The general role that neurological lesions and physiochemical imbalances play in producing pathology can be grasped with only a minimal understanding of the structural organization and functional character of the brain. However, it is important that naive misconceptions be avoided. Among these is the belief that psychological functions can be localized in neurohormonal depots or precise regions of the brain. Psychological processes such as thought, behavior, and emotion derive from complex and circular feedback properties of brain activity. Unless the awesomely intricate connections within the brain that subserve these psychological functions are recognized, the result will be simplistic propositions that clinical or personality traits can arise as a consequence of specific chemical imbalances or focal lesions (Purves & Lichtman, 1985). Psychological concepts such as emotion, behavior, and thought represent diverse and complex processes that are grouped together by theorists and researchers as a means of simplifying their observations. These conceptual labels must not be confused with tangible events and properties within the brain. Certain regions are more involved in particular psychological functions than others, but it is clear that higher processes are a product of brain area interactions. For example, the frontal lobes of the cortex orchestrate a dynamic pattern of impulses by selectively enhancing the sensitivity of receptors, comparing impulses arising in other brain spheres, and guiding them along myriad arrangements and sequences. In this regnant function, it facilitates or inhibits a wide range of psychological functions.
Clinical signs and symptoms cannot be conceived as localized or fixed to one or another sphere of the brain. Rather, they arise from a network of complex interactions and feedbacks (Purves & Lichtman, 1985). We might say that all stimuli, whether generated externally or internally, follow long chains of reverberating circuits that modulate a wide range of activities. Psychological traits and processes must be conceived, therefore, as the product of a widespread and self-regulating pattern of interneuronal stimulation. If we keep in mind the intricate neural interdependencies underlying these functions, we should avoid falling prey to the error of interpretive simplification.
Nevertheless, if the preceding caveats are considered, certain broad hypotheses seem tenable. Possessing more or less of the interactive neurological substrates for a particular function, for example, such as pleasure or pain, can markedly influence the character of experience and the course of learning and development. Evidently, the role of neu-roanatomical structures in psychopathology is not limited to problems of tissue defect or damage. Natural interindividual differences in structural anatomy and organization can result in a wide continuum of relevant psychological effects (Davidson, 1986; R. J. Williams, 1973). If we recognize the network of neural structures that are upset by a specific lesion and add the tremendous individual differences in brain morphology, the difficulties involved in tracing the role of a neurological disturbance become apparent. If the technical skills required to assess the psychological consequences of a specific brain lesion are difficult, we can only begin to imagine the staggering task of determining the psychological correlates of natural anatomic differences.
Each child enters the world with a distinctive pattern of dispositions and sensitivities. Nurses know that infants differ from the moment they are born, and perceptive parents notice distinct differences in their successive offspring. Some infants suck vigorously; others seem indifferent and hold the nipple feebly. Some infants have a regular cycle of hunger, elimination, and sleep, whereas others vary unpredictably (Michelsson, Rinne, & Paajanen, 1990). Some twist fitfully in their sleep, while others lie peacefully awake in hectic surroundings. Some are robust and energetic; others seem tense and cranky.
The question that must be posed, however, is not whether children differ temperamentally but whether a particular sequence of subsequent life experiences will result as a consequence of these differences; childhood temperament would be of little significance if it did not undergird subsequent patterns of functioning. The clinician must ask whether the child's characteristics evoke distinctive reactions from his or her parents and whether these reactions have a beneficial or a detrimental effect on the child's development (Kagan, Reznick, & Snidman, 1989; Maccoby & Martin, 1983). Rather than limit attention to the traditional question of what effect the environment has on the child, the focus might be changed to ask what effect the child has on the environment and what the consequences of these are on the child's development.
Patterns of behavior observed in the first few months of life are apparently more of biogenic than psychogenic origin. Some researchers speak of these patterns as "primary" because they are displayed before postnatal experience can fully account for them. Investigators have found that infants show a consistent pattern of autonomic system reactivity; others have reported stable differences on biological measures such as sensory threshold, quality and intensity of emotional tone, and electroencephalo-graphic waves. Because the pertinence of psychophysiological differences to later personality is unknown, investigators have turned attention to the relationship between observable behavior and later development.
The studies of a number of research groups (Escalona, 1968; Escalona & Heider, 1959; Escalona & Leitch, 1953; Murphy, 1962; Murphy & Moriarty, 1976; Thomas & Chess, 1977; Thomas, Chess, & Birch, 1963, 1968) have been especially fruitful in this regard. Their work has contributed to not only an understanding of personality development in general but also the development of personality pathology in particular. Several behavioral dimensions were found to differentiate the temperament patterns of infants. Children differ in the regularity of their biological functions, including auto-nomic reactivity, gauged by initial responses to new situations; sensory alertness to stimuli and adaptability to change; characteristic moods; and intensities of response, dis-tractibility, and persistence (Goldsmith & Gottesman, 1981). Although early patterns were modified only slightly from infancy to childhood, this continuity could not be attributed entirely to the persistence of innate endowments. Subsequent experiences served to reinforce the characteristics that were displayed in early life (Kagan, 1989). This occurred in great measure because the infant's initial behaviors transformed the environment in ways that intensified and accentuated initial behaviors.
