Developmental Disorders

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DEVELOPMENTAL DISORDERS

The term "developmental disorders" describes alterations in the normal process of development and any functional structures resulting from those alterations.

As early as Studies on Hysteria (1895d), Freud conceived of psychoneuroses as functional structures that had been altered by factors having a premature effect on the normal processes of psychogenesis. He thus developed a theory of the etiology of hysteria whereby psychic trauma (a sexual aggression) occurred at an early age but did not take full effect until puberty (1894a and 1896b). He also attributed a similar etiology to obsessional neurosis (1895c). After 1897 he admitted that the causative moment of a neurosis could equally well derive from fantasies or from real events, and he maintained throughout his work that the pathological structure thus constituted was explicable in terms of fixations and regressions. Three major clinical texts illustrate this thesis: Little Hans (1919b), The Rat Man (1919d), and The Wolf Man (1918b [1914]). Beginning in about 1908, he extended this system to the psychoses—which he considered to be narcissistic neuroses—despite certain theoretical difficulties, as witnessed by his conversations with Jung.

After Freud, psychoanalytical thinking spread particularly to the field of psychiatry and especially to infant and child psychiatry, which it contributed to creating. It would take a major comprehensive study to review the developmental disorders that psychoanalysis can envisage treating with one or another of its specific modes of action (whether a classic analysis, face-to-face psychotherapy, or psychoanalytic psycho-drama), or with other modes of action (psychiatric, educational) guided by a psychoanalytical approach to the disorder. A classification of these developmental disorders is presented in Traité de psychiatrie de l'enfant et de l'adolescent (Treatise on child and adolescent psychiatry), edited by Serge Lebovici, René Diatkine, and Michel Soulé (1995), and the following is based on its main sections:

Disorders resulting from disturbances in the early mother-child relationship: these disorders (particularly in cases of infantile autism or psychosis) from the pre-oedipal period affect the very foundations of personal identity and the development of a distinct, autonomous, and permanent Self.
Symptomatic disorders of early childhood (disorders relating to sleeping, eating, and psychosomatic disorders such as infantile asthma): without excluding possible organic etiologies, these disorders should always be considered as the causes and effects of dysfunctions in the family structure and can, in serious cases, jeopardize the life of the baby.
Disorders in psychological development resulting from dysfunctions of the motor or sensory systems that may be congenital or may have developed prematurely (epilepsy, cardiopathies, cerebral motor infirmities, blindness or amblyopia, deafness, etc.).
Disorders with a neurotic structure (hysterical or obsessional functioning, states of anxiety): here we must distinguish between the "normal" infantile neurosis, resulting from the oedipal drama, and childhood neuroses that call for specific interventions. Many cases present a more localized symptomatology, to be considered in the context of neurotic organization: persistent bed-wetting, eating disorders, language problems and problems with fine motor skills, intellectual inhibitions (which can be mistaken for mild or moderate mental handicaps), academic phobias or failure, etc.
Borderline states and psychopathic structures (Misès, 1990). Perverse structures are rare in children; in adolescents and adults they indicate serious disorders in the processes of identification and must be understood in the light of the subject's history.
Finally, many disorders in children can be understood in terms of deprivation or serious alterations in the environment, primarily in the family (premature separation from the mother, alcoholism and/or sexual aggression by the father, maltreatment); even in the absence of a pathological condition in the parents, problems relating to adoption or medically assisted procreation may justify the intervention of a psychoanalyst. In all these cases, even more than those previously mentioned, it is the whole family, over and above the individual subject, that needs to receive care.

In this entire field, but no doubt more so in cases that strike us by their severity (infantile autism, for instance), there are controversies and polemics that oppose psychoanalysts (and those who speak in their name, sometimes making outrageous claims) and organicists intent on ignoring the specifically psychic and relational dimensions of the issue in question.

Reconstructing the subject's past remains one of the major pathways in the psychoanalytic approach to disorders. Dysfunctions in the present structure of a given person are analyzed with reference to the developmental stages of that structure and by referring to a model of normal development.

The practice of analyzing children has greatly contributed to defining such developmental models. It is worth noting in this regard that some authors (André Green) criticize the use in certain developmental models of an ad hoc "fictitious baby" and stress structure (synchronic organization) rather than history (diachronic).

Roger Perron

See also: Abandonment; Adolescent crisis; Autism; Autistic capsule/nucleus; Deprivation; Identity; Infantile psychosis; Prematureness; Prepsychosis; Three Essays on the Theory of Sexuality .

Bibliography

Freud Sigmund. (1894a). The neuro-psychoses of defence. SE, 3: 41-61.

——. (1895c). Obsessions and phobias: Their psychical mechanism and their aetiology. SE, 3: 69-82.

——. (1896b). Further remarks on the neuro-psychoses of defence. SE, 3: 157-185.

Lebovici, Serge, Diatkine, René, and Soulé, Michel. (1995). Nouveau traité de psychiatrie de l'enfant et de l'adolescent. Second edition. Paris: P.U.F.

Misès, Roger. (1990). Les Pathologies limites de l'enfance. Paris: P.U.F.