Defense Mechanisms in Mania,Bipolar Depression and Unipolar Depression

The present study compared the use of defense mechanisms in ten bipolar manic, ten bipolar depressed and ten unipolar depressed patients. The defense mechanisms were assessed by two methods: TAT stories scored by Defense Mechanism Manual and Defense Mechanism Rating Scale ratings of psychodynamic interviews. The severity of symptoms was assessed by Beck Depression Inventory for depressed patients and Young’s Manic Rating Scale for manic patients. Both bipolar manic and depressed groups used the defense mechanism of denial, borderline level defenses and immature defenses significantly more than the unipolar depression group. The manic group showed greater dependence on narcissistic level defenses as compared to the other two groups. Positive relationships were found between severity of manic symptoms and the defense mechanisms of denial as well as the narcissistic level defenses. The bipolar depression group also used more action level defenses as compared to the unipolar depression group. The unipolar depression group scored higher on the defense mechanism of identification and adaptive level defenses as compared to the manic group. A negative correlation was found between the severity of depressive symptoms for unipolar depression group and the defense mechanism of identification. The neurotic level defenses were used most frequently by unipolar depression group, followed by the bipolar depression group and manic group. Some of these findings are in consonance with the psychoanalytic understanding of mania and depression.     

Psychoanalytic observations on the effect of lithium on manic attacks

This paper describes a predictable relation between our manic-depressive patients' blood lithium levels and particular changes in their conscious and unconscious mental processes (i.e., their thoughts, wishes, fantasies, inclinations, and feelings). These changes were, in turn, predictively related to specific changes in these patients' overt manic symptomatology. Because each of our patients' manic episodes was heralded by a marked increase in unconscious or conscious phallic sexual thoughts, feelings, and behaviors, and because this increase preceded any observed deterioration in ego or superego functioning, we hypothesize that a primary increase in our patients' phallic instinctual drives secondarily overwhelmed the capacity of their egos to defend against these drives, and that this, in turn, resulted in the development of our patients' overt manic symptoms. Psychoanalysis (or psychoanalytically oriented psychotherapy) made our patients consciously aware both of their previously unconscious phallic sexual thoughts and impulses, and of their defenses against them. This new awareness enabled our patients to recognize when their, now conscious, phallic sexual impulses and thoughts became inappropriately intensified; and this, in turn, permitted them to avoid overt manic episodes by counteracting these inappropriate inclinations with increased doses of lithium.     

Two modalities of manic defences: Their function in adolescent breakdown

The aim of this paper is to explore two different modalities of manic defences and their specific underlying anxieties. I will describe the relation between these defences and the role of the superego and their specific function in adolescent breakdown. While one type of manic defence operates by the ego’s identification with a sadistic superego the other one operates via evacuation of a guilt-inducing superego. I will illustrate the proposed ideas with clinical examples from the analysis of two adolescents. This paper stresses the specific differences between these two modalities and the clinical importance of both identifying and addressing the enactment in the transference of the unconscious phantasies and anxieties (paranoid and depressive) that give rise to these two types of defences.     

Manic depression and religious experience: The use of religion in therapy

In the article, I explore the use of spiritual strategies in the treatment of manic depression in religiously oriented psychiatric inpatients. Manic depression, a disorder primarily of mood, is characterized by bouts of mania alternating with depression. Religious themes and mystical experiences pervade the language of manic depressive illness, e.g., sensing one is God, being given a divine mission, receiving divine messages, having ecstatic experiences, and so on. Debate exists concerning the effectiveness of spiritual interventions in manic patients. I suggest that a trained religious leader may be able to work therapeutically with such patients, provided that two goals are kept in mind: emphasizing beliefs that facilitate positive coping and challenging irrational religious beliefs (i.e., beliefs that lead to negative coping). When examined psychoanalytically, patients’ religious symbols and beliefs reveal deeply held beliefs about themselves. In particular, splitting and idealization and devaluation can be seen in their religious belief system. The role of culture in promoting maladaptive belief systems must not be overlooked. In employing spiritual interventions in patients diagnosed with manic depression, potential dangers are imposing one's values on patients and overstating the importance of spirituality.     

Epistemically self-defeating arguments and skepticism about intuition

An argument is epistemically self-defeating when either the truth of an argument’s conclusion or belief in an argument’s conclusion defeats one’s justification to believe at least one of that argument’s premises. Some extant defenses of the evidentiary value of intuition have invoked considerations of epistemic self-defeat in their defense. I argue that there is one kind of argument against intuition, an unreliability argument, which, even if epistemically self-defeating, can still imply that we are not justified in thinking intuition has evidentiary value.     

Evolutionary psychology is not the only productive evolutionary approach to understanding consumer behavior

I respond to Vladas Griskevicius and Douglas T. Kendrick (G&;K) and Gad Saad's (S) defenses of the view that Consumer Studies would benefit from the appeal to evolution in all work aimed at understanding consumer behavior. I argue that G&;K and S's reliance on one theoretical perspective, that of evolutionary psychology, limits their options. Further, I point out some specific problems with the theoretical perspective of evolutionary psychology. Finally, I introduce some alternative evolutionary approaches to studying human behavior that could profitably be adopted in consumer research.     

