Structural theory of mind and ego defense mechanism

All about the Human nature, behavior, ego psychology, defense mechanisms with appropriate examples of major ones

1. Structural THEORY OF MIND & EGO DEFENSE MECHANISMS Presenter: Dr UDAYAN MAJUMDER Resident in psychiatry, RIMS

2. Plan of Presentation Introduction and key concepts Sigmund Freud Overview of hu man Nature Structural theory of Mind Genesis of defence mechanisms Understanding defence mechanisms Classifications of defence mechanisms Few Important defence mechanisms References

3. Introduction Among other theories on Human Behavior developed by well known pillars in the field of Psychology, Sigmund Freud’s Psychoanalytic Theory, stands up even until today, as one of the most controversial, as it included terms and concept on sex, the unconscious and the interpretation of dreams. The theory had provided a wide breeding ground for developing other kinds of theories that aim to understand human behavior. Such as Carl Jung’s own mix of Analytical Psychology, and Erik Erikson’s Psychosocial Stages of Development, a more ‘toned down’ and a greater supplement to Freud’s Psychosexual Stages of Development Psychoanalysis proves to be one of the more useful techniques when it comes to handling internal psychological conflicts that can alter the person’s perception of reality.

4. Sigmund Freud The proprietor and the original initiator of the Psychoanalytic approach on Human Behavior. Eldest among 8 children, Freud was well known for his utter devotion to expand the borders of his theory. He was very dedicated to his theory, and had very little tolerance to persons who had thought otherwise or critiqued his school of thought He had dismissed two of his closest colleagues, Carl Jung and Alfred Adler, who had disagreed on Freud’s views, and created their own theories stemming from Freud’s Work. Sigmund Freud died in September 1939 due to an inoperable cancer of the jaw.

5. Key Concepts It’s General Psychology all over again.

6. A set of philosophical of human nature Psychoanalysis is both an approach to therapy and a theory of personality Emphasizes unconscious motivation – the main cause of behavior lie in unconscious mind OVERVIEW OF PSYCHOANALYSIS

7. Human nature is “Purely Deterministic” In most cases on his work on Psychoanalysis, Freud has drawn a clear line on two things concerning Human Nature. Simply put, Human Nature “Happens because it happens”, there is no point in time in where we “call the shots” (or having control over our behavior). Because according to Freud, our behavior is determined by Irrational forces, unconscious motivations and biological & instinctual drives that are stemmed from repressed childhood memories or experiences that hold a certain degree of impact to our lives.

8. “Instincts” & Psychoanalytic Approach Instincts are actively displayed in times of survival. Leans towards growth, development and creativity. Freud originally termed this as “Libido”, comprising of sexual energy, but then broadened the term to “Life Instincts”. Where all ‘pleasurable’ acts serves as a person’s goal in life to simply gain pleasure and avoid pain.

9. LEVEL OF MENTAL LIFE : TOPOGRAPHICAL MODEL UNCONSCIOUS Contains all the feeling, urges or instinct that are beyond our awareness but it affect our expression, feeling, action PRECONSCIOUS Facts stored in a part of the brain, which are not conscious but are available for possible use in the future by concentration 3. CONSCIOUS Only level of mental life that are directly available to us The awareness of our own mental process (Thoughts/feeling)

10. FREUD’S MODEL ON PERSONALITY STRUCTURE

11. The Id Infants are born with Id intact Operates on PLEASURE PRINCIPE – to gain pleasure, avoid pain Driven by sexual and aggressive urge The Id is considered as the primary and original system of personality, the source of psychic energy, and the seat of instincts. It lacks organization, is blind, and very insistent. It cannot tolerate tension, and once it does feel tension, it functions to immediately discharge it. Id is working under the domination of Pleasure Principle and primary process. Translation from need to wish is called PRIMARY PROCESS

12. The Ego The rational level of personality Operates on REALITY PRINCIPLES – does realistic and logical thinking The balance between Id and Superego Is guided by the reality principle , which seeks to delay gratification of the id’s urges until appropriate outlets and situations can be found. The ego engages in secondary-process thinking, which is relatively rational, realistic, and oriented toward problem solving.

