of psychopathology. The approach here will be in the nature of a survey, directed at the specification of a number of problems—conceptual, methodological, and pragmatic—as they arise in various attempts to define and to provide criteria for applying the concepts of mental health and mental illness.

In recent years there has been considerable discussion and controversy concerning the concepts of mental health and mental illness. The controversy has centered around the problem of providing criteria for an adequate conception of mental health and illness, as well as difficulties in specifying a clear and workable system for the classification, understanding, and treatment of psychological and emotional disorders. In this paper I shall examine a cluster of these complex and important issues, focusing on attempts to define “mental health” and “mental illness”; diverse factors influencing the ascription of the predicates “is mentally ill” and “is mentally healthy”; and some specific problems concerning these concepts as they appear in various theories of psychopathology. The approach here will be in the nature of a survey, directed at the specification of a number of problems—conceptual, methodological, and pragmatic—as they arise in various attempts to define and to provide criteria for applying the concepts of mental health and mental illness.

Due to the growing disappointment with psychoanalytic and behavioral/cognitive theories of psychopathology, the hypothesis that psychiatric disorders are the result of neurochemical changes is gaining popularity. As stated by Reich (1982),“American psychiatry has in fact undergone a significant shift from an emphasis that was primarily psychological to one that is more clearly biological … in every sphere of psychiatric enterprise”(p. 189). Likewise, Telch (1988) specified that,“biological theories of panic and agoraphobia have shown a major increase in popularity”(p. 507), and Spanos expressed a similar opinion (1996, pp. 287-290). However, as will be shown in this chapter, although psychiatric disorders are associated with adverse neurophysiological variables, the research findings observations are insufficient to validate the biological causality of neurosis or psychosis. Moreover, the biological model is fraught with theoretical difficulties that intensify the improbability that advocates of this theory will ultimately succeed in proving their biological thesis. Nevertheless, the relationship between various neurochemical changes and psychiatric disorders cannot be overlooked in any new endeavor to understand the development of psychiatric disorders.

CHAPTER 1 - Mechanics: A Review of Some Basic Principles

Chapter 12 offers a four-factor theory of psychopathology intended to extend the limited model for understanding the basis for psychological disturbances in human beings propagated in the Eurocentric paradigm of mental illness. The chapter problematizes the prevailing BioPsychoSocial (BPS) theory of psychopathology that forms the canon for understanding mental illness and treatment within Western psychological literature, and demonstrates that in contrast to the Eurocentric paradigm of mental illness, the Africentric paradigm which proposes the BioPsychoSocial-Spiritual (BPS-S) theory of mental illness traces causality for misfortune beyond the visible world. This follows from the assumption in African culture and worldview that the visible and the invisible worlds are highly interconnected and do influence one another. The ultimate goal of the chapter is to enable clinicians in Africa and the global world to recognize the strength and limits of Western psychology, particularly when working with Black African clients with difficult illness presentations.

Attachment theory is a theory of normal development as well as a theory of psychopathology. Attachment theory and research suggests that different types of parental bonding can be important determinants of illness behaviour, depression, pain perception and treatment response in individuals with chronic pain. Different types of parental bonding have been shown to be associated with specific personality characteristics and a variety of psychiatric disorders. We assessed 65 patients with chronic pain who visited the pain management unit of Larissa University Hospital in Greece. All patients completed the Parental Bonding Instrument, the Beck Depression Inventory and the Visual Analogue Scale (VAS) for pain. Results demonstrated that patients who reported an affectionless bond­ing (overprotective and insensitive) with their parents, and especially their mother, reported significantly greater depression and higher VAS scores. Conversely, chronic pain patients with an optimal parental bonding reported lower depression and VAS scores. These findings suggest that parental bonding style could be a useful construct for examining factors affecting psychiatric disorders and pain perception in patients with chronic pain.

Despite millennia of philosophical debate and the enormous strides that have been made in neuroscience over the last century, the pathophysiology of psychiatric disorders remains unclear. Although the monoamine hypothesis has, for more than fifty years, provided a strong basis of support for the use of antidepressants in the treatment of depression, the overall success rate with antidepressants has been disappointingly low. Coincidingly, the monoamine hypothesis has come under increasing scrutiny for failing to explain all of the phenomena that characterize mood disorders. Consequently, mental health researchers, in an effort to find new molecular targets for treatment, have been searching for a more comprehensive explanation of the means by which psychiatric symptoms develop. Recently, several new models of depression have been proposed, including the immune, the endocrine, the glutamatergic, the GABAergic, the mitochondrial, and the neuroplastic; but none of them integrate the workings of the mind with the workings of the brain, and none of them explain how abnormalities in brain function actually translate into abnormalities in thought and emotion. However, an emerging hypothesis—one that reconceptualizes the anatomy of the cognitive-emotional system and unifies previous psychological and biological theories of psychopathology—posits that psychiatric symptoms are induced by a vicious cycle of mutual overstimulation between the mind and the brain. According to the Multi-Circuit Neuronal Hyperexcitability Hypothesis of Psychiatric Disorders, the mind, when under stress, overstimulates the associated neurons and circuits. The associated neurons and circuits, in turn, overstimulate the mind, particularly if the neurological system is inherently hyperexcitable. The result is an abnormal increase in the intensity and the duration of the associated thoughts and emotions, a change that distinguishes functionally abnormal thoughts and emotions from normal ones. A more detailed understanding of the mechanism by which psychiatric symptoms develop and perpetuate has important implications for treatment, as it would allow psychotherapists to better visualize what is happening in the cognitive-emotional system; it would allow psychiatrists to better visualize the target for medical interventions; and, by reducing the stigma of mental illness, it would allow patients to be more willing to seek and follow through with mental health care.

