Dr.Achama Lenu Thomas BHMS,MD(Hom)
Medical Officer, Dept. of Homoeopathy, Govt. of Kerala
Toward the end of the nineteenth century. it was clear to many that there were mental disorders with a psychological basis as well as those with an organic basis. But one major question remained to be answered- How do these psychologically caused mental disorder”, actually come about?
Freud and the beginnings of psychoanalysis.
The first systematic attempt to answer this question was made by Sigmund Freud. Freud was a brilliant young Viennese physician who at first specialized in neurology and received an appointment as lecturer on nervous diseases at the University of Vienna. On one occasion, however, he introduced to his audience a neurotic patient suffering from a persistent headache, and mistakenly diagnosed the case as chronic localized meningitis.
As a result of this error in diagnosis, he lost his job al though, as he pointed out in his autobiography, greater authorities than he were in the habit of diagnosing Similar cases as cerebral tumor. Freud went to Paris in 1885 to study under Charcot and later became acquainted. He was impressed by their use of hypnosis on hysterical patients and came away convinced that powerful mental processes may remain hidden from consciousness.
On his return to Vienna, Freud worked in collaboration with an older physician,_Joseph breuer. who had introduced an Interesting innovation in the use of hypnosis on his neurotic patients, chiefly women. He let the patient under hypnosis talk about her problems and about what bothered her- Under these cir- cumstances the patient usually spoke rather freely, displayed considerable emotion, and on awakening from the hypnotic state felt considerably relieved. Because of the emotional release involved, this method was called the “cathartic method.” This simple innovation in the use of hypnosis proved to be of great significance, for not only did it help the patient discharge their emotional tensions by discussion of her problems, but it revealed the nature of the difficulties that had brought about her neurotic symptoms. The patient saw no relationship between her problems and her hysterical symptoms, but the therapist could usually see it quite readily.
Thus was made the discovery of the “unconscious”—the realization of the important role played by unconscious processes in the determination of behavior. In 1893, Freud and Breuer published their joint paper 0n the Psychical Mechanism!, of Hysterical Phenomena, which constituted one of the great mile stones of psychodynamics.
Freud soon discovered. moreover, that he could dispense with the hypnotic state entirely. By encouraging the patient to say freely whatever came into her mind without regard to logic or decency- Freud found that she would eventually overcome inner obstacles to remembering and would discuss her Problem
freely. The new method was called free association, and the term psycho analysis was given to the principles involved in analyzing and interpreting what the patient said.. and in helping her gain insight and achieve a more adequate adjustment.
Freud devoted the remainder of his long and energetic life to the development and elaboration of the psychoanalytic model. His views were formally introduced to American scientists in 1909, when he delivered a now-famous series of lectures at dark University at the invitation of G. Stanley Hall, the eminent American psychologist who was then president of the university. These Introductory Lectures on Psychoanalysis led to a great deal of controversy that helped publicize the concepts of psychoanalysis to both scientists and the general public.
Basic principles of the psychoanalytic model.
The psychoanalytic model is both highly systematized and complex, and we shall not at- tempt to deal with it in detail. Its general principles. however, may be sketched as follows:
1- Id, ego, and superego. Basically the individual’s behavior is assumed to result from the interaction of three key subsystems within the personality: the id, ego, and superego.
The id is the source of instinctual drives,which are considered to be of two types (a). constructive drive primarily of sexual nature. which constitute the libido or basic energy of life, and (b) destructive drives which tend towards aggression, destruction, and eventual death. Thus life or constructive, in- stincts are opposed by death, or destructive, instincts. Here it may be noted that Freud used the term sex in a broad sense to refer to almost anything pleasurable, from eating to creativity. The id is completely selfish, condeemed only with the immediate gratification of instinctual needs without reference to reality or moral considerations. Hence it is said to operate i terms of pleasure principle.
RELATION OF ID, EGO, AND SUPEREGO
While the id can generate mental images and wish-fulfilling fantasies, referred to as the primary process, it cannot undertake the action needed to meet instinctual demands.