Theorists have often viewed disorders to be the result of experiences that individuals have no part in producing themselves (Jones & Raag, 1989; Zanolli, Saudargas, & Twardosz, 1990). This is a simplification of a complex interaction (Sroufe & Waters, 1976). Each infant possesses a biologically based pattern of sensitivities and dispositions that shape the nature of his or her experiences. The interaction of biological dispositions and environmental experience is not a readily disentangled web but an intricate feedback system of crisscrossing influences. Several components of this process are elaborated because of their pertinence to development.
The temperament dispositions of the maturing child are important because they strengthen the probability that certain traits will become prepotent (Bates, 1980, 1987; Thomas, Chess, & Korn, 1982). For example, highly active and responsive children relate to and rapidly acquire knowledge about events and persons in their environment. Their zest and energy may lead them to experience personal gratification quickly, or, conversely, their lively and exploratory behavior may result in painful frustrations if they run repetitively into insuperable barriers. Unable to fulfill their activity needs, they may strike out in erratic and maladaptive ways. Moreover, temperament also influences the expression of psychological variables such as attachment (Belsky & Rovine, 1987).
Organismic action in passive children is shaped also by their biological constitution. Ill-disposed to deal with their environment assertively and disinclined to discharge their tensions physically, they may learn to avoid conflicts and step aside when difficulties arise. They may be less likely to develop guilt feelings about misbehavior than active youngsters, who more frequently get into trouble and receive punishment and are, therefore, inclined to develop aggressive feelings toward others. Passive youngsters may also deprive themselves of rewarding experiences, feel "left out of things," and depend on others to protect them from events they feel ill-equipped to handle on their own.
Previously, we spoke of personality as a system. However, a systems notion need not be confined to operations that take place within the organism. Interpersonal theorists often speak of dyads and triads as systems of reciprocal influence. Childhood temperament evokes counterreactions from others that confirm and accentuate initial temperamental dispositions (Papousek & Papousek, 1975). Biological moods and activity levels shape not only the child's own behaviors but also those of the child's parents. If the infant's disposition is cheerful and adaptable and care is easy, the mother quickly displays a positive reciprocal attitude (Osofsky & Danzger, 1974). Conversely, if the child is tense or if his or her care is difficult and time consuming, the mother may react with dismay, fatigue, or hostility. Through this distinctive behavioral disposition, then, the child elicits parental reactions that reinforce the initial pattern. Innate dispositions can be reversed by strong environmental pressures. A cheerful outlook can be crushed by parental contempt and ridicule. Conversely, shy and reticent children may become more self-confident in a thoroughly encouraging family atmosphere (Smith & Pederson, 1988).
There is an unfortunate tendency of clinicians and theorists to speak of parental responses to their children as if they were identical (uniformly abusive or uniformly loving, etc.). In fact, what is most likely is that parents differ in their attitudes and behaviors toward the child, often rather strikingly so. When parental consistency occurs, it may be relatively easy to trace the connection between early experiences and later behavior styles. However, when these crucial parental relationships differ appreciably, the equation of influence becomes much more complex, especially if we also consider the effects of one or more siblings, perhaps some older and others younger.
Depending on the character and mix of influences, what is learned may result in any number of behavioral and attitudinal styles on the part of the child. Some youngsters may develop conflicting or split images of self; others may find a way to synthesize these contrasting patterns; still others may shift or vacillate from circumstance to circumstance, depending on their similarity to their parents' divergent behaviors (e.g., learning to behave in a caring and affectionate manner with women because of the actions of a consistently nurturing and valuing mother; with men, however, this same person inevitably behaves in a competitive and hostile manner because of the father's rejecting and derogating attitudes).
Although the idea that biophysical aspects constrain future development is easily understood, not all features of an individual's constitution are activated at the moment of birth. Individuals mature at different rates. Potentials may unfold only gradually as maturation progresses. Thus, some biologically rooted influences may not emerge until the youngster is well into adolescence, and it is not inconceivable that these late-blooming patterns may supplant those displayed earlier.
A crucial determinant of whether a particular temperament will lead to personality pathology appears to be parental acceptance of the child's individuality. Parents who accept their child's temperament and modify their practices accordingly can deter what might otherwise become pathological. On the other hand, if parents experience daily feelings of failure, frustration, anger, and guilt, regardless of the child's disposition, they are likely to contribute to a progressive worsening of the child's adjustment. These comments point once more to the fact that biogenic and psychogenic factors interact in complex ways.
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