Anna Freud Diagnostic Profile - Continuation of Defence Mechanisms

In any case, we left it at identification with the aggressor. Just before that, we have talked a little bit about what identification is and the difference between the identification and imitation.

Now, the identification with the aggressive is a special form of identification what uh people do and it happens both to children and adult children, adolescent and adults. Uh, very common in children in more primitive forms, as you will see in a moment, and um, very common in adults as well, sometimes in very dramatic situations. For example, what this means is that whoever is perceived as an aggressor or a danger to you, somebody who hurt you or has the potential to hurt or damage you, you identify with him and you become like him. He's partly in the principle that you can beat them, join them. Okay?

Now, children do that. For example, if they go to, I don't know, to the dentist and they have some dental work done, they may go home and then get the little sister and play dentist to them, try to pull the teeth or the cat or whoever it may be. You know, it's an identification with the aggressive, reasonably benign, you know, an attempt at mastering the kind of activity. And um, that one is not too bad. It's a way of dealing with with anxiety, which is what defenses are for, to keep the ego balanced.

Adults. For example, perhaps the most dramatic example is in concentration camps when some Jews in fact identify with the Nazis and participated in the atrocities of the Nazis. That was not a common phenomenon, but it did happen and is an extreme case of it.

Is um, some children in schools and we see this as a common phenomenon nowadays. We all have bullies in school. Somebody who is more aggressive and is abusive and is a little sadistic and probably has learned that from things that he may be experiencing at home or seeing at home, whatever it may be. And then of course, many of the children become very uh frightened and concerned about these bullies. And what some of them do is to join the bully. They become bullies. They become part of a bully crowd. Identification with the aggressor is a way of dealing with fear and anxiety and danger and things of that kind. Yeah.

Now there is a regression. Regression is a common uh defense. We have been talking in the past about fixation and regression and all that. Remember when we were talking about the phases of developing how you can move through the phases and then if the difficulties at the high levels are too much or too strong, you go, you regress back where you left your fixation points. It's a common phenomenon. It's difficult for the neurosis. It's very easy to identify if and these things apply to all ages.

If it is a child, the mother may tell you, well, you know, he he sucked his tongue until he was two and a half and then he stopped. Never did that. He was a big boy. He put his saw the kids putting his finger in his mouth. He said, "You're a baby or something." But when he was five and after all of this happened or the father left the house or he had surgery, whatever it may be, he has gone back to sucking his tongue and he's not any longer ashamed of doing it in front of. See, that's a regression to a previous stage of development where something you was a desirable activity, you know, comforting, a comfort type of activity.

Um, adults do the same. They and this is a typical mechanism of typically when the situation that leads to the explosion of symptoms. You know, the conflict becomes the balance between the forces in conflict become such that the only solution is the production of simple information. If the patient cannot keep themselves at the high level, they may go back to whatever the most important fixations are and then they will manifest in behavior, in fantasies, and ego interest the phenomena that is typical for that phase.

For example, somebody may become a collector of stamps [clears throat] or whatever, you know, um, if he has an inner fixation, that's one way of showing it. He may be very interested in this sort of thing. Or um, somebody may start to overeat or to smoke or to do a variety of different things with the mouth which just points to the fact that they have made a significant move back to the oral stage of development and now orally regress and with that goes a lot of other ego phenomena. You know, when people goes that far back, you know, their ego gets somewhat affected by the regression and some they become a little more hopeless and more clinging and more demanding and feel less capable of coping with the world and need help and get very wrapped. If nobody is there to see what the needs are and why they don't help me and why they ask me to do these things and, you know, they become regressed to that level and that level people feels kind of hopeless and a little helpless.

Very common the some adults, for example, adults that become obsessional as adults suddenly start to develop obsession, ruminations, and symptoms and so on. [clears throat and cough] We show a lot of signs of activity of the anal stage of development. Is that's the point to which they regress because remember one regresses to wherever the manifixation point has been established in the way forward. And so these people may start to develop interests that they never had before which are related to that stage of development or the aspects may change. They may have been very clean people, reasonable people. Now they are dirty. They develop interests in activities that they wouldn't have thought of before that are somewhat anal oriented and things of that kind. That obviously include sexual activities of certain types as well.

Now there are a number of forms of withdrawal, particularly three of them is the ones that one seem to pay more attention to. One of them is withdrawing to fantasy and that's a very common mechanism. Everybody uses it. Uh, it's a very common resource a human being uses without necessarily being h by using this mechanism, particularly neurotic or anything of the sort in type. It is a very useful way to restore the balance temporarily. You know, you are in pain, you develop a fantasy where you feel relief and you remember what we said about the fantasies is a world, a way of thinking in which you suspend reality testing, but you are not crazy like people that suspend reality testing. When you suspend reality testing, you usually become psychotic because you don't distinguish inside from outside. What is your own thoughts with what is really happening out? You confuse them and then that means you are not reality. You are psychotic. In the world of fantasy though, you suspend reality testing, you know that the fantasy is unreal. In other words, you don't lose the contact with reality. You just decide to suspend the criteria that usually you use in reality to deal with things and behave as if these rules didn't exist. All right.

So in your fantasy, instead of you, I don't know, being in debt because you pay more money than you should with your credit cards, now you have a big balance in the bank and you're going to pay all your accounts. All that is is a withdrawal into fantasy, common, very common use in any number of painful circumstances. And children do this a lot. They will grow into any number of fantasies. Um, and when that happens, usually their performance deteriorates because they can't pay attention. They are no longer paying attention to the teacher. They are now withdrawn into a world of fantasies. And teachers frequently will tell the parents, "He, he's not here. He's in a world of his own. You can see that he's somewhere. We don't know what he's thinking, but it's certainly not here." Common in children, as I said, common in adults, frequently in children when there are difficulties at home and conflicts between the parents and things of that kind. And then the children, of course, have all kind of fantasies about what is going to happen, who's going to leave, who's going to hurt whom, all kind of things. And so they are lost in this uh play, you know, fantasies. And in that case, obviously, they are not creating compensatory fantasies where things are made good from something bad become something good. Some of the fantasies are like trying to guess what is going to happen given the limited amount of information that they have as to the consequences of parents fighting and threatening one another or being violent verbally or physically to one another and so on.