Consequently a second key subsystem develops-the ego which mediates between the demands of the id and the realities of the external world. The basic purpose of the ego is to meet id demands, but in such a way as to ensure the well-being and survival of the individual. This requires the use of reason and other intellectual resources in dealing with the external world, as well as the exercise of control over id demands. Such adaptive measures o f the ego are referred to as the secondary process and the ego is said to operas in terms of the reality principle. Freud viewed id demands especially sexual and aggressive strivings as inherently in conflict with rules and prohibitions imposed by society.
Since the. id-ego relationship is merely one of expediency, Freud introduced a third key subsystem—the superego-which is the out-growth of learning the taboos and moral values of society. The superego is essentially what we refer to as conscience, and is concerned with right and wrong. As the superego
develops, we find an additional inner control system coming into operation to cope with the uninhibited desires of the id. However, the superego also operates through the ego system and strives to compel the ego to inhibit desires that are considered wrong or immoral.
The interplay between these intrapsychic subsystems of id, ego, and superego is of crucial significance in determining behavior.Often inner conflicts arise because each sub- system is striving for somewhat different goals. Neuroses and other mental disorders result when the individual is unable to resolve these conflicts.
2, Anxiety, defense mechanisms, and the unconscious. The concept of anxiety is prominent in the psychoanalytic model. Freud distinguished among three types of anxiety, or psychic -pain. that people can suffer from reality anxiety, arising from dangers or threats in the external world (b) neurotic anxiety, caused by the id’s impulses threatening to break through ego controls, resulting in behavior that will be punished someway; and (c) morall anxiety, arising from a real or contemplated action in conflict with the individual’s super ego or moral values, and arousing feelings of guilty
Anxiety is a warning of impending danger as well as a painful experience, so it forces the individual to undertake corrective action. Often the ego can cope with the anxiety by rational measures; if these do not suffice, however. the ego resorts to irrational protective measures—such as rationalization or repres sion—which are referred to as ego-defense mechanisms and will he examined in detail later .These defense mechanisms alleviate the painful anxiety, but they do so by distorting reality instead of dealing directly with the problem. This creates an undesirable schism between actual reality and the way the individual sees reality.
Another important concept in the psychoanalytic model is that of the unconscious, Freud thought that the conscious represents a relatively small area of the mind while the unconscious part like the submerged part of an ice berg, is the much larger portion. In the depths are the unconscious are the hurtful memories, forbidden desires, and other experiences that have been pushed out of the conscious. Al- though the individual is unaware of such unconscious material, it continues to seek expression and may be reflected in fantasies and dreams when ego controls are temporarily lowered. Until such unconscious material is brought to awareness and integrated into the ego structure—for example, via psychoanalysis-it presumably leads to irrational and mal-adaptive behavior.
3. Psychosexual development. Freud viewed personality development as a succession of stages, each characterized by a dominant mode of achieving libidinal (sexual) pleasure-5i’ The five stages as he outlined them were
a) Oral stage. During the first two years of life the mouth is the principal erogenous zone; the infant’s greatest source of gratification is assumed to be sucking.
b) Anal stage. From age 2 to age 3. the membranes of the anal region presumably provide the major source of pleasurable stimulation.
c) Phallic stage. From age 3 to age 5 or 6, self-manipulation of the genitals provides the major source of pleasurable sensation.
d) Latency stage. In the years from 6 to 13,, sexual motivations presumably recede in importance as the child becomes preoccupied with developing skills and other activities.
e) Genital stage. After puberty the deepest feelings of pleasure presumably come from heterosexual relations.
Freud believed that gratification during each stage is important if the individual is not to be fixated at that level. For example, an individual who does not receive adequate oral gratification during infancy ^may^be prone to excessive eating or drinking in adult life.
