Manic Defence Research Articles

How to study psychological mechanisms of mania? Asystematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder.

Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement. A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology. A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and-attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used. There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.

The inability to mourn and nationalism in Japan after 1945

ABSTRACT Failure to deal with the issue of collective and social loss increases the risk of extreme nationalism. When taken too far, a repetition of manic defence can arise that manifests itself in the form of war. In this paper, the notion of the “inability to mourn” by the German Psychoanalysts A. and M. Mitshcerlich (1967) is discussed in relation to the problem of Japan’s post World War II nationalism, and its silence on social matters. The process of confronting past atrocities committed by the state is then discussed from the perspective of structural theory.

The Narcissistic dynamics of submission: the attraction of the powerless to authoritarian leaders.

Ferenczi’s conception of identification with the aggressor, which describes children’s typical response to traumatic assaults by family members, provides a remarkably good framework to understand mass social and economic trauma. In the moment of trauma, children instinctively submit and comply with what abusers want—not just in behavior but in their perceptions, thoughts, and emotions—in order to survive the assault; afterwards they often continue to comply, out of fear that the family will turn its back on them. Notably, a persistent tendency to identify with the aggressor is also typical in children who have been emotionally abandoned by narcissistically self-preoccupied parents, even when there has not been gross trauma. Similarly, large groups of people who are economically or culturally dispossessed by changes in their society typically respond by submitting and complying with the expectations of a powerful figure or group, hoping they can continue to belong—just like children who are emotionally abandoned by their families. Not surprisingly, emotional abandonment, both in individual lives and on a mass scale, is typically felt as humiliating; and it undermines the sense that life is meaningful and valuable.But the intolerable loss of belonging and of the feeling of being a valuable person often trigger exciting, aggressive, compensatory fantasies of specialness and entitlement. On the large scale, these fantasies are generally authoritarian in nature, with three main dynamics—sadomasochism, paranoid–schizoid organization, and the manic defense—plus a fourth element: the feeling of emotional truth that follows narcissistic injury, that infuses the other dynamics with a sense of emotional power and righteousness. Ironically, the angry attempt to reassert one’s entitlements ends up facilitating compliance with one’s oppressors and undermining the thoughtful, effective pursuit of realistic goals.

Understanding the impact of the COVID-19 pandemic on psychiatric trainees and what can help.

The COVID-19 pandemic has increased rates of psychological distress and burnout in healthcare staff. How can we understand our experiences of the pandemic? We reflect on the experiences of psychiatry trainees in two north London mental health trusts. From a psychoanalytic understanding, states of extreme anxiety can lead to a manic defence and functioning in the paranoid-schizoid position. This position is derived from object relations theory and is characterised by binary thinking, splitting, projection, defensiveness and 'knee-jerk' decision-making. This can affect our perceptions, responses to others, relationships and ability to function and, therefore, our clinical practice and well-being. We consider the importance of recognising these processes and of organisational containment and having space to reflect. This supports functioning in the depressive position, a state of mind where we can tolerate anxiety, address difficult realities and develop new ideas. We hope these understandings are helpful to our colleagues in all professions.

Clinical Commentary 43

British Journal of PsychotherapyVolume 37, Issue 4 p. 550-564 Clinical Commentary Clinical Commentary 43 Katya Orrell, Corresponding Author Katya Orrell katya.orrell@gmail.com Address for correspondence: [katya.orrell@gmail.com]Search for more papers by this author Katya Orrell, Corresponding Author Katya Orrell katya.orrell@gmail.com Address for correspondence: [katya.orrell@gmail.com]Search for more papers by this author First published: 26 October 2021 https://doi.org/10.1111/bjp.12673 An index offence is the patient's criminal act for which a sentence was passed by law, or in a psychoanalytic sense, it could be the external enactment of an earlier trauma, the equivalence of a neurotic symptom, a manic defence or a means of concealing a deeper perversion. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume37, Issue4November 2021Pages 550-564 RelatedInformation

