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  2. STRUCTURES OF THE PSYCHE Freud proposed three structures of the psyche or personality: Id Ego Superego
  3. ID • The id, the most primitive part, can be thought of as a sort of house of biologically based urges. The urge to eat, drink, eliminate and, especially, to be sexually stimulated. • The sexual energy that underlies these urges is called the libido. • The id operates according to what Freud called the pleasure principle. That is, if left to itself, the id would satisfy its fundamental urges immediately and reflexively as they arose, without regard to rules, the realities of life, or morals of any kind. • The id, however, is usually bridled and managed by the ego.
  4. EGO • The ego consists of elaborate ways of behaving and thinking which constitute the "executive function of the person. The ego delays satisfying id motives and channels behavior into more socially acceptable outlets, keeps a person working for a living, getting along with people, and generally adjusting to the realities of life. Indeed, Freud characterized the ego as working in the service of the reality principle.” • That is as ego tries to satisfy the id's urge for pleasure but only in realistic ways that take account of what is possible in the real world. The ongoing tension between the insistent urges of the id and the constraints of reality help the ego develop more and more sophisticated thinking skills.
  5. SUPEREGO • The superego corresponds closely to what we commonly call the conscience. It consists mainly of prohibitions learned from parents and other authorities. The superego may condemn as "wrong certain things which the ego would otherwise do to satisfy the id. But the superego is not all fire and brimstone. Its conscience-like proddings are also guided by what Freud called the ego ideal, a set of positive values and moral ideals that are pursued because they are believed to be worthy.
  6. • The ego's task of satisfying both id and superego requires a somewhat risky balancing act. For example, if the ego yields to the id's desire for something that is morally forbidden, the superego may "punish" the ego with feelings of guilt.
  7. • Freud proposed three levels of consciousness, or awareness: the conscious, the preconscious, and the unconscious. • At the conscious level, we are aware of certain things around us and of certain thoughts. • At the preconscious level are memories or thoughts that are easily available with a moment's reflection-for example, what we had for breakfast, or our parents' first names. • In contrast, the unconscious contains memories, thoughts, and motives which we cannot easily call up.
  8. • All of the id is unconscious; the ego and superego include material at all three levels of consciousness.
  9. • When anxiety becomes overwhelming, it is the ego's place to protect the person by employing defence mechanisms. • The signaling function of anxiety is seen as crucial, and biologically adapted to warn the organism of danger or a threat to its equilibrium. • Defence mechanisms work by distorting the id impulses into acceptable forms, or by unconscious or conscious blockage of these impulses. • All defence mechanisms are responses to anxiety and how the consciousness and unconscious handle the stress of a social situation.
  10. GEORGE VALLIANT’S CLASSIFICATION • Narcissistic-psychotic Defences: • Projection, Denial, Distortion. • Immature Defences: • Acting out, blocking, hypochondriasis, introjection, passive aggressive behaviour, projection, regression, schizoid fantasy, somatisation. • Neurotic Defences: • controlling, displacement, dissociation, externalization, inhibition, intellectualization, isolation, rationalisation, reaction formation, repression, sexualization. • Mature Defences: • Altruism, anticipation, asceticism, humour, sublimation, suppression.
  11. NARCISSISTIC-PSYCHOTIC DEFENCES: • These defences are commonly found as a part of a psychotic process, but may also occur in young children and adult dreams or fantasies. • They share a common note of avoiding, negating or distorting reality.
  12. PROJECTION • Individuals attribute characteristics they find unacceptable in themselves to another person. • Eg.: A husband who has a hostile nature might attribute this hostility to his wife and say she has an anger management problem. • In some cases projection can result in false accusations.
  13. DENIAL • Denial involves the rejection of a fact that is too painful for a person to accept. Freud argued that there are three types of denial: • Simple denial: occurs when someone denies that something unpleasant is happening. For example, a person with terminal cancer might deny that he/she is going to die. Minimization: occurs when a person admits an unpleasant fact while denying its seriousness. A person about to get divorced might, for example, brush the divorce off as no big deal. Projection: For example, the cancer patient might insist that his or her doctor is providing inadequate care and that a different doctor could provide a different outcome.