In general, each stage of development places demands on the individual that must be met. and arouses conflicts that must be resolved. One of the most important conflicts occurs during the phallic stage, when the pleasures of masturbation and accompanying fantasies pave the way for the Oedipus complex- Oedipus, according to Greek mythology, unknowingly killed his father and married his mother. Each young boy. Freud thought, symbolically relives the Oedipus drama. He has incestuous cravings for his; mother and views his father as a hated rival; however, he also dreads the wrath of his dominant male parent and fears especially that his father may harm
The female Oedipus (Electra) complex is more intricate, but it is based essentially on the view that the girl wants lo possess her father and replace her mother. For either sex, resolution of the Oedipal conflict is considered essential if the young adult is to develop satisfactory heterosexual relationships.
Impact on our views of psychopathology. Ac- cording to the psychoanalytic model, people are dominated by instinctual biological drives as well as by unconscious desires and motives.
Although there is a constructive libidinal side in each individual, there are also the darker forces of aggression leading toward destruction and death. And although the ego tends toward rationality, the counter forces of intra- psychic conflict, defense mechanisms, and the unconscious all tend toward a high degree of irrationality and maladaptive behavior. In addition, behavior is further determined through past learning, especially from early experiences. About the best we can hope for is a compromise from which we will realize as much instinctual gratification as possible with miinimal punishment and guilt.
Thus the psychoanalytic model presents a negativistic and deterministic view of human behavior that minimizes rationality and freedom for self-determination. On a group level it interprets violence, war. and related phenomena as the inevitable product of the aggressive and destructive instincts present in human nature.
Many of Freud’s ideas have been revised or discarded as a result of subsequent research findings, and the psychoanalytic model is no longer widely used as a principal frame work for organizing and interpreting scientific observations about psychopathology, However two of Freud’s contributions stand out as particularly noteworthy:
1. The development of psychoanalytical techniques-for example. free association and dream analysis .for becoming acquainted with both the conscious and unconscious aspects of the mental life of the individual. the data thus obtained led Freud to emphasize (a) the dynamic role of unconscious motives and ego-defense processes, (b) the importance of early childhood experiences in later personality adjustment and maladjustment (c)the importance of sexual factors in human behavior and mental disorders although as we have said, Freud used the term sex in a much broader sense than it is ordinarily used, the idea caught the popular fancy, and the role of sexual factors in human behavior was finally brought out into the open as an appropriate topic- for scientific investigation,
2. The demonstration that certain abnormal mental phenomena-such as repression of traumatic experiences and irrational fears occurred as a result of attempts lo cope with difficult problems ,and were simply exaggeration.
Built-in” psychological coping and damage-repair mechanisms
There appear to be a number of coping and damage-repair mechanisms built into the human system which operate on a psychological level. While learning may influence these reaction patterns, they appear to operate automatically and to be part of the coping resources of human beings. Among the more common and important of these mechanisms, a re the following:
“Crying it out” seems to be a common means of alleviating emotional tension and hurt. This reaction-is commonly seen in children who have bean frustrated or hurt, but It is not uncommon among adults. This pattern is particularly apparent as part of the “grief work” one goes through to regain emotional equilibrium after a period of bereavement for the foss of a loved one.
Talking It out
This pattern is so widely used that Its importance is often overlooked.
Yet people who have undergone traumatic experiences seem to have a need to repetitively tell others about the experience as a means of alleviating tension and desensitizing themselves to the point where the experience can be accepted as something in the past and integrated into the self-structure.
Laughing it of. Viewing setbacks and hurts with a sense of humor and trying to joke about them and laugh them off is another common damage-repair mechanism. In essence this pattern appears to both alleviate emotional tension and also help the Individual see the experience In a broader perspective. Historically this reaction has been emphasized in the role of the clown who presumably laughs to cover his Inner sadness: in fact. when this mechanism fails, the individual often bursts into tears.
In times of stress, infants often put their arms around their mothers and cling to them for protection and support. On an adult level, we see the same pattern In more sophisticated form, as in the increased need of critically ill patients for affection and companionship. But even in less severe stress situations, many people turn to others for emotional support until they can regain their own equilibrium.
Dreaming and nightmares.