13. The Ego Known as the “Traffic Cop”, it has it’s touch with reality (circumstances of external world) It formulates rational and logical decisions and plans for satisfying need Duty of the Ego is to keep in check, and balance the demands of the pleasure-seeking and unorganized Id, and of the perfectionist-centered and radical moral objectives of the Superego

14. According to Freud, development of ego or we can say structural make up of ego is like the issue related with our survival. Progress in life lies in tracing the paths and stages by which our ego capacities become mature. We have to increase its scope and power, leading ultimately to, a more mature and adaptive set of ego functions. Ancient and current, in both eras, development of ego is viewed holistically. And that is what nothing but, the emergence and consolidation of sense of self and observation of reality as it is without any distortion. Contd.

15. “THE BALANCE”

16. The Superego Partially unconscious Operates on MORAL PRINCIPLES Able to differentiate between good and bad, right and wrong If people follow their superego, they will feel proud but if they don’t follow, they will feel guilty and anxious

17. The Superego The Judicial Branch of the three. Comprised of an individual’s moral conduct and the concept of right and what’s wrong given from earlier life experiences and the cultural values given from the environment. The Superego holds the Moralistic Principle. It strives to inhibit the Id and seeking to be “Perfect” by persuading the ego to replace it’s realistic goals for the more “perfectionist” ones. Unconsciously most of the super ego forms by collecting the pieces of memory of same gender parent in early childhood.

18. “Genesis of defence mechanisms” 18 The ego deals with the demands of reality, the id, and the superego as best as it can. But when the anxiety becomes overwhelming, the ego must defend itself. It does so by unconsciously blocking the impulses or distorting them into a more acceptable, less threatening form. The techniques are called the ego defense mechanisms

19. Defense Mechanisms 19 Acc to Sigmund Freud “Unconscious mental processes employed by the ego to reduce anxiety.” ‘Father of Psychoanalysis’

20. “Anxiety : Freudian Concept” 20 Freud identified three different types of anxiety: Reality Anxiety: This is the most basic form of anxiety and is typically based on fears of real and possible events, such as being bitten by a dog or falling from a ladder. The most common way of reducing tension from Reality Anxiety is taking oneself away from the situation, running away from the dog or simply refusing to go up the ladder. Neurotic Anxiety: This is a form of anxiety which comes from an unconscious fear that the basic impulses of the ID will take control of the person, leading to eventual punishment. Moral Anxiety: This form of anxiety comes from a fear of violating values and moral codes, and appears as feelings of guilt or shame.

21. “DEFENSE MECHANISMS” Defense mechanisms are largely unconscious resources used by the ego to reduce conflict between the id and superego and thereby anxiety. Under the pressure of excessive anxiety , the ego sometimes is forced to take extreme measures to relieve the pressure. These measures are called defense mechanism. All defense have two things in common: They deny , falsify , or distort reality. They operate unconsciously.(person not aware of it)

22. Q1: What exactly do defense mechanisms defend against? Above all else, defense mechanisms shield the individual from the emotional discomfort that’s so often elicited by stress. Their main purpose is to ward off unwelcome emotions or to reduce their intensity. Q2: How do they work? Through self-deception. Defense mechanisms accomplish their goals by distorting reality so that it doesn’t appear so threatening. Contd.

23. 23 Defences used by a person are specific to Id impulses i.e specific defences are effective in handling specific Id impulses. Quiet often inappropriate defences are used, primarily because those defences person feels most comfortable using. Normally as development progresses, defences used in previous stage should be completely replaced by defences in next stage but quiet often defences perceived in previous stages do persist in adult life, primarily because developmental process was not smooth and there were points of fixation. Defences most preferably used by a person determines his personality and as well as psychopathology. Contd.

24. Freudian Defense Mechanisms 24 Freud's list of basic Defense Mechanisms (9) includes: Denial Displacement Intellectualization Projection Rationalization. Reaction Formation Regression Repression Sublimation

25. Anna Freud Identified as the First voice of Ego-Psychology Best known for elucidating the Defence Mechanisms in the book – EGO AND THE MECHANISM OF DEFENCE, 1936. The Identified Defence mechanisms were – Regression Repression Reaction- Formation Isolation Undoing Projection Introjection Turning against the self Reversal Sublimation

26. GEORGE EMAN VAILLANT George Eman Vaillant , M.D. (born 1934) is an American psychiatrist and Professor at Harvard Medical School and Director of Research for the Department of Psychiatry, Brigham and Women's Hospital