  14. DISTORTION • Grossly reshaping the experience of external reality to suit inner needs, including unrealistic megalomaniac beliefs, hallucinations, wish-fulfilling delusions, and employing sustained feelings of delusional grandiosity, superiority, or entitlement. • Minor: devaluation, idealization, omnipotence. • Major: autistic fantasy, projective identification, splitting of self image • Dysregulation: delusional projection, psychotic denial, psychotic distortion.
  15. • Devaluation: • Attributing exaggerated negative qualities to self or others. • Idealization: • Attributing exaggerated positive qualities to self or others. • Omnipotence: • Acting as if self is possessed with special powers and abilities and is superior to others.
  16. • Autistic fantasy: • Excessive daydreaming as a substitute for human relationship, effective action or problem solving. • Projective identification: • Falsely attributing to another the feelings thoughts or impulses of self, differing from simple projection by the fact that the individual doesn't fully disavow what is projected; rather miss attributes them as justifiable reactions to the other person. • Frequently the individual induces those very feelings in others that were believed to be there, making it difficult to untangle the situation. • Splitting of self image: • Compartmentalizing opposite effect states and failing to integrate the positive and negative qualities of self orders into cohesive images self an object images tend to alternate between polar opposites
  17. • Delusional projection: • Attributing non reality based thoughts emotions and impulses to others delusions about external reality usually of a persecutory nature example blaming others society history economy for self failure • Psychotic denial: • Gross impairment of reality testing. • Psychotic distortion: • Gross impairment in pursuing reality differently than others.
  18. IMMATURE DEFENCES: • Fairly common in preadolescents years and in adult character disorders. • Often mobilized by anxieties related to intimacy or its loss. • Although regarded as socially awkward and undesirable, they often moderate with improvement in interpersonal relationships or with increased personal maturity.
  19. ACTING OUT • The direct expression of an unconscious wish for impulse in action to avoid being conscious of the accompanying affect. The unconscious fantasy, involving objects, is lived out and impulsively enacted in behavior, thus gratifying the impulse more than the prohibition against it. On a chronic level, acting out, Involves giving in to impulses to void the tension that would result from postponement of their expression. • Acting out may include fighting, throwing fits, or stealing. In severe cases, acting out is associated with antisocial behavior.
  20. BLOCKING • Patient blocks out bad thoughts or memories, having no memory of them. • Eg.: • During exams or viva. • Introducing girlfriend to family.
  21. HYPOCHONDRIASIS • Exaggerating or overemphasizing an illness for the purpose of evasion and regression. • Responsibility can be avoided , guilt can be circumvented and instinctual impulses are warded off.
  22. PROJECTION • Mechanism by which the ego attributes its own intolerable sexual and aggressive impulses to the outside person or agency. • Coping with one’s unwanted motives by shifting them on to someone else. • Anxiety arising from internal conflicts can then be reduced and problem dealt with as though it were in the external world.
  23. INTROJECTION • Introjection is the opposite of projection. Introjection, which is common among children and parents, occurs when a person internalizes the beliefs of other people. • While everyone learns from the external world and takes on elements of other people’s beliefs and ideas, introjection occurs with minimal thought. A woman who adopts her friends’ views, after they have been carefully explained and considered, is not introjecting, but a child who reflexively adopts a parent’s views without thought can be said to be introjecting. • Introjections involve attitudes, behaviors, emotions, and perceptions that are usually obtained from influential or authoritative people in one’s life. They are neither digested nor analyzed; they are simply adopted as a part of one’s personality as concepts that one considers should be believed or behaviors that one thinks ought to be followed. Introjections do not involve an individual’s personal integrity or morality.
  24. PASSIVE AGGRESSIVE BEHAVIOUR • These patients turn their anger against themselves. This phenomenon is called masochism, includes procrastination, silly or provocative behavior, self demeaning ,clowning and frankly self destructive acts. • Instead of expressing hostility against another person, represses the hostility but ventilates it against own self in the form of self criticism and self accusation.
  25. REGRESSION, • Attempting to return to an earlier libidinal phase of functioning to avoid the tension and conflict evoked at the present level of development. • The ego abandons the matured path of gratification and takes resort to pregenital or less objectionable attitude towards its object of gratification. • Regression is normal phenomenon as well. Some amount of regression is needed for relaxation, sleep and orgasm in sexual intercourse. • In the face of threat, one may retract to an earlier pattern of adaptation, possibly a childish or primitive one. • For eg, an adolescent who is overwhelmed with fear, anger and growing sexual impulses might become clingy and start exhibiting earlier childhood behaviors he has long since overcome, such as bedwetting, nail biting etc.
