Contexts and Connections: An Intersubjective Systems Approach to Couples Therapy

David Shapiro deepens his now-classic studies of psychopathology (Neurotic Styles and Autonomy and Rigid Character) with this conceptualization of a dynamics of the whole character -- a self-regulatory system that encompasses personal attitudes, modes of activity, and relationship with the external world.

Symptomatically and diagnostically diverse conditions are by no means as discrete as they may seem, he demonstrates; rather, they are closely related variations of modes originating early in life ("pre-volitional"), in which the experience of personal agency or responsibility is diminished and anxiety thereby forestalled.

Shapiro proposes that it is reliance on these rigid or passive-reactive modes and their adaptive overdevelopment that shapes defenses and determines symptoms. He shows the formal relation of obsessive-compulsive to paranoid, hysterical to psychopathic, and psychopathic to hypomanic conditions. Then he examines the relation of neurotic conditions to schizophrenia, and concludes that the qualitatively changed forms of schizophrenic symptoms are better understood as radical extensions of neurotic defense systems than as disruptions or breakdowns of defense.

A resonantly reasoned response to the reduction of complex processes of mind to products of biological defect or psychological trauma, this extends and magnifies Shapiro's original and elegantly coherent vision of psychopathology.