There is withdrawing to the self and that means that people no longer is interested in the object world. So they withdraw from the friends. They withdraw from the usual activities. If they went to bars and then drink or went to [clears throat] a bar or somewhere to hear music or to restaurants to eat, and so they abandon all of that activities and always thrown into the self. They are by themselves. They don't want to see anybody or they avoid contact with other people. And that obviously is a a massive part of defense that limits the ego tremendously. And kind of builds a wall between you and the object world. Yeah.

Now, why that happens? Any number of reasons will lead to withdraw into the self. Not uncommonly, disappointment with objects will lead to that.

Withdraw into passivity is a different and the last form of withdrawal that we really concern ourselves with. And what that means is that people abandon um activity. In other words, anything that needs to be done to get where you want to go, you don't do anymore. You become passive. So if there is a a new job being offered that you have been eyeing for years in the where the place of work and so on and it does require that you go and fill an application and talk to two or three people and so you don't do any of that and consider that with run into passivity. You stop all activity that will lead you there. You become passive and of course, it's very maladaptive. I mean, you're not going to get anywhere where you perhaps have gone to.

Now [clears throat] passivity is like a character. It's across the board. Withdrawing into passivity means that somebody was not passive before but has now suddenly become passive. So before he could be active when he needed to be active and then now he has withdrawn into a passive attitude. Passivity is a pervasive general attitude where people are simply passive like the person that is withdrawing to that passive state at that stage, only that that is universal and across the board it becomes like a character trait. So that's obviously very maladaptive defense that will limit your ability to deal with the world effectively and to be successful because you know you require to exercise a certain amount of active. Go get it. Go and compete. Go and be aggressive behavior. And whoever has his defense has abandoned all of this behavior. So he doesn't do anything that requires activity.

Now, and this is number 21 for those of you that have the list. It's one called turning passive into active. And that is uh, some people feels a lot better and less anxious if they do it themselves than if it is done to them. Uh, let me give you examples. Uh, some people will rather give themselves shots than have somebody give them shots. They feel more comfortable that way. No, no, tell me how to do it. I do it myself. That's a form of um, this this type of defense, you know, of turning passive into active. In other words, something that is going to happen to you that you will have to suffer possibly or submit yourself possibly to it. You want to take an active role and do it yourself.

Now [clears throat] extreme cases of me have people who are told you have 3 months to live. That's all you have and no way out of it. You have whatever it may be, a malignant form of cancer, the survival, you know, possibility is about 3, 6 months, whatever it is. And these people don't wait for death to come. They will actively seek death and they feel a lot better that way, you know. So that's an extreme case. But the in between these two extremes, there are all kind of variations. Or these things is very commonly used and sometimes it's usable. Sometimes it's actually an adaptive defense in certain situations.

Now there are this defense which is here in the list number 22. This one is called rationalization. And what that means is that you're trying to explain to or justify to yourself or to somebody else something that really doesn't make any sense and in the light of logic and reason would not stand that test. People would think, "What are you saying? I mean, that doesn't make sense." But people will use any number of arguments to try and convince you. You know, I don't know. I always use some ridiculous examples. Uh, for example, you want, I don't know, Flat Earth Society, huh? The Flat Earth Society in London, how they believe that it's an optical illusion. Yeah. Well, let's say that you want to buy a car. Mhm. That is very expensive and a little bit out of your really budget and you watch it. But what you want to buy that car is incredibly expensive and we really have, you know, the mortgage and the chicken's co, whatever. And he said, "Well, yeah, but think about it. This car, it is true, it consumes a lot of gas because it has a very powerful engine, but look, the range says that it breaks very rarely. So we are probably going to save a lot of money from not going to." You know what I mean? You start to build a web of what I call rationalization, which means an attempt to explain something that doesn't really stand the test of logic and can be seen in the light of reason and be agreeable. So, but we sell this to ourselves and to a lot of other people. Rationalization is an extraordinarily common use defense and it's at times quite irritating, particularly if you are close to somebody who uses pre rationalization. They make your life pretty miserable because they're selling you the Brooklyn Bridge and you know it is not for sale, you know. And it's a constant event, you know, they're always trying to spend the inexplicable on the light of reason. And usually that has consequences for the family, for the children, for the work, for whatever it may be. Yeah. So that's rationalization.

Certain age groups use this defense as as a preferred mechanism. Adolescence. Adolescents rationalize anything. And sometimes it's incredibly ridiculous. You say, "What?" But they tell you with a straight face. They're trying to make it sound real good and you say, "It doesn't make any sense." But adolescents do that. They use a lot of rationalization.

Intellectualization is different. Rationalization. Usually you can see through it. You say, "It doesn't make sense. It only makes sense to you. It doesn't make sense to anybody else." Intellectualization is different. Yes. People use the intellect and the knowledge to try and explain situations and they go into the most complicated kind of exercises in their mind in terms of trying to explain why this happened or why they did this or why they didn't do that. And so misintellectualization is usually, as you will imagine, a favoring defense of highly intelligent people because they can play with arguments. Lawyers are very good at this. Yeah. And children in the best of lawyers. This kind of a skill is one of the ones that they look for because it's an argument which is a logical sound argument, may not quite fit to the facts, but J is not completely isolated from the facts. And um, obsessionals, which usually are highly intelligent, use an enormous amount of intellectualization because they like to deal with ideas and so they play with ideas. It's like a kind of mental masturbation. They don't like effects. So they avoid anything that has an emotional charge with their ideas. That's wonderful. So that's a defense. As I said, all of these defenses of preference tend to be used by certain type of psychopathology in certain cases of psychopathology and in certain types of ego are more. For example, as I told you, intellectualization requires obviously a certain level of intelligence and knowledge and verbal skills so you can, you know, play in your own mind with these things because you are not necessarily doing this for anybody else. That may be the case. You frequently are doing this to yourself. You are convincing yourself through these argumentations of something that you did probably shouldn't have done or feeling guilty about or whatever. And you're trying to coat the pill with sugar, kind of.

