Freud’s Ego Defence Mechanisms and Health

Question 1

Recap of Psychoanalytic Theory

Answer 1

•Three levels of the mind 
–Conscious 
•What we are ware of 
–Pre-conscious
•Retrievable from memory with ease
–Unconscious 
•Hard and sometimes impossible to retrieve
•Three structures of human personality 
–Id
•Desire for immediate satisfaction
–Superego
•Observes the rules and regulations of society
–Ego 
•Mediator

Question 2

Psychodynamic Perspective

Answer 2

•Derived from Freud’s development of traditional psychoanalysis
•Idea that psychopathology is largely caused by the repression of forbidden wishes or instinctual drives •Unconscious conflicts are the root of psychological distress
–Therapy is based on helping the client to gain insight into the underlying causes of emotional difficulties
•In order to bring about changes within personality and behaviour

Question 3

Basic Assumptions of the Psychodynamic Perspective

Answer 3

•Most of our behaviour is determined by unconscious thoughts and desires largely emanating from childhood
•The idea or belief that most of our behaviours originate from childhood experiences that reside within the unconscious is called psychic determinism
•Maladaptive behaviour is the result of unresolved unconscious conflicts originating from childhood
–E.g. Experiences of trauma
•Resolution occurs through accessing and confronting unresolved conflicts and unravelling the associated defence mechanisms
1. An important part of Freud’s theory was the idea that there are frequent conflicts (occasioned by adverse, difficult, traumatic or uncomfortable experiences in childhood) between the idand superego often leading or causing individual anxiety

Question 4

Conflicts Between The Id And Superego

Answer 4

•The ego dedicates much time trying to resolve these conflicts with the use of ego defence mechanisms
–Defence mechanisms are indicative of high levels of anxiety
•As a healthcare practitioner being aware of defence mechanisms will enable you to help the patient/client move forward psychologically by tailoring communication to enable openness from the client/patient

Question 5

How is the Ego Protective?

Answer 5

•Defence mechanisms are strategies that individuals most often use to ward off often painful anxiety
–They function as a tool of managing unpleasant feelings
•They operate at an unconscious level, sparked by the conflict between the id and superego
•Defence mechanisms can
–Have adaptive value
•Help with anxiety caused by repressed feelings/thoughts
OR
–Become self-defeating•Used all the time to avoid facing reality

Question 6

Examples of Psychological Defence Mechanisms

Answer 6

• Repression
• Displacement
• Projection
• Intellectualisation
• Reaction formation
• Denial
• Regression
• Rationalisation
• Identification

Question 7

Repression

Answer 7

Unconsciously blocking distressing, unwanted, or unacceptable thoughts and feelings from the mind
•Extreme reactions or high levels of anxiety by the patient/client may indicate repressed thoughts or feelings
•How to deal with it?
–Clients or patient should be invited to talk about their anxieties and encouraged to discharge negative emotions, thoughts, memories, etc.
•This method is called catharsis

Question 8

Repression (Examples)

Answer 8

•A woman who found childbirth particularly painful continues to have children
–And each time the level of pain is surprising)
•An optimist remembers the past with a rosy glow and constantly repeats mistakes
•A man has a phobia of spiders but cannot remember the first time he was afraid of them

Question 9

Displacement

Answer 9

Diverting emotional feelings such as anger from their original source, or expression of an unconscious thought/ impulse against a substitute person or other object
•This is commonly done when it does not feel safe to express these feelings or thoughts directly
•Displacement can result in some socially acceptable or beneficial activity, called sublimation
–Such as when a negative feeling, thought, or impulse against some group is channelled to assisting the same group

Question 10

Displacement (Examples)

Answer 10

•Feeling angry with your lecturer for receiving a poor mark but being unable to express it so going home and getting angry at your parent
–Sublimation
•Choosing to direct more energy into studying
•A healthcare worker mistreating elderly patients, reflecting a diverting of a negative emotional feeling with elderly people from their own life

Question 11

Projection

Answer 11

Attributing one’s own unwanted or unacceptable thoughts, feelings, characteristics, or motives to others
•Unwanted material is ‘projected’ outward into an ‘innocent person’
•Positive thoughts and feelings can also be projected
•Usually project that which we do not want to acknowledge about ourselves

Question 12

Projection (Examples)

