The psychodynamic basis of compensation: a contribution to the study of ego defences.

Abstract

Thus we see in this brief and necessarily incomplete summary of a very complex problem, covering the breadth and scope of psychiatry in its magnitude, how the use of a new parameter (consisting of the cultural and sociological changes which permit the organizations described in this paper, or in industry, to take greater responsibility for the individual's welfare and care) is incorporated by the patient and used as an additional framework within which psychopathology can operate. This framework is often used by some as part and parcel of their ego defences, i.e., their defences to maintain touch with reality against underlying psychopathological conflicts. Modifications in the form, symptomatology, interpersonal relations, and “natural course” of psychiatric, medical, surgical illnesses thereby result. Amnestic data, too, becomes distorted so that the obtaining of accurate information sometimes becomes impossible since this, too, is tailored, often unconsciously, to fit this new reality framework of being able to obtain care and money. New cultural value systems come into play. Some groups consider it moral to get as much money as possible out of an impersonal state or institution which can be visualized alternately as benevolent and all giving, or denying and hostile. Many jokes exist in totalitarian communities about the state. A patient, a former citizen of a totalitarian country, reported a saying current there which seemed apropos, to wit: “Ah! This is an awfully rich country—everyone steals and there is so much left over.” Such comments illustrate the changes produced in value systems where huge, impersonal institutions, rather than individuals, are related to, as givers of care, security, and welfare measures. These cases, therefore, furnish excellent experimental data on how the new social conditions offer a framework for modification of psychiatric symptomatology. The psychodynamic basis of the functional neuroses and psychoses remain the same. Their symptomatic expression, and the incorporation of these new bits of reality into the framework of ego defences, produces the symptomatic modification of these illnesses in adaptation to the changes in the social matrix. These cases therefore offer fruitful material for the study of ego defences in relationship to social change.