Now there are a number of defenses which and this group here is really a typical of obsessionals, as you will see in a moment, that relate to isolation. And there are two main types of isolation. One is isolation of content and the other one is isolation of affect. Isolation of content is like if you have a number of shoe boxes where you put information. While it is in the shoe box, this shoe box, it can communicate with the next shoe box because they are walls and yet they are related, but you isolate one from one another. And so people doesn't see the obvious relation. You know, people isolates content in that particular way. Common defense, typically used by obsessionals all the time. They are great isolators of content. And um, I have given you examples of this in the past. Um, you remember when we were talking about another offense, I gave you an example of somebody who is uh rude to the wife in the morning because the coffee didn't have enough sugar and, you know, say coffee and left in a huff and comes in the evening with a bunch of roses and she says, "Put them, you know, where I don't want your roses." He is extraordinarily surprised because he has isolated the incident in the morning from what she's doing now. She put it in the first box, shoe box, and so it's not in the second shoe box. "Why is she reacting this way?" You know, he lost the connection. It's isolation of content. So since remain isolated and as you know, obviously, if you use that defense extensively and severe obsessionals do, you are very handicapped because your work is split into bits and pieces and they don't necessarily connect with each other when you need to see the connection. And that obviously creates a lot of problems.

Isolation of affect is that you take the affect that corresponds to a content and take it away. So the person will tell you something got off. "My child got run over by a 12-wheeler last night and his brain looked like this uh piece of paper was flat like that. Cool like a lettuce." No affect to it. He isolated the affect. If you don't isolate the affect, such a content will produce an emotional outburst. Yeah. But isolators of affect manage to talk about things in a way that they look cool like and indeed they are because they have taken the affect somewhere else. Now that's a problem because usually that affect gets attached to some place where it shouldn't be. And so somewhere else there is going to be an enormous reaction which is not related to the stimulus that provokes that reaction because that affect that was taken out of here was added over there. And so the explosion takes place over there, not here. You see what I mean? Is there is that kind of interaction? Very typical of obsessionals. As I told you, obsessionals don't like dealing with subjects. They like playing with ideas.

Another defense of obsessionals is called doing and undoing. I gave you an example which contains both isolation of content and doing and undoing when I told you of the fellow in the morning blast his wife because the coffee is not uh sweet enough and then comes with the flower. What he's doing? He's trying to undo what he did in the morning. That's why it's called doing. He did something in the morning. Is trying to undoing it with some other behavior. So the buying of the flower is an attempt to undoing it. He gets lost it well because he has isolated the content. So he doesn't relate what happened in the morning with the rejection. Now that's a different type of defense mechanism [laughter] but frequently they go together. Yeah. Remember many of these defense mechanisms are will act in pairs or in trials. You know, two or three of them get together to produce a certain result. Very common doing and undoing. It happens all the time. It's very typical of obsessions. And the reason for that is that they are very severe super egos and which is always questioning. What they do is very punitive, very archaic and primitive. And so they have to be appeasing it all the time. Practically anything that they do is wrong and they get persecuted by the super ego and they are trying to appease it by doing with some other kinds of behavior. Very painful problem.

Splitting. Splitting is a very malignant defense most of the time except for, you know, rare temporary forms of splitting that may take place sometimes and be not that bad. But most of splitting is very damaging because essentially you have taken a part of yourself and put it somewhere else. In a way, it's like isolation of content, you know, part of your ego and another part of your ego is completely uh ignored. The difference is that in isolation of content, you then cannot relate what happened in the morning to what happened in the evening. Here you have to split a whole bit of your ego. It's not an incident that you split the content. It's the whole of your ego. A big chunk of it is taken out there and you don't know that it is there. Now, sometime people are split into more than two pieces. Indeed, as you know, this is a phenomenon that is closely associated with dissociative phenomena. And there are some dissociation types that may have three, four different types of personalities here. So a splitting is a very malignant defense. It does a lot of damage. In the best cases of a splitting, you have lost a significant chunk of yourself which is not now available to you. And that's never good. And in the very malignant case, of course, it can do an incredible amount of damage. are essentially psychotic, you know. And indeed, some forms of dissociation are kind of psychotic dissociation with the behavior. Both the dissociated part may be criminal and murderous, sadistic murderers and things like that. So that's splitting. No good. Try not to do that if you can help it. As I told you, you can choose these things. Do happen. Yeah. Obviously, people that sit here are not likely to be splitting. But uh, but you will see many patients that do this.

Now there are some forms of what is called reversal. There are reversal of affect and reversal of roles. Reversal of roles is very simple and is commonly done. It's very common in children and in late kids. A little less common in adults, but it does exist. And some of you patients will do that. They reverse roles. They come to you to talk about whatever their problems, their difficulties, inhibitions, their symptoms and so on. And suddenly they become your therapists. They are wondering, they're giving you interpretations about your behavior and things of that kind. That's a reversal of roles. Instead of being a patient, now he's a therapist and he's treating you as a patient. Yeah. Obviously, that is generally speaking a resistance to the treatment. And that's the purpose that it mostly fulfills. The patient is trying to avoid looking at himself. So he's looking at you. And uh, is sometimes therapist, particularly if you are not familiar with the fence or don't have a lot of experience, you can get very irritated by this because you don't know what to do with it. And these patients usually are very perceptive, which means that what he may be remarking on is true. And you know it's true. None of his business, but it's true. And so it hits you somewhere. When in fact, this is very g very good grease for the mill because you can show him usually what it is that he is hiding behind this behavior or when it is that he started to the veteran reverse role on it was when you started to talk about this that the other and then that became a little bit too much. And now you are interested in me, not any longer in yourself and what you were saying the other. Okay. And so you can, you know, control the situation. But it is, it is common. Children do this a lot. They reverse roles. So a child that is having a bad time at school because the teacher is unhappy with him and punishing him or sending him to the corner or whatever, gets home and does that to the family. Is a a little like identification with the aggressor, only that here is not the aggressive part of it that becomes a part of you. And what you identify with here is the role of the person which need to be aggressive, maybe even a role. And the child reverses the roles. He becomes a teacher who He's telling the cat, "You don't behave. Go to the corner or puts the cat in in the room or whatever it is because he made a mess." You know, maybe he pissed on his pants in the school or whatever it may be that is happened. So, reversal of roles is very, very common in children, particularly.

