Defense Mechanisms

Dr Nilima Shah

Assistant Professor, Psychiatry

B.J. Medical College

Ahmedabad

Defense mechanisms

• Intrapsychic conflict

Anxiety

Reliance on defense mechanisms

Structural theory of mind

Defense Mechanisms

Sigmund Freud- Introduced the concept, Repression

Anna Freud- Comprehensive study

George Vaillant’s classification

• Narcissistic

• Immature

• Neurotic

• Mature

Normality and Mental health

• Mental health as above normal

• Mental health as positive psychology

• Mental health as maturity

• Mental health as socioemotional intelligence

• Mental health as subjective well-being

• Mental health as resilience

Mental Health as Resilience

• “ It is not stress that kills individuals but the healthy mastery of stress that permits individuals to survive”

• 3 broad classes of coping:

• Consciously seeking social support

• Conscious cognitive strategies

• Adaptive involuntary coping mechanisms (defense)

Lodestars of Human Conflict

Ego

Affect Reality

RelationshipsConscience

Instinct , id, drive, passion, emotion, impulse

Sudden changes in existing reality

People who you cannot live with or without

Cultural taboos, imperatives, social learning, superego

Involuntary Homeostatic mental mechanisms (Defense)

‘Defense’

• The term was discarded by 1970 due to lack of consistent definition and rater reliability

• Since 1970 idea of ‘involuntary coping’ re-entered.

• Later experimental strategies like videotape and q-sort have improved reliability

• DSM IV- TR offered a tentative hierarchy and glossary of consensually validated definitions

Levels of defensive adaptation: DSM IV TR

• High Adaptive Level

• Mental Inhibition Level

• Minor Image-distorting Level

• Disavowal Level

• Major Image-distorting Level

• Action Level

• Defensive dysregulation level

High Adaptive level

• Affiliation

• Altruism

• Anticipation

• Humor

• Suppression

• Sublimation

• Self-assertion

• Self-observation

Affiliation

• Turning to others for help and support

E.g. going to support group, therapy or a spiritual counsel

Altruism

• Dealing with stressors by dedicating oneself to meeting the needs of others.

• Constructive service to others which brings pleasure and satisfaction.

• E.g. A person whose parents died in a road-traffic accident forms an organization for creating public awareness in traffic rules

Anticipation

• Dealing with stressors by anticipating the consequences and the feelings associated with possible future events and considering realistic solutions

• E.g. A person who is getting old thinks ahead and plans his retirement wisely

Humor

• The individual deals with emotional conflicts, or internal or external stressors, by emphasizing the amusing or ironic aspects of the conflict or stressor

E.g. Gallows humor ( humor in the face of or about very unpleasant, serious, or painful circumstances)

As a man is about to be executed, the firing squad leader offers the man about to be executed a cigarette. He replies, "No thanks, I'm trying to quit."

Suppression

• The individual deals with emotional conflicts, or internal or external stressors, by voluntarily avoiding thinking about disturbing problems, wishes, feelings or experiences temporarily.

E.g. Focusing on studying for the exam and not worrying about job opportunities after passing at the moment.

Sublimation

• Channeling of unacceptable and potentially disruptive impulses/ thoughts/ emotions into socially acceptable behavior

• E.g Punching bag to channel angry impulses. Sports

Self-assertion

• The individual deals with emotional conflicts, or internal or external stressors, by expressing one's feelings and thoughts directly in order to achieve goals. Firmly and respectfully

• Not aggressively/coercively/manipulatively

• E.g. Wife regarding husband consuming alcohol:

“I said I was leaving and that he had to make a choice between me and drinking, and I left and went to Florida with my parents. I met my parents there, and I found a job there”

Self-observation

• The individual deals with emotional conflicts, or internal or external stressors, by reflecting on his or her own thoughts, feelings, motivation and behavior

• E.g. Diary writing, self-exploration, bibliotherapy

Mental Inhibitions level

• Displacement

• Dissociation

• Intellectualization

• Isolation of Affect

• Reaction formation

• Repression

• Undoing

Displacement

• Generalizing or redirecting a feeling about or a response to an object onto another, usually less threatening, object. The person may or may not be aware that the affect/impulse expressed toward the displaced object was really meant for someone else.

• E.g. The boss gets angry on his employee who goes home and shouts at his wife, who in turn shouts at their son. The son goes and kicks the dog.

• A man wins a lottery, turns to the person next to him, and gives him a big hug!

Dissociation

• Breaking off part of memory, consciousness or perception of the self or environment to avoid a problem situation

• E.g. An otherwise honest person cheating in income tax and keeping both the sets of values separated and unintegrated

• E.g. Dissociative amnesia

Intellectualization

• The excessive use of abstract thinking or complex explanations to avoid disturbing feelings.

• E.g. A person who is in heavy debt builds a complex spreadsheet of how long it would take to repay using different payment options and interest rates.

Isolation of Affect

• Not experiencing simultaneously the cognitive and affective components of an experience because the affect is kept from consciousness.

• E.g. Medical student dissects a cadaver without being disturbed by thoughts of death.

Reaction formation

Substituting behavior, thoughts, or feelings that are diametrically opposed to a person’s unacceptable thoughts or feelings.

E.g. A married woman who is disturbed by feeling attracted to one of her husband's friends treats him rudely.

E.g. Treating someone you strongly dislike in an excessively friendly manner in order to hide your true feelings.

Repression

• The involuntary exclusion of a painful or conflictualthought, impulse, or memory from awareness

• E.g. A child who is abused by a parent later has no recollection of the events, but has trouble forming relationships.

Undoing

• Behavior designed to symbolically make amends for negate previous thoughts, feelings, or actions.