27. Robert Plutchik (1979) Views defences as derivatives of basic emotions, which in turn relate to particular diagnostic structures. According to his theory :- Reaction formation relates to Joy (and manic features) Denial relates to acceptance (and histrionic features) Repression to fear (and passivity) Regression to surprise (and borderline traits) Compensation to sadness (and depression) Projection to disgust (and paranoia) Displacement to anger (and hostility) Intellectualization to anticipation (and obsessionality)

28. Classification of Defence Mechanisms Developmental Classification Oral Stage : Distortion, Denial, Projection Anal Stage : Identification, Undoing, Reaction Formation, Isolation, Regression Phallic Stage : Intellectualization, Repression Latency Stage : Repression, Symbolization, Sublimation.

29. Classification by Freud 1 . Psychotic – Projection ,Denial. 2. Neurotic - Isolation, Reaction formation, Repression, Regression 3. Mature - Sublimation

30. Classification of Defence Mechanisms George Vaillant (1977) categorized defenses to form a continuum according to their psychoanalytical developmental level. Level I - Narcissistic defenses Level II - Immature defenses Level III - Neurotic defenses Level IV - Mature defenses

31. TYPES OF DEFENSE MECHANISMS Pathological / Narcissistic 1. Denial 2.Distortion 3. Projection Immature Defenses 1. Acting out 2. Blocking 3.Hypochondriasis. 4. Introjection 5.Passive-aggressive behavior 6. Regression 7.Schizoid fantasy. 8.Somatization

32. Contd. Neurotic Defenses 1.Controlling 2. Displacement 3.Externalization 4.Inhibition 5. Intellectualization 6. Isolation 7. Rationalization 8.Dissociation 9. Reaction formation 10. Repression 11.Sexualization Mature Defenses 1. Altruism 2.Anticipation 3. Asceticism 4.Humor 5. Sublimation 6. Supression

33. NARCISSISTIC / PSYCHOTIC Basic behind these defences is that they not really have much of a sense of self. Boundary between yourself and other (environment) is highly permeable. Narcissistic defences are not bad but they distort reality much more, so it takes fair much amount of time to regain reality which is necessary for survival.

34. PROJECTION Internal feeling, ideas or wishes are seen as part of external world. Anna Freud also called “Displacement outwards” Not “mine”, but “others”. Projecting your feelings on the external world or tendency to see ones unacceptable desires in other people Linked to: Paranoid personality Auditory hallucination

35. Contd. e.g. 1- A husband, good & faithful, terribly attracted to a charming & flirtatious lady next door. Couldn’t handle his own hardly abnormal lusts, becomes increasingly jealous of his wife and constantly worried about her faithfulness. 2- A woman finds herself having vague sexual feeling about her girlfriends. As she couldn’t acknowledge her feelings, becomes overtly concerned about increasing lesbianism in the society

36. Denial Reality does not penetrate. In other immature or neurotic defenses reality is somehow accepted in a distorted form but here external reality does not penetrate in first place. So in some cases reality can not become a part of memory also. Common after bed news about illness or death. Link to: Substance abuse- Do you have a substance problem ? Big “NO” in response.

37. Splitting World is seen as extreme. Because its easier to see the world as extreme. All good or all bad. All white and all black. Intermittent gray of reality, middle ground of reality is hard to perceive in splitting. Linked to: Idealization Borderline personality disorder- unrealistic sense of extreme and transit between extreme idealization and extreme discrimination could be literally a matter of hours.

38. IMMATURE DEFENSES Person has a sense of self, but with some vulnerable spots “Tissue paper ego”. A fragile boundary between self and environment These mechanisms are often present in adults and more commonly present in adolescents.

39. Blocking Transition inability to remember. Often embarrassing or disruptive. e. g . 1- During exams or during viva. 2- Introducing your girl friend to your family. What is the reason behind blocking in most of the cases? You rather like to say I don’t know then give a wrong answer. Making you not know, protects you from being wrong.

40. CONTD. Solution is get used to be wrong. Blocking is more about forgetting a name than an event. More focal, small things, particular piece of information A memory lapse of focal things. Focal is disruptive because of being focal.

