Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients.

Christoph Kowalski,Evamarie Brock-Midding,Johannes C. Ehrenthal,Nicole Ernstmann,Sarah Halbach,Rachel Würstlein,Rainer Weber

doi:10.3389/fpsyt.2021.718076

Abstract

Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients.Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report.Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping.Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.

Highlights

The observation that the mind has the ability to protect itself from confrontation with unpleasant thoughts and memories was first described by Freud in the context of his hysteria studies [1]
There were a total of 124 male breast cancer patients who wished to participate in the study
To the best of our knowledge, this is the first study that has looked at the relationship between defense mechanisms and the concept of repressive coping and other psychological variables in men with breast cancer

Summary

Introduction

The observation that the mind has the ability to protect itself from confrontation with unpleasant thoughts and memories was first described by Freud in the context of his hysteria studies [1]. The concept of defensive functioning provides a framework for describing and understanding regulatory mental processes in mental disorders as well as life stressors or serious chronic stressors such as a cancer diagnosis. These expansions of the defense concept incorporate several important questions. Anna Freud’s approach was influential in advancing the discussion of the benefits or harms of defenses. These questions have been controversially discussed in the context of an assumed dichotomy of “adaptive vs non-adaptive” defenses [5]

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