Developmental Aspects of Psychological Disturbances

Psychoanalysis deserves much credit for having demonstrated that psychological disturbance does not spring solely from constitutional or neurophysiological defect, but has a far more complex etiology that is related to the whole history of the individual's development. Studies of the origins of both neurotic and psychotic conditions have demonstrated that such conditions cannot be fully understood without a reconstruction of the experienced past. And effective therapy often requires a reliving, a working through, an undoing of the fixations, inhibitions, and foreclosures left by that past. My goal in this paper is to present a preliminary set of concepts that may eventually enable us to better understand the close connection between disturbed or pathological states and the normal developmental process.

To emphasize the developmental aspects of psychological distress is not to deny the importance of other factors. An adequate explanation of psychopathology, and in particular of psychotic conditions, must also include a thorough discussion of constitutional and neurophysiological factors, an awareness of the psychosocial, cultural, and historical matrix within which disturbances become apparent or by which they are triggered, an assessment of the here-and-now pressures that impinge upon the individual, and an understanding of how each of these factors interrelates to each other and to the process of development. This discussion of the developmental aspects of psychological disorder, then, will not claim that these aspects are necessarily central. I will merely argue that in all psychological disorders there is a developmental component, and that we need more precise concepts to describe the many ways in which developmental factors influence psychological disorder.

A brief account of how I came to this subject may help place these remarks in context. For the past 15 years, I have conducted a series of prolonged