Individuals who have undergone highly traumatic experiences—for example, severe earthquakes, fires, airplane crashes, or other civilian catastrophes—often report repetitive dreams or nightmares in which they relive the traumatic experience. As in the case of repetitive talking, this pattern appears to desensitize the individual to the traumatic experience so that he can accept it as something in the past and integrate it into his self-structure without undue disruption.
These built-in reaction patterns may be used in varying degrees and combinations depending on the individual, the social setting, and the nature of the traumatic event which resulted in the psychological hurt or damage.
Repression is an extremely important self- defense mechanism in that it affords protection from sudden, traumatic experiences until time has somewhat desensitized the individual to the shock. Repression may also help the individual to control dangerous and unacceptedable desires-and at the same time alleviate the anxiety associated with such desires. The reality of repression in freeing the individual from anxiety has been demonstrated in an interesting study by Sommerschield and Reyher (1973). They induced posthypnotic conflicts in their subjects and found that various symptoms, including gastric distress, tension, and anxiety, appeared as the hypnotically induced repression weakened and the conflict threatened to enter consciousness.
Repression, in varying degrees, enters into many other defense mechanisms. There is some evidence that it is only when repression fails that stronger, more maladaptive defenses are tried.
4. Rationalisation. Rationalization is justifying maladaptive behavior by faulty logic or ascribing it to noble motives that did not in fact inspire it. Rationalization has two major defensive values: (a) it helps justify_specific behaviors, and b) it aids in softening the dis- appointment connected with unattainable goals
“Typically, rationalization involves thinking up logjcal. socially approved reasons For past. present, or proposed behaviors. With a little effort a person may be able to justify to himself spending money needed for essentials on lavish entertainment, neglecting work for cultural pursuits, or marrying someone whom he does not love- Even callous brutality can be rationalized as necessary or even praise worthy. Adolf Killer saw the extermination of the Jews as his patriotic duty.
Rationalization is also used to soften the disappointment of thwarted desires. “A common example of such rationalization is the “sour grapes” reaction-stemming from Ae- sop’s fable of the fox who, unable to reach a cluster of delicious grapes, decided he did not want them after all because they were proba- bly sour. Similarly, students may justify their mediocre college performance On the grounds that they are refusing to gel involved in the “competitive rat race” of model society. One way of reducing the discrepancy embodied in failure to take action toward a desired goal is to decide that the goal is really not anything worth having anyway.
Frequently,. of course, it is difficult to tell where an objective consideration of realities leaves off and rationalisation begins. Behaviors that commonly indicate rationalization are (a) hunting for reasons to justify one’s behavior or beliefs; (b) being unable to recognize inconsistencies or contradictory evidence; and (c) becoming upset when one’s “reasons” are questioned- Such questioning is a threat to the defenses the individual has managed to construct against self-devaluation.
5. Projection. Projection is a defensive reaction by means of which (a) others are seen as responsible for one’s own shortcomings, mistakes, and misdeeds; and (b) others are seen as responsible for one’s unacceptable impulses, thoughts, and desires,
Projection is perhaps most commonly evidenced by the first tendency. The student who fails an examination may feel that the teacher was unfair; “the delinquent teen-ager may blame her problems on a rejecting and non understanding parent; and even the small boy being punished for fighting may protest, “it wasn’t my fault-he hit me first.” Fate and bad luck are particularly overworked objects of projection. Even inanimate objects are not exempt from blame. The three-year-old who fails off a hobby horse may attack it with blows and kicks; the basketball player who slips return to inspect ‘the alleged slippery spot. In extreme cases individual may become convinced that other persons or forces are systematically working against him. Such ideas may develop into delusions of persecution involving the supposed plots and conspiracies of “the enemy.”
