Mental illness or illness from the point of view of the personality system is the morbid process. In the seventh and final part of the in-depth research, Prof. Ashoka explains various concepts, in the weekly column, exclusively for Different Truths.
Development forces upon you the necessity to exchange one conception of the desirable for another. If you refuse, if you are not ready for, such renunciation, we may term this after Freud an inhibition of development. If you agree to make such a renunciation, but rather unwillingly, remaining attached to the abrogated notion and returning to it whenever the obduracy of external reality or your own limitations lead to your frustration in connection with later notions, we may speak with Freud of fixation and regression. Such inhibition of development, fixation, regression, create and exacerbate disharmony in your relations with others or within yourself or both, in any event, increasing the likelihood of frustration. If at a certain time of life a concatenation of circumstances rather abruptly contrives to increase the clamour of a particular tendency to be realised, increases the significance of an internalised symbolic representation, disturbing your previous degree of devotion to this tendency or symbolic representation and the careful arrangements made for its relations to other tendencies or symbolic representations, and straining both the patience of external reality and your own capacities for substitution and sublimation, then we may remember Freud’s references to the frustration following upsurges of libido at adolescence or menopause. Even if you are enthusiastic about exchanging one kind of satisfaction for another, renouncing one goal in favour of the adoption of a new one, you may find that the new ideal is incompatible or conflicts with other of your rather entrenched ideals. (Freud writes of people “falling ill . . . as often when they discard an ideal as when they seek to attain it.”) Since you must change — the world in which you live expects it; in becoming yourself, you internalise these expectations as your own; the behavioural organism matures — since change you must, with all the risk such change entails, then you are lucky indeed if you do not fall ill in the course of your lifetime.
Mental illness or illness from the point of view of the personality system is the morbid process — and the effects of attempts to recover from it — initiated by some degree and duration of frustration of a wish to attain a symbolised desirable state of affairs that remains unmitigated by adaptive mastery of external reality, substitution, or sublimation. (The desirable state of affairs symbolised may, of course, come to involve a conception of avoidance of, or escape from, harm or threat). The obstacle to the attainment of a desirable state of affairs itself is with respect to a mental illness most significantly — from the point of view we have developed here — constituted by or originated in aspects of symbolic processes. The response to frustration constitutes the morbid process. The process is morbid because, with respect to attaining gratifying states of affairs, in reality, it is destined to fail. Differences in the response to frustration, as well as in the attempts to recover from the morbid process, differentiate psychological illnesses from each other. One response —characteristic of what we call neurosis — is to give up your efforts to attain a gratifying state of affairs in reality, but to rest content with imagining such a state of affairs, that is, with phantasy. To use Freud’s language, you may withdraw cathexis or libido from current reality object-representations, and invest such cathexis or libido in the object-representations of phantasy. In other words, for you, the object-representations of external reality appear to have less and less significance with respect to particular kinds of aims or goal-strivings. (Keep in mind that this describes a circumscribed process and not the entire personality.) At the same time instead, you attribute greater and greater significance to the object-representations of inner reality. Having little incentive to cling to progressive conceptions of the desirable that have met such an unhappy fate, you relinquish these. The symbolisations of phantasy tend to find their best material in other regressive conceptions of the desirable, remnants of past eras of your life — “better days.” These conceptions are revalued and effort is allocated to the creation of phantasies of their fulfilment. However, there is not much gratification in phantasy. What there is illusory, and even an animal symbolicum finds it difficult to rest content with that. The regressive conceptions of the desirable, perhaps in part as a result of their characteristics as symbolisations, in turn, begin to be associated with impulsions to actualisation in reality. Such a development may be viewed as a kind of attempt to recover from the turning-away from object-representations of external reality initiated by the pathogenic frustration. However, the regressive conceptions conflict with other conceptions of the desirable in the personality system. Symbolic manoeuvres the so-called defences—aim at the extrusion of these disturbing regressive conceptions. It is important to realise that, as such writers, as Isaacs and Schafer have pointed out, defences are not “mechanisms”—a word borrowed from positivistic terminology—but are themselves symbolic processes. In fact, defences are phantasies, representing conceptions of internal events, of contents or objects imagined within or without; representing conceptions of imagined interactions with, imagined the location of, and imagined operations upon, self-representations and object-representations. Differences in these manoeuvres or defences differentiate to a large extent between the various neuroses and account (along with manifestations of the regressive conceptions) in the form of neurotic symptoms. Neurotic symptoms are understandable, then, as attempts at recovery, as efforts — which are only partially successful and which often lead to considerable pain to struggle against the largely silent, morbid neurotic process. The response to frustration characteristic of psychosis is to withdraw cathexis or libido from current reality object-representations and from object-representations in phantasy as well. As Freud is careful to point out in his discussion of the Schreiber case, this does not mean that a person insofar as he is psychotic has no interest in reality or phantasy. Withdrawal from reality has a more specific meaning than is usually attributed to it. It means only that with respect to particular kinds of aims or goal-strivings — Freud classifies these as sexual a person insofar as he is psychotic attributes less and less significance to current reality object-representations or to object-representations in phantasy, and greater and greater significance to his own self-representation or to an undifferentiated state (perhaps devoid of symbolisation processes?) in which neither object-representations nor self-representation exists or in which, to the extent such representations have some form (no matter how rudimentary), neither has such significance.
Megalomania, with its narcissistic overvaluation of the self, is one manifestation of this abandonment of other objects in favour of the self. Preoccupation with the end of the world catastrophe may represent the patient’s experience of the loss of all other objects in current external reality or in inner reality.
According to Freud’s conception of schizophrenia, the schizophrenic person’s use of language, hallucinations, and delusions are all evidence of processes of reconstruction or attempts at recovery, however dysfunctional their consequences. In an effort to return to the world of objects, the patient attributes to words the significance of the objects to which words are ordinarily attached. As unconscious thing-representations, sensory images are subjected to primary processes of condensation and displacement, so word-representations rather than thing-representations come to be subjected to such processes. Words are treated by the patient as things.
Delusions and hallucinations represent part efforts to create a new reality, in the form of thought or image, to replace the rejected reality. The new reality has elements at least more favourable to gratification than the rejected reality. In a hallucination, object-representations once again are significant especially with respect to wish-fulfilling phantasies; but they pass into consciousness as images without the benefit of secondary thought processes, which have been disrupted by the morbid psychotic process.
Although there is much to say and to question about this model of mental illness, many of you no doubt feeling that as a model of neurosis it is limited perhaps to hysteria and that especially as a conception of schizophrenia it is neither the most important nor most useful model available to us. In order to prepare us for an account of another conception of schizophrenia, it would, I believe, be especially useful to consider Freud’s ideas about language, consciousness, and unconsciousness. In these ideas, there seems to me to be still another meaning of cathexis, different from any we have mentioned and leading to another idea of mental illness.
Prof. Ashoka Jahnavi Prasad
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Ashoka Jahnavi Prasad is a physician /psychiatrist holding doctorates in pharmacology, history and philosophy plus a higher doctorate. He is also a qualified barrister and geneticist. He is a regular columnist in several newspapers, has published over 100 books and has been described by the Cambridge News as the ‘most educationally qualified in the world’.