Answer 12

• “I have not made a mistake, it is you who is critical of me and everything I do”
• A patient/client who dislikes a doctor, accuses them of being unfriendly or hostile

Question 13

Intellectualisation

Answer 13

Involves removing the emotion from emotional experiences, and discussing painful events in detached and uncaring ways to block confrontation with an unconscious conflict and its associated emotional stress
•Individuals may understand all the words that describe feelings, but have no idea what they really feel like

Question 14

Intellectualisation (Examples)

Answer 14

• Not feeling depressed or anxious after being diagnosed with a fatal disease, but researching about the disease and what it involves, looking up self-help groups, etc.
• Working on cadavers requires one to intellectualise the situation by looking at the gruesome and macabre setting (almost reminiscent of a morgue) purely as an assignment

Question 15

Reaction Formation

Answer 15

An anxiety laden impulse, thought, or feeling is replaced in consciousness by its opposite
•Occurs when a person feels an urge to do or say something and then actually does or says something that is effectively the opposite of what they really want–It also appears as a defence against a feared social punishment
•A common pattern in Reaction Formation is where the person uses ‘excessive behavior’

Question 16

Reaction Formation (Examples)

Answer 16

• Behaving badly towards someone because you really like them
• A person who is angry with a colleague actually ends up being particularly courteous and friendly towards them
• An alcoholic extols the virtues of abstinence.
• Loss of control or low self esteem can result in the patient/client hiding such feelings by acting overconfident or even aggressive

Question 17

Denial

Answer 17

The ego is incapable of dealing with threatening facts and therefore fails to acknowledge what has happened, is happening, or will happen
•Although denial may be a normal coping mechanism, it can be a problem if it starts interfering with compliance with medical or health advice
–Instead of confronting the patient who is denialist, rather discuss the concerns that they may have

Question 18

Denial (Examples)

Answer 18

•When you know your partner is having an affair, but say that they are not
•Smokers may refuse to admit to themselves that smoking is bad for their health
•Someone who is suffering from a substance abuse problem will often flat-out deny that their behaviour is problematic
–In other cases, they might admit that they do use drugs or alcohol, but will claim that their substance abuse is not a problem

Question 19

Regression

Answer 19

Closely linked to fixation, it involves regressing to “immature” behaviours that are comforting during times of stress and characteristic of earlier stages of development
•How to deal with it?
–Offer appropriate information and coping strategies to the patient/client which encourage relaxation

Question 20

Regression (Examples)

Answer 20

• A child may begin to suck their thumb or wet the bed when they need to spend some time in the hospital
• A person who suffers a mental breakdown assumes a fetal position, rocking, and crying
• A college student carefully takes their teddy-bear with them (and goes to sleep cuddling it).
• A patient/client who has a temper tantrum to get his way at a consultation

Question 21

Rationalisation

Answer 21

Creating false but plausible excuses to justify unacceptable behaviour
•How to deal with it? –Allowing or creating space for the patient to discuss concerns, advising on alternatives, while also encouraging the patient/client to stay the course because of the risks

Question 22

Rationalisation (Examples)

Answer 22

• A person evades paying taxes and then rationalizes it by talking about how the government wastes money
• A man buys a expensive car and then tells people his old car was very unreliable, very unsafe, etc.
• A person fails to get good enough results to get into a chosen university and then says that they didn’t want to go there anyway
• A patient/client stopping treatment believing that he/she is not getting better anyway because of the side effects of the treatment

Question 23

Identification

Answer 23

Bolstering self-esteem by fostering an imaginary or real alliance with some group
•It can be positive
–Such as when a patient/client joins an activist group to fight for treatment or the rights of people faced with a shared predicament as a way of bolstering self-esteem
•It can be negative
–When the imaginary or real alliance that someone imagines or forms leads to destructive behaviours for the person or other people

Question 24

Identification (Examples)

Answer 24

•If you are afraid of someone, and want to conquer that fear by becoming more like them
•An extreme example of this is the Stockholm Syndrome, where hostages identify with the terrorists
–E.g. Patty Hearst and the SymbioneseLiberation Army•Patty was abused and raped by her captors, yet she joined their movement and even took part in one of their bank robberies

Question 25

psychic determinism

Answer 25

The idea or belief that most of our behaviours originate from childhood experiences that reside within the unconscious