Cultural factors influence how and what we see. As Husserl points out, the basic truth of perceptual experience is that what we see is directly dependent upon the perspective from which we see it. Although we are all conscious that there is only one world, we also see it differently, interpret it differently, and attribute different meanings to it at various times. In a process of selection and exclusion, a world-view will be filtered through the hopes and fears, the expectations and the experiences of the individual. The end result is a set of perspectives which have been multiply modified in the transmission. ‘Meaning and interpretation belong together inseparably. Anything which visibly has a meaning is in that same instant invested with an interpretation by each and every onlooker’ (Poole 1972: 6). The fact that we confer meaning on the world, instead of it imposing meaning on to us, implies that we are active participants in this process.

Following Husserl, Poole (1972) and Zukav (1979) point out there is no one single truth but only truths dependent upon the perspective from which we see it. What we term ‘objectivity’ consists of all the beliefs and unquestioned assumptions of a given society. Ignoring this essential fact is a serious error in the theories, clinical practice and research endeavours that describe models of psychopathology, an error reflected in conceptualizations of scientific paradigms and research methodologies. The current scientific paradigm individualizes science and ignores the fundamentally subjective and interactive nature of experience in its quest for so-called ‘objectivity’.

This view, as we have seen in other posts, is emphasized in labelling theory, concerned with societal reactions. Attempting to reduce everything to one reality or unreflectively asserting the importance of one reality over others has many critical implications. It affects the language we use, and ultimately all our thoughts and perceptions. Cultural factors are therefore embedded in and shape what we think we ‘know’. In turn this gives legitimacy to certain forms and content of ‘knowledge’. Sayal (1989), writing on black women and mental health, illustrates some of the issues: there are often sweeping generalizations made about black people, that, for example, ‘passive’ Asian women are subjected to oppressive practices within the family, or that Afro-Caribbean women are strong and dominant.

Stereotypes are accepted as ‘facts’ and are frequently used by mental health workers. Sayal claims that by accepting pathologizing notions about ‘black families’ we collude with the pseudo-science that gives legitimacy to popular racism, since we make presumptions about homogeneity that we do not make about white families. This process is seen at the level of professional ‘science’, for example, in concepts such as ‘ethnicity’ and ‘transcultural psychiatry’. An examination of the studies conducted in this area suggests that most of the studies claiming to be on black family life are actually concerned with poverty. Sayal points out that the poor are frequently identified as ‘ “culturally deprived” . . . so that poverty is discussed as if it is a personal trait rather than a social condition, and deviations from ethnocentric norms are viewed as deprivation’ (1989: 4). A consequence of this is that a high proportion of black children are in care because black women are viewed as unfit for mothering, and until recently as unfit for fostering and adoption. Sayal also describes how psychiatric formulations are made of black-specific mental illnesses, such as ‘West Indian psychosis’. The psychiatric theories which claimed that black genes were causal factors in mental illness have now been substituted by theories which view black culture as a causal factor in mental illness.

Many of the values we hold in Western society about the goals of psychotherapy are themselves potentially culturally specific. Therapy focuses on the individual with for example, restoring ‘a sense of autonomy’ or ‘taking responsibility for the self’, set as goals of treatment. Other cultures take a different approach to therapy. A Hindu in India might instead be helped to reintegrate within their social group and to restore the sense of interdependence rather than independence.

Our cultural context therefore shapes how we think about psychopathology. What are taken to be ‘facts’ in mental health are culturally determined. Definitions and classifications are not absolute but change across cultures across time. Albee (1996) gives the example of the psychiatric view of homosexuality. The first edition of DSM classified homosexuality as a sexual deviation. However, in 1973 the second edition of DSM was modified when the American Psychiatric Association eliminated the general category of homosexuality as a mental disorder, unless it was distressing to the person concerned. Thus, in the 1970s, thousands of US citizens were changed overnight from being defined as mentally ill to normal.

Psychological distress or symptoms of psychopathology are manifested differently in different socio-cultural contexts. A syndrome traditionally not seen in Western cultures is ‘amok’, where men erupt, following a period of depression and brooding, into a sudden state of frenzied and unprovoked indiscriminate violence ending in exhaustion and amnesia. The condition has traditionally been associated with the Malayan people and was relatively common a few hundred years ago, although rare today. Theorists have speculated that amok was related to the cultural values that placed heavy restrictions on adolescents and adults and the belief in magical possession by demons and evil spirits. There are other culture-bound syndromes (see Westermeyer 1985), and, even when similar psychological problems are seen in different parts of the world, the way a particular syndrome is perceived may vary from culture to culture (Erinosho and Ayonrinde 1981).