41. Regression Returning to earlier level of functioning. Childish way to deal the problem. Common when people are tired, ill or stressed. Where do we retreat when we are stressed ? Its to the last time when we felt safe & secure, as per Freudian theory.

42. CONTD. Linked to: Enuresis- less connection with mother, want to regain the connection unconsciously. Being regressive is not totally bad. Somehow sometime it is the source of some joy to life. For example in case of primitive behavior- eliminating some higher level cognitive functions and behaving more primitive. Like playing as in childhood, intense love activity but in childish way.

43. Introjection (identification) Making features from the outside as a part of the self. Gathering pieces of world around one, bring them in and make them a part of one self. Opposite of projection. When conscious = imitation Link to: Super – ego Professional education Psychotherapy.

44. A ccording to Freud, introjection is a critical part of everybody’s development. Superego at age of 2 and more, where to get them? Its introjection - taking it from the same gender parent. Getting a sense of what is socially acceptable and what is wrong. Contd.

45. e.g. A child who is left alone frequently may in some way try to become “MOM” in order to lessen the fears telling their dolls and pets not to be afraid. Professional education - Unconsciously taking your professor’s attitude, belief, professional decision and assembling as a part of you, that you want to be. Psychotherapy - Patient misses some pieces of self he need or has some bad pieces of memory. Aim of psychotherapist is to make patient get rid off those bad pieces and to fill them with good pieces. And what is source of patient for good pieces? Ans :- The therapist...does it look odd? Contd.

46. Identification with the aggresso r Identification with the aggressor is a version of introjection that focuses on the adoption, not of general or positive traits, but of negative or feared traits. If you are afraid of someone, you can partially conquer that fear by becoming more like them. A more dramatic example is one called the Stockholm Syndrome . After a hostage crisis in Stockholm, psychologists were surprised to find that the hostages were not only not terribly angry at their captors, but often downright sympathetic.

47. PASSIVE AGGRESSIVE BEHAVIOUR Expression of hostility, not by doing but by failing to do. Expressing aggression toward others indirectly through passivity, masochism, and turning against the self. Non performance after setting the expectation of performance. Unconscious expression of hostility. e.g. - Child who gets scolded by his parents doesn’t revolt against the parent, rather stays silent and just refuses to stays food ultimately become lethargic while the parent in turn gets worried and scared.

48. SOMATIZATION Converting psychic derivatives into bodily symptoms and tending to react with somatic manifestations, rather than psychic manifestations. Real identifiable physical symptoms entirely a result of psychological processes. Physical symptoms replaces anxiety. e . g. 1- on the door of girl friend’s home, you started feeling nauseous. 2- on a podium going to deliver a speech. Everybody is watching you. you don’t want to feel anxious. But unconsciously you develop ringing sensation in ear and that doesn’t go away until you sit down again. When this symptoms don’t go and functions impaired for a long time, this defense becomes a disorder- Somatoform disorder.

49. NEUROTIC DEFENSES Here you have sense of self, fairly enough and robust. Purpose of these defence is to keep you away from feeling bad. To siphon off that unpleasant feeling, we often see as anxiety. These mechanisms are considered neurotic, but fairly common in adults. Most number of defences fall under this cluster.

50. RATIONALIZATION Rationalization is not about reasoning to a decision, it simply trying to feel better about the decision you already made. N eed of this defense occur in case when you did some thing particular which is acceptable to you, but not usually in your unconscious because of your superego. Usual pattern is like a string of reasons. Example; 1. Rationalizing a killing of a man.

51. 2- A married man sitting in a bar, saw a woman and thinking to be get lucky tonight. To justify this betraying thinking, because he is already married, he rationalizes this behavior by thinking that he is a hard working guy, he deserve this thing at least once on the other hand his wife is now became fatty, she used to quarrel with him. In some sense he already decided what to do, now he is just want to feel good about his decision by being rational. 3- “ The day is cloudy, Saturday evening, had a very tiresome day, scolded by boss too, girlfriend is also not responding on phone properly today, so would a few pegs of whiskey with 90s songs will really be a crime ?” , while the person already determined or even brought the whiskey bottle for the evening. Contd.

