I - Experiential Psychopathology
When the organism, individual or family, is under attack from psychic noci-vectors, it has to meet the attack and, if possible, contend successfully with it and defend the integrity of the “idea of self”. Thus it has to cope by the use of a number of devices or expedients to meet or attenuate the effect of the attacking agent and repair its damage. Coping involves defence, adaptation, and reparation. It is the price the organism has to pay to preserve its integrity.
The coping devices may be completely or only partly successful. If partly successful, then the organism is left with a handicap. This may be general or focal, i.e. sensitivity to any stress or to one stress only, e.g. social intercourse.
Just as the psychic noci-vectors are acquired through experience, usually within the preceding family, so too are the coping devices. The child imitates, consciously or automatically, the devices adopted by his fellow family members of any age. Sometimes by chance he comes across a device that for him, in a particular circumstance, appears to work. This will be his special device until experience causes an adjustment or change. He may use it even at times when its employment is inappropriate. Thus some of the coping devices are employed in common by many people. Others are particular to a person, stamped on him by previous experience, and become his “stock in trade”. The same applies to a family or to any larger group.
To contend with the opposition, the whole functioning of the organism may be called to action. This will include the endowment as well as the acquired aspects of the psyche. Not only does a coping device need an apparatus for its execution, but it consists of an attitude and is associated with a feeling tone or mood; mood is especially evident in the more acute and automatic reactions, e.g. aggression.
The acquired aspect of the psyche can react by use of either automatic or directed devices. The advantage of the automatic devices is that they are immediate and overwhelming. But they may be ill-directed, inappropriate, and diffuse. The automatic devices are primitive, e.g. anger and flight. The directed devices are slower, more acute, and sometimes highly sophisticated, e.g. sarcasm and carefully-thought-out acts. Animals are more dependent on automatic response and homo sapiens, on directed response.
In an acute attack, the organism may be forced to react by shock – the centres of defence become exhausted. This passive state has the advantage that the organism cannot grasp any further significance in the attack and thus its influence is reduced. Exhaustion of attention is an important merciful defence mechanism of the organism. It is likely to be reached earliest in acute trauma. In sustained trauma the threshold of exhaustion is seldom reached, hence the powerful effect of long-drawn-out stress.
The attack may be directed at one aspect only of the self and thus only a local defence is required, e.g. an attack on the person’s social status. The attack may also be directed at a number of aspects or on the whole self, e.g the statement “I hate you”.
A study of the ways by which well-adjusted people react to attack will expose devices that can be employed in therapy, e.g. forgetting is a fundamental biological coping device; yet at times in therapy we make forgetting impossible by repeated recollection of previous mishaps. Constructive phantasy, hope, is another healing device.
The use of a particular coping device may be dictated by the situation. The appropriate devices must be employed in a given situation and this may limit the choice or dictate the employment of one device, e.g. faced with a deaf-mute, a non-verbal response is essential.
The nature of the attacking agent may determine the most appropriate response; its source, the meaning conveyed, the senses used for conveyance, its dynamic qualities (strength, number, repetition, sequence), whether acute or chronic, short or sustained, the vulnerability of the organism to that trauma, and age are all elements which determine the response to stress. A source within one’s own psyche has to be handled differently from an external source. Normally the defence involves the same senses as those used by the attacking agent, but not always. Usually, the more acute and severe the trauma, the more severe and automatic the defensive response. A sustained attack calls for a sustained defence. A repetitive attack calls for a discontinuous response – with the possibility of learning the most effective response in between attacks. A number of noci-vectors may have to be met by the psyche with an equal number of defensive vectors to match them.