The individualization of distress

Even though in the different models of psychopathology there are a variety of theoretical ideas and practical procedures, many of them markedly incompatible with each other, there are nevertheless some general issues common to most models that distinguish them from the socio-cultural model.

A major criticism that may be made of models of psychopathology generally is that they are inherently too individualistic from their theoretical conceptualizations to their practical applications. The reductionist view of science prevalent within our culture is reflected in the empirical research paradigm of contemporary psychology and psychiatry. This research is used to legitimize the current models of psychopathology and confer validity on their theoretical underpinnings.

Chomsky (1968) and Poole (1972) point out that science is inadequate when it focuses on selected parts rather than the totality of problems. Poole defines an adequate science as ‘the study of the totality of problems, objective and subjective, by the whole thinker, taking into account all the evidence, both quantifiable and unquantifiable’ (Poole 1972: 108–9). However the traditional scientific paradigm of empirical research emphasizes an analysis and solution of problems, and ignores wider contextual issues. This type of research into human behaviour is seen, for example, in the geneticists’ quest to isolate genes for happiness, aggression, and so on; as well as in psychiatric and psychological researchers isolating specific symptoms, or specific events of the therapeutic process, or isolating the client and/or therapist from the total subjective context within which therapy takes place. It is questionable whether these different frameworks actually help clients to understand the source of their unhappiness, or merely elevate the notion of illness. Writers such as Masson (1990, 1991), Heath (1992), Smail (1987, 1993) and Szasz (1971) point out the inappropriate therapies and treatments given for conditions of which we do not know the fundamental causes, but which may turn out to be psycho-social in origin. They draw attention to the inappropriate and inadequate view of the nature of the self that ignores political, economic and cultural sources of pain and distress and which avoids any real analysis and criticism of a social order based on inequality of wealth, opportunity and choice. They challenge the view that focuses, simplistically, on individuals and families as the target of intervention. In therapy, while close attention is paid to personal and interpersonal processes, the focus is on the significance of events in particular, isolated contexts. For example, Masson criticizes Freud for his inherently individualistic view in ignoring external sources of distress, stating: ‘Freud is asking us to shift the direction of our attention, from the external to the internal. Freud was perpetuating a tradition that did not begin with him. Its basic characteristics were that it was male-oriented, ethnocentric, sexist, and rigidly hierarchical’ (1991: 208).

Models of psychopathology view the cause of distress as being due to some deficit or fault located within the individual’s psyche or biochemistry, or as an inadequacy in coping with external situations rather than the cause of distress being located in the wider context. The different models concentrate on the significance of events in particular isolated contexts; for example, bio-medical models concentrate on a specific symptom, or set of symptoms, while cognitive and behavioural models focus on specific behaviours and dysfunctional thought patterns. In the psychoanalytic model and its derivatives, close attention is given to the unconscious, to transference or shifts in group dynamics, and so on. When wider influences are considered, this is usually confined to issues close to the individual’s immediate context such as a consideration of relationships within the family; or what is described about such circumstances is viewed and interpreted by therapists in symbolic or iconic forms, rather than as the literal or material reality experienced and described by the patient. This has led to serious limitations of the explanatory power of models of psychopathology theories and practical applications that have been derived from them.

The ethos of individualism is also reflected in the institutional and professional cultures of our working environment, and a sociopolitical system that emphasizes individual effort and responsibility. Smail (1993) documents how psychotherapy, psychology and psychiatry have helped shape a culture of individualism where it has become almost impossible for people to differentiate inside from outside, or to attribute the pain they often feel about themselves to its appropriate source. We often wrongly locate the origins or ‘cause’ of our pain as being located inside us and as being a reflection of our own inadequacy or personal failing.

Traditional and contemporary bio-medical and psychological models of psychopathology tend not to recognize that distress is often caused by a person finding that they are unable to meet the requirements of what Smail terms ‘form’. For example, we cannot change homosexuality to heterosexuality. While mental health practitioners no longer expect their clients to be able to alter their sexual preferences at will they still often assume that people have access ‘within’ them to forms of behaviour which are more ‘adjusted’ than those they are currently displaying; and all that is needed is some kind of individualistic enterprise usually framed in terms such as ‘moral effort’, ‘cognitive understanding or restructuring’, ‘emotional insight’ or the ‘medication of choice’ or ‘taking responsibility’.

