Coping mechanisms and ego defense

1. Coping mechanisms and ego defense Jeffrey Clothier, M.D.

2. Objectives • Student will be able to describe the defense mechanisms • Student will be able to identify defense mechanisms from short vignettes

3. Study of ego defense mechanisms - psychodynamics • Describes the dynamic interactions of unconscious and conscious forces in the mental life of a person • The dynamic interactions are often interpreted as conflicts in unconscious drives and forces which in turn become expressed in the relationships of the individual

4. Ego defenses • When the conflicts in the unconscious rise to a heightened level the the conflicts threaten to become manifested in the conscious life of the person • This is a way to discharge the anxiety created between the unconscious conflicts

5. The tripartite model of the mind • Freud • Ego • ID • Superego • The id is need gratifying and impulsive, instinctual • Hedonic drives for instance • Superego is roughly eq. to conscience • Determines that some needs are not consistent with an underlying view of one’s self (Ego ideal)

6. Ego • Ego is the mediator between the unconscious world of the Id and Superego and the conscious world of reality • The ego’s job is to mediate the struggle between the superego and id • When superego and id are in conflict the person experiences ‘signal anxiety’ • Ego must convert the signal anxiety to defuse it and make it less threatening.

7. Ego Defenses • If the signal anxiety cannot be defused it may overwhelm the ego and allow the primitive primary process thinking of the unconscious to become manifested in the conscious life of the person

8. Developmental aspects • The Id is the earliest component of the psychodynamic apparatus • The infant is basically in a pleasure seeking mode of operating (sometimes this is confused with ‘sexuality’) • The infant also conceives of the world in a narcissistic fashion. Things exist only as they relate to him or her • At times the pleasure seeking runs into barriers in the outside world • This result in infants being confronted with reality • New skills and coping mechanisms develop

9. Orderly sequence of development • Normally there is an orderly sequence as the child matures • If significant trauma occurs the child may have difficulty learning the mechanisms that are normally learned at these times • Fixated – uneven development of ego function which results in a part of the ego retaining more primitive or immature function • Repetition compulsion – replay of events related to significant traumas

10. Stages • Oral • Anal • Phallic • Latency • Genital

11. There are characteristic defense mechanisms used in specifc stages • It is possible to describe defense mechanisms along a hierarchy of maturation- actually done first by Freud’s Daughter (Anna) • The defenses used provide some evidence for stages where there are fixations

12. Defense mechanism classification

13. Other immature defense mechanisms • Splitting-the tendency to see things as either black or white • The rigidity prevents the normal flexibility which is necessary in dealing with ambiguity • Borderline and narcissitic PD use this • Magical thinking- • Undoing

14. Some characteristic defenses used in specific stages • Oral- narcissistic defenses • Projection, denial, distortion • Anal- • Identification, undoing, reaction formation, isolation, regression • Phallic / oedipal • Intellectualization • Latency • Symbolization, sublimation

15. Examples • After a difficult day on Internal medicine a Medical student returns home to his wife. He recounts every thing he encountered in meticulous detail without apparent emotional display. • Name that defense mechanism

16. #2 • When his wife mentions that he seemed to not have much emotion about all that happened the student becomes irate and belittles his wife. • Name that defense mechanism

17. #3 • At work the next day the student reports his outbursts to his colleagues and states “she deserved it after-all she should know better than to bother him after a long day”

18. #4 • Maria is a song writer. She reports her best work is done when she feels near despair. It is as though her grief is expressed through her music.

19. #5 • After Christmas you notice you over spent. You ‘decide to forget’ to pay one of your credit card bills. Throughout the next month you periodic remember it needs to be paid but do not.

20. #6 • You have just received the pathology report on one of your patients. It is cancer. When you inform the patient she becomes withdrawn and noncommunicative

21. #7 • With time, 2 days, she begins to respond but becomes more dependent on her family for things she previously did even 2 days before.

22. #8 • “The lady doth protest too much, methinks”

23. #9 • Molly is in love with Bob. She describes him as her soul mate. On Saturday night he is sick and cancels their date. On Sunday she gets up and is extremely angry with Bob and breaks up.

24. #10 • Molly misses Bob after 7 days and then goes out on Saturday night to a singles bar. She then ends up with a one night fling which she regrets.