In a well-balanced organism, the coping devices are usually controlled, well directed, and, usually, successful. The less-balanced organism has so many weaknesses that its response may be ill-judged. Excess of anxiety leads to inattention, dithering, indecision, and even to a misunderstanding of the nature of the attack. A balanced organism may suffer considerable attack and be able to respond appropriately. For example, a loved person is lost (almost like losing a part of the self). At first there may be a stunned response with apparently little reaction; this is followed by maximum grief; this fades as reparation sets in – forgetting plays a part and there is a realistic reappraisal of the situation and a deployment of its assets. In the unbalanced, guilt, anxiety, hostility, may be superimposed on grief.
In children, the coping devices, especially the directed, tend to be simple. They get more complex with age. They are crude in simple folk and sophisticated and subtle in the intelligent, e.g. the latter may believe it is better to have an adverse decision than no decision – at least it allows of a trial operation.
Psychic noci-vectors may be contradictory. The same psychic source may emit simultaneously two or more messages having conflicting or different meanings. Or the conflicting or different messages may come from a number of sources. This can cause bewilderment in the recipient, but not madness. This occurrence is so frequent in day-to-day life that organisms quickly develop obvious ways of coping with it. Given a number of different or contradictory messages, the recipient can:
- Ignore them all, claim they show lack of agreement in the senders, and use them as an argument for following his own policy.
- Behave according to the resultant of the forces bearing on him; his behaviour may please all his assailants or none.
- Select the one message that most appeals.
- Select the message that is most compelling or strongest.
- Do nothing.
Coping involves establishing attitudes which are strongly held, these are attempts to adapt and they may clash with the attitudes of others and therefore be destructive and maintain the opposition of others. Such attitudes are difficult to change, as they are considered essential by the self as coping devices. They are easier to dissipitate if the coping becomes unnecessary, i.e. the threat is diminished and security increased. Hence in therapy it is essential to produce security, or coping devices against insecurity must continue to operate.
Examples of Coping Devices
The whole organism can be brought into action in any attack and one or many of the devices below brought into action. The devices can be divided into those that are primitive and automatic, and those that are directed.
There are three groups:
- Those involving aggression, such as verbal hostility (abuse, swearing, sarcasm, cynicism, etc.) or non-verbal (ignoring, depriving, punishing, tantrum, physical harm, homicide).
- Withdrawal in verbal terms (silence) or non-verbal (to move away, to hide, to contrive not be noticed, apathy, sleep, suicide).
- Anxiety – to be in an anticipatory state. The alarm mechanisms are kept on the alert – sometimes for a lifetime. Anxiety can be displaced on to objects, themselves harmless, which are associated by chance with the fear situation – thus phobias are created.
Any apparatus of the organism may be implicated:
Perception – any of the sensations from the five senses may be exaggerated or dulled, e.g. an inability to hear. In a state of heightened tension, meanings may be misconstrued and harmless objects regarded as the subjects of suspicion, leading to paranoid states. There may be partial or complete denial of meanings.
Memory – The normal machinery of forgetting is a healthy defence against stress and always comes into play in time. It may operate inappropriately and too early. In the process of remembering, events and meanings may be projected on to the wrong person.
Realistic Thought – Healthy reactions include apology, understanding, toleration, relating to previous experience, forgiving, diversion, avoidance and insightful rationalisation to find effective answers, rationalisation in humour.
Unrealistic Thought – Lying, attention-seeking and hysterical behaviour, attention-seeking by regression or illness, selfishness, meanness, overprotection arising from fear or guilt.
Phantasy – Daydreams, overcompensation leading to boasting, snobbery, etc., identification.
Behaviour – Overactivity (illusion of action), obsessions and compulsions (an attempt to control and predict events so that they can be anticipated), conformity, perfectionism, hypermorality, and artificial aids such as rhythmic activity, (thumbsucking), chewing gum, drugs, alcohol, excessive sexual activity.
Physical – The whole of the organic apparatus also responds protectively. Its responses may lead to psychosomatic illness – not to be confused with hysterical behaviour. In the former there is no contrived illness; it is an inevitable result of psychic trauma. In hysterical states there is a simulation of illness because of the overwhelming need of the organism to cope. Illness is a common method of avoidance and widely employed.