Theory and Psychopathology

Lines of thought

Remission of Schizophrenia and Defense Mechanisms

Denial and repression as aspects of therapeutic defense against psychosis.

Note that this author has published a book, entitled “Illuminating Schizophrenia: Insights into the Uncommon Mind”, available on Amazon.com.

Anna Freud (1937) created a theory of defense mechanisms that implicated the use of repression in protecting the ego or the self from psychic pain. She theorized that these defense mechanisms are used by what Sigmund Freud termed “the ego” to reduce anxiety when the wishes of “the id” conflicts with those of society.

According to Sigmund Freud, “the id” is an irrational aspect of the self that is motivated to seek pleasure, and “the ego” is a rational aspect of the self that uses reason and rationality to curb the desires of the id. It was theorized by Anna Freud that these defense mechanisms are theoretical constructs that explain the individual’s tendency to distort the reality of psychic pain by repressing the id’s wishes when the id’s desires are thwarted.

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It should be noted, however, that defense mechanisms do not simply protect one from the id’s instinctual desires. They also protect one from the anxiety of confronting one’s weaknesses and personal defects.

It is my opinion that, in terms of the punitive aspects of paranoid schizophrenia involving hallucinations and delusions, psychic pain may become so unbearable that the psychotic individual may recede into “repression” as a defense mechanism against the punitive aspects of his delusional system and experience.

Hallucinations can be punitive in that they may be incessant and unremitting. The delusions of the paranoid schizophrenic may be punitive in that they inspire intense fear and foreboding. While not perhaps synonymous with the kind of pain that can be associated with the id, the reality of psychic pain that delusions and hallucinations entail can be negated by use of defense mechanisms. Note that defense mechanisms may result in healthy or unhealthy consequences depending on the circumstances and frequency of the mechanism used.

Some defense mechanisms include the following:

1. Repression

This occurs when a threatening idea, thought or emotion enters consciousness; this defense mechanism causes suppression of threatening material or intrusive thoughts. Using this defense mechanism, one may engage in any of the other defense mechanisms listed below.

2. Projection

This occurs when a person’s own unacceptable and threatening feelings are repressed and attributed to someone else. For example, a schizophrenic on a psychiatric ward may accuse another patient of wanting to harm him because he, himself, feels aggressive toward that individual.

3. Displacement

This occurs when people direct their emotions to things or animals and other people that are not the real object of their feelings. For example, a psychotic individual may try to punch a smaller person rather than the individual whom he is actually angry at, because he fears the other, larger person.

4. Reaction Formation

This occurs when a feeling that produces unconscious anxiety is transformed to its opposite in consciousness. This may occur, for example, when a schizophrenic professes to enjoy group therapy even though it actually makes him very nervous to speak with others in a group setting.

5. Regression

This occurs when a person reverts to a previous phase of psychological development, for example, when an adult schizophrenic sleeps with a teddy bear.

6. Denial

This occurs when people refuse to admit that something unpleasant is happening to them. This can result in a person saying that their medication is working even though this is not true. Denial can amount to an individual seeing the world from an artificially optimistic viewpoint, and, even though they do not recognize their own artifice, they engage in denial of the reality of their mental health disorder.

For some people, paranoid schizophrenia may be episodic, in that episodes of acute psychosis, and even prolonged episodes of psychosis, may abate as a result of the predominately unconscious application of defense mechanisms to the painful realities of psychosis, from which the paranoid schizophrenic individual seeks relief. The use of repression and denial to combat psychic pain constitutes an explanation why some paranoid schizophrenics go into remission periodically, even though schizophrenia is usually a chronic condition.

The fact of the use of denial and repression as a means of combating psychic pain in the paranoid schizophrenia may be counterintuitive as an explanation why some paranoid schizophrenics may go into remission regarding their illnesses.

Defense mechanisms are traditionally thought to represent a way of lying to oneself about one’s psychological pain by attributing it to any number of factors, based upon the use of repression. The fact that repression may be used to deny illusory experience and ideas, constituted by hallucinations and delusions, may seem to represent use of defense mechanisms to affirm reality. Nevertheless, the operation of defense mechanisms is implicit in denial of hallucinations and delusions in the paranoid schizophrenic. It is asserted that repression is a curative aspect of psychological functioning that may be engaged in by paranoid schizophrenics to combat psychotic processes.

 

 

Ann Olson is a doctor of psychology, a writer of fiction, creative nonfiction and poetry.

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