Reversion of affect is really a very u kind of interesting defense. Uh, it's used by all kind of people. It is usually a very maladaptive defense except in children. Reversal of affect in children is nearly normal. Uh, at least during certain stages in development. In adults, it's not so normal. And that is what could it be that somebody comes and gives you very bad news and really should make you cry, you start to laugh. You know, what is he laughing about? Nothing to laugh about. It should be very perturbed about this. It's a reversal of the feeling that will be toler for example, will be devastating, in fact, will be traumatic. And that's why the role is the affect is reversed to avoid the the the damage to the ego, the ego paralysis that will ensure if this is taken literally. You know, children do that a lot. And sometimes in most dramatic circumstances, for example, a child whose mother may have died and He heard the news, "A mother died." He may not even understand that too well, but it's obviously bad because everybody is crying. And so he may go into the street laughing. "My mother died. My mother." Everybody's watch this child crazy. He's not crazy. It's a reversal of affect. And for him, that's normal. Children have no tolerance for intense affect. They can't contain them and they're very devastating. They don't know what to do with him. They have an ego to handle them or to dispose of them or to neutralize them or to put some here. And so is devastating to them. And so what they do is they reverse it. And it sounds very uncanny. [clears throat] Because even the family said, "Doesn't he love his mother? I mean, what is he crazy? His mother died. Why is he laughing?" You know, that's very, very, very, very common. And indeed, it may be that everybody is mourning and very distressed. And so he wants to see the cartoons and laugh like crazy, even the cartoons and so on because he needs to to do that, you know. It's a reversal of affect. Otherwise, it'd be a devastating trauma for them. Yeah.

You have reversal of affect where people can't experience joy, like just negative or somebody, particularly the other way around, experience joy. You could. Yeah, there are people that's rare at all. But there are people that cannot accept any good happening. That's frightening and dangerous. And is like a for some tragedy that will follow because you don't deserve anything good. And so these people, if you praise them or they get a good grade or whatever, they quickly dismiss that. They don't enjoy. Indeed, sometimes they go to streams. I give you an example and go the painter Vincent. When he was a kid, he used to draw very well. He had a gift for them. And his mother used to draw and he was the eldest. He was not really the eldest. There was another child born before him that died at birth, which called Vincent Van Go too. So he was the second Vincent Van. But because that one died, he was the eldest son. And of course, he like many children did copy some of the activities of the parents. And sometimes they have inherited some of the skills, you know, the brain pathways, metro, something that you can do easily. He did that very easily. But if anybody praised what he did, he will destroy immediately. And people couldn't understand it. You will destroy it immediately. Now, later on [clears throat] when he was an adult and a painter, you know, he had a lot of problems. So towards the end of his life and as you know, he was never very successful during his lifetime. His success. In fact, he sold one painting in his lifetime and that was to the sister of a painter friend of [clears throat] him. And obviously did it as an act of charity. But as soon as he died, very quickly thereafter, his paintings skyrocket, worth $50 million. That's a lot of money. In any case, later on, as I said, towards the end of his life, there was an exhibition in Paris where, and this was shortly before he committed suicide, may have had something to do even with his suicide. There was an exhibition in Paris and the critics praising to the heavens. First time in his life, he became incredibly disturbed and wrote letters to all the creators saying, "You shouldn't do that. You shouldn't praise me. Praise go. He is a real painter. I'm nothing. Don't praise me." You know, he didn't destroy his paintings, but that was his attitude. He couldn't receive any kind of yeah. He's an interesting character for analyst because you can learn a lot about him. You Okay, let's see. That's reversible path. But that part, that second way of doing it is very rare. Happens, but it's rare. But there are a group of patients that fear anything good happening to them as danger because somewhere they have obviously an enormous unconscious sense of guilt. And if anything good happens, that means that a catastrophe has to follow very closely because this is people again, we are backing people that have very archaic and primitive super egos. Very they get persecuted. ed by the superhero. So it happens to a certain type of people or in certain specific set of circumstances.

All of these defenses, incidentally, are very good in that sense. If you are really familiar with the defenses, you usually can draw an inference as to what it is that is being defended and why and from what time it came and things of that kind. And that of course throws a lot of information in the patient that you, it's like suddenly opening a window and seeing a landscape that you have never seen before. You know, it's is very telling and meaningful. These other defenses are a little more difficult to some of them to define, but they are definable. And remember what I told you, each one of these defense is unique. It is a unique entity. It is distinct from all other defenses. It's a fine difference. It's a character on its own right. It's a personality different from other defense personalities. Okay.

Now there is one that is called anticipation by provocation. Common and it's drawn by everybody, perhaps very common. It's easy, easier seen in children because they may have done something bad that the parents don't know anything about it, but when the parents get home, he's raising holy hell until he gets a spike, then he's satisfied. That's called anticipation by provocation. He's feeling so guilty and super ego is really telling You need to be punished. So that he does something that will irritate the parents enough of he gets punished. That's anticipation by provocation. Very visible in children. It's obvious. You have children. You would have seen that more than once. Uh [clears throat] and it leads you to think, well, what is it that he's being in need of punishment for? You know, that's the next question. Why? Why does he need this? What did he do? Or what did you do?

In any case, adults do that too. They do the same. What they do is they provoke somebody, the boyfriend, the husband, whatever it is. There is a big problem and a big fight, maybe a falling out and and you know, bad situation. And that's not anticipation but proation. People are feeling very guilty and they procure something to appease the super ego. They have learned. I was wondering if you could do that within the self. If you could devote yourself. Yeah, you can. You can. That's still the same defense. Yes, sure. That's more complex. So this is usually done with objects in the outside the self, but yeah, that's possible. But there are other ways perhaps of describing that which are more fitting than anticipation by provocation in terms of the self. But conceivably it could be done. I never thought of it, but yeah, I think it could be done like with a masochistic, huh? Like with a masochistic type person. Yeah, do that. Yeah. Yeah.

Now there is one course of accusation. This is people that transform things into hypochondriacal preoccupations or symptoms and things of that kind of use that as a defense. It's common. It's kind of hysterical type of defense. I mean, the wife say, "Oh, I have such a don't even mention it tonight." In uh something like that. You know, the husband who say, "Oh, I have such a day. I mean, I couldn't possibly think of it. It's too late. Forget it. You know, maybe tomorrow or whatever." It's is it's the juice, the use of somatic complaints to avoid certain things. You know.