In other projective reactions, the individual attributes his own unacceptable desires and thoughts to others. This tendency appears to be particularly common among those with rig- id moral values and strict conscience development. For example, a man who is sexually attracted to children may Insist that a child is behaving seductively toward him- Consequently, the child becomes the offender, while the man remains conveniently “pure,” un- aware of his own unacceptable inclinations
6. Reaction .formation. Sometimes an individual protects himself from dangerous de- sires by not only repressing them, but actually developing conscious attitudes and behavior patterns that are just the opposite. Thus he may conceal hate with a facade of love, cruel- try with kindness, or desires for sexual promiscuity with moralistic sexual attitudes and behavior. In this way the individual erects obstacles or barriers that reinforce his repression and keep his real desires and feelings from conscious awareness and from being carried out overtly.
On a simple level, reaction formation is il- lustrated by the old story about the spinster who looks hopefully under her bed each night for fear that a man may be lurking there. On a more complex level, reaction formation may be manifested by people who crusade against loose morals, alcohol, “pornography,” gambling. and other real or alleged evils. Often such people have a background of earlier difficulties with these problems themselves. and their zealous crusading appears to be a means of safeguarding themselves against recurrence of their difficulties.
Self-appointed protectors of the public morals may gain vicarious satisfaction- for example. by reviewing “pornographic” materials without endangering their self-concepts. In some cases reaction formation is more subtle, as when. say. a juror demands the severest penalty under the law for an infraction tat he himself has been tempted to commit
Reaction formation. like repression. may have adjstive value in helping the individual maintain socially approved behavior and avoid awareness of threatening and self-de- valuating desires- But because this mechanism, too, is self-deceptive and not subject to conscious control, it often results in exaggerated and rigid fears or beliefs that may com- plicate an individual’s adjustive reactions and lead to excessive harshness or severity in deal ing with the lapses of others.
7. Displacement. In displacement there is a shift of emotion or symbolic meaning from a person or object toward which it was original- ly-directed to another person or object. Often displacement involves difficult emotions, such as hostility and anxiety. A common subject for cartoons about displacement is the meek office clerk who has been refused a raise by his domineering boss. Instead of expressing his hostility toward his employer-which would be dangerous—he goes home and snaps irritably at his wife because dinner is a few minutes late.
In some instances the individual whose hostility has been aroused by an outside person or event may turn the hostility inward, engaging in exaggerated self-accusations and recriminations, and feel severe guilt and self-devaluation. Such intropunitive reactions do protect the individual from expressing dangerous hostility toward others, but may lead to depression and even to attempted or actual suicide.
Through a process of symbolic association, displacement may become extremely complex and deviant. Swearing is commonly used as a means of discharging pent-up feelings. Destructive criticism and vindictive gossip frequently are only disguised methods of expressing hostility. In a study of skydivers. Fens’, and Epstein (1969) found that the fear and anxiety associated with skydiving was displaced onto other situations unrelated lo parachuting. It is as if the jumper were saying’. ‘This feeling of fear that 1 have, it is of other things, not parachuting'” , This type of defensive reaction is referred to as “stimulus displacement”: while the fear or anxiety remains, it is displaced ;o other situations.
8. Emotional Insulation. Here the individual reduces his emotional involvement in situations that are viewed as disappointing and hurtful,
Since many disappointments are encountered in life, people usually learn to keep their anticipations within limits. Until hoped for event occurs, their are careful to avoid premature celebrations or to let their hopes run too high. The boy who looks forward to a date with a very attractive girl may not let himself get too excited or enthusiastic for fear she may not like him. Such reactions are well ex- pressed in the common saying, “I didn’t dare even hope.”
In more extreme cases of long-continued frustration, as in chronic unemployment or prison confinement, many persons lose hope, become resigned and apathetic, and adapt themselves to a restricted way of life. Such “broken” Individuals thus protect themselves from the bitter hurt of sustained frustration
by becoming passive recipients of whatever life brings them. Similarly, in extreme forms of alienation the individual may become non- involved and apathetic, feeling Isolated, bewildered, and without hope. In certain mental disorders, too, such as chronic schizophrenia, there is often an extreme use of insulation that apparently protects the individual from emotional involvement in a life situation and world that have proved unbearably hurtful.
