Manic Defence Research Articles

Holding on and letting go: developmental anxieties in couples after the birth of a child

AbstractThe authors propose a theoretical sequence for the psychological development of couples from narcissistic, autistic‐contiguous and paranoid‐schizoid levels to depressive position functioning. The authors illustrate their observations with vignettes from couple therapy with a husband and wife who are dealing with the impact of a third on their fragile relationship, initially in the form of their baby, subsequently his lover and lastly the couple therapist. They show how dealing with resistance and transference enables the couple to give up a shared manic defence, grieve together and move along the developmental levels to achieve a more satisfying reality. Copyright © 2004 Whurr Publishers Ltd.

Book Review: Three Faces of Mourning: Melancholia, Manic Defense, and Moving On. Edited by Salman Akhtar, M.D. Jason Aronson Inc., 2001. 234 pp. Retail price: not listed

Book Review: Three Faces of Mourning: Melancholia, Manic Defense, and Moving On. Edited by Salman Akhtar, M.D. Jason Aronson Inc., 2001. 234 pp. Retail price: not listed

Hypomanic traits and response styles to depression.

To test the hypothesis that the manic defence involves specific response styles to depression, namely distraction and indulging in dangerous activities. A correlational study was conducted with undergraduate participants assessed for hypomanic traits using Eckblad and Chapman's Hypomanic Personality Scale. Participants also completed the Beck Depression Inventory, and an expanded version of Nolen-Hoeksema's Response Styles Questionnaire. Depression was strongly associated with a ruminative response style. Hypomanic traits were associated with rumination, a distraction response style and with indulging in dangerous activities. However, as only 17% of the variance in hypomania scores was accounted for, other factors must play an important role in determining this trait. Hypomania (and possibly mania) may be products of ineffective styles of coping with negative emotions.

The troubled mind of Northern Ireland: Social care object relations theory and political conflict

Although a great deal has been written about the Northern Irish conflict, there have been few attempts to apply psychoanalytical theory to social work, social care and health care practice. In this paper the authors argue that object relations theory, in particular the work of Klein and post-Kleinian writers, can be used to explore the relationship between wider social conflict, individual thought processes and professional interventions. Object relations theory will be used to illustrate how conflictual states of mind find their way into everyday discourses. In particular the concepts of paranoid-schizoid functioning, destructive narcissism, manic defences and psychotic personality functioning are used to highlight the way in which madness becomes part of a way of life in a society exposed to 30 years of the troubles. The authors conclude that a wider use of object relations theory may be helpful to professionals in the context of the current peace process in Northern Ireland.

OKness as it Pertains to the Manic Defense

There is a tendency in some quarters to assume that clinicians are responsible in all cases for reassuring and assisting patients to somehow feel OK about themselves. Such an understanding of the therapist's role may preclude recognition of the fact that for some patients, this sense of unconditional OKness may lead to further acting out. This article cautions clinicians to recognize that the patient's sense of OKness may have an inverse relationship to his or her positive behavior and state of health.

The Hypomanic Personality Scale, the Big Five, and their relationship to depression and mania

The present study investigates (1) if the Hypomanic Personality Scale [Hyp; Eckblad, M., & Chapman, L.J., (1986). Development and validation of a scale for hypomanic personality. Journal of Abnormal Psychology, 95, 214–222.] correlates with other personality traits and (2) whether the Hyp scales or other measures such as Neuroticism and Extraversion are more strongly associated with affective symptoms. The participants (n=224) completed questionnaires including the Hyp scale, the NEO-FFI, and the CES-D and were independently interviewed with the CIDI to assess depression and mania. The results showed that the Hyp scale correlated only with the NEO-FFI dimensions Extraversion and Openness. In contrast to Extraversion, the Hyp scale was significantly associated with symptoms of depression and mania, and was more strongly related to manic symptoms than Neuroticism was. Decile scores of the Hyp scale were not associated with depressive symptoms, but were associated with manic symptoms. Discussion focuses on the question of whether the Hyp scale represents a possible risk factor for bipolar disorder. The possibility of a “manic defense” against depression is also discussed.

The Class That Would Not Read: Utilizing Bion’s Affect Theory in Group

While Bion’s group theory continues to inspire contemporary group psychotherapists, his theory of human emotion is not as well known. Bion also introduced a system of alphabetical and mathematic symbols to offer a shorthand for his epistemology in order to make his ideas accessible, flexible, and practical for the working clinician. This article presents aspects of Bion’s theory and metapsychological shorthand to conceptualize affectual dimensions of group process, thinking operations, and countertransference. The constructs considered include Klein’s paranoid-schizoid and depressive positions; manic defenses; basic assumptions; “proto-mental” and “pre-monitory” emotions; instinctive drives L, H, and K (plus or minus); beta elements; and alpha functioning. With these ideas, the author was able to work through aspects of a group experience in which, as leader, he unknowingly found himself at an opposite affective pole from the members.