Now there is something called overcompensation. As you know, there is I only think of a complex of inferiority and that's common. We all have some of that somewhere. We all grow that rose in the back garden, but it it depends, as I always tell you, how many you grow and how big the bushes you grow in your back garden. Uh, but um, we all do something like that. The we don't have, we don't talk of a complex of superiority. That's not a a concept that Freud thought was a valid concept. But what he, what people that is using this definition for this type of the things is that they all compensate for their feelings of inferiority by going the self. It doesn't really mean that they feel they they are this grand, this big. The feeling of inferiority is still there. So it's always the primitive phenomena is a feeling of inferiority. What people does in order to cover it, which may be overcompensating by grandio fantasies, is just a thing to cover up the whole. But it never does, you know. And that's why they keep doing it. If you didn't have the feeling of period, you wouldn't need the overcompensation. You will stop it, you know. But it's a never-ending phenomena. So making reparations. That's sounds like undoing, but it isn't because undoing is related to an event. Something that you did that you had to do. It's a specific event, specific action, specific incident, whatever it took place. Making reparations is a general trait, more universal. Is people that constantly have to do things in order to make reparations for a sense of guilt that they don't understand. But it forces them to constantly be making reparations. It's not related to any specific incident. It's not trying to do anything specifically. It's more like a character trait, you know.

Then there is another form of uh defense, very commonly used. It's called turning aggression against the self. In other words, there are people that when they feel violent or angry or get provoked and want to lash out somebody or hurt somebody or attack somebody or whatever, you know, destroy somebody, kill them, whatever their fantasy is. What they don't do that they do is they turn aggression against the self. And these people are accident prone. You have to be very careful with them, particularly if they are children. You remember today in the seminar we were talking about children early on having fantasies of jumping out of the window because they want to do like Peter Pan. And I was telling the cave here story of a patient that I had many years ago who had a little girl who had seen Peter Pan play [snorts] and wanted to fly out the window. And she was very concerned because I live in a house that had a very extensive second floor. And so what she did is she took a a little girl to the second floor and with a couple of eggs. She liked eggs because she had little cheeks coming out of the eggs and, you know, kept them and so she liked eggs. She told them the eggs and said, "See the eggs? She liked them." So yeah, we have cheeks. She said, "No, these are eggs like the one that you get, but let me show you what happens if they fly out of the window." So she dropped them. And took the little girl down the stairs. And when she go down, I said, "Jesus, where are the eggs?" And the mother said, "Hey, that's it." But it's not doesn't love it any longer. Look like an egg. It's not recognizable anymore. It got destroyed. It got damaged. And since you fly out of the window, that's what will happen to you. You will look like an egg. And of course, you didn't want to fly out of the window ever again, you know, which I thought was very clever. What's a way of dealing with the problem in a way that she could understand. This was a four, 4 and a half years old child. And um, but we were I mentioned this because people that turn aggression against the self tend to have a lot of things, particularly children. You know, you have children and you will see this in psychotherapy that become aggressive and want to hurt you or somehow become aggressive in the session. They may start to do things that are dangerous. I wanting to collide on top of the desk and jump or, you know, pull on the bookshelf, open the window, hit the wind, go knows what. But you have to become very careful because they have a tendency to hurt themselves. And that obviously is something that you need to avoid as much as you can.

Now adults do that too. In adults, it's a very malignant defense. So it is in children because it could hurt them very badly, particularly in children because they don't remember. The younger they are, the less they are able to draw cause and effect inferences like this little girl. And that's why I thought they showing someone throwing the eggs now was such a good example because that she could understand. Otherwise, you couldn't explain that to her verbally because it capac a capacity for abstraction at that age is not there to be able to put this together as a whole concept. You know what I mean? Well, adults do that and they tend to turn aggression against the self. And usually that's very malignant. A lot of masochistic people does that. What they do is they turn aggression against the self. In other words, the, you know, what they do is they get the sadism which was directed towards the object and that's called primary sadism. Yeah. And he's turned against the self and it becomes primary masochism. And it's a common [clears throat] very common type of defense. It's obviously very maladaptive, creates a lot of problems. It and there are many forms of this. The turning of aggression against the self doesn't always means that violence is done to the self in the sense of hurting the self. There is moral masochism, which is another form of turning aggression against the self. You know, um, so, you know, some people that feel that they need to be punished, think very bad about themselves and make a whip and whip themsel like in the Middle Ages to atone for the sins. Other people thought about it how bad they were and felt very ashamed and so, but left it at that point, didn't have to wave themselves or go to certain measures. And so there are all of these differences. That particular defense, as I think I told you once before, is one that you have to watch for in people that are depressed. People are very depressed. Yeah. The the of turning aggression against the self in a depressed person is not good because that increases the risk of suicide tremendously. And as you remember, I told you, if you have one such patient with one such tendency, you look as well at his self-esteem before the depressive episode. In other words, what kind of self-esteem did they have before they became depressed? And when they were healthy, did they value the self? Did they have good self-regard? They have good self-esteem. If they did, they are better protected than somebody that gets depressed and whose self-esteem has always been very poor because he has nothing to protect. And if on top of that, it turns aggression against yourself, the chances of suicide get potentiated, you know, and tremendously. So you watch that very closely, particularly in suicidal people. If I have any patient that is oppressed, whatever type of depression he has, I will always come for feelings of self-regard before the incident, how they regulate the self-esteem, how good that was because typically in many patients that was good before. It becomes a mess when they become depressed because part of the depression. But before that they had good self-esteem, then the chances of these people committing suicide diminish some. It's not that they are free of risk, but they are at least as somebody who values the self not at all from in memorial times and that on top of that has a tendency to turn a relation against the self because that's like a supposed combination.

Now just as you can use the things to enrich your thinking about certain type of patients clinically and, you know, take care of them in a certain way. Most of these offenses you can do the same with it. You just have to get familiar with them. And uh, as I said, know what they mean, what they cover, what type of conflicts they typically are used against, what type of stage of development. As I told you earlier, these defenses I [clears throat] know there all from the beginning. They appear in a sequence. You remember we talked about that a little while back. And that sequence is related to the cognitive development of children. Obviously, you cannot use intellectualization at two years of age or rationalization. You need a a good well-developed ego capacity to be able to do this. So, it takes some time for you to be able to do that. And so, so the all of these defenses appearing in sequence. Now, you know, the ones that appear early tend to be very primitive. And this ones of introjection and projection, internalization, things of that kind. And as you grow older, then the ego has better ways of dealing with things. So by the type of the things you usually can say this is a very primitive conflict and came from a long way back in development or it is not such a primitive conflict, is related to this that or the other and came from much later in development. And so you, you are constantly, it's like an archaeologist. You find your little, you know, charts and and you say, "Oh yeah, I know what this belongs to, what culture this was, and possibly what time it happened and all of that." So this is the same. Yeah.

