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M05.05.02 Defence mechanism
In Freudian psychoanalysis, defense mechanisms are unconscious psychological processes employed by the ego to manage anxiety arising from internal conflicts between the id, superego, and reality. These mechanisms aim to protect the individual from overwhelming emotions, unacceptable thoughts, and urges.
Key Points for Medical Students:
- Unconscious Nature (with one exception): Most defense mechanisms operate outside of conscious awareness. Individuals are typically unaware they are utilizing these strategies. Suppression, however, can be a conscious effort to push down unwanted thoughts or feelings.
- Dynamic and Evolving: Defense mechanisms are not static. They can change and develop throughout an individual’s life as they encounter new experiences and challenges.
- Adaptive vs. Maladaptive: Defense mechanisms can be beneficial or harmful. Adaptive defenses help healthily manage anxiety, while maladaptive defenses distort reality or hinder emotional growth.
Table 1: Common Defense Mechanisms
| Category | Defense Mechanism | Description | Example | Adaptive/Maladaptive |
|---|---|---|---|---|
| Immature Defenses | Denial | Refusal to acknowledge a stressful reality. | A person with cancer insists they are healthy despite medical evidence. | Maladaptive |
| Projection | Attributing one’s own unacceptable thoughts or feelings onto others. | A jealous person accuses their partner of being flirtatious. | Maladaptive | |
| Displacement | Redirecting emotions from a threatening object to a safer one. | A child angry at a parent takes it out on a sibling. | Can be adaptive or maladaptive | |
| Mature Defenses | Repression | Unconsciously pushing down unacceptable thoughts or feelings. | A person forgets a traumatic experience. | Can be adaptive or maladaptive (if excessive) |
| Intellectualization | Focusing on the intellectual aspects of a situation to avoid emotional distress. | A person analyzes the logistics of a breakup rather than feeling the sadness. | Adaptive if not used excessively | |
| Humor | Using humor to make light of a stressful situation. | A patient jokes about their illness to cope with anxiety. | Adaptive | |
| Altruism | Unselfishly helping others to manage guilt or anxiety. | Volunteering to distract from personal problems. | Adaptive |
Table 2: Additional Points to Consider
- Defense mechanisms are often used in combination.
- The effectiveness of a defense mechanism depends on the individual and the situation.
- Excessive reliance on maladaptive defenses can contribute to mental health problems.
Understanding defense mechanisms is crucial for medical students in various fields, including:
- Psychiatry: Recognizing maladaptive defense mechanisms can aid in diagnosing mental health disorders.
- Psychotherapy: Therapists can help patients identify and modify unhelpful defense mechanisms.
- Primary Care: Understanding defense mechanisms can improve communication and empathy with patients.
Bibliography:
- Sigmund Freud (1926). The Ego and the Mechanisms of Defense. Hogarth Press.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association.
- Westen, D. (2017). Psychodynamic Psychotherapy: Theory, Practice, and Research (3rd ed.). American Psychological Association.