Friday, February 17, 2006

When is a Psychological Defense A SYMPTOM; And When Is It A Healthy ADAPTATION ?

Let me start out by apologizing for the length of this post!

I have written quite a lot about psychological defense mechanisms on this blog, primarily because I think that a solid understanding of these critical psychological processes shed quite a bit of light on human behavior. For a review of some of the major defenses you can go here.

There are three key books that I refer to repeatedly that have shaped my own understanding of defense mechanisms; Anna Freud’s The Ego and the Mechanisms of Defense; and George Vaillant’s two books, Adaptation to Life and The Wisdom of the Ego. I can highly recommend all three books for anyone interested in these topics.

Before I tackle the question posed in the title of this post, I would like to provide some background and context on some of the research into psychological defense mechansisms.

Many people mistakenly confuse "pop" psychology--the kind of advice you read in supermarket tabloids and magazines-- with real clinical psychiatry; and the ideas of Freud, Kohut and other theorists, with those of best-selling self-help gurus, who mostly oversimplify to the point of misrepresenting those psychological concepts and ideas. Between those people who worship the gurus and those who think anything from the psychological realm is a a load of BS, there is not a lot of understanding or appreciation of the importance of some of the basic concepts of psychology and their relationship to what we now understand of neurophysiology.

Freud wrote at one point in his life about his theories that,
...The deficiencies in our description would presumably vanish if we were already in a position to replace the psychological terms by physiolgoical and chemical ones.

Since Freud wrote that insightful comment, considerable neurophysiological evidence vindicating many of his theoretical concepts has emerged. Interdisciplinary groups studying neurology, physiology and psychoanalysis are discovering how useful Freudian ideas are for understanding the way the brain works and to interpret the physiology, while offering a template upon which further understanding can be built.

I can highly recommend an article in the May, 2004 Scientific American titled "Freud Returns" for an overview of this issue (article is available online only by subscription or purchase). In the article, Eric Kandler, the 2000 Nobel laureate in physiology states that psychoanalysis is "still the most coherent and intellectually satisfying view of the mind."

George Vaillant is a brilliant researcher who has spent most of his professional career studying psychological defense mechanism and collecting data over their use during the lifetime of many individuals. I can summarize some of Vaillant's conclusions based on his extensive research thusly:
• Psychological defenses are real and used regularly by everyone
• These defenses can be reliably identified and analyzed
• The “maturity” of a person’s defenses is positively related to mental health
• This positive association between mature psychological defenses and mental health appears to be independent of gender, social class, culture, or educational level
• Maturity of defenses also predicts a person’s satisfaction with life
• Maturity of defenses predicts physical health up to about age 65. After that age, other factors (most likely genetic and biological) take over.
• People with significant cognitive impairment (e.g., with IQ's less than 80; or someone who is brain-damaged) have demonstrably less mature defensive styles.

Defenses are typically considered in a hierarchy extending from immature to mature. The least mature—or psychotic defenses include: denial, distortion, and delusional projection (paranoia); the immature defenses are: fantasy, projection, hypochondriasis, passive-aggression and acting out. Neurotic defenses are: intellectualization, repression, reaction formation, displacement, and dissociation. The mature defenses include: sublimation, suppression, anticipation, altruism, and humor. Other defenses exist, but these are the ones most commonly discussed.

The purpose of all psychological defenses, whether mature or not-- is to assist the individual in coping with sudden changes; or severe internal or external conflict that threatens to overwhelm the sense of self. Such changes or conflicts may relate to the people in our lives; to factors or behavior which overwhelm our values or our emotional capabilities; or to changes in reality that shake the foundations of our view of the world.

All such defenses-- to a greater or lesser extent-- distort reality. The less mature distort reality greatly; while the most mature allow for the expression of the inner conflict in socially appropriate and psychologically healthy ways that at least conform to reality, even if they don't necessarily acknowledge it.

The key to understanding psychological defenses is to realize all of them--no matter how infantile or immature--are attempts to adapt to a difficult situation. What matters is not that an immature defense is being used, but how long the individual uses it before it becomes maladaptive, dysfunctional, pathological and/or potentially dangerous and life-threatening to the individual and/or group using it.

To put it plainly: it is not at all healthy for either an individual or a culture to distort reality for very long. In the short-term the use of an immature or even a psychotic defense can give a person time to adapt to painful reality without their sense of self falling apart. It gives them time to change themselves and adapt; or alternatively at the other extreme, it can preserve the psychological self at the expense of the physical self. Generally, death is a rather high price to pay simply because accommodating the real world is too difficult or abhorrent.