52. Repression Repression and suppression are very similar defence mechanisms. They both involve a process of pulling thoughts into the unconscious, and preventing painful or dangerous thoughts from entering consciousness. The difference is that repression is an unconscious force, while suppression is a conscious process, a conscious choice not to think about something. After that it is followed unconsciously. Repression is defined by “Keeping distressing thoughts and feelings buried in the unconscious.”

53. REPRESSION The person forces the unacceptable or threatening feeling out of awareness to a point where he/she becomes unaware of it. Examples e. g. an old friend reminding about ex girl friend. how it differ from suppression?

54. Suppression (MATURE) Conscious decision to exclude from consciousness. Repression “light” Conscious set up, unconscious follow through With right clue, will be recalled. Consciously or semiconsciously postponing attention to a conscious impulse or conflict.

55. Displacement Shifting an emotion or drive from one idea or object to another that resembles the original in some aspect or quality. Displacement permits the symbolic representation of the original idea or object by one that evokes less distress. Simply like “when I am angry at you, I yell at you”. Target changes, emotion remains the same. Tends to run down hierarchies. The example is a worker, angry at his boss, obviously unable to direct his anger and hostility to his intended target, comes home and yells at his wife. She, now also angry and upset, displaces her anger on the child, who then further displaces it on their pet dog. When I’m angry, I box at the gym .

56. According to Freudian phobias are purely the result of displacement In systemic desensitization you can get rid off the particular stimuli but later on you again reconnected to the totally different stimuli. So phobia will still remain there. And you have to solve the problem all over again. Because the root of problem is deep in unconscious. Your fearing is not really the source of problem, its merely symbolic, its representative of underlined issues. Contd.

57. Isolation of affect We recognize isolation not by what is present but by what is absent. E xperience of world C ognition emotions, reactions, response (figure, details) Lack of emotional component after realizing the cognitive component of reality. Facts without feeling.

58. I solation Involves stripping the emotion from a difficult memory or threatening impulse. Something that should be a big deal is treated as if were not e.g. Describes very comfortably about ones childhood sexual abuse D escribing a murder with graphic details with no emotional response. A medical student dissects a cadaver without being disturbed by thoughts of death.   Isolation may be temporary (affect postponement).

59. Begins as isolation of affect. Once when feelings are stripped away, now there is a sense of emptiness. This defense works in this situation. Feeling removed and replaced with cognation, to fill the sense of gap. Facts instead of feelings. Content is academically, but not personally, relevant. Link to :- Rumination (obsessive compulsive) Intellectualization

60. Avoiding unacceptable emotions by focusing on the intellectual aspects. e.g.1. focusing on the details of a funeral as opposed to the sadness and grief. 2. focusing of details of pancreatic cancer as oppose to the empathy and emotional support. Intellectualization can helps to protect against anxiety by separation from the painful or stressful events Contd.

61. Acting out (Immature) Again, begins with isolation of affect. Here also person want to get rid off sense of emptiness by filling the gap. This time not with cognition but with sensation producing behavior. This strong behavior covers unconscious actual feelings. islation of affact replaced by cognitive component intense feeling (but not related to actual feeling) intellectualization acting out

62. ACTING OUT Substance abuse, overeating, fighting, driving fast, intense sex. Acting out vs Displacement Link to: Adolescent Borderline personality disorder. Anti- social personality disorder.

63. Reaction Formation Anna Freud called “believing the opposite” Reaction formation is a defense mechanism in which anxiety-producing or unacceptable emotions are replaced by their direct opposites. Strong attraction too much that becomes treat to the self, so it becomes repulsion. e.g. 1. Having a bias against a particular race or culture and then embracing that race or culture to the extreme. 2. One who is strongly attracted to pornography, but has moral or religious obligations to avoid it, might become its staunch critic. 3. A child, angry with her mother, may become overtly concerned, rather dramatically show her affection

64. o riginal Impulse Manifest behaviour Strong , forceful and often dramatic opposite Contd.

65. Undoing Involves magical gestures or rituals that are meant to cancel out unpleasant thoughts or feelings after they have actually occured Action to reverse an unacceptable impulse. A focal fixing or repairing. Superstitious behaviors, verbal reflexes, atonement. e.g. 1- Seeing attractive girl and thinking sexuality with her, later on giving flower & chocholates to the wife after returning home

66. In essence, it involves feeling guilty and trying to do something to undo the harm that may have been inflicted. It is trying to reverse or undo a feeling by acting in some opposite or compensatory manner. Other example of this defence mechanism at work is an apology. Freud used undoing to explain some obsessive-compulsive acts, such as a youth reciting the alphabet backwards to undo his sin of sexual thoughts and feelings Contd.