Suicide, Melancholia, and Manic Defense in Byron’s Manfred

Richard Lansdown, “Suicide, Melancholia, and Manic Defense in Byron's Manfred” (pp. 1–32) This essay presents a literary-critical account of Lord Byron’s verse drama Manfred (1817) from the perspective of Freudian and Object Relations psychological theories, in particular as regards the distinction between melancholia and mourning and the presence of part-objects within the psyche. It argues that whereas it is important to preserve a distinction between the poet and his works, such a distinction can never be total: like Childe Harold, Manfred is clearly in part a personal projection, given Byron’s state of mind at the time of composition. To provide context for these discussions the essay surveys both Byron’s personal views concerning suicide and the history of self-slaughter in Western culture, with Romanticism as a particular focus. The poet’s attitudes were many and various, depending on which cases he had in mind. Furthermore, the Romantic tradition initiated by Johann Wolfgang von Goethe’s The Sorrows of Young Werther (1774) and continued by Byron’s numerous treatments of suicide mark a complication of the attitudes we find voiced by Enlightenment philosophers and, indeed, by Sigmund Freud himself.

Revisiting the “manic defence hypothesis”: assessing explicit and implicit cognitive biases in euthymic bipolar disorder

ABSTRACT Objective: The manic defence theory of bipolar disorder suggests that manic symptoms arise from an attempt to overcompensate for underlying depression. This depression avoidance may also be active in euthymia, raising concerns about the accuracy of explicit self-report measurement, and, more importantly, the presence of underlying negative cognitions. Methods: Ninety-six individuals identifying as bipolar-depressed, bipolar-euthymic, unipolar-depressed, unipolar-euthymic (based on self-reported diagnosis and mood state), and 53 non-psychiatric controls completed a series of online questionnaires assessing explicit and implicit measures of activated negative schemata. These included the Dysfunctional Attitudes Scale and the Young Schema Questionnaire, and an implicit measure, the Pragmatic Inference Task. Results: When assessed explicitly, bipolar-euthymic individuals endorsed negative schema content at a level intermediate between depressed individuals (bipolar and unipolar) and controls. However, when assessed implicitly, bipolar-euthymic individuals endorsed the highest levels of negative schema content of all groups. Conclusions: These findings indicate depression avoidance during euthymia, suggesting that implicit measurement may have a role in understanding latent negative cognitions in bipolar euthymia. The results have clinical implications as they suggest that reliance upon explicit self-report may overlook underlying and unconscious affective instability. KEY POINTS (1) People with bipolar euthymia reported low levels of explicit negative schemas, but high implicit signs of negative/depressive cognitions. (2) This implicit negative schema activation was higher than that seen in depression. (3) Bipolar euthymia may not represent wellness but suppression of negative cognitions.

Corrective Emotional Experience in Couple Therapy: An Integration between Imago Approach and Psychoanalytic Concepts in Light of Neuropsychological Studies

The article examines the potential contribution of psychoanalytic concepts—such as manic defense and corrective emotional experience—to couple therapy, especially to Imago Relationships Therapy (IRT). Several vignettes demonstrate how the IRT dialogue, characterized by a horizontal and close setting, inspires a reexperiencing of painful memories, triggering their automatic defensive behavior patterns, and offers empathic, validating responses. Integrating relevant findings from neuroscience, it demonstrates how activating mirror neurons, reducing reactivity, stimulating oxytocin and the dopamine reward system via IRT afford the three necessary steps for unlocking the emotional brain, leading to a reconsolidation of healthier, more satisfying patterns of relationships.

Pulsion de vie : lier coûte que coûte, investir sans fin, espérer toujours, aimer encore…

La pulsion de vie est une élaboration de l’excitation de vie. Comme telle, elle s’exprime à la fois par une constante activité de liaison hallucinatoire et positive, un affect d’Espoir, des capacités d’investissement significatives, et surtout un mouvement psychique amoureux qui se déploie jusqu’aux extrêmes. La défense maniaque accompagne l’Éros dans sa lutte contre le risque entropique d’effondrement du moi. La destructivité provient surtout des défenses du moi fourvoyant l’Éros en utilisant notamment l’emprise (hétérodestructrice) et l’envie (auto et hétérodestructrice). Avec nos patients, adultes et adolescents, dans l’analyse de la négativité, comment nous situer « du côté de la vie » ? Si nous y parvenons, la question du bonheur comme affect de vie peut se poser.

