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III. A. The Role of Conflict in Development: Developmental Deficits and Psychosis The ‘ conflict versus trauma’ debate was expanded by a model of structural deficit. Here, hypotheses of pathogenicity do not postulate drive-motivated conflicts but work with the concept of an a priori weakened ego (caused by traumatic environmental influences or predisposition). Related terms are “basic fault” (Balint 1968), “early personality disorders” and “structural ego disturbances” (Fürstenau 1977). Proponents of the deficit hypothesis, based on the assumption of causal, severe traumatic events in early childhood – some of them not very evident, and even more often caused by a deficit in responding, containing, holding on part of the caregivers – argue that after the onset of psychosis, trauma takes on the function of a deficit. This implies, that patients are subjected to events, that they are victims of their circumstances and that they themselves do not have sufficient capacities for influencing these processes. The treatment then consequently aims mainly at substitution and psycho-educational influence. Opposing this conceptualization of developmental conflict , other considerations assume that even psychotic processes are caused by intra-psychic conflicts. Fundamental internal dilemmas, far exceeding neurotic conflict, that take place between two mutually exclusive tendencies, lead to splitting processes, de-symbolisation and concrete action. In many of these cases, early childhood trauma was reported (Kapfhammer 2012a, 2012b). The conflict model does not see the trauma itself as a cause of psychoses but understands psychotic functioning as the result of a process, in which the mental apparatus attempts to find a solution for the existence-threatening internal incompatibilities in the aftermath of traumatic events by employing excessive psychic splitting. Therefore, possibilities of actively shaping symptom development are attributed to the patient through the process of psychoanalytic treatment and through the immersion in a shared language and reality that takes place in this process, supporting re-symbolisation and integration of the previously unthinkable. Psychoanalysis began as a theory of mental conflict, a constant and universal aspect of the human condition and a kind of fuel for psychic development. Conceived as the main focus of a discipline aimed at unearthing and resolving unconscious conflict, over time, this nuclear concept was taken for granted and became implicit in a psychoanalytic perspective, to the extent of not requiring any new specific definition. With the deepening of investigation into the psychic world and the subsequent development of new ways of understanding unconscious mental life, the role of conflict in psychic dynamics has been reduced: although conflict is still conceived as the main concern of psychoanalysis, the focus has shifted to other issues that take into their account the various theoretical and clinical models. After the important change in viewing the role of conflict resulted from Hartmann’s introduction of the idea of conflict- free ego apparatuses (Hartmann 1939), around the middle of the twentieth century, the focus of psychoanalytic theory and technique extended beyond conflict theory. What most influenced its minor role in understanding psychopathology and in carrying on an analytic treatment was a greater focus on pre-conflictual stages of development and on relational factors in bringing about change. Yet, such a shift of emphasis hasn’t involved all the psychoanalytic schools in the same way. If we assume, in a somewhat schematic and simplified way, that the many psychoanalytic
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