That's the main group. Is there a particular relation between um bipolar disorder and turning aggression on the self? Not necessarily, no. All bipolar disorders turn aggression against the self. Some turn to the objects real fast and efficiently. They can be very dangerous. Um, usually when bipolar disorders get hurt, they get hurt by the lack of judgment, by the feelings of omnipotence and grandiosity and so on. It's only when they are in the depressive state that these things become an issue. You know, but the bifural pressure in the manic state feels on top of the world. He's gone, you know, nothing can happen to him. He's uh, you know, and that's why they don't come, they don't like to come down from that place because it feels so good. They do. But sometimes it takes people years to accept the fact that they better take medication in spite of how good their feeling is because it ruins their life and they have to go to the bottom, bottom of the barrel sometimes 10, 15, 20 years before they say, "Look, I have to take medication. This is no viable. Feels very good, but it's very destructive." So that's the problem. So there's so there's no close association between that disorder and that defense mechanism like there is between OCD and isolation factor. No, no, no.

Okay. Remember this, these defenses, and this is another important concept. These offenses are particularly useful in the conceptualization of disorders where the symptom information is based on the existence of psychological forces in conflict. In other words, these defenses are applicable, but we all use them. What they, what the ego does to deal with defenses. But generally speaking, this apply to neurotic type of conflicts. When you have a

schizophrenic patient or a bipolar disorder. And sometimes that's a genetic disorder. Disarray the brain in a different way, and these defenses may be visible because they still have context. They still think about something. And some of these defenses may be there, but they don't have the same meaning anymore because you have a a brain that is in this array where these things don't apply anymore. You know, it's, um, that you have to keep them apart. The major psychiatric disorder are something somewhat different where this is not as applicable. It doesn't mean to say that if you are the oppressor of bipolar schizophrenic, that the content of your delusions is not related to your developmental history and your conflicts. But your ego is not capable of using these defenses as it does in a neurotic patient. Your ego is completely out of whacko. And so you can, you can use it in the same way. Yeah. Though it helps you to understand much of the content of the illusions and the hallucinations and so on.

We, we had talked, uh, you and I about a week ago about, I think it was, um, projection and displacement and the differences between those. Projection. Yeah. No, it's totally different. You said you would describe the difference between. There were three of them. I was trying to remember what they were. Projection, displacement, and one more. Internalization, maybe. Maybe. Or was it internalization and internalization or externalization, maybe? You don't know. These are closely related. Which one are you having problems for? Me, I think it was projection or displacement. Well, displacement is very simple. It really means that the object that is the subject of your impulses, whatever they may be, and is usually aggressive ones that will get you in trouble with your parents or society, whatever. You displace someone else to someone else. So instead of kicking your brother in the head, you kick the dog. That's not too good, but it's not as bad as kicking. It will produce the same response in your parents. It still will produce a response, but may not be as dramatic. So that's displacement. Animals do that all the time. You know, they display a lot of aggression, but then they display, they go and bark and, you know, peck at the tree rather than peck at the head of another turkey or whatever it may be.

And projection, that's what is something that is in you, is not acceptable to you, and you throw it out. You externalize it. So, it's out there. It is no longer you. Some things you can only externalize to another human object. For example, [clears throat] if it is a bisexual conflict and you are not sure whether you are homosexual or you have a clear heterosexual identity and you are conflicted about it, the homosexual aspect of it, you may throw it out, but you can't throw it to the door. The door is not something that you can attribute that type of interest or behavior to. So you choose another human being and you say, "I know, but he probably is." That's long as it stays there is externalization. Externalization has a bad habit of the bull. You throw it out and it hits something over there, but then comes back to you. And the way it comes back to you, that that you put over there becomes a threat to you again. You say, "I'm not, but he thinks who I am. I'm going to kill him if he makes a pass on me." You see what I mean? It's a very malignant type of defense because you lost reality testing. You no longer know that this is you. You're not testing reality. You don't know inside from outside. You throw it out there and now you believe that that is true. So you're being, in that space of your mind, you are psychotic. Your reality testing is completely gone.

So what's the difference between that and projection? Between what and projection? Externalization and projection. Externalization stays out there, doesn't come back to you. It only becomes projection when the danger that you internalize is coming back to you as a threat. Okay? You understand the difference? Do you understand the difference? I think so. It's not projection until it comes full circle. That's correct. It's like a boomerang. It's not projection until it's come back to your hand. Yeah. Say the, the, uh, defense projected identification. That's when you project something unwanted to another person and then you identify with that. It's a way to take it back. But I understand that you, I avoid them like the plague. Projective identification. I avoid. That's why I don't mention it because there are people that describe it in many different ways. What you describe is one way of describing it. And, um, in a way, it, it does happen, but it's very difficult to describe and dissect. And there are, what people mean by projective identification is very complex. But you describe it well. It's something that is in you, you put it out there, and then you take it back, but you say, "This wasn't mine. I took it from him or from her." Oh, so it's a way of saying, "It's not mine. I, it's his fault. If it is bad, it's not me that is bad. I learned it from him." Okay. [laughter] All right. But attached to the identification of the other. Yeah. You just. But other people use it in a completely different manner, and it becomes very, very confusing.