Mark making or making a mark? Perversion and sublimation in the work of Estela Welldon, Martin Frishman, and Aubrey Beardsley

This short article explores the relationship between sexual perversion, as defined by Estela Welldon and illustrated by the late architect and author, Martin Frishman, and the work of the nineteenth-century artist, Aubrey Beardsley. It primarily argues that in both the acting out of sexual perversion and the creation of illustrations considered perverse, there is a shared desire to transform the experience of shame into the experience of fame. In the perpetrating of a perverse sexual offence, the assault can be regarded as an uncontrollable compelling urge for immediate action. Despite knowing this action is wrong, the offender cannot resist the impulse. The action of the assault offers immediate relief from unbearable anxiety and ultimately transfigures shame, however briefly, into fame. In the creation of sexualised and scandalous drawings, it is argued that the feeling of shame is sublimated, and the desire for fame is achieved without the destructive and perverse use of violence. It contemplates how Beardsley’s provocative drawings, in particular his illustrations for Aristophanes’ play Lysistrata, may have influenced the aesthetic of Frishman’s images explaining perversion as a manic defence against depression. Lastly, it considers the way in which unconscious societal prejudice may lead to confusion between sexual perversion and sexual difference.

A Clinical Application and Dynamic of The Manic Defence for The Loss of The Major Object

본 연구의 목적은 기독(목회) 상담현장에서 나타나는 상실에 대한 주요한 방어기제 중 하나인 ‘조증방어’의 개념을 소개하고, 이에 대한 임상적 활용을 모색하는데 있다. 조증 방어는 투사적 동일시와 함께 Klein의 대표적인 방어기제중 하나로써 이는 상실에 대한 회피와 부정을 일으켜 핵심적인 정서를 탐색하는 것을 방해하고, 치료에 어려움을 준다. 그러나 조증방어는 내담자가 상실을 대처하는 하나의 방식이자 자기(self)를 보호하는 주요한 기제이기도 하다. 따라서 상담 안에서 발생하는 많은 상실의 주제에서 나타나는 역동에서 조증방어의 기제를 탐색하여 이를 치료적으로 활용하는 것은 치료에 대한 하나의 기점을 형성하는데 도움을 줄 수 있다. 본 연구는 Klein이 주창한 ‘편집 분열적 자리’와 ‘우울적 자리’라는 두 위치를 횡단하는 조증 방어의 개념과 형성 원인, 그 형태와 과정을 살펴보고, 실제 임상 안에서 이러한 조증 방어가 어떤 과정으로 나타나는지에 대한 분석의 틀을 제시한 뒤, 이에 대한 활용 및 한계를 고찰해 보았다.

Animating the Capacity for Concern: The Imago Couple Therapist Embraces Winnicott

This article examines the Imago couple therapist’s work through Winnicott’s concepts, such as holding, mirroring, and, especially, the capacity for concern. Drawing on vignettes from couples in treatment, I demonstrate methods employed by Imago therapists to encourage the expression of each spouse’s “true self” and enable the emergence of Hendrix’s “hidden,” “denied,” or “lost” self. The “manic defense” concept will elucidate the couple’s “exits” that serve to avoid intimacy, and destruction of the object. Negative and positive emotional reactions of the therapist are discussed. The opportunity for a corrective experience is also examined in light of neuropsychological research.

Psychoanalytic psychotherapy in times of social crisis: The impact on therapeutic relationship