Loving them to death: The anorexic and her objects

The author suggests that eating disorders function to reinforce phantasies of control of the internal parents, a feature of Klein's view of the manic defence. Using this hypothesis, she attempts to differentiate between anorexia and bulimia. It is argued that in anorexia objects are felt to be permanently in thrall, suspended or frozen, whereas in bulimia they are attacked in a frenzied and intermittent way. Using case material from three seriously ill patients, the author draws attention to some important differences between them. Two of the patients were treated in psychoanalysis, while the third was seen for an extended consultation and once‐weekly treatment thereafter. It is suggested that the nature and degree of the murderous attack on the internal couple may determine the severity of the illness as well as the patient's capacity to benefit from treatment. The conclusions drawn are discussed in relation to some contemporary views on eating disorders as well as writings on the difficulties of working through the Oedipus complex more generally. The author suggests that eating disorders may represent a special case of oedipal illusions.

Work with dying patients: Team dynamics and team work1

SUMMARY This paper addresses some issues in palliative-care work that emerged in a short-term staff-support group, and shows that work with terminally-ill cancer patients had an impact on the staff and team as a whole. In dealing with distressing and disturbing feelings related to work with dying patients, the staff used manic defences and denial of differences within the team.

Mental pain and the cultural ointment of poetry.

The author argues that mental pain consists of a wordless sense of self-rupture, longing and psychic helplessness that is vague and difficult to convey to others. It usually follows the loss of a significant object or its abrupt refusal to meet one's anaclitic needs. This results in the laceration of an unconscious, fused self-object core of the self. Abruptly precipitated discrepancies between the actual and wished-for self-states add to the genesis of mental pain. Issues of hatred, guilt, moral masochism as well as fantasies of being beaten can also be folded into the experience of mental pain. The feeling is highly disturbing and is warded off by psychic retreat, manic defence, induction of pain into others and changing the form and function of pain. Each of these can have a pathological or healthy outcome depending upon the intrapsychic and social context and upon whether they ultimately permit mourning to take place or not. Poetry serves to render mental pain bearable by enhancing empathy with one's own repudiated parts. With the help of two clinical vignettes, the multi-faceted (defensive, formal and content-based) role of poetry in reducing mental pain, enhancing mentalisation of its sources and facilitating mourning is discussed. It is suggested that through poetry, culture and affect meet and, in this encounter, both are enriched.

Social cognition and the manic defense: Attributions, selective attention, and self-schema in bipolar affective disorder.

Manic patients, depressed bipolar patients, and normal controls were compared on measures of social cognition. Manic patients showed a normal self-serving bias on the Attributional Style Questionnaire, but depressed patients attributed negative events more than positive events to self. On an implicit test of attributional style, both patient groups attributed negative events more than positive events to self. Both patient groups showed slowed color naming for depression-related but not euphoria-related words. Manic patients, like normal controls, endorsed mainly positive words as true of self but, like the depressed patients, recalled mainly negative words. Findings from the implicit tests indicate a common form of psychological organization in manic and depressed patients, whereas the contrasts between the scores on the implicit and explicit measures are consistent with the hypothesis of a manic defense.

Social cognition and the manic defense: attributions, selective attention, and self-schema in bipolar affective disorder.

Manic patients, depressed bipolar patients, and normal controls were compared on measures of social cognition. Manic patients showed a normal self-serving bias on the Attributional Style Questionnaire, but depressed patients attributed negative events more than positive events to self. On an implicit test of attributional style, both patient groups attributed negative events more than positive events to self. Both patient groups showed slowed color naming for depression-related but not euphoria-related words. Manic patients, like normal controls, endorsed mainly positive words as true of self but, like the depressed patients, recalled mainly negative words. Findings from the implicit tests indicate a common form of psychological organization in manic and depressed patients, whereas the contrasts between the scores on the implicit and explicit measures are consistent with the hypothesis of a manic defense.

Medicine and the Manic Defence

The aim of this paper is to explore the relevance of the concept of the manic defence to understanding the treatment behaviours of doctors, and psychiatrists in particular. The manic defence and manic reparation are defined. Treatment approaches by doctors in physical and psychiatric medicine are examined within the perspective offered by these concepts. Evidence for the operation of a manic defence can often be discerned in treatment approaches to psychological and psychosomatic disorders. Widespread reliance on the prescribing of antidepressant medication for depression provides an example. In the face of psychological and psychosomatic presentations, doctors may resort to reductionist aetiological formulations which promote active but reductionist treatments. Such approaches represent the enactment of a manic defence against depressive anxieties that might otherwise be experienced by patient and/or practitioner.

