DEFENSE MECHANISMS Dr. Heriani/Dr. Sylvia Detri Elvira Department of Psychiatry Faculty of Medicine - University of Indonesia 1
Shinta, female, 23 years old, was shocked 3 months ago, by the news that her fiancé had married another woman because the woman was already pregnant. Later she vomited, staggered out, and felt as if she was going to pass out. During the week after, she had difficulty in sleeping, experienced multiple awakenings at nights, and when she ate she often felt nauseous. Her condition recovered gradually, but her sight was getting worse and now she cannot see at all. The ophthalmologist stated that there was not any single problem in her eyes. 2
Adi, male, 46 years old, a once quite successful businessman. During the monetary crisis 10 years ago, he suffered a huge loss and his company went bankrupt. Since then his wife started complaining, insulting, frequently asked for divorce, and finally left him about two years ago. According to him, he tried to be optimistic, but he complained of chest pain, as if it was pressed by a heavy burden and he often felt short of breath. He went to see a doctor and was told that his heart was rather weak. That really struck him and he didn’t feel optimistic anymore. For the last months he prefers to be alone and sometimes he has suicidal ideas. 3
HOW CAN WE EXPLAIN THOSE CASES?
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Usually, an organ is mentioned as having a pathology if there is a deviation or destruction. But how about the mind? Symptoms: anatomy = normal, but the function is disturbed Abnormality – related to the situation & culture Changing in function (expresses in behavior, feelings and thoughts), is triggered by:
A. ORGANIC Factor B. PSYCHOLOGICAL Factor C. A + B 5
SEVERAL ESSENTIAL FACTORS (RELATIONSHIP OF THE BODILY FUNCTION & DISTURBANCES IN MIND) Events
which shock the emotion, can trigger abnormality in the function of the body or cause illness in an individual. Emotional responses are usually followed by physiological changes (disgust, nausea, etc.) Physical responses can be prolonged resulted in body and mind disorder Attitude, behavior, words of a physician play an important role in alleviating & aggravating a patient’s condition.
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DEFENSE MECHANISMS
Individual: tries to fulfill the needs X problems Capability ~ limitation The environment (+) or (-)
To achieve the goal: Avoid or minimize failure
Human has a great capacity, if in reality cannot achieve satisfaction → shift → fantasy 7
What does an individual do when he or she faces a problem ? (a) Makes changes or adjustments to the situation that he or she is dealing with: - Has experienced → knows how to handle - A new situation → experiment before finding the right way (b) Avoid or make a distance to the situation a + b : - it might work → safe & satisfied - if it doesn’t work → sense of insecurity & dissatisfaction (c) Try and learn to live with insecurity & dissatisfaction 8
To face & overcome the problems of life: there are certain methods & techniques that will be used: DEFENSE MECHANISM
Broad definition: every method that are used: * rational & irrational * Cs & Ucs * realistic & fantastic
Narrow definition: mechanism of ego to * eliminate anxiety * shift to fantasy: several ways, Cs & UCs 9
WHAT HAPPENS IF AN INDIVIDUAL IS FACED WITH A PROBLEM? Disturbances in the equilibrium stress uses all of ways, methods & techniques: * rational & irrational * Cs & UCs * realistic & fantastic changes (physical & psychological) A new adjustment : works & doesn’t work
new adaptation
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new stress
SEVERAL DEFENSE MECHANISMS (WHICH ARE POTENTIALLY PATHOGENIC)
From the most immature or pathological to the most mature or healthy
Denial Projection Reaction formation Undoing Isolation
Splitting Projective identification Introjection Repression Blocking 11
DEFENSE MECHANISMS
THAT ARE POTENTIALLY PATHOGENIC
DENIAL: refusing to acknowledge, or negating painful reality REPRESSION: painful ideas, feelings or unacceptable impulses are pushed out of the Cs-mind. PROJECTION: perceiving and reacting to unacceptable inner impulses and their derivatives as though they were outside the self; attributing one’s own unacknowledged feelings to others. 12
DEFENSE MECHANISMS
THAT ARE POTENTIALLY PATHOGENIC (2)
INTROJECTION: internalization of the object (other person) to establish closeness & constant presence of it. REACTION FORMATION: the management of unacceptable impulses by permitting expression of the impulse in antithetical form. UNDOING: ritualistic action that has symbolic meanings to undo or negate or forget an idea or thought or impulses (the individual doesn’t aware of it) 13
DEFENSE MECHANISMS
THAT ARE POTENTIALLY PATHOGENIC (3)
ISOLATION:
splitting or separation of affect/emotion from content e.g. the memory of a traumatic experience.
BLOCKING:
an inhibition of affect, thinking or impulse, usually temporary in nature.
DISPLACEMENT:
purposeful, UCs shifting from one object to another to solve a conflict. 14
DEFENSE MECHANISMS
WHICH ARE POTENTIALLY PATHOGENIC (4)
RATIONALIZATION: a justification of attitudes, beliefs, or behavior that may otherwise be unacceptable by an incorrect application of justifying reasons or the invention of a convincing fallacy REGRESSION: return to a previous stage of development or functioning to avoid the anxieties or hostilities involved in later stages (in effort to handle or adjust to an extremely difficult situation) 15
DEFENSE MECHANISMS
WHICH ARE POTENTIALLY PATHOGENIC (4)
SOMATIZATION: the defensive conversion of psychic derivatives into bodily symptoms, tendency to react with somatic rather than psychic manifestations.
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DEFENSE MECHANISMS WHICH ARE POTENTIALLY PATHOGENIC (5)
SPLITTING: is an UCs process that actively separates contradictory feelings, self-representations, or object representations from one another (good from bad, love from hate, etc, to preserve positively colored experiences, affects, self & object representations, in safely isolated mental compartments, free from contamination by negative counterpart). 17
DEFENSE MECHANISM
WHICH ARE POTENTIALLY PATHOGENIC (6)
PROJECTIVE IDENTIFICATION:
is an UCs three-steps process by which aspects of oneself are disavowed and attributed to someone else (e.g. the therapist).
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MATURE DEFENSE MECHANISMS
SUPRESSION ALTRUISM SUBLIMATION HUMOR
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MATURE DEFENSE MECHANISMS
SUPRESSION:
the Cs banishing unacceptable thoughts or feelings from your mind
ALTRUISM: the vicarious but constructive and instinctually gratifying service to others; the subordination of your own needs and interests to those of others 20
MATURE DEFENSE MECHANISMS (2)
SUBLIMATION:
an UCs process by which consciously unacceptable drives or wishes are channeled into socially acceptable alternatives
HUMOR:
the ability to playfully poke fun at yourself and the situation you are in – an invaluable part of mental health. 21
Thank you
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