Psychoanalysis and Contemporary Psychology: Retrospect and Prospect 127psychodynamic framework humans are seen as inherently
irrational creatures. Like most questions in psychoanalysis,
this one has more than one answer. On the one hand, humans
are indeed irrational—driven by forces they do not understand,
their thoughts and feelings are distorted in ways they cannot
control. On the other hand, humans are as rational as can be ex-
pected given the constraints of their information-processing
skills, their need to cope with and manage anxiety, and the
adaptations necessary to survive in an unpredictable, threaten-
ing world. Within the psychodynamic framework, all humans
are irrational, but most are irrational in a rational way.
Normal and Pathological Functioning
As any psychologist knows, all humans may be irrational,
but some are more irrational than others. Like most person-
ality theorists, psychoanalysts see psychopathology as re-
flected in a greater-than-expected degree of self-destructive,
self-defeating (i.e., irrational) behavior (Millon, 1996). In
most psychodynamic frameworks, psychopathology is also
linked with increased self-deception, decreased insight into
the underlying causes of one’s behavior, and concomitant
limitations in one’s ability to modify dysfunctional inter-
action patterns and alter self-defeating responses (Eagle,
1984).
Psychodynamic models conceptualize psychopathology
in terms of three general processes: (a) low ego strength,
(b) maladaptive ego defenses, and (c) dysfunctional introjects.
Low ego strength contributes to psychopathology because the
ego cannot execute reality testing functions adequately; intra-
and interpersonal distortions increase. Maladaptive defenses
prevent the individual from managing stress and anxiety ade-
quately leading to higher levels of self-deception, increased
perceptual bias, and decreased insight. Dysfunctional intro-
jects (including a distorted or deficient self-representation)
similarly lead to inaccurate perceptions of self and others, but
they also foster dysfunctional interaction patterns and propa-
gate problematic interpersonal relationships.
A key premise of the psychoanalytic model of psy-
chopathology is that psychological disorders can be divided
into three broad levels of severity (Kernberg, 1970, 1975).
The classic conceptualization of this three-level framework
invokes the well-known terms neurosis, character disorder,
andpsychosis.In most instances, neuroses are comparatively
mild disorders which affect only a few areas of functioning
(e.g., phobias). Character disorders are more pervasive, long-
standing disorders associated with problematic social rela-
tionships, distorted self-perception, and difficulties with
impulse control (e.g., borderline personality disorder). Psy-
choses are characterized by severely impaired reality testing
and low levels of functioning in many areas of life (e.g.,
schizophrenia).
Although this tripartite model is both theoretically heuris-
tic and clinically useful, it is important not to overgeneralize
regarding differences among different levels of functioning.
There are great variations in both severity and chronicity
within a given level (e.g., certain neuroses may be more debil-
itating than an ostensibly more severe personality disorder).
In addition, there is substantial comorbidity—both within and
between levels—so that a disordered individual is likely to
show multiple forms of psychopathology (Bornstein, 1998;
Costello, 1995).
As Table 5.5 shows, all three dimensions of intrapsychic
dysfunction—low ego strength, maladaptive defenses, and
dysfunctional introjects—can be mapped onto the tripartite
psychopathology model. In this respect, the model represents
an integrative framework that links different psychodynamic
processes and connects the psychoanalytic model with con-
temporary diagnostic research. Although the term neurosisis
rarely used today in mainstream psychopathology research,
perusal of contemporary diagnostic frameworks (including
theDSM-IV;APA, 1994) confirms that the tripartite model
has had a profound influence on the way practitioners con-
ceptualize and organize psychological disorders (see also
Masling & Bornstein, 1994, and Millon, 1996, for discus-
sions of this issue).PSYCHOANALYSIS AND CONTEMPORARY
PSYCHOLOGY: RETROSPECT AND PROSPECTPsychodynamic models of personality occupy a unique place
in contemporary psychology. On the one hand, they continue
to be roundly criticized—perceived by those within and out-
side the discipline as untested and untestable and denigrated
by skeptics as a quasi-phrenological pseudoscience that has
hindered the progress of both scientific and clinical psychol-
ogy. On the other hand, Freud’s theory continues to fascinate
many, occupying a central place in undergraduate and gradu-
ate psychology texts and influencing in myriad ways ourTABLE 5.5 Levels of Psychopathology in Psychodynamic Theory
Level Ego Strength Ego Defenses Introjects
Neurosis High Adaptive-mature Articulated-
(displacement, differentiated
sublimation) and benign
Character Variable Maladaptive-immature Quasi-articulated,
disorder (denial, projection) malevolent, or both
Psychosis Low Maladaptive-immature Unarticulated-
or nonexistent undifferentiated
and malevolent