  26. SCHIZOID FANTASY • Indulge in Autistic fantasy (daydreaming, eccentric speech) to resolve conflict and to obtain gratification. • Inter personal intimacy is avoided and eccentricity serves to repel others. • The person does not fully believe in fantasies and does not insist on acting them out. • Example: A 15-year-old boy dreams of being the world chess champion. He spends nearly all of his time alone studying the game and won't discuss other topics. • Clinically seen in Schizoid & Schizotypal Personality ,Narcissistic Personality Disorders.
  27. SOMATISATION • Converting psychic derivatives into bodily symptoms and tending to react with somatic manifestations rather than with psychic manifestations.
  28. NEUROTIC DEFENCES: • Common in apparently normal, healthy individuals as well as in neurotic disorders. • Function usually in the alleviation of distressing affects and may be expressed in neurotic forms of behaviour. • Depending on circumstances, they can also have an adaptive or socially acceptable aspect.
  29. CONTROLLING • Attempting to manage or regulate events or objects in the environment to minimize anxiety and to resolve inner conflicts.
  30. DISPLACEMENT • The motive remains unaltered but the person substitutes a different goal object for the original one. • Often the motive is aggression that for some reason, the person cannot vent on the source of anger. • Shifting an emotion or drive from one idea or object to another that resembles the original in some aspect or quality. • Ex.: A man gets angry at his boss, but can’t express his anger to his boss for fear of being fired. He instead comes home and kicks the dog or starts an argument with his wife.
  31. DISSOCIATION • Polly anna(subconscious bias towards the positive) like replacement of unpleasant affects with pleasant ones. • Temporarily but drastically modifying a persons character or one’s own sense of personal identity to avoid emotional distress. • Includes fugue states and hysterical conversion reactions. • Personality Disorder, PTSD, Somnambulism.
  32. EXTERNALIZATION • Tending to perceive in the external world and in external objects, elements of one’s own personality, including instinctual impulses, conflicts, moods, attitudes and styles of thinking. • For example, a patient who is overly argumentative might instead perceive others as argumentative and himself as blameless.
  33. INHIBITION • Involuntary decrease or loss of motivation to engage in some goal directed activity to prevent anxiety arising out of conflicts with unacceptable impulses. • Eg in Normal: Social Shyness. • Clinically in OCDs & Phobias.
  34. INTELLECTUALIZATION • Excessively using intellectual process to avoid affective expression or experience. • To avoid intimacy with people, attention is paid to external reality to avoid the expression of inner feelings and stress is placed on irrelevant details to avoid perceiving the whole. • Professionals who deal with troubled people may intellectualize in order to remain helpful without being overwhelmed by sympathetic involvement.
  35. ISOLATION • Characteristic of the orderly, controlled persons who are labelled as Obsessive compulsive personalities. • Splitting or separation of an idea from the affect that accompanies it, but is repressed. • In splitting, persons towards whom patients feelings are, or have been, ambivalent are divided into good and bad. • Ex. In a ward, a patient may idealize some staff members and uniformly disparage others.
  36. RATIONALISATION • Offering rational explanations in an attempt to justify attitudes, beliefs or behaviour that may otherwise be unacceptable. • It is a method to support an attitude with false reasons. • Substituting an acceptable conscious motive for an unacceptable unconscious one. • Ex.: Grapes are sour.
  37. • Rationalization is very common among medical professionals in covering up medical errors. • “Why disclose the error?, the patient was going to die anyway” • “Telling the family about the error will make them feel worse” • “It was patient’s fault, if he wasn’t so obese, sick etc. this error wouldn't have caused so much harm” • “Well we did our best, these things happen.”
  38. REACTION FORMATION • Transforming an unacceptable impulse into its opposite • Characteristic of obsessional neurosis • If this mechanism is frequently used at any early stage of ego development it can become a permanent character trait, as in obsessional character. • Thus love may cover up unconscious hate, shyness serves as defence against exhibitionism. • Ex : when a 2nd child is born in a family the first child may show extraordinary concern for the welfare of the Newborn. This way his unconscious hate and aggression for his little brother is covered up.
