Zur Entwicklung der Psychogenese-Konzepte

Abstract

This overview focuses on the development of modern psychogenesis concepts and their theoretical background and origin. The psychogenetical concepts and their association with unconscious conflicts in the 19th century are presented in a historical review. Freud developed a systematic psychopathology of conflicts, which continued with the emergence of psychoanalytical theories. Psychodynamics as a theory of intrapsychic processes aims at understanding the role of unconscious conflicts in the development of psychic disorders (and the psychopathology of everyday life). The sedimented life history of early childhood was believed to be an important factor in understanding the origin of mental illness. The intrapsychic dimension of conflict was increasingly enlarged to include the interpersonal dimension (internalised object relationships). Ego- and self-psychology led to the conceptualisation of structural ego-disturbances and of the dynamic link between structural deficit and conflict. This finally gave way to the concept of multidimensional diagnostics. In view of the variety and complexity of individual processes and symptoms, and the belief that individual cases cannot simply be categorised, earlier assumptions that symptoms result from specific conflicts were rejected. Nevertheless, it seemed clinically practicable to adopt ideal types of constellations. In the context of a three-dimensional model for psychic disorders, symptoms may be related to the actual conflict, the structure of personality and the processing mode of defence and compensation. A further subject-oriented theory of psychic disorders was developed in the framework of anthropologic psychiatry, addressing the connection between how the illness is subjectively experienced and how the illness is actually diagnosed. Similar models relating to the development of the vulnerability concept emerged later, and further concepts derived from system theoretical approaches centring around the idea of homoeostasis were presented. Another development was the family therapeutic model, which considered the patient's family environment and relationships. This dimension plays a significant role in the formation of binding constellations and was one of the key factors in the discussions concerning different models for psychic disorders. Moving away from introspection, in the context of behaviourism, a laboratory paradigm was developed, explaining the brain as a black box. This was finally superseded by the turn towards cognitivism. The past ten years have seen a greater focus on affective processes in the context of experience. The latest developments concerning binding theory, affect theory and neuroscience and their role in the creation of today's multidimensional psychogenesis models are discussed. Psychosis as the result of the combination of circular somatic and psychic processes in the brain, and depression as the result of such combined processes in the drive-mood system are just two examples of the attempts to explain the complex interactions involved. However, integrating neurobiological findings - albeit a worthwhile and important challenge - should not be the primary focus of attention, neglecting prolific clinical tradition. Moreover, methodological limitations should also be considered.