67. DISSOCIATION Temporary drastic modification of one's personal identity or character to avoid emotional distress; Separation or postponement of a feeling that normally would accompany a situation or thought. Classical phrase for this defense - “ third person experience of first person event” eg . 1. girl being raped, having a sense of, that she is floating on the roof and seeing her body being raped. A kind of de personalization. 2. After a life threatening accident and when you survived in it. The feelings of just after accident. Sense of dream like state. Everything is going slow. 3.Fugue states and hysterical conversion reactions are common manifestations of dissociation.

68. MATURE DEFENSES Mature not mean good but in some sense these look healthier to deal with underlined conditions. Healthier means easy to regain reality when we compare them to another set of defense like projection, denial and splitting. Least distortion of reality with these defenses. With these defenses its easy to cop up the situations with conflicting emotions and thoughts.

69. ALTRUISM Why you help any body? Yes. I’m a good person. And if I do some thing good to other person, he will feel good. In altruism, it is not only the person you help feels good but inside yourself, you feel good too. Constructive service to others that brings pleasure and personal satisfaction to the self. The individual receives gratification either his own schema of goodness or from the response of others.

70. HUMOR Overt expression of ideas and feelings that gives pleasure to others. (especially those that are unpleasant to focus on or too terrible to talk about) Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others. It allows the person to tolerate and yet focus on what is too terrible to be borne; it is different from with a form of displacement that involves distraction from the affective issue.

71. Asceticism Renunciation of needs Recently became relevant after emergence of the disease ANOREXIA Preadolescents, when they feel threatened by their emerging sexual desires, may unconsciously try to protect themselves by denying, not only their sexual desires, but all desires. They get involved in some kind of ascetic (monk-like) lifestyle wherein they renounce their interest in what other people enjoy. Girls in our society often develop a great deal of interest in attaining an excessively and artificially thin standard of beauty. In Freudian theory, their denial of their need for food is actually a cover for their denial of their sexual development

72. Sublimation Sublimation is the refocusing of psychic energy away from negative outlets to more positive outlets. In Freud's theory, erotic energy, or libido, or id is only allowed limited expression due to repression, and much of the remainder of a given group's erotic energy is used to develop its culture and civilization. Sublimation, therefore, is the process of transforming libido into "socially useful" achievements, re- channeling drives which now can find an outlet into acceptable forms of expression, such as art.

73. Freud considered this defence mechanism the most productive, and psychoanalysts have continued to refer to sublimation as the only truly successful defence mechanism. Doing something socially acceptable is not sublimation. We can do socially acceptable things with reaction formation or displacement or undoing. Sublimation is just not be socially acceptable, but having a sense of gratification from it. e. g : 1. blood loving guy becomes a surgeon. Anna Freud's own life appears to be an example of sublimation. Anna stayed with her father all her life, never marrying, but she worked hard to advance his theory. Contd.

74. Defence mechanisms : How far helpful ? Anti- fruedian & neo- fruedian ideas All defenses are, of course, lies, even if we are not conscious of making them. But that doesn't make them less dangerous – in fact it makes them more so. Lies breed lies, and take us further and further from the truth, from reality.

75. After a while, the ego can no longer take care of the id's demands, or pay attention to the superego's. The anxieties come rushing back, and you break down Freud himself suggested that there was one positive defense, which he called sublimation. Presence of single defence mechanism is very unlikely and occurs in combination, usually one follows another in the thread Contd.

76. References http://changingminds.org/explanations/behaviors/coping/defense_mechanisms.htm Freudian Defense Mechanisms and Empirical Findings in Modern Social Psychology: Reaction Formation, Projection, Displacement, Undoing, Isolation, Sublimation, and Denial Roy F. Baumeister, Karen Dale, and Kristin L. Sommer Case Western Reserve University. 101 defences by : Jerome S. Blackman Comprehensive Textbook of Psychiatry : Kaplan & Saddock , 9 th edition. Tasman Psychiatry 4 th Edition

77. THANK YOU