Anxiety disorders, along with dissociative disorders and somatic symptom and related disorders (see Chapter 6), were classified as neuroses throughout most of the 19th century. The term neurosis derives from roots that mean "an abnormal or diseased condition of the nervous system.” The Scottish physician William Cullen coined the term neurosis in the 18th century. As the derivation implies, it was assumed that neurosis had biological origins. It was seen as an affliction of the nervous system. At the beginning of the 20th century, Cullen's organic assumptions were largely replaced by Sigmund Freud's psychodynamic views. Freud maintained that neurotic behavior stems from the threatened emergence of unacceptable, anxiety-evoking ideas into conscious awareness. According to Freud, disorders involving anxiety (as well as the dissociative and somatic symptom disorders discussed in Chapter 6) represent ways in which the ego attempts to defend itself against anxiety. Freud's views on the origins of these problems united them under the general category of neuroses. Freud's concepts were so widely accepted in the early 1900s that they formed the basis for the classification systems found in the first two editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ego is governed by the reality principle. It considers what is practical and possible, as well as the urgings of the id. The ego lays the groundwork for developing a conscious sense of ourselves as distinct individuals. During middle childhood, the superego develops from the internalization of the moral standards and values of our parents and other key people in our lives. The superego serves as a conscience, or internal moral guardian, which monitors the ego and passes judgment on right and wrong. When it finds that the ego has failed to adhere to the superego's moral standards, it metes out punishment in the form of guilt and shame. Ego stands between the id and the superego. It endeavors to satisfy the cravings of the id without offending the moral standards of the superego. Stages of Psychosexual Development Freud argued that sexual drives are the dominant factors in the development of personality, even in childhood. Freud believed that a child's basic relationship to the world in the child's first several years of life is organized around the pursuit of sensual or sexual pleasure. In Freud's view, all activities that are physically pleasurable, such as eating or moving one's bowels, are in essence “sexual.” (What Freud meant by sexual is probably closer in present- day meaning to the word sensual.) The drive for sexual pleasure represents, in Freud's view, the expression of a major life instinct, which he called Eros-the basic drive to preserve and perpetuate life. He called the energy contained in Eros that allows it to fulfill its function libido, or sexual energy. Freud believed that libidinal energy is expressed through sexual pleasure in different body parts- called erogenous zones—as a child matures. In Freud's view, the stages of human development are psychosexual in nature because they correspond to the transfer of libidinal energy from one erogenous zone to another. Freud proposed the existence of five psychosexual stages of development: oral (first year of life), anal (second year of life), phallic (beginning during the third year of life), latency (from around age 6 to age 12), and genital (beginning in puberty). The Structure of Personality According to Freud's structural hypothesis, the human personality is divided into three mental entities, or psychic structures: the id, ego, and superego. The idº is the original psychic structure, present at birth. It is the repository of our baser drives and instinctual impulses, including hunger, thirst, sex, and aggression. The id, which operates completely in the unconscious, follows the pleasure principle : It demands instant gratification of instincts without consideration of social rules or customs or the needs of others. During the first year of life, a child discovers that every demand is not instantly gratified. He or she must learn to cope with the delay of gratification. The ego develops during this first year to organize reasonable ways of coping with frustration. Standing for “reason and good sense” (Freud, 1933/1964, p. 76), the ego seeks to curb the demands of the id and to direct behavior in keeping with social customs and expectations. Gratification can thus be achieved, but not at the expense of social disapproval. Let's say the id floods your consciousness with hunger pangs. Were it to have its way, the id might prompt you to wolf down whatever food is at hand or even to swipe someone else's plate. However, the ego creates the idea of walking to the refrigerator, making a sandwich, and pouring a glass of milk. Psychodynamic theory is based on the contributions of Sigmund Freud and his followers. Freud's version of psychodynamic theory, called psychoanalytic theory®, is based on the belief that the roots of psychological problems involve unconscious motives and conflicts that can be traced back to childhood. Freud put the study of the unconscious mind on the map (Lothane, 2006). To Freud, unconscious motives and conflicts revolve around primitive sexual and aggressive instincts and the need to keep these primitive impulses out of consciousness. Why must the mind keep impulses hidden from conscious awareness? Because, as Freud held, were we to become fully aware of our most basic sexual and aggressive urges-which, according to Freud, include incestuous and violent impulses-our conscious self would be flooded with crippling anxiety. By the Freudian account, abnormal behavior patterns represent "symptoms” of these dynamic struggles taking place within the unconscious mind. The patient is aware of the symptom, but not the unconscious conflict that lies at its root. Let's take a closer look at the key elements in psychoanalytic theory.
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