Up to a point, emotional insulation is an important means of defense against unnecessary disappointment and hurt. But life involves calculated risks, and most people are willing to take a chance on active participation. Emotional insulation provides a protective shell that prevents a repetition of previous pain, but it reduces the individual’s healthy, vigorous participation in life.
9. Intellectualization (isolation). This defense mechanism is related to both emotional insulation and rationalization. Here the emotional reaction that would normally accompany a painful event is avoided by a rational explanation that divests the event of personal significance and painful feeling. The hurt over a parent’s death is reduced by saying that he or she lived a full life or died mercifully with- out pain. Failures and disappointments are softened by pointing out that “it could have been worse.” Cynicism may become a convenient means of reducing guilt feelings over not living up to one’s ideals. Even the verbalization of good intentions, as in a glib admission that “I should work harder” or should be less selfish and more interested in the welfare of others,” seems to cut off a good deal of guilt and relieve one of the necessity of positive action.
Intellectualization may be employed under extremely stressful conditions as well as in dealing with the milder stresses of everyday life. Bluestone and McGahee have found that this defense mechanism was often used by prisoners awaiting execution. They have de scribed the pattern as follows: ” ‘So they’ll kill me; and that’s that’-this said with a shrug of the shoulders suggests that the affect appropriate to the thought has somehow been isolated”
10. Undoing (atonement). Undoing is de- signed to negate or annul some disapproved thought, impulse, or act. Apologizing for wrongs, repentance, doing penance, and undergoing punishment are all forms of undoing.
Undoing apparently develops out of early training in which the child learns that once he apologizes, makes some restitution, or is punished for disapproved behavior, his misdeed is negated and he can start over with a clean slate and with renewed parental approval. As a consequence of such early learning, people commonly develop methods of atoning for or undoing their misdeeds—methods to avoid or ameliorate the punishment and self-devaluation that would otherwise result, The unfaithful husband may bring his wife presents; the unethical executive may give huge sums of money to charity.
The opportunity for confession and the assurance of forgiveness in some religions appear to meet a deep human need to be able to get rid of guilt feelings and make a new beginning. As an ego-defense mechanism, however. undoing operates on an unconscious level, The individual assuages feelings of guilt by making some kind of reparation, but without conscious awareness of the intent of the action.
11. Regression. Regression is a defense mechanism in which one returns to (lie use of reaction patterns long since outgrown. When a new addition to the family has seemingly undermined his status, a little boy may revert to bed-wetting and other infantile behavior that once brought him parental attention; the young bride may return home to her mother at the first sign of trouble.
Summary chart of ego-defense mechanisms
- Denial of reality. Protecting self from unpleasant reality by refusal to perceive or face it
- Fantasy. Gratifying frustrated desires by imaginary achievements
- Repression. Preventing painful or dangerous thoughts from entering consciousness
- Rationalization. Attempting to prove that one’s behavior is “rational” and justifiable and thus worthy of self and social approval
- Projection. Placing blame for difficulties upon others or attributing one’s own unethical desires to others
- Reaction formation. Preventing dangerous desires from being expressed by exaggerating opposed attitudes and types of behavior and using them as “barriers”
- Displacement. Discharging pent-up feelings, usually of hostility, on objects less dangerous than those which initially aroused the emotions
- Emotional insulation. Reducing ego involvement and withdrawing into passivity to protect self from hurt
- Intellectualization (isolation). Cutting off affective charge from hurtful situations or separating incompatible attitudes by logic-tight compartments
- Undoing. Atoning for and thus counteracting immoral desires or acts
- Regression. Retreating to earlier developmental level ‘ involving less mature responses and usually a lower level of aspiration
- Identification. Increasing feelings of worth by Identifying sell with person or institution of illustrious standing
- Introjection. Incorporating external values and standards into ego structure so individual is not at their mercy as external threats
- Compensation. Covering up weakness by emphasizing desirable [‘ail or making up for frustration in one area by over gratification in another
- Acting-out. Reducing the anxiety aroused by forbidden or dangerous desires by permitting their expression, young bride may return home to her mother &the first sign of trouble.