It is often the absence of form in our rapidly changing mobile society that leads to distress. For example there are few forms to guide our relationships with each other in modern Western society. To acquire new forms when the old ones have disappeared or disintegrated may or may not be possible. When an individual’s experience cannot receive its meaning from an appropriate public form – the result is often pain, including forms of pain such as blame and guilt. People find themselves isolated with feelings, impulses, ideas or thoughts that are not reflected in formal public concepts or meanings. Often they will then seek help from a psychiatric and therapeutic industry only too ready to produce a formal diagnosis for their difficulty.

One implication of this is that symptoms of pathology or variations in the expressions of human distress are not constant, but fluctuate according to what is happening in the social environment. Numerous community studies point out that the prevalence of psychological distress is as great as 18 to 20 per cent of the population. Given these figures, as the work of the American community psychologist George Albee (1996) emphasizes, it is both practically and ethically unreasonable to suggest that the distress of such a high proportion of the population should be viewed as evidence of psychopathology. However, since neither the causes nor cures of distress are, in the socio-cultural model, just an individual matter, clinicians may only alleviate some of the painful consequences of distress. Writers such as Davies (1995), Richards (1995) and Pilgrim (1997) point out that the explanations have limited relevance where there is little or no understanding of the individual’s cultural and social context. Others, such as Pillay (1993) suggest that greater knowledge of the social and economic reality would be more useful in understanding psychological processes, than assuming culturally based psychosis in Afro-Caribbeans and somatization in Asians. As Sayal, states: ‘As a clinician, I think it is crucial to relate personal misery to its environment, history and political context. If you rob a person of their history, you rob them of their sense of self’ (1989: 6).

Early in his career Jung developed a word association test, thus linking experimental psychology with psychoanalysis (Studies in Word Association 1914, 1916, 1919). Jung went on to develop his own theories and technique of psychotherapy which is termed analytical psychology. Despite initially being a disciple and then a colleague of Freud’s there are fundamental differences between the two men over the nature of libidinal energy and over infantile sexuality as the cause of neurosis. As early as 1907, Jung disputed whether sexuality was the central factor (1907: 59), and in Symbols of Transformation (1912) and Theory of Psychoanalysis (1913b) Jung put forward a new concept of libido, purely energetic and desexualized. This was an outright rejection of Freud’s view of the libido as exclusively sexual or pleasure orientated in origin and that sexuality alone was the prime motivating force. In Jung’s view libidinal energy was only one of several motivating forces. For example he noted that the hunger drive is more appropriately viewed as a survival instinct rather than one devoted to the pursuit of pleasure. Jung hypothesized that libido is non-specific psychic energy and can be channelled. Freud viewed the unconscious as containing unacceptable sexual and pleasure impulses repressed since childhood and located solely in the past, whereas Jung emphasized that libido (or impulses) arising from the unconscious has relevance to both the past and present. Whereas Freud saw the libido as essentially sexual in nature, Jung viewed it as essentially spiritual. Jung also challenged Freud’s basic tenet of the Oedipal complex. Although acknowledging that boys become powerfully attached to their mothers, potentially bringing about conflict with their fathers, Jung denied that either attachment or conflict was inevitably sexual. Instead he described the son’s attachment for his mother as being spiritual rather than physical or sexual in nature, reflecting a need for psychological renewal.

According to Freud the ego has an intermediary function in the conflict between the id and superego. However, Jung argued that the superego is not separate from the ego. Instead he termed the part of our ego which is concerned with parental and societal values and expectations as the persona – our mask to the outside world. The persona is conscious while the superego is partly unconscious. Jung also conceptualized another part of the unconscious that compels us forward termed the Self. While Jung recognized that the unconscious contained repressed material, he also emphasized its positive side, as the source of psychic energy and creativity pushing us forward to higher levels of consciousness. Jung found Freud’s theory of dream interpretation and wish fulfilment too rigid and reductive, ignoring the paradox and ambiguity of unconscious contents.