The Dark Interval: Inner Transformation Through Mourning and Memory

For D.W. Winnicott, one way the ego defends against the death of the false self is through breakdown and emptiness. Melanie Klein says that in mourning, healing occurs through psychic restoration of the idealized love-object. Manic defenses prevent us from the fullness of reparative experience in breakdown and mourning. But Winnicott underestimates what the Christian faith offers in what he calls the ascensive-depressive experience. And Klein, relegating the mother to only the psyche, neglects the bodily significance of the Transfiguration and the Resurrection. Augustine's memoria and scriptural accounts of the empty tomb serve as a basis for exploring the difference between mourning and remembering in the unfolding of the interior life. Mary Magdalene witnesses to how a perspective that does not consider spirit as integrative to its developmental schema neglects transformation in its fullest definition.

The Anatomy of the Entrepreneur: Clinical Observations

In psychoanalytic theory, studies of work behavior have been relatively scarce. Most of the existing literature concerns itself with cases of work inhibition or compulsion. Occasionally, one finds a discussion of people in the creative professions. No attention has been paid, however, to a major contributor to economic development in society, the entrepreneur. This contrasts sharply with the amount of attention given to entrepreneurs by other disciplines. The object of this study is to better understand the dynamics of entrepreneurship, and in particular the work behavior of entrepreneurs. First, there is a brief overview of the role of work in psychoanalytic theory. Then a number of factors important to entrepreneurship are reviewed from the perspective of economic, sociological, anthropological, psychological, and organizational theory. A case history is presented of one entrepreneur who chose to be treated through psychoanalysis. The intensity of this type of treatment means that continuity in observation is provided. This case study therefore offers a unique insight into the complex "inner theater" of one particular entrepreneur. Previous research on entrepreneurship has identified a number of themes common among some entrepreneurs. In the entrepreneurial theater a need for control, a sense of distrust, a desire for applause, and resorting to primitive defensive mechanisms such as splitting, projection, denial, and the flight into action ("the manic defense") appear to be common. The behavior of a number of entrepreneurs also seems to have a cyclothymic quality. Moreover, for many of them, their narcissistic development tends to be of a "reactive" nature reflecting difficulties in the regulation of self-esteem. This case history illustrates these themes, and furthermore, shows that running a business is not necessarily a rational process. On the contrary, in many instances, the process seems to be more a question of retrospective "rationalizing" of decisions already made. Finally, inferences are made about the person-organization interface by identifying some of the characteristics of the dramatic organization, a configuration typically created by a number of entrepreneurs.

Escaping to the angels: a note on the passing of the manic defence.

This essay examines how some psychologically adroit individuals use creativity as a manic defence against the affects that they cannot bear to experience directly. Conceived within the perspectives of Jungian psychoanalysis, manic creativity is shown to effect a defence against the subjective distress of personal complexes by means of an identification with the archetypal cores of the complexes. This defensive use of creativity, however, may ultimately play a decisive role in healing. Indeed, when considered from a prospective or teleological point of view, manic creativity, for all its insensitivity to the suffering that has inspired it, can also be understood as gradually creating a container in which affects formerly defended against may be received and suffered, felt and grieved. It is in this way that manic creativity, though clearly a defence (and at times a very costly one), participates in the reparative initiative of the self.

Heroic deeds, manic defence and intrusive identification: Some reflections on psychotherapy with a 16-year old boy

(1993). Heroic deeds, manic defence and intrusive identification: Some reflections on psychotherapy with a 16-year old boy. Journal of Child Psychotherapy: Vol. 19, No. 1, pp. 79-94.

Le discours mélancolique au T.A.T.

This paper deals with the economy of depression in TAT stories. As is the case in neurosis, TAT stories closely reflect defensive movements against depression. Revival of the depressive nucleus is not only manifested in idealization and emphasis on a supporting-type of relation, in disavowal, denial of affects of hatred or of suffering, in irony and volte-faces in thought. Indeed the impact of archaic melancholia on thought process is blatant in TAT stories and constitutes, through « manic » defenses, what the author designates as a depressive style of speech in TAT stories. Key-words : Depression - Thought process - Manic defenses - Projective pathology

Emotional Stroop performance and the manic defence

Undergraduate subjects were selected on the basis of high, low and medium scores on Eckblad & Chapman's Hypomanic Personality Scale and were given an emotional Stroop test. Hypomanic traits were associated with interference of colour naming for depressive but not euphoria-related words.

Melanie klein's work: An adaptation in practice

Kleinian theory seems both intimidating and alien to many American psychotherapists. This paper offers an entry into Klein's work. The theory is approached by emphasizing three areas especially valuable in clinical practice: mourning and manic defenses, schizoid relationships, and envy and idealization. A detailed presentation of an individual psychotherapy case is offered as an illustration of how her ideas may be integrated into a broader objectrelations treatment perspective.