  39. REPRESSION • Repression is the unconscious blocking of unacceptable thoughts, feelings and impulses. • Ego excludes from the consciousness all the psychological contents which it cannot fit in harmoniously. • Primary Repression: Curbing of ideas and feelings before they have attained consciousness. • Secondary repression : Excluding from awareness what was once experienced at the conscious level.
  40. • Repressed feelings do not cease to exist by mere expulsion from the consciousness. Ego takes further steps to deal with these pent up impulses : • a) Further reinforcement of repression • b) Finding out substitute channels for outlet of impulse.
  41. SEXUALIZATION • Endowing an object or function with a sexual significance that it did not previously have or possessed to a smaller degree, to ward off anxieties associated with prohibited impulses or their derivatives.
  42. MATURE DEFENCES: • Healthy and adaptive throughout the life cycle. • Socially adaptive and useful in integration of personal needs and motives, social demands, and interpersonal relations. • They can underlie seemingly admirable and virtuous patterns of behaviour.
  43. ALTRUISM • Involves an individual getting pleasure from giving to others what the individual would have liked to receive. • Ex. Using Altruism a former alcoholic serves as an Alcohol Anonymous sponsor to a new member, achieving transformation process that may be life saving.
  44. ANTICIPATION • Realistically planning or anticipating future inner discomfort. • Involves careful planning or worrying and premature, but realistic anticipation of dire and potentially dreadful outcomes. • Ex. Moderate amount of anxiety before surgery promotes post surgical adaptation.
  45. ASCETICISM • Eliminates pleasurable effects of experiences. Uses morals to assign values to specific pleasures. • Derives gratification from renunciation of all consciously-perceived base pleasures.
  46. HUMOUR • Using comedy to overtly express feelings and thoughts without personal discomfort and without producing an unpleasant effect on the others. • Mature humor allows individuals to look directly at what is painful.
  47. SUBLIMATION • For Freud, sublimation was the highest level of ego defence • Consists of redirection of sexual impulses to socially valued activities and goals. • He believed that much of our cultural heritage is the product of sublimation. • Ex. A writer may divert his libido to creation of poem/ novel. Thus indirectly satisfying drives. • Rejection by lover may induce one to divert his energy to human welfare or artistic and literary activities.
  48. SUPPRESSION • Consciously or semi consciously postponing attention to a conscious impulse or conflict. • Issues may be deliberately cut off but they are not avoided.
  49. • Underlying defenses—the unconscious mental processes that the ego uses to resolve conflicts among the four lodestars of the inner life: instinct (wish or need), reality, important persons, and conscience. • When defenses are most effective, especially in those with personality disorders, they can abolish anxiety and depression. • Thus, abandoning a defense increases conscious anxiety and depression—a major reason that those with personality disorders are reluctant to alter their behavior.
  50. WHERE DO DEFENCE MECHANISMS OPERATE ? • Delusional disorder: • Reaction Formation: against Aggression, Dependence Needs and feelings of Affection and transform the need for dependence into staunch independence. • Denial: To avoid awareness of painful reality. • Projection: To protect themselves from recognizing unacceptable impulses in themselves.
  51. • Personality disorders. • Fantasy: many people with schizoid personality, seek solace and satisfaction within themselves by creating imaginary lives, especially imaginary friends. • Dissociation/Denial: behave like anxious adolescent adults who, to erase anxiety, carelessly expose themselves to exciting dangers, • Isolation: characteristic of controlled, orderly persons who are often labelled obsessive-compulsive personalities. Remember the truth in fine detail, but without affect. • Projection:
  52. • Splitting: Persons towards whom patients’ feelings are ambivalent are divided into good and bad. • Passive Aggression: Turn their anger against themselves.
  53. • Substance use disorder. • Denial: often the 1st Line of Defence. He will reason that because he hasn’t lost a job or been rushed the ER, there not be a problem. • Compartmentalization: when a addict separates a part of themselves (the part that doesn’t conform to their personal beliefs and values) from all other parts. • Repression: Occurs when Denial no longer gets the job done. Allows the addict to simply forget the effects of the behaviour. • Rationalization: particularly insidious because it masquerades as reason.