Thus we come to our fundamental question. How does one assess if someone is using a maladaptive defense that is a symptom of an underlying pathology? Even more importantly, how can you tell when YOU YOURSELF are using a maladaptive defense to disguise your own biases and unacceptable feeliings?

Vaillant makes the following pertinent observation:
“…whether a defense is normal or abnormal depends on the eyes of the beholder. We always regard our own vigilance toward our enemies as adaptive, but we view their mistrust of us as an unwarranted projection of their own shortcomings”

This is why accusations go back and forth in political debates that can best be summarized by the following exchange:

"You are projecting!"
"No, you are!"
"Who's projecting now?"

And so on. This gets rather tiresome very quickly as you might imagine. Each person in the argument believes they are free from the “contamination” of using a psychological defense (in the case above “projection”) while the other person exemplifies its use.

Feelings can be useful pieces of data with which to understand reality, but they are certainly not the best tool for that purpose; and a reliance on them to the exclusion of using reason and critical thought is a strategy that cannot succeed for long-term survival. Nevertheless, with that said, sometimes feelings are all one has to go on.

While each person's perception rests on their own subjective experience, one of the unique aspects of psychiatry is learning how to use one's own feelings and subjective reactions to glean information from reality. In a previous post on "Feelings, Countertransference and Reality", I wrote:
To make an assessment of the gut feeling's appropriateness, the contents of the unconscious must be explored and brought to the conscious level and considered. Those unconscious internal conflicts can easily mask the inappropriate aspects of the feelings, making them worthless as a means of understanding the external world.

Taking this kind of action as a method of checking and understanding one's own feelings is a process called "insight" or "self-awareness". Some people do this quite naturally and honestly. Some learn in therapy or when they are in crisis. But if insight is absent then one's feelings have the potential to do great harm --both to one's self and to others.

Some unconscious factors, or psychological defenses, that can make one's feelings untrustworthy are: 1) the person you are responding to has become symbolic of someone else in your life (displacement, fantasy, or perhaps distortion); 2) focusing on one particular aspect of a person, you ignore other, more objective data that are available to you about the person (denial); 3) you place your own unacceptable feelings onto the other person--e.g., I'm not an angry person, -- he's an angry person! (projection or full-blown paranoia).

The truth is that there are countless ways that unconscious processes within ourselves can distort our responses to others and to reality itself.

Growing up and attaining maturity requires that we take a moment to consider such factors playing a role in our emotions before we act on those emotions. If we come to know ourselves and understand our own weaknesses, vulnerabilities, limitations and secrets; then our emotional responses to people or to the world can be very valuable tools to help interpret the world. But they are only tools, and if not used wisely, they can do more harm than good. Feelings cannot be used in a court of law--for good reason. And they are not ultimate truth in the court of reality, either.

As I have gained experience in psychiatry, more often than not, when I trust such feelings and proceed to analyze what is bothering me about the situation, I discover a wealth of information that would have otherwise remained hidden. Sometimes that "wealth of information" is only about myself; but even in that case, I learn something new --frequently something insightful that I didn't want to know--about myself.

Even with all the training; and even with self-awareness and a keen insight into one's own motivations and interpersonal dynamics, when it comes to implicitly trusting one's feelings above and beyond all other data; one has to be very cautious. All too often, mistakes are made; feelings can simply be wishes that have nothing whatsoever to do with the reality. If we are lucky, we discover this before too much damage is done.

The key to gaining control over behavior that is motivated by unconscious defenses is to make them conscious. This requires that a person be able to reflect on his or her behavior or feelings and on the contents of one's mind; and with honesty and forthrightness develop some insight into why one feels, thinks, or acts a certain way. This is particularly important if the way one is thinking, feeling or acting is causing serious problems to one's self or to others.

Let us return to the acrimonious political debate mentioned earlier. How can you decide if someone is "projecting" versus accurately responding to and interpreting objective reality? In other words, how do you tell if the use of a defense is a symptom of some underlying psychological problem versus whether it is adaptive and healthy?