Listening to the Erotic Commentary on Paper by Eric Sherman

In this commentary I examine homoerotic countertransference within the context of the analyst's erotic countertransference experience. Discussing male analysts' difficulties receiving and experiencing homoerotic feelings as a function of their dominant erotic desires (along gender lines), I propose both cognitive and affective explanations to illuminate their defenses. I suggest that Sherman's erotic countertransference is best understood when viewed as a product of both induced feelings emanating from his patient's dissociated sexual abuse and also his anxiety and shame in response to particular relational configurations with his patient that arouse him. Finally, I point to the site of the transgressive as integral to the construction of erotic desire and suggest shifts that need to occur in the erotic subjectivity of this dyad so that the treatment can move forward.     

Response to Donald Kalsched

I have attempted to focus this discussion by looking at three interrelated matters. There is the issue of Sue's final dream – the enigma with which Don Kalsched leaves us. I first have a go at that, from my own, as well as some other, perspectives. Then, there is the question central to this presentation of the archetypal defense itself. What, in fact, arethese defenses, and how is the author using the concept of the ‘archetypal’? Finally, I wouldn't be me if I didn't rise to the bait of Sue's shame, more prevalently peppered throughout the first draft than the present one.     

The use of the analyst as an autistic shape

In this paper I describe through detailed clinical material the challenges posed by patients who employ entangled autistic defenses. I discuss the complicated nature of treating a patient who employed entangled autistic defenses and utilized my voice in an effort to preserve an undifferentiated state of dual unity. My patient's pursuit of dual unity took a very concrete form in her attempt to mitigate the terror of separateness. This concreteness was expressed via the patient's urgent request that I read letters she wrote to me between sessions. This type of autistic defense placed great strain on my ability to think analytically and I also became increasingly concrete in my response to the patient. Crucial to the analyst's regaining a space in which to think and a sense of separateness is the ability to contact the ground floor of her separate bodily experience. This is just the beginning step in the analyst separating herself from the powerful press to join the patient in a state of dual unity. Interpretation in action (Ogden, 1994) was an effective way to convey the importance of creating and tolerating internal space in myself and begin to create internal space in the patient. Previously such space had been closed down in order to manage primitive fears of annihilation. When a patient is absorbed in an entangling autistic retreat words do not reach the patient on a symbolic level but rather are experienced primarily as an assault on the need for dual unity with the analyst. The patient's need to be wrapped in a sensation based world of dual unity is preferable to a world of spoken words that carry the danger of delineating psychic separateness. In essence there is no self to speak words, only a whirl of an amorphous sensation self lacking definition. I believe with certain kinds of patients it may be necessary to first lose and then work to regain one's analytic mind, as I have powerfully described in the case of Linda. Linda's profound loss of connection to the ground floor of her experience could only begin to be addressed when I worked to extricate myself from ‘our magic carpet ride’ of dual unity, contacting the reality of my bodily experience, and begin to tolerate the terror I felt regarding my separateness from Linda. I also describe the confusing vacillation between entangled and encapsulated defenses in patients like Linda as previously identified by Cohen and Jay (1996). Ultimately, this kind of slow difficult analytic work began to help Linda develop a capacity to think and provided an alternative to the deadened world of her autistic protections.     

The unwelcome child and a lack of acceptance of new ideas

Ferenczi’s idea of the unwelcome child and his death instinct is used as a background for discussing the treatment of adult patients who do not expect to be received and understood and who turn their aggression back upon themselves, destroying their will to live. When these patients enter analysis, they are very difficult to reach because they have internalized an obstructive object (Bion, 1958). Further, I have linked the unwelcoming of a child to the hatred of the new idea. The paper highlights the deadening defenses that arise in response to awareness of premature separateness between mother and baby, inevitably experienced by an unwelcome child. Coming alive involves suffering the pain of the original loss. To avoid this pain, patients reject anything new, and become stuck in monotonous, seemingly lifeless, patterns where new ideas and new ways of being threaten the static order. This includes the threat that relationship with the analyst brings.

     

Divine Freedom and Free Will Defenses

This paper considers a problem that arises for free will defenses when considering the nature of God's own will. If God is perfectly good and performs praiseworthy actions, but is unable to do evil, then why must humans have the ability to do evil in order to perform such actions? This problem has been addressed by Theodore Guleserian, but at the expense of denying God's essential goodness. I examine and critique his argument and provide a solution to the initial problem that does not require abandoning God's essential goodness.     

Defensiveness and Defense Mechanisms

This introduction to the Journal of Personality's special issue on the topic of defense mechanisms raises the question of why defenses have been largely overlooked in personality research. Although defenses were originally discussed in the context of psychopathology, for the past 60 years psychodynamically oriented psychologists have understood that defenses play an important part in normal psychological development. Recently, psychologists outside the field of personality have incorporated the ideas of unconscious mental processes and of defenses into their research programs. In this issue, personality researchers discuss their ideas about defense mechanisms, organized around three topical areas: current conceptualizations of defense, the measurement of defense mechanisms, and the integration of defense mechanisms into personality research. The issue concludes with a commentary on these articles and provides suggestions for future work.     