A major difference with Freud concerns Jung’s views of the process of development. For Jung this occurs across the lifespan rather than solely concerned with childhood processes. He introduced the concept of individuation, a process beginning at about forty years of age. This is the inner force or drive, ingrained in the species and present in the individual psyche that compels us towards personal growth and development of the self. An integral component of this process is the individual’s drive for meaning. Jung also emphasized the spiritual or religious function of the psyche and thought that its repression could lead to neurotic or psychotic manifestations of psychopathology.

This drive enters our consciousness intermittently, calling for change or, more precisely, the continuation of mental evolution. Jung viewed neuroses not only as a disturbance but also as a necessary impulse to broaden a consciousness that is too narrow, and thus acts as an incentive to maturation and healing. From this positive view, a psychic disturbance is not just a failure, illness or arrested development but a drive towards self-realization and wholeness. Jung also viewed dreams as pointing the way forward and not just concerned with the past. The positive emphasis on growth encouraging interpretations of psychological experience has some links to the humanistic models of psychopathology.

Analytical Psychology

In his Analytical Psychology, Jung developed a psychological typology that delineates attitude types (introvert-extrovert) and function types (feeling-thinking, sensation-intuition). Every person can be classified according to one of the four basic function types determining their typical way of experiencing reality. The psyche in Jung’s model is an auto-regulated system, combining the typical characteristics formed by influences as species, race, nation, and the spirit of the age with uniquely personal ones. Its functioning results from the interrelation of the two realms of the unconscious (personal and collective) and their relation in turn to consciousness. The ego identifies with the conscious mind acting as a filter so that all ego reflections go to the personal unconscious. The personal unconscious includes both memories easily brought to mind and what Jung described as lost memories, repressed painful idea and subliminal perceptions and content not yet ready for consciousness. These repressed thoughts and feelings form clusters or complexes in the personal unconscious. The third part of the psyche in Jung’s theory is the collective unconscious or ‘psychic inheritance’. Freud did not see the necessity of such concept which became one of the main reasons for their rift.

Jung viewed that thoughts, feelings, and memories group themselves into dynamic clusters of complexes. Jung’s conceptualization of the collective unconscious and the function of archetypes developed from his exploration of his own dreams and from his studies of the dreams, hallucinations and delusions of his schizophrenic patients. He explored delusory systems, comparing them with mythological and cultural themes, which led to his idea of primordial images and later to his ideas on collective (archetypal) material in the unconscious psyche. Complexes are the means by which archetypes manifest themselves in the personal unconscious. Jung observed that many of the images related to him by patients reflected recurring mythological images and symbols universal to mankind. From these observations he went on to conceptualize the collective unconscious which he describes in ‘Man and his Symbols’ (1957) as an inaccessible layer of the psyche containing universal experiences and images. He described it as being the reservoir of our experiences as a species, a form of knowledge we are all born with yet not directly conscious of influencing all our emotions, experiences and behaviour. We only know about it indirectly by looking at those influences. Examples of the effects of the collective unconscious include the spiritual experiences of mystics, dreams, fantasies, fairy tales and the immediate recognition of certain symbols and the meanings of certain myths. Jung viewed that all such examples could be understood as the conjunction of our outer reality and the inner reality of the collective unconscious.

Archetypes are the central organizing structure of a complex. They are the innate forms of the psyche consisting of universal primordial images and patterns of symbol formation recurring throughout humankind. They are not inherited images as such but rather inherited possibilities predisposing us to form typical image. Jung viewed that archetypal patterns were biologically determined although their manifestation in imagery often carries a symbolic meaning for the individual. The unconscious aspect of an event is revealed to us in dreams because in dream-like states where consciousness is not present to protect the ego from the manifestations of the unconscious, it appears not as a rational thought but a symbolic image. The four important archetypes that play a very significant role in everyone’s personality are the Persona, Anima(us), Shadow and the Self. The archetype of the Self is both the totality of the personality, conscious and unconscious, and the process of becoming of the whole personality. Jung viewed our deepest needs to be for meaning and purpose and saw religious practice as a fundamental archetypal need and deprived of its symbolism, individuals were cut off from meaning, and societies perished. Meaning can be found through dreams and their symbols in the form of archetypical images, arising from the collective unconscious. Jung defined neurosis as the suffering of the soul which has not discovered its meaning.