The developmental process from dependence to independence is by no means an easy one. Consequently, it is not surprising that in the face of severe stress or new challenges, an individual may retreat to a less mature level of adjustment. We might expect something akin to regression to occur merely on the basis of the frequent failure of newly learned reactions to bring satisfaction. In looking for other, more successful modes of adjustment, it would be only natural to try out discarded pat- terns that previously had brought satisfaction.
However, regression is a more comprehensive reaction than merely trying out older modes of response when new ones have failed. For in regression the individual re- treats from reality to a legs demanding personal status—one that involves lowered aspirations and more readily accomplished satisfactions.
This point is well illustrated by Bettelheim’s reference to a general “regression to infantile behavior” seen in nearly all the prisoners at the Nazi concentration camps of Dachau and Buchenwald.
“The prisoners lived, like children, only in the immediate present: . . . they became unable -o plan for the future or to give up immediate pleasure satisfactions to gain greater ones in the near future. . . – They were boastful, telling tales about what they had accomplished in their former lives, or how they succeeded in cheating foremen or guards, and how they sabotaged the work. Like children, they felt not at all set back or ashamed when it be came known that they had lied about their prowess.”
In our discussion of the psychoses, we shall describe patients whose regression is so extreme that they are no longer able to dress, feed, or otherwise take care of themselves
12. Identification. Identification often lakes place in imitative learning, as when a boy identifies with his father and uses him as a model. Identification may also operate as a defense mechanism in enhancing feelings of worth and protecting the individual against self-devaluation.
The growing child soon learns that the way in which he is evaluated by others depends heavily on his Family and other group memberships. During adolescence and adulthood, the mechanism of identification is expanded to include a wide range of persons and groups.
Not only does society evaluate the individual in the light of his group memberships, but he comes to evaluate himself in the light of them. Students may identify with the college they attend, and many employees identify with the power and prestige of the company for which they work. By doing so, they take as their own some of the desirable attributes of the groups to which they belong. Particularly for persons who feel basically inferior, such identifications may have important supportive and defensive value.
When feelings of adequacy and worth are. based too heavily on identification with others,however, the individual becomes highly vulnerable to stress situations in which such identifications prove devaluating, for example, when the values and behavior of the group prove disillusioning, when the group suffers humiliation, or when the group is rele- gated to low social status. In such cases, the individual’s identifications lead to self-devaluation rather than to self-enhancement. This is one reason it is difficult for an athletic coach to hold his job when his team loses consistently.
13.Introjection is closely related to identification. As a defense reaction it involves the acceptance of others’ values and norms as one’s own even when they are contrary to one’s previous assumptions. After revolutions leading to dictatorial forms of government, for example, many people interject the new values and beliefs as a protection for themselves. By internalizing the socially pre- scribed values and norms, they can then trust themselves to avoid behavior that would brine social retaliation and punishment.
In describing the use of intoreject ion under extreme conditions;, it is again useful to refer to the experiences of Bettelheim at the Nazi concentration camps of Dachau and Buchenwald- Under the cruel and insidious camp experiences, previous values and identifications were broken down and new norm’; were introjected—Nazi norms.
“A prisoner had reached the final stage of adjustment to the camp situation his personality so as to accept as his own the value of the Gestapo. … old prisoners were sometimes instrumental in getting rid of the until, in this making a feature of Gestapo ideology a feature of their own behavior.”
Introjection has been referred to as “identification with the aggressor” and is a defensive reaction that seems to follow the principle. ” you can’t beat ’em, join ’em.” However, it is evident that inrojection may lead to seriously distorted and maladaptive behavior.
