The fate of the ego in contemporary psychiatry with particular reference to etiologic theories of schizophrenia.
Despite its fruitfulness, the concept of the ego has fallen into disuse in contemporary psychiatry. It is the aim of this paper to explore the phenomenon of the decline of the concept of the ego by looking at the psychoanalytic theory of schizophrenia in which the ego is central and the genetic/neurochemical theory in which the ego is absent. Kuhn's (1970) explication of the competition of explanatory paradigms is utilized to frame this investigation and some of the factors involved in the displacement of the ego-oriented theory with the genetic/neurochemical theory are elucidated. Each theory is reviewed as to its theoretic and epistemological assumptions and its overall explanatory power. The psychoanalytic theory centers on the role of regression to an early state of ego development, and utilizes an intersubjective mode of data collection to describe developmental determinants of pathognomonic ego deficits. The genetic/neurochemical theory rests on the therapeutic outcome of neuroleptic treatment and family clustering of the illness. In failing to take into account data derived from intrapsychic, interpersonal, and cultural influences, the genetic/neurochemical theory is limited in its ability to provide a comprehensive understanding of the nature of schizophrenia. The ego-oriented theory gains significance at the border of these limitations. The concept of the ego is capable of integrating a wide range of biologic, developmental, and social influences that can account for the clinical phenomena of schizophrenia and should be restored to a central position in etiologic theories.
Diamond
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DB
Brigham and Women's Hospital, Boston, MA 02115, USA.
D000300:Adoption; D003072:Cognition Disorders / Q000209:etiology; D003469:Culture; D004532:Ego; D006801:Humans; D008279:Magnetic Resonance Imaging; D011570:Psychiatry; D011574:Psychoanalytic Theory; D012559:Schizophrenia / Q000175:diagnosis / Q000209:etiology*; D012565:Schizophrenic Psychology; D014057:Tomography, X-Ray Computed; D014427:Twins / Q000523:psychology