Tuesday, September 29, 2009

Psychiatric Defence Mechanisms

The term "defence" was coined by the early psychoanalysts. Freud perceived the ego as negotiating between the demands of the id, (sometimes referred to as the wild one, or child) and the superego (sometimes referred to as society or the "parent"). Eric Berne, the psychoanalytic founder of Transactional Analysis described Freud's Superego, Ego, and Id as Parent, Adult and Child looking at the transactions ocurring between these modes of thinking and relating in the more conscious and interpersonal world whereas Freud's work had been predominantly uncovering what occurred unconsciously. The early analysts decribed the ego 'defending' against the demands and later therapists would describe these as 'coping' mechanisms.

In Sadock's Comprehensive Textbook of Psychiatry 7th ed, there's a excellent Classification of Defence Mechanisms in Table 6.1-2. In this table the defences are grouped in 4 major categories, Narcissistic, Immature, Neurotic and Mature.
Narcissistic defences are listed as , Denial, Distortion and Projection.
Immature defences are Acting out, Blocking, Hypochondriasis, Introjection, Passive Aggressive behaviour, Regression. Schizoid Fantasy, and Somatization.
Neurotic Defences are seen as Controlling, Displacement, Externalization, Inhibition, Intellectualization, Isolation, Rationalization, Dissociation, Reaction formation, Repression and Sexualization.
Mature Defences are Altruism, Anticipation, Asceticism, Humor, Sublimation, and Suppression.

Knowing the origins of these words and how the understanding of each developed over a hundred years of psychoanalytic studies is most illuminating.
Today while some of these words continue to hold true to their original meaning others have been quite distorted in pop psychology. They are also used too often in a denigrating way and not ironically the so called "mature defences" of humor, asceticism and altruism once wonderfully agreed on by society and it's leading therapists are now not infrequently maligned.

The world of advertising and popularity consensus political machinations indeed appeals to the majority who not uncommonly live little in the rarified world of "mature defences".

"Don't worry, be happy," is a marvellous theme song for Denial though in a different light it becomes the Suppression of maturity.
Distortion is what politics and the media live on.
Projection is the defence where I say you are doing what I'm thinking and feeling and thereby deny my own part in the subsequent interaction. The paranoid bully forever asks "what are you looking at!"
Beaurocrats live on 'passive aggression'. Confrontation is a 'dirty' word in a world where 'deniability' is the end all and be all of success and survival.
Schizoid fantasy is the promise of drugs and alcohol. Why experience "reality on reality's terms when a little something will allow you to alter reality. Increasingly the game world allows you to be the hero of your existence as well.
"Acting out" is the television favourite. Every TV hero from " Bueler" to "Godfather" celebrates the adolescent solution to all problems. "Don't think, do it!
"Controlling" is what the accountants and tax department tell you is the solution to life's anxieties while all of them and their leadership have spent the tax payers money and lives with impunity, denial, distortion and supreme acting out.
"Rationalization" is what makes the legal profession go round while intellectualization is the basis of academia. But the humor about these is the major stuff of comedians when the 'disconnects' are so readily apparent on an almost daily basis.
"Reaction formation", turning an unnacceptable impulse into it's opposite, is the bread and butter of censors and the judgemental. The televangelists condemn human behaviour while being caught themselves in animalistic orgies.
"Sexualization" is the essence of marketting. All life's anxieties are reduced with underarm deodorants and musk scented Depends.
But where is Altruism, anticipation, asceticism, sublimation in our society. "I want it all and I want it now" goes against any of these ideas. Yet the original analysts collectively understood that these were the most enduring and mature coping strategies which came into play as individuals gained wisdom and maturity.
We all use all of the defences mechanisms some of the time. It's only human. What we rely on reflects what historically was seen as emotional maturity. The defences or coping strategies have stood the test of time and are still recognised for their contribution to understanding why so often even our best intentions go awry.

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