Discussion on defining therapy factors develops along two lines: one focusing on the interpretation and another focusing on the relationship. Changes in the socio-economic circumstances, cultural particularities, dismissal of institutions, constant negation, lack of boundaries, confusion of roles, various family secrets revealed due to "collapses," major conflicts, violence and aggression filling the individual as part of both the internal and the external reality - all are known risk factors causing the individual to experience trauma either due the nature of the received stimuli/threats or due to the loss of the enabling/supportive environment. Also, this situation affects the analyst's psychic structure as well. The analyst will have to strike a balance between their own internal objects, which under the circumstances activate the analyst's own suppressed conflicts, and the multiple intense projections of the analysand. First of all, the internal struggles taking place in the analyst's psychism regarding their own griefs, frustrations, and conflicts concerning their adjustment to the current reality, as well as individual griefs relating to their narcissistic doubts and the projections of omnipotence they receive. The question is whether the analyst will go through a destabilization process, being overwhelmed by psychic stimuli in multiple levels, or react with "manic defences" resulting, perhaps, in the prevalence of anti-psychoanalytic dynamics on the transference - countertransference axis. A second line of thought involves the internal struggles taking place in the psychic structure of the analysand, and often the "meeting" of the latter with the analyst through the "parallel process." Finally, we think about the multiple - due to psychic tensions - instances of enacting (or acting out) and the setting being put to the test in terms of frequency, fees, difficulty of symbolic processing, and aggressiveness towards the interpretations and demands of the analyst as object introjected to the superego and requiring "compliance" to certain standards, the setting principles. We refer to the internal processes resulting from conflicts in the therapists' psychic structure as regards their own internal objects, life experiences, frustrations in relation to the parent/authority, adolescent conflicts with the system, political views, life philosophy, and sense of fairness. Issues are more complex in the therapy of children and adolescents. Their mental condition is affected by that of their parents. When it is hard for the therapist to become an object of identification and idealization, since all institutions around them have been undermined, confirming the adolescent's guilt-ridden fantasy aggression? How, then, will the therapeutic process move forward when models crumble; when parents are being proved weak and unable to receive the aggressiveness of the independence-gaining process; and when reverie fantasies cease to exist? Today, more and more often we see adolescents who cannot develop because they are involved in their own parents' unprocessed situations. Despite the aforementioned difficulties, the therapy space as a setting with boundaries and empathetic functions could function as a "womb" that will give birth to new mental life. And this life will bloom as long as therapists preserve intact within them their values and principles - and their ability for reverie!

Acknowledging the Other’s Suffering

Acknowledging the Other’s Suffering

Psychiatrie et psychanalyse : le divorce est-il consommé ? À propos des « troubles bipolaires »

Background Following the publication of the proceedings from the conference on bipolar disorders and psychoanalysis organized in March 2012 in Paris, the authors propose deepening the discussion regarding the diagnosis and treatment of bipolar disorders given recent advances in the scientific understanding of this disease and its etiology. It could be argued that the term “bipolar” has become a source of confusion for the medical community and the general public alike. As Jean Delay emphasized, mood is by nature bipolar and is “a fundamental affective disposition, rich with all the emotional and instinctual aspects, which gives each of our moods a pleasant or unpleasant tone, oscillating between the two extremes of pleasure and pain.” While the pathophysiology of the bipolar disorder is now much better known and understood, the “extended bipolar spectrum” as a nosological concept may be ill-defined in that certain personality disorders or neurotic problems may be mis-diagnosed within this spectrum. In many cases, this may inhibit further medical exploration as well as lead to inappropriate therapeutic management. Moreover, this is a troublesome development in that the bipolar disorder has seen a significant diagnostic inflation over the past 20 years, most noticeably in the United States but as well as in Europe. Within the context of modern science and current medical understanding, the authors reflect on the role of psychoanalysis as a potential therapeutic treatment for this disorder?

High up on bar stools: manic defences and an oblivious object in a late adolescent

The author discusses four inter-related themes of late adolescence: birth/death throes, oblivious objects, manic defences and the potential for physical symptoms, sometimes in emergency form. These issues will be elucidated through the psychoanalysis of a late adolescent who was bulimic and binge drinking. Though her symptoms were severe, elements of her dynamics are seen as characteristic of late adolescence. The definitive separation–individuation processes of late adolescence are seen as a final death throe of childhood and a birth throe of adulthood. In these death throes, the adolescent can see objects as oblivious. The late adolescent can resort to manic leaps to negotiate passages she feels unready for. Such leaps sometimes take the form of physical symptoms, sometimes in crisis form, as late adolescents separate more definitively than in earlier developmental periods.

