Tag: Defence Mechanism

An Overview of Rationalisation (Defence Mechanism)

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Introduction

Rationalisation is a defence mechanism (ego defence) in which apparent logical reasons are given to justify behaviour that is motivated by unconscious instinctual impulses. It is an attempt to find reasons for behaviours, especially one’s own. Rationalisations are used to defend against feelings of guilt, maintain self-respect, and protect oneself from criticism.

Rationalisation happens in two steps:

  • A decision, action, judgement is made for a given reason, or no (known) reason at all.
  • A rationalisation is performed, constructing a seemingly good or logical reason, as an attempt to justify the act after the fact (for oneself or others).

Rationalisation encourages irrational or unacceptable behaviour, motives, or feelings and often involves ad hoc hypothesizing. This process ranges from fully conscious (e.g. to present an external defence against ridicule from others) to mostly unconscious (e.g. to create a block against internal feelings of guilt or shame). People rationalise for various reasons—sometimes when we think we know ourselves better than we do. Rationalisation may differentiate the original deterministic explanation of the behaviour or feeling in question.

Brief History

Quintilian and classical rhetoric used the term colour for the presenting of an action in the most favourable possible perspective. Laurence Sterne in the eighteenth century took up the point, arguing that, were a man to consider his actions, “he will soon find, that such of them, as strong inclination and custom have prompted him to commit, are generally dressed out and painted with all the false beauties [color] which, a soft and flattering hand can give them”.

DSM Definition

According to the DSM-IV, rationalisation occurs “when the individual deals with emotional conflict or internal or external stressors by concealing the true motivations for their own thoughts, actions, or feelings through the elaboration of reassuring or self serving but incorrect explanations”.

Examples

Individual

Rationalisation can be used to avoid admitting disappointment: “I didn’t get the job that I applied for, but I really didn’t want it in the first place.”
Egregious rationalisations intended to deflect blame can also take the form of ad hominem attacks or DARVO. Some rationalisations take the form of a comparison. Commonly, this is done to lessen the perception of an action’s negative effects, to justify an action, or to excuse culpability:

  • “At least [what occurred] is not as bad as [a worse outcome].”
  • In response to an accusation: “At least I didn’t [worse action than accused action].”
  • As a form of false choice: “Doing [undesirable action] is a lot better than [a worse action].”
  • In response to unfair or abusive behaviour from a separate individual or group to the person: “I must have done something wrong if they treat me like this.”

Based on anecdotal and survey evidence, John Banja states that the medical field features a disproportionate amount of rationalisation invoked in the “covering up” of mistakes. Common excuses made