14. Compensation. Compensatory reactions are defenses against feelings of inferiority and inadequacy growing out of real or imagined personal defects or weaknesses, as well as out of the individual’s inevitable failures and setbacks. Such reactions may take. many forms and may represent constructive, deliberate, task-oriented behavior, as in the case of an individual who attempts to overcome a physical handicap through increased effort and persistence- Demosthenes, the great orator, had to overcome early stuttering, and Wilma Rudolph, crippled and unable to walk until she was eight years old. became an Olympic track winner. Compensatory reactions of this type may be a deciding factor in success, as biographers are quick to point out,
More commonly, compensatory reactions are indirect; there is an attempt to substitute for the defect in some way or to draw attention away from it. The physically unattractive boy or girl may develop an exceptionally pleasing personality, the puny boy may turn from athletics to scholarship, and the mediocre nobody may become the Grand Imperial Potentate of some secret order. Much of the cosmetics industry has developed ground minimizing undesirable facial features and emphasizing desirable ones.
15. Acting out. Acting out is a reaction in which the individual reduces the anxiety and tension associated with dangerous desires by actually permitting their expression. For ex- ample, a person who feels mistreated and dis- criminated against may lash out in physical violence against those viewed as responsible. Often the damage or destruction of property, as in instances of vandalism, appears to be serving this function.
All of us have probably experienced times of acute conflict or stress when tension and anxiety have built up to such a level that almost any action that would “get it over with” is welcome. Soldiers under the stress of waiting have been known to leave their relatively safe shelter and blindly attack the enemy. But al- though such acting-out behavior may momentarily reduce tension and anxiety, it is obviously not well designed to deal effectively with the stress situation eliciting the anxiety. Under most circumstances acting out is not feasible except for those who have relatively weak reality and value controls; most people are deterred not only by their values but by the likelihood of social disapproval, punishment, personal injury, or other aversive results.
Evaluation of ego-defense mechanisms. These defense mechanisms are ordinarily used in combination, rather than singly, and often they are combined with task-oriented behavior- Because they are essential for softening failure, alleviating anxiety and hurt, and protecting one’s feelings of adequacy and worth, we may consider them to be normal adjustive reactions unless they seriously interface with the effective resolution of stress situations. Both the “positive” and “negative” functions of such defenses have been weli illustrated in an investigation of the ego defenses used by thirty hospitalized women who were awaiting the outcome of breast tumor biopsy. These researchers found the defense mechanisms of denial and rationalization to be highly effective in coping with anxiety, particularly when used in combination. They also found, however, that many of the women who allayed their anxieties with these defenses did not seek early enough medical help.
In summary, it may be emphasized that these defense mechanisms are, in the main, learned; they are designed to deal with inner hurt, anxiety, and self-devaluation; they oper- ate on relatively automatic and habitual levels; and they typically involve some measure of self-deception and reality distortion.
Decompensation under excessive stress
When the individual’s coping behavior fails to deal effectively with the stress situation, there is a lowering of integrated functioning ‘and eventually a breakdown of the system. This lowering of integration is referred to as de- compensation. Whether stress becomes “excessive” depends, of course, not only on the nature of the adjustive demand but also on the individual’s available resources for coping with it. Decompensation has been observed on biological, psychological, and group levels.
Biological decompensation. A model that helps explain the course of biological decompensation under excessive stress has been advanced by Selye (1956, 19G9) in his formulation of the general adaptation syndrome. Selye found that the body’s reaction to sustained and excessive stress typically occurs in three major phases: (a) alarm and mobilization—representing a general call to arms of the body’s defensive forces; (b) stage of resistance—in
which biological adaptation is optimal in terms of bodily resources; and (c) exhaustion and disintegration -in which bodily resources are depleted and the organism loses its abilily to resist so that further exposure to the stress can lead to disintegration and death.
Where decompensation does not run its en- tire course and result in the death of the organism, maintenance mechanisms attempt to repair damage and reorganize normal function. If the stress has resulted in extensive damage, this restorative process is often a matter of reorganizing “remaining part’ and
resources,” but there >s n permanent lowering of the previous level of integration and functioning.
Dr Achama Lenu Thomas BHMS,MD(Hom)
Medical Officer, Dept. of Homoeopathy, Govt. of Kerala