It is in the field of schizophrenia where conceptual differences between Freud and Jung are most apparent. Jung elaborated Janet’s concepts concerning the neuroses and applied these to the study of schizophrenia (1911). He considered that the primary symptoms of schizophrenia as described by Bleuler (1911) were defensive reactions of the individual due to being ‘overwhelmed’ by the complexes. A psychotic episode occurs when the unconscious overwhelms the conscious psyche as it effectively shuts out and represses the psyche as a whole. Jung viewed psychopathology as being a continuum, conceptualizing a similarity between diverse psychological states, for example between certain mechanisms underlying the formation of symptoms in hysteria and the symptoms in dementia praecox (1907: 62–83), that is between the neuroses and the psychoses.

Jung considered biological factors as part of the aetiology of schizophrenia including the possibility of an unknown ‘brain toxin’ as a causal factor. He later elaborated his theory describing a biological or instinctual format of the mind or psychosomatic organizations of complexes. Jung emphasized the role played by the complexes in schizophrenia where they would split completely from conscious control, ‘swallowing’ completely the ego and producing psychotic symptomatology. Thus, although psychotic visions illustrate an access to the collective unconscious, the person has been in effect consumed by it, resulting in a loss of ability to function and relate. Jung described this split-off quality of the complexes as being physiological and unsystematic, and radically different from their expression in the neuroses (1939/47). Schizophrenic symptoms could not be understood as just a reflection of archetypal imagery: This is usually not the case, any more than it is in normal dreams; here as there the associations are unsystematic, abrupt, grotesque, absurd, and correspondingly difficult if not impossible to understand. Not only are the products of schizophrenic compensation archaic, they are further distorted by their chaotic randomness. (1958)

A complete split between the ego and the complexes results in disintegration in the personality as the schizophrenic identifies with unconscious content. Schizophrenic symptoms seem so bizarre because the general symbols manifested by the collective unconscious are so far removed from a particular individual that they may appear as being beyond comprehension. Their oddness brings about an even greater resistance by the conscious psyche resulting in the contents of these manifestations becoming even more distorted and stranger.

Jung also recognized the role of psychological factors in schizophrenia (1919). He pointed to evidence for this in the changes produced in the illness after environmental modifications (the disappearance of a great number of catatonias after the reform of the asylums), in psychological factors precipitating onset and relapse, and above all in the existence of a great number of cases of latent schizophrenia usually hidden behind a neurotic façade, which emerged in the course of psychological treatment. Nevertheless, Jung claimed that psychological factors alone were not enough to explain schizophrenia. He hypothesized a ‘special predisposition’ or ‘abnormal sensibility’. Due to an external conflict or internal imbalance in the psyche the unconscious responds with a complementary attitude trying to re-establish the psychic equilibrium. In normal circumstances this occurs successfully. However, in the psychoses there is an attempt to escape from the unconscious compensatory trends. The precipitating factor may arise from ignoring or defending against unconscious manifestations and refusing to accept its compensatory significance, for example, the content of one’s dreams, whose function is to compensate for deficiencies and to warn of present dangers. This consequently reinforces a vicious cycle, as lack of awareness of unconscious manifestations results in an intensification of the unconscious compensatory strivings. Jung described how the resultant split was disastrous because ‘the unconscious soon begins to obtrude itself violently upon the conscious processes. Then come odd and incomprehensible thought and moods, and often incipient forms of hallucination, which plainly bear the stamp of the internal conflict’ (1914: 63).

Jung viewed the symptoms associated with schizophrenia, which illustrate the collective unconscious, as connected to normal dreaming because the unconscious material is identical in both. Schizophrenics could be described as existing in a dream-like state. He described dreaming as a mental condition in which formerly unconscious elements are given the value of real factors to an extent that they take the place of reality. Elements of the collective unconscious will be most likely to appear when one is relaxed and off guard, such as in dreams and day time fantasies because these things are the least controlled by a conscious sense of the limits of real life and they are more apparent in all cases of serious psychoses. From this perspective, Jung viewed that the dreamer is normally insane. Thus Jung developed a theory about the psyche, radically different from Freud’s. He saw individuation as a developmental process, manifested through adulthood and in symbolic life. He focused his psychotherapy on the development of individuality by means of increasing self-awareness. Jung’s rich exploration into the contents of psychoses was a hermeneutic study of huge scope offering an alternative to theories postulating an ontological split in the psychoses. His pioneering work in applying psychodynamic concepts to the psychoses has had great influence in later theoretical developments.