Can you say what you just said? That's the best I ever heard described. Can you say it one more time? What you do is there is something in you that is not acceptable to you. So you put it in somebody else and then you take it back. But now you are saying, "It's not mine. I took it from there." So if this is bad, it's a fault, not mine. You understand what I mean? It's people can do that about anger or whatever. Like, "I wasn't the one." Like, maybe they were originally angry at you, but they kind of projected onto you, then they kind of, whatever it is, you see. It may be something that your superego finds unacceptable. Well, maybe then you'll say, "Maybe then you'll say, 'Oh, I understand why that person is angry. I'm angry too for them.'" So it's a way of expressing. Yeah, you could, you could say that. And indeed, these people will say that, they will say, "Yeah, I understand it." But in fact, they took it from. Right. Of course, they understand it. It was wrong. They throw it out to be back, and so they have only to us, only that they are owning it and disowning it at the same time. You see what I mean? An Indian giver. Yeah. Because then you can say to your superego, "But don't blame me. It came from their fellow, you know." It doesn't, it doesn't work too well. Tells you we have, uh, about, about nine more minutes. All right. Give me a minute or two before it's going to be finished. Yeah. I, um, um, um, there's, I've heard different opinions of splitting. And I guess the way that I generally heard it is that it's an inability to see the complexity of a person or an object, and that you, um, split, like the good side from the bad side. But in the, in the definition you were using it in a different way. No, no, this is splitting of the ego. Okay. There are many other forms of splitting. We are not referring to that of the object. No, no, it's not a splitting of the object. You can split objects into good and bad objects and so on, and then good and bad, but whatever you have to think about. Um, can I understand about a really severe splitting of the ego, like in dissociative disorders? Can you give an example of milder splitting? You know, historical splittings. Yeah. And I gave one here the other night. It's a complex one, and maybe we will end there. There is little more that I wanted to tell you about defenses, but I gave you an example many years ago. You may, some of you that came to the adoptions and abuse, already was in a patient who had a number of psychosomatic symptoms. You know, hypochondria. In fact, hysterical compressions is essentially what it was. It was a young woman married to a young man. They, glowing young couple. They were very attached to each other, and they came to me with this large number of somatic complaints, compulsion symptoms. And they used to live in a very remote part of the country, had no access to anybody. So I thought, well, in those days, one used to use hypnosis for these type of cases. Because what you try to do is substitute the symptoms. You don't, you could take the suggestion, the symptoms away, depending on the case. But if you did that, shortly thereafter, they produced all the symptoms. So you learn not to do that. What you learn to do is, I'm going to take this symptom which is very handicapping and put another one that is more tolerable, and those less damaging. So you take the bigger damage and make it a little less damaging. Then I got this woman and said, "Well, I told the husband, I'm going to work with her in hypnosis to see if I can get to this hysterical conversions and substitute this symptom for something more benign." Said, "Fine." He didn't understand what I was saying, but he said, "Fine." [clears throat] So I took her into my office, that was my private office, put in a couch, and proceeded to hypnotize her. It took a few minutes to hypnotize her. She was a wonderful hypnotic subject. In no time at all, she was in a deep trance. So I started my business, and suddenly she started to talk like a Chinese male, which was common in my country. There were a lot of Chinese people that had little stores in the corner where they sold ice cream and vegetables and things like that. And I said, "What the heck is this? I wasn't expecting that. I haven't heard anything about this woman being able to dissociate or anything like that. That's not what you came for." So there was a Chinese man. You had to deal with the Chinese man. Said, "What? Who are you? What are you doing?" And he told me who he was. She said he was, uh, he had known this woman since she was a little girl. This is all with a male voice and a Chinese accent, which I could imitate, but she really sounded like a typical Chinese, uh, male speaking Spanish. So I said, "Well, what are you doing here?" Said, "Well, you know, she wants to get pregnant." I said, "Well," he said, "Well, you know, a husband can't make her pregnant. She needs help. It's important for her to be pregnant. That's the most important thing in her life. And she, I want you to help her." Well, that sounded very fishy to me. So I said, "But what do you, you want me to help her?" I said, "Well, you know, make her pregnant." I said, "No, I can't do that." And at that point, that woman jumped on me. I was sitting, you know, she was lying on that couch. I was sitting over here. She jumped on me, knocked me out of the chair. And there I was. She was strong. You wouldn't believe it. It was a little woman, but it became very strong. How long? In Cuba, you used to wear short white coats in your office instead of the long ones that we use here. Too hot there. So you, it's not hotter than here, but people use short. She was, she covered me in little stick and, you know, rush. And my secretary was, my, you know, wondering what happened, you know, crying, worrying, you know, not crying, but she shouting, "What's wrong? What's wrong? Open the door, open the serpent." So after a while, I sat on the woman, which is the best I could do. Then I took her out of the trance and sat. She was completely indifferent to all of this. She sat there, and I was thinking to myself, as I told people here yesterday or the other day, how the heck am I going to tell this man, how did I, how would I explain this? You know. So I said, "Well, told us." I called him to say, "I said, call the husband." And I brought him in and told him, you know, and this is going to be difficult to explain, but this is what happened. While I had her in the car, she became this Chinese man. Jump on me, and I had a hell of a time dealing with it. Say, "Oh, the Chinese man. You saw the Chinese man too?" Say, "Yeah, you know the Chinese man?" He said, "Yeah, he comes frequently in the evening about midnight, wakes me up and threatens me that he will kill me." And, uh, he said, "Occasionally there is a knife that she has on her hand when she dissociates like this, to kill me." I said, "Are you frightened of the possibility that that you no want to do me anyhow?" So I was as pos, what is this? The Chinese man said, "She wants to get pregnant with someone." Oh, yeah. Yeah. She, you know, this is the problem, and she has been having problems since that time. The problem is that she wants children, and we went to a gynecologist and were very, you know, kind of examined and so on. The gynecologist told me, "She can have children. You will never have a child from her." But he knew that it was so important to her that he said, "Don't tell her that. Please tell her that I am sterile, that it is my fault." And he did. And say, "Fine." Told her, "It's your husband's fault." So I told him, "Well, I wish you had told me that before then." And he said, "Well, I didn't think it was important, you know, that something happened a long time ago." So I told him, "Well, we had to tell her, otherwise this Chinese man is all going to disappear, and things may become worse. And not so true that one day she might not try to hurt you, you know, in this dissociated state, because people that dissociate sometimes murder people." So he was convinced that she wouldn't. And I was inclined to believe that this woman loved that man and did, and that was a conflict. Otherwise, she would have run somewhere and found. It's not difficult to find somebody to make you pregnant, is it? But obviously, she couldn't do that. She was, as well, a religious woman and really loved her husband. This was a very good working-class couple, not very culturable, very attached to one another. So he said, "Well, okay, go ahead and tell her." Said, "No, no, no. We put her in a hospital, and I will tell her then, but I will take a few days because you're going to become very depressed and possibly suicidal." And, um, so we took her to Valdes Castillo. You remember Valdes Castillo? Probably didn't exist anymore in Helena. Uh, this was a famous sanatorium that had the name of a psychiatrist who founded it. And I had her there for several days. Little by little, we talked about this problem of the pregnancy. She obviously had some inkling that she had problems, you know. And so I finally took away the suicidal precautions. So she was 24 hours precautions of somebody with her and all that. And I was going to see her a couple of times a day. And I said, "Well, there are solutions to this. What is this the problem? You can adopt a child. She wanted a girl. So you can adopt a little girl." Well, that idea took on her. And after a few days, I said, "Can you help me a little bit?" I said, "Yeah, I can put you in touch with people that you can adopt children from." And that was the answer to the problem. They adopted the child and followed them for several years. The Chinese man never came back, and she was very happy. That's not a malignant dissociation. That's a hysterical dissociation in a woman that, though primitive and very badly wanting a child, is still had morals, was religious, and loved her husband, and that was enormously conflictual to her. Otherwise, she would have gone anywhere, and it's not difficult to find somebody that will, uh, make you that kind of favor, you know. So that's, but that's very different from [clears throat] some malignant dissociative phenomena. Some of them are very dangerous. Very, very dangerous indeed. They are sadistic murder.

