Term Paper on "Clinicians Have Always Been Reminded or Expected"

Term Paper 15 pages (4252 words) Sources: 1+

[EXCERPT] . . . .

Clinicians have always been reminded or expected to perform examinations of mental disorders and draw diagnoses from objective factors, such as symptoms. But recent studies showed that, despite this traditional outlook and persistent reminders, clinicians still rely or choose to use their personal theories in examining and diagnosing patients with mental disorders. Among the personal theories in popular use are Alfred Adler's and the Existential Theory. Adler's theory draws from an inherent motivation to self-perfection and social interest, while the Existential Theory restores patients' lost, damaged or unrecognized autonomy, freedom and responsibility for their own actions, lives and destinies.

Introduction

The influence of clinicians' personal theories over their diagnosis of mental disorders was the subject of a recent study conducted by two experts on 35 clinicians and 25 clinical trainees (Holmes 2002). The experts, Dr. Woo-kyoung Ahn of Vanderbilt University and Nancy Kim of Wesleyan University, asked the subjects to perform four basic tasks, namely, draw the relationship between the symptoms of certain disorders; identify the relative importance of these symptoms with the disorders; diagnose some hypothetical cases; and then test the participants' recall of the symptoms several hours after diagnosis. The study showed that, despite considerable efforts placed by leaders in the field of clinical psychology to keep diagnosis objective, clinicians' theoretical beliefs still exert major influence on diagnosis. The findings of the study were published in the December 2002 issue of the Journal of Experimental Psychology General (Holmes)..

Clinical psychologists have always been expected to base their diagnosis on a checklist of symptoms, but the findings revealed that clinicians' diagnosis draws heavily from their individual theories (Holmes 2002). They are likelier to make a diagnosis of mental disorder when the person displays symptoms central to the clinician's own theory of the disorder than if the patient's symptoms were peripheral to those of the clinician's theory. Furthermore, all the subjects of the study, who were practicing clinicians and graduate students, held different and complicated theories about mental disorders, from schizophrenia, major depression and anorexia to diverse kinds of personality disorders and that individual theories did not have many things in common. There was no basic understanding or agreement on the causes and the clinicians' theorizing can be erratic or lead to conflicting diagnoses. In addition, clinicians' recall of the symptoms was influenced by the theories they held. If the symptoms were peripheral, clinicians tended to forget them more (Holmes).

Among the personal theories used by clinicians are those of Alfred Adler and existentialism.

Personal Theories: Adler and Existentialism

Adler. - Adler was born in Vienna, Austria on February 7, 1870 (Boeree 1997). He could not walk until he was four years old because of rickets and also nearly died of pneumonia at five. His physical condition impelled him to acquire a medical degree from the University of Vienna in 1895. He began working as an ophthalmologist and then switched to general practice in the lower-class part of Vienna.. Most of his patients were circus performers who suffered from organ inferiorities and this led to an interest in organ deformities and compensation, clearly also because of his own experience of deformity and disability as a child. He later shifted to psychiatry and joined the discussion group led by Sigmund Freud. Adler wrote papers on organic inferiority, an aggression instinct and children's feeling of inferiority.

Adler suggested that the single motivating force or drive behind human behavior and experience is the striving for perfection (Boeree 1997). It is the desire to fulfill one's potential or come closer to one's ideal, similar to or the progenitor of the modern concept of self-actualization. Initially, he referred to this as an aggression drive, which is the reaction when other drives are thwarted or frustrated, among these the need to eat, get sexual satisfaction, get something done or the need to be loved.

Adler also referred to this basic motivation as compensation or the striving to overcome (Boeree 1997). He believed that our personalities would be so structured as to compensate or overcome problems, shortcomings or inferiorities of any kind. One of his earliest phases was masculine protest, whereby boys were expected to be strong, aggressive and in control, rather than weak, passive or dependent, which girls were expected to be. Boys and men were viewed as basically better than or superior to girls and women, so that boys and men were accorded with power, education, talent and motivation to accomplish great things not expected of girls and women. But Adler did not view boys and men as inherently superior or better, but only encouraged to be assertive, while girls and women are discouraged. He saw that both boys and girls possess the same capacity for protest.

His last phase before changing to striving for perfection was the striving for superiority (Boeree 1997, Stein 1991), which compares with the philosophy of Friedrich Nietzsche on the will to power as the basic motive in human life. Adler believed that this striving was not only for superiority but also to be better than others. He used this in connection with unhealthy or neurotic striving. Rather than adopt Freud's reductionistic view that breaks a person down to smaller concepts of superego, ego and id, Adler adhered more to the theory of Jan Smuts, a South African philosopher and statesman, who saw man as a unified whole and within the context of his physical and social environment. This was the holistic approach, which Adler adopted. He saw people as wholes instead of parts, as did Freud, and labeled his approach as individual psychology. And rather than perceiving personality as a complex of internal traits, structures, dynamics and conflicts, he referred to life style or the way one lives life, how he handles problems and relationships. In Adler's eyes, individuality expresses and molds itself in its own environment and against a background of other and different environments. It has its own life pattern and is not a merely mechanical reaction to the environment (Boeree).

Next to the striving for perfection, the human person naturally pursues social interest (Boeree 1997, Stein 1991). Under his holistic approach, a man pursues that perfection within a community or out of a community feeling. Man does not only exist and strive alone. His social interest is both inborn and learned but parents and culture must teach a person to empathize. He interpreted this social interest as a broad sense of caring for family, community, society, humanity and for all life. It means being useful for others. A lack of concern for others he perceived as the cause and definition of mental ill health. He traced all failures as deriving from that lack - neurotics, psychotics, criminals, drunks, problem children, suicides, perverts and prostitutes. In Adler's view, these individuals suffer precisely because of a lack of social interest and their pursuit of personal superiority is blocked and whatever seeming triumphs they may have are meaningful only to themselves. He enumerated four psychological types of person, namely, ruling, learning, avoiding and the socially useful. The ruling is aggressive and dominant and bullies and sadists come under this type. The learning type is sensitive, with low energy level and dependent. He easily develops phobias, obsessions and compulsions, general anxiety, hysteria, amnesia, depending upon his life style. The avoiding type has the lowest energy level who survives only by avoiding life itself, especially other people. When pushed to the limit, he can turn psychotic and retreat to his own personal world. And the socially useful is healthy and whose life style is characterized by social interest and vast energy.

Childhood plays a large role in Adler's theory. It sets forth three basic childhood situations that can lead to a faulty lifestyle (Boeree 1997, Stein 1991). These are organ inferiorities, pampering and neglect. A person with organ inferiorities is often overburdened and has a strong sense of inferiority. He may also compensate through superiority complex. Pampering is self-defeating because the person does not learn to do things for himself and does not learn how to deal with others. And neglect breeds a sense of inferiority as well as selfishness. The person's birth order is another factor. The only child is often pampered and assertive. The first child is similar to an only child until another or other siblings are born. The second child and other middle children are more passive than the first or oldest and youngest children.

In diagnosing mental disorder, Adler's approach will seek out the patient's birth order, his serious illnesses from childhood, childhood habits, dreams and self-expression (Boeree 1997, Stein 1991). His approach to therapy differs from Freuds. Adler would have everyone sitting up and talking among themselves face-to-face. It would recognize a patient's resistance as another sign of a lack of courage to give up his neurotic lifestyle. The patient must be made to understand how his lifestyle and his self-centered fictions account for his mental condition. The objective of the therapy should be to bring him to that state of feeling where he will… READ MORE

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