It is generally acknowledged that some psychiatric disorders are more commonly found among members of one sex rather than the other (e.g., Dohrenwend and Dohrenwend 1976; Gove and Tudor 1973; Kass et al. 1983; Robins et al. 1984; Rosenfield 1980; Weissman and Klerman 1977). Females, moreover, are consistently overrepresented in treatment populations of different sorts, and various reasons involving responses to illness and inclination to seek treatment have been offered to account for this (Finkler 1984; Kessler et al. 1981; Nathanson 1975; Verbrugge and Wingard 1987). In contrast to accepted gender differences in prevalence, incidence and inclination to use services, a prevailing view about psychopathology is that the actual content or manifestations of a disorder should be "culture free" or universal. In the theory of psychopathology (e.g., implicit in DSM-III), general descriptors of the person (i.e., demographic and cultural) play a comparatively minor role in the stipulation of the manifestations of psychiatric illness. Among socially and culturally oriented psychiatrists, on the other hand, such descriptors are considered important clues to origins of psychopathology. However, in such analyces, sociocultural is usually equated with altogether different symbolic/language traditions (e.g., Finkler 1985; Lieban 1978), although reports exist of sex differences in symptom expression in Western societies (Brown and Harris 1976; Hinkle et al. 1960; Nathanson 1979). Feminist critics assert that even within the sociocultural tradition linked to Anglo-American society, a bias exists with respect to how psychopathology is shaped, defined and handled (Kaplan 1983; Showalter 1985). The topic of gender differences in psychiatric morbidity is thus of considerable general interest and one that can be approached from a number of different perspectives. In this study we compare psychopathology in males and females who were referred to an intake setting. The DSM-III formulations and level and type of symptoms were the focus of analysis. The results are interpreted in light of findings in psychiatric epidemiology and social psychiatry.

The term “neurosis” was first used by the Scottish physician, Cullen, in 1787; he wanted to express his understanding that mental disorders are caused by the nervous system. Neuroses were and are one of the main areas of responsibility of psychoanalysis and psychodynamic psychotherapy. The psychotherapist needs professional knowledge of the mental disorders as a theory of psychopathology, but he also draws on his clinical experience, understanding that the patients are not necessarily as described in the textbooks: they are much more different and complex. Many textbooks in psychoanalysis, psychotherapy, and psychiatry followed the classifications of International Classification of Diseases-10 and DSM-IV and gave up the historical psychoanalytical concept of neurosis. Neuroses and psychosomatic diseases are difficult to differentiate clearly. For example, the heart phobia is a typical neurosis, but it can be classified as a psychosomatic disorder, too, because bodily symptoms are at the centre of the patient’s suffering.

Mental disorders are among the leading causes of global disease burden. To respond effectively, a strong understanding of the structure of psychopathology is critical. We empirically compared two competing frameworks, dynamic-mutualism theory and common-cause theory, that vie to explain the development of psychopathology. We formalized these theories in statistical models and applied them to explain change in the general factor of psychopathology (p factor) from early to late adolescence (N = 1,482) and major depression in middle adulthood and old age (N = 6,443). Change in the p factor was better explained by mutualism according to model-fit indices. However, a core prediction of mutualism was not supported (i.e., predominantly positive causal interactions among distinct domains). The evidence for change in depression was more ambiguous. Our results support a multicausal approach to understanding psychopathology and showcase the value of translating theories into testable statistical models for understanding developmental processes in clinical sciences.

Special Report: Highlights of the 2004 Institute on Psychiatric Services

The way we define health and well-being has shifted throughout human history. This chapter reviews three primary views of health and illness (pathogenic, salutogenic, and halogenic models) and how each view influences our understanding of mental health and illness. We discuss the idea that health and illness may be viewed both as a continuum of wellness, and as distinct, but related, concepts. Next, we review various theories of psychopathology (biological, psychological, and social theories) and introduce the current biopsychosocial theory of illness. Finally, we review the two primary nosologies used for diagnosing mental health conditions, and estimating their prevalence, in the United States.

Explicitly or implicitly, psychopathology is often defined in terms of statistical deviance, requiring that an affected individual be sufficiently distant from the norm in some dimension of psychological or neural function. In recent decades, the dominant paradigm in psychiatric research has focused primarily on deviance in neural function, treating psychopathology as disease of the brain. We argue that these conceptualizations are misguided. We recently proposed a novel theory of psychopathology, based in cybernetics and drawing additionally from neuroscience, psychometrics, and personality theory (DeYoung & Krueger, 2018a). In this theory, deviations from the norm in psychological and neural functioning serve as important risk factors for psychopathology but are not in themselves necessary or sufficient to identify psychopathology, which requires the presence of cybernetic dysfunction. Psychopathology is defined as persistent failure to move toward one's goals, due to failure to generate effective new goals, interpretations, or strategies when existing ones prove unsuccessful. We argue that adopting a cybernetic theory to replace conceptualizations of psychopathology as statistical deviance or brain disease would facilitate improvements in measurement, diagnosis, prevention, and treatment of psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).