Why did she pick a, a Chinese man role? Is there any logic to that? Apparently, there was a Chinese man in the corner of her house. Oh, okay. Yeah. But, you know, I only saw her this time. Never saw her again except occasionally, once every so many years, actually. And occasionally got a, you know, Christmas card or, "We are doing well. I forget the name of the little girl. Let's say that she was called Joyce. Joy is doing beautiful. You should see her. She's come to school. Whatever, you know." So, Mike, uh, I actually misread it. You have, um, eight more minutes. Eight more minutes. I actually make it seven. Okay. Well, let me tell you then this, because next time we want to, uh, talk a little bit about, um, affective states and responses. Though, as you would have read in this profile, that was an experimental section, and we were not doing much with it. We were trying to get the information, and as you will see, the information is significant and helpful, but still, we, we didn't have the same knowledge about this that we have about other parts of this diagnostic evaluation. What you have to do now with these defenses is, with the defenses is, you have to notice the secondary interference of defense activity with single achievements. You remember I told you all defenses have a price. They solve a problem, but all defenses, for most defenses, has have a cost, and the cost is usually in terms of energy. We have so much energy, and if we put it into the defensive activity of the ego, especially certain types of defenses, and you remember I told you repression, which is an anticis that takes a lot of your resources and attaches them to that conflict, and you lost it. So you cannot use that energy for naturalized activities like going to school and learning or doing your job or what not. All this, as you remember, sublimation, reaction formation has an initial cost, but then it pays enormous dividends to you. So these are very good defenses. So what they are asking you is, look at all of these defenses that you see in the patient, and you won't see the 34 of them. Patients come to use four, five, six of them. The more they use, the more deterred they are. If the defenses are effective and of good quality, usually patients don't use a large array of defenses. The more you see, it means that the ego is thinking and saying, "Send more reinforcement. Same from there, same from here, same from anywhere else, you know." And then you see nothing is working. But then you see a lot of affective activity here. What they are trying to tell you is, take a look at all of that and try and make some judgment between the interferences that are due to quantitative factors, such as excessive expenditure of energy in conflicts, like in repression, or qualitative factors, such as use of projection that interferes with reality testing and damages your ego in that sense. It really makes you psychotic in a certain area of the personality, or withdrawal into fantasy, for example, that will interfere with your concentration. If you are a child in school, you would not learn at work. You will become inefficient. You may be fine things of that kind. You know, you are a student, you may not be able to study and pass your exams and things of that kind. Now, that's the damage that it does. Okay. You look at the gains that the defense, that defense use have produced. So you're making some judgment of what gains were made by using the type of defensive structure that the patient has, and that might be significant. Other times, you say the gain is nil. It's all lost. You know, it's like a bad balance budget. So you then look at the balance between the secondary interference, the illness as a whole, and these gains, and and you examine them together. And such considerations are frequently a significant factor in estimating the advisability and possible response to treatment, and what kind of treatment you are going to use. Obviously, if you have people with very primitive and large number of defenses, you have a very disturbed person, maybe a borderline narcissistic character disorder, or something akin to a psychotic kind of disorganization, and you're not going to recommend that they go into analysis. That'd be crazy. So it gives you some idea as to what you need to do and, uh, how you should handle, uh, that situation. Um, sometimes with some type of patient, the decision that you make is, "Don't touch it." That's the best they can do. And we sometimes therapists have the idea that we can do better than the patient did. And that's frequently not true. A good dose of modesty is something that we all have to learn, and we are not willing to learn, and we are going to be taught the hard way because you're going to put your foot in your mouth once in a while. And what that means is you have to have a great deal of respect for what the patient could do by himself. You always have to say, "That's the best this patient could do at that time in his circumstances, given his resources, his genetic giving, his environment, and his developmental disease." Can you do better? Can you change that? Has he got resources that are there but got damaged or are being blocked, you know, by the defense use of the conflicts that he is suffering from? And can you really leave these forces and have them move forward? Can you change some of the maladaptive solutions that the patient found, which sometimes you can, because he was little, had little resources, may not have too much of the development, may have been too frightening, may have been too brutal a father or a mother or whatever, and now situations are different. He had, on the other hand, grown a lot of genes. And so you are trying to see, "Can I really helping to produce a better, more adaptive solution with the resources that I see he has, you know, than the one he has produced?" And sometimes you can do that, and sometimes you cannot. And there are patients that you'd be wise to leave well alone. What you do is you are supportive. You see them, you pat them on the shoulder. You need to, you give them advice. You do whatever you can, but you don't mess up with the arrangement that they have, because you, you may not only make it better, you may make it worse, you know. So you have to be very careful. Yeah. We can see. So you have to, to check these things very carefully, and this helps you. This helps you. The, the defense structure of the patient will tell you a lot about the ego strength and resources of his patient, and what is hidden behind all.