What Is Music? Is There a Definitive Answer?

Philosophers frequently defend definitions by appealing to intuitions and contemporary folk classificatory norms. I raise methodological concerns that undermine some of these defenses. Focusing on Andrew Kania's recent definition of music, I argue that the way in which it has been developed leads to problems, and I show that a number of other definitions of interest to philosophers of art (and others) run into similar problems.     

The non-epistemology of intelligent design: its implications for public policy

Intelligent design creationism (ID) is a religious belief requiring a supernatural creator’s interventions in the natural order. ID thus brings with it, as does supernatural theism by its nature, intractable epistemological difficulties. Despite these difficulties and despite ID’s defeat in Kitzmiller v. Dover Area School District (2005), ID creationists’ continuing efforts to promote the teaching of ID in public school science classrooms threaten both science education and the separation of church and state guaranteed by the U.S. Constitution. I examine the ID movement’s failure to provide either a methodology or a functional epistemology to support their supernaturalism, a deficiency that consequently leaves them without epistemic support for their creationist claims. My examination focuses primarily on ID supporter Francis Beckwith, whose published defenses of teaching ID, as well as his other relevant publications concerning education, law, and public policy, have been largely exempt from critical scrutiny. Beckwith’s work exhibits the epistemological deficiencies of the supernaturally grounded views of his ID associates and of supernaturalists in general. I preface my examination of Beckwith’s arguments with (1) philosopher of science Susan Haack’s clarification of the established naturalistic methodology and epistemology of science and (2) discussions of the views of Beckwith’s ID associates Phillip Johnson and William Dembski. Finally, I critique the religious exclusionism that Beckwith shares with his ID associates and the implications of his exclusionism for public policy.     

Disruption and Working Through in the Supervisory Process: A Vignette From Supervision of a Psychoanalytic Candidate

This paper describes the author’s supervision of a psychoanalytic candidate, including the development and resolution of impasse in both the supervised analysis and the supervisory relationship. When the author became aware of the degree to which her own anxieties and defenses were implicated, she sought consultation, after which both supervision and analysis moved forward. As supervision continued, work on supervisee’s and supervisor’s interlocking anxieties and defenses, and understanding of their impact on the supervised analysis, deepened. The author concludes that exploring supervisory disruptions allows both members of the supervisory dyad to come to grips with conflicts that subtly distort their work and facilitates a deepening of the supervised analysis.     

Epicureanism About Death and Immortality

In this paper I discuss some of Martha Nussbaum’s defenses of Epicurean views about death and immortality. Here I seek to defend the commonsense view that death can be a bad thing for an individual against the Epicurean; I also defend the claim that immortality might conceivably be a good thing. In the development of my analysis, I make certain connections between the literatures on free will and death. The intersection of these two literatures can be illuminated by reference to my notion of a Dialectical Stalemate.     

Psychoanalytic perspectives on music: an intersection on the oral and aural road

This paper is organized around two ideas. The first invites the reader to consider the importance of music in emotional life, suggesting that for some people, music can have profound, deep, and transformative effects, both in loosening defenses and in deepening the psychoanalytic experience. The second idea is that analysis of the formal properties of music have both specific and overdetermined meanings that share elements with psychoanalytic principles. I suggest that, if the verbal analysis of dreams paves a royal road to the unconscious, the formal properties of music provide an aural road to the same destination. Two clinical vignettes and scenes from Verdi's opera Otello are used to illustrate these interrelated ideas.     

How To Think About Philosophical Methodology

Experimental philosophy, at least in its ‘negative’ variety, has standardly been portrayed as presenting a dramatic challenge to traditional philosophical methodology. As such, it has prompted a large variety of counter-arguments and defenses of intuition. In this paper, I argue that many of these objections to experimental philosophy rest on various oversimplifications that both experimental philosophers and their opponents have made regarding intuitions and philosophical methodology. Once these oversimplifications are abandoned, I argue that the experimentalist critique of current philosophical methods becomes somewhat less dramatic, but also much less open to objection.

     

Mean Beck Depression Inventory-II total scores by type of bipolar episode

The 1996 Beck Depression Inventory-II was administered to 120 outpatients diagnosed with DSM-IV-TR bipolar I disorders who had recently experienced manic, mixed, or depressed episodes. A focused contrast supported the hypothesis that the mean Beck-II total score for the 40 patients with depressed episodes (M=34.1, SD = 13.2) was higher than the mean Beck-II total score for the 40 patients with mixed episodes (M=25.9, SD= 13.6) which was, in turn, higher than the mean Beck-II total score for the 40 patients with manic episodes (M= 11.7, SD=7.8, p<.001). The Beck Depression Inventory-II appears to be useful for measuring self-reported depression in patients with bipolar I disorders.