In order to be adaptive, a defense:

• should regulate, rather than remove affect – that is, instead of totally anesthetizing a person, the defense would just reduce the pain (and therefore make it easier to cope; rather than to avoid coping altogether)

• should channel feelings instead of blocking them (i.e., allow a healthy expression of those feelings in a way that can discharge them in socially acceptable ways rather than keep them hidden and motivating behavior)

• should be oriented to the long-term; and not simply the short-term

• should be oriented toward present and future pain relief; and not focused past distress

• should be as specific as possible (i.e., be as a key is to a lock; not as a sledgehammer applied to a door)

• the use of the defense should attract people and not repel them (Vaillant points out that the use of the mature defenses --i.e., humor, altruism, sublimation etc.-- is perceived by others as attractive and even virtuous; while the immature defenses are perceived as irritating, repellant, and even evil).

For the purposes of answering the title question (which may have become lost in this rather long and windy discussion): when is a psychological defense a SYMPTOM and when is it a healthy ADAPTATION; I would like to consider two words used frequently these days; comparing and contrasting their use in political discourse.

The two words are "antisemitism" and "islamophobia".

A discussion of the difference between the two concepts--which are considered similar processes by many is instructive. First, I will turn to ShrinkWrapped , who has an excellent and rather elegant discussion of anti-semitism, which can be thought of as a particularly virulent psychological projection that makes itself known in the world of politics.
Most of us in the West have long recognized the danger of anti-Semitism. Victor Davis Hanson recently pointed out that it is symptomatic of totalitarian societies which need to deflect the blame for their failures onto others:
Anti-Semitism, of course, is the mother's milk of fascism. It is always, they say, a small group of Jews — whether shadowy cabinet advisers and international bankers of the 1930s or the manipulative neoconservatives and Israeli leadership of the present — who alone stir up the trouble.
The beauty of anti-Semitism is that the Jews have a long tradition of being small in number yet relatively visible in the societies in which they lived. Thus, they serve as the perfect objects on which to project ambivalently held traits. For example, the leading anti-Semites of the world are now found in the Arab world. Their projection of all evil traits onto the Jews is a thing of beauty in its incoherent hatred.

SW correctly notes that a significant amount of the anti-semitism in the world derives from Middle Eastern and Islamic countries (although is certainly not confined to it). The rampant viciousness toward Jews in this culture appears to be boundless and, in many cases, unwaveringly repellent.

Tales of Jews eating muslim babies; pictures of them dripping with the blood of innocents are standard fare within Islamic culture. It is also clear that most muslims are completely oblivious to their own inappropriate and bizarre hatred. Presidents of Islamic countries openly announce that Jews are to be wiped off the map; and that perhaps the greatest genocide in the history of humanity is a made-up fantasy to generate sympathy for Jews. You know I am not making these items up. You also know (I hope) that Jews do not eat Palestinian babies in blood rituals or harvest the organs of muslims for secret research (although this kind of horror was actually done by the Nazis to Jewish victims of the holocaust).

In response to a few innocuous cartoons published in a Danish newspaper, we have international riots and violence. Leaders of Islam announce fatwas and put bounties on the lives of hapless cartoonists. Iran announces an ingenious "contest" to encourage the publication of "holocaust" cartoons, which they imagine equals the outrage they feel has been perpetrated on them and which they consider an expression of their "free speech" (which in some ways it certainly is, but I am more interested in the psychopathology that underlies such "speech").

Here is one response to their contest that demonstrates how to effectively cope with unrestrained hatred being projected your way. Humor is alway an effective strategy for coping with insanity. So, for that matter are the other mature defenses.

Now, I ask you to compare and contrast using the criteria I outlined above. Consider the affect/emotion and how it is presented--positively or negatively; whether unpleasant truths or shameful feelings are being confronted or avoided; whether a "key" or "sledgehammer" is being used; whether the amount of affect is appropriate to the present circumstances and so on.

Look again at the Mohammed cartoons that started all the fuss. Then look at these cartoons that are typical of what has been regularly published in the Arab world about Jews. Which are truly offensive or at least more offensive by all objective criteria.

Consider the violent and over the top reaction of muslims to the Mohammed cartoons. Consider the reactions of Jews to the holocaust cartoons (were we witness to the eruption of the "Jewish street" as it acted out in anger and rage at the shame and humiliation of being told that the holocaust never occurred?).

Consider the point that Ahmadinejad was trying to make by initiating his "contest" for the drawing of holocaust cartoons; and consider the response I linked to above from Jewish students worldwide.

Is the ubiquitous, almost casual, anti-semitism of the Islamic world a healthy, adaptive response to some injustices perpetrated by Jews that muslims have to deal with in the real world; or is it a projection that is symptomatic of some serious psychopathology within the muslim world?