• E.g. When asked to recommend a friend for a job, a man makes comments which prevent the friend's getting the position; a few days later, the man drops in to see his friend and brings him a small gift.

Minor image distortion level

• Devaluation

• Idealization

• Omnipotence

Devaluation

• Attributing exaggeratedly negative qualities to oneself or others

• E.g. A writer about herself: “Oh I am not a real writer.. I just write non-fiction. I have no imagination”

• E.g. Wife about husband: “Oh he did care for me in his own twisted way”

Idealization

• Attributing exaggerated positive qualities to self or others.

• E.g. A lover speaks in glowing terms of the beauty and intelligence of an average-looking woman who is not very bright.

Omnipotence

• Acting superior to others, as if one possessed special powers or abilities, to artificially prop up self-esteem

• E.g. Someone acts self-assured and asserts an 'I can handle anything' attitude, in the face of obviously doing a doubtful or poor job of dealing with his own problem

Quiz time

“ As a diabetic I can’t have it now, but if my HbA1c comes normal the next month, I shall

treat myself with a small piece.

Disavowal level

• Denial

• Projection

• Rationalization

Denial

• Refusing to acknowledge some aspect of external reality or of his or her experience that would be apparent to others

• E.g. A person refusing to accept his physician’s opinion that he has cancer and seeking a second opinion

Projection

• Falsely attributing his or her own unacknowledged feelings; impulses; or thought to others. The subject disavows his or her own feelings, intentions or experience by means of attributing them to others

• E.g. A man does not like another person. But he has a value that says he should like everyone. So he projects onto him that he does not like him. This allows him to avoid him and also handle his own feeling of dislike.

• E.g. An unfaithful man suspects his wife of infidelity

Rationalization

• Devising reassuring or self-serving but incorrect explanations for his or her own or others' behavior

• E.g. A parent punishes his child badly and says that it is for his own good!

• E.g A person evades paying tax and then explains how the government is anyway wasting money and it is better for people to keep with themselves only as much money as they can

Major image distortion level

• Autistic fantasy

• Projective identification

• Splitting

Autistic fantasy

• Excessive daydreaming as a substitute for human relationships, more direct and effective action, or problem solving

• E.g. Someone tells a story of future plans which are apparently unrealistic. However, it becomes clear that he obtains gratification from elaborating the details while ignoring the constraints or effort potentially involved. He enjoys the fantasy, preferingnot to discuss the reality aspects.

Projective Identification

• In projective identification the subject has an affect or impulse which he finds unacceptable and projects onto someone else, as if it was really that other person who originated the affect or impulse.

• However, the subject does not disavow what is projected --unlike in simple projection-- but remains fully aware of the affects or impulses, and simply misattributes them as justifiable reactions to the other person!

• E.g. The person accuses the interviewer of having negative feelings like anger towards the subject; due to the subject's own angry or accusatory state. No matter what the interviewer says, the latter cannot set the subject straight. The more muddled things become, the angrier the subject gets (e.g. 'I know you think I'm stupid, your question was childish ... so of course I'm angry')

Splitting

• Viewing himself or herself or others as all good or all bad, failing to integrate the positive and negative qualities of the self and others into cohesive images; often the same individual will be alternately idealized and devalued

• E.g. A patient in the ward tells a nurse that she is the only person who cares for him, and yet, the very next day, refuses to talk to her.

Action level

• Acting out

• Apathetic withdrawal

• Help-rejecting complaining

• Passive Aggression

Acting out

• Acting out involves the expression of feelings, wishes or impulses in uncontrolled behavior with apparent disregard for personal or social consequences

• E.g. A child’s temper tantrum when he does not get his way with the parent

• E.g . Self- injury may be a form of acting out, expressing in physical pain what one cannot stand to face emotionally

Apathetic withdrawal

• Decreases emotions, activity and social interactions

• E.g. On especially difficult days Mr. X (suffers from cancer) is sad and appears to lack energy. He then withdraws into a state of apathy, a protective distancing marked by emotional indifference and a reduction in social interactions and outside activities. He shows unusually passive submission to events and to caregivers.It allows him to make his life more bearable

Help-rejecting complaining

• Help-rejecting complaining involves the repetitious use of a series of complaint in which the person ostensibly asks for help. However, covert feelings of, hostility or resentment towards others are expressed simultaneously by the person’s rejection of the suggestions, advice, or whatever others offer. “Depicting oneself with self-pity as the unsavablevictim”

• E.g. The subject presents a seemingly insoluble dilemma about an important problem in life (e.g.threatened job loss, health, marriage) and systematically rejects all suggestions that others offer to a degree that prevents any progress toward a solution

Passive Aggression

• Indirectly and unassertively expressing aggression toward others. There is a facade of overt compliance masking covert resistance toward others

• E.g. Not talking to a friend because she forgot your birthday

• E.g. A patient refusing to take antihypertensive medication after a family quarrel

Defensive dysregulation level

• Delusional projection

• Psychotic denial

• Psychotic distortion

Delusional projection

• Persecutory delusions

• E,g. A 43 year old, single, farmer claims that spacemen at night cause his headaches.

• Interviewer: I will protect you against these spacemen and give you medication that will relieve your headache

• Patient : So do you believe that spacemen cause my headache?

• Interviewer: I cant tell you that, but I know you feel this and I know that the medication may help

Psychotic Denial

• Negation of obvious reality

• E.g. A person having complex hallucinations of deceased mother and believing that she is still alive.

Psychotic distortion

• Profound misperception and misinterpretation of external reality and feelings

• E.g. megalomaniacal beliefs/ delusions; collecting coins in a bag and believing that one is a millionaire

Quiz time

Thankyou