Death and the Executive: Encounters with the 'Stealth' Motivator

Death anxiety is a primary motivational force that drives much of our behavior. It puts our defenses on high alert, and we make strenuous efforts to repress or deny the unwelcome truth of our inevitable end. The way each of us denies death not only affects life in its broadest sense but also influences the way we behave in organizations. Death anxiety underlies much executive behavior and action. However, traditional motivational theories do not acknowledge the influence of death anxiety on our behavior. Although they attempt to help us better understand employee motivation, they are not sufficiently inclusive. This article takes a clinical lens to explore death anxiety as a motivational force, how it affects behavior in organizations, and how we metabolize the feelings death evokes. In addition, I examine the various ways we deal with our knowledge of death. Some of us go into overdrive in trying to suppress it, while others fall into a state of resignation and depression. To deal with the ultimate narcissistic injury that death represents, we resort to a variety of immortality strategies to create permanent or enduring meaning. Furthermore, from an organizational perspective, three maladaptive responses to death anxiety are explored: the manic defense, succession issues, and the edifice complex.

Freud and Klein in The Lion King

This paper is presented as a potential teaching resource for those starting out in their psychoanalytic understanding, whether aiming at clinical work or the academic study of psychoanalytic ideas. Some central ideas from Freud and Klein are illustrated and illuminated in an accessible way using the Disney film The Lion King. Key elements from the film are used to bring to life concepts such as infantile omnipotence, manic defences, Oedipal conflict, persecutory guilt, destructive envy, the superego, reparation and mourning. The story of Simba is taken as demonstrating universal struggles to overcome Oedipal rivalry and destructive envy in order to reach maturity.

Manic defenses against loneliness in adolescence

Dans cet article je souligne les difficultes auxquelles les adolescents sont confrontes alors qu’ils essayent de parvenir au changement d’objet. Meme pour les individus qui vont bien, ce processus est long et conflictuel, entrainant un etat interne insoutenable, qui est declenche par le sentiment de perte d’objet.Se sentir seul a l’adolescence est la consequence non pas d’un retrait d’amour de la part de l’objet, mais plutot d’un processus incontournable a l’interieur de l’adolescent qui, de facon progressive, retire les investissements libidinaux des objets primaires pour les transferer sur de nouvelles relations adultes. Ainsi, un sentiment profond « d’etre » vide, ressenti par beaucoup d’adolescents, est associe a ce processus. Les defenses mobilisees pour combler ce vide sont de caractere maniaque, y compris l’acquisition compulsive des objets de remplacement (e.g., musique telechargee sur Internet, jeux video, nourriture, vetements, chaussures, etc.) ainsi que la consommation excessive d’alcool, de drogue et de cigarettes. Toutes ces defenses semblent temoigner d’une tentative regressive, relevant d’un registre oral et des processus primaires (souvent cyclique, rythmee par des mouvements « d’incorporation » et « d’expulsion »), pour tenter de transformer la depression et le sentiment d’etre seul en allegresse, et de trouver repit dans des activites fondees sur le principe de plaisir. J’ajouterai que, bien que les causes de ce sentiment d’etre seul soient complexes, il fait partie des nombreux elements qui sont a l’origine de la promiscuite sexuelle, des troubles d’alimentation et des symptomes de scarification et d’auto-mutilation.

Risk for Mania and its Relationship to Implicit and Explicit Achievement Motivation

There is evidence that bipolar disorders are associated with achievement-related cognitions such as setting high goals. A psychodynamic model, the manic defense hypothesis, postulates that a threat to fragile self-esteem triggers grandiosity and manic behaviors in vulnerable people. Vulnerability to bipolar disorders should therefore be positively associated with indicators of explicit hope of success (HS) and implicit fear of failure (FF). Using an online sample (n = 252), we tested these hypotheses using the well-validated Hypomanic Personality Scale as risk indicator for mania, the Multi-Motive Grid for achievement motivation, controlling for current and lifetime depression. Contrary to expectations, we found that vulnerability for mania was significantly and positively related to implicit HS but not to FF after controlling for depression. All measures were self-report tools. Our results contradict the Manic Defense Hypothesis, but they are in line with the idea that achievement-related cognitions are of relevance to vulnerability in bipolar disorders. This is in line with research focusing on the role of the Behavioral Activation System in relation to vulnerability for mania.