Now, let us consider the charge of "islamophobia" that is angrily thrown out by CAIR or muslims whenever anyone dares to question the behavior of the adherents of Islam.

These adherents violently protest with signs that say "death to those who insult Islam" and other assorted threats like "Behead those who insult Islam"; "Europe you will pay, 3/11 is on the way"; and "Be prepared for the real holocaust". Sadly, the signs cannot merely be considered exaggerated rhetoric; nor can the burning of embassies and the mindless violence be considered the expression of restless youth. Remember Salman Rushdie; Theo van Gogh; and others who have the threat of death or who have died because they dared to "insult" this religion. Consider 9/11, 3/11; and the London, Bali and Beslan travesties. Consider the plight of women who would like to live life outside a Burqa; or consider the kidnappings, abuse, torture, humiliation and decapitations carried out by the practitioners of the religion of peace on a regular basis. Consider--in case you have forgotten--the words of Bin Laden when he declared war on the U.S. Consider the discussion in Islamic circles about how many women and children it is permissible to kill with nuclear weapons.

Now, after you have thought all about these events and behaviors; do really you think it is unreasonable to have some "fear" about people who engage in such cognitive dissonance and irrational behavior and who are members of this religion? Would this be adaptive? Realistic? Based on the actual behavior one witnesses almost every day by real people in the Islamic world?

Certainly there are many decent and honorable muslims in the world; but they are trapped in a religious connundrum that is currently unsolvable; and hence have little or no impact on the direction their religion has been takinig.

The word "islamophobia" is bandied around as if it were somehow a complementary concept for muslims, similar to what "anti-semitism" is for Jews. This is objectively not the case.

There has been no wholesale exploitation or abuse of muslims anywhere in the world--except by other muslims (Saddam and the Taliban come to mind; as well as all the other oppressive regimes in the Middle East). There has been no genocide of muslims--except by other muslims (consider Darfur; consider what Al Qaeda is doing to Iraqi civilians). There have been no systematic outrages perpetrated on the people of Islam--except by other people of Islam.

And if you are someone who believes Israel has oppressed the poor Palestinians; consider just for a moment the fact that the poor Palestinians would much rather kill Jews than work to better their own lot in life--even after they have been finally given their own territory.

Let me be clear that I am not saying that real islamophobic behavior cannot be the result of projection or paranoia on the part of some individuals or groups. For it is the case that ANY CONVENIENT GROUP MAY BE USED TO PROJECT ONE'S OWN UNACCEPTABLE FEELINGS ONTO. Historically, the Jews have been the recipients of such pathology fairly frequently; but they are hardly the only group that has had to deal with it. The leaders of Islam, however, seem to be suffering from a case of "victim envy"; for all intents and purposes desirous of acquiring the label of victim even as they go around victimizing the rest of the world with their suicidal rage; and even as they plan the final solution for the demonized Jewish population.

Objectively, there is just no case at all to support the idea that other groups are systematically "projecting" their own unacceptable feelings or acting out toward the muslim population at large; nor are the scant number of individual cases of prejudice very compelling either; despite the unbelievable rhetorical flourishes of Al Gore and other apologists. On the contrary, there is much evidence to suggest that the world is trying its best (perhaps trying too hard) to be decent and give as much leeway to muslim anger as is possible; and is even bending over backwards to make sure muslims understand that they are being treated equally with all other religions and groups.

When "islamophobia" is used as a bludgeon to accuse and attack anyone who makes the mildest criticism of Islam; no matter how well-meaning; the attack becomes yet another psychological projection by muslims that deflects their own sense of shame, humiliation and inferiority and helps them to believe that such feelings would go away if only they got some respect. Unfortunately for them, their historical shame and humiliation; as well as their medieval cultural and religious backwardness must be confronted and their behavior must change before they can be an effective part of the modern world. If it were not for the fact that oil happens to be found in that part of the world, I seriously doubt that Islam or Arab culture would have any impact on the world today; and the rest of the world could comfortably watch as their culture continued on its rush toward primitivism.

In the end, both antisemitism and the accusations of islamophobia are parallel symptoms of a single disease that is running rampant in Islamic countries and among those raised in a religion that thrives on hatred and violence, but somehow manages to believe in its heart that it is loving and peaceful and following the will of God.

In the end, there is only one effective treatment for these psychological symptoms: take one heaping dose of reality and two teaspoons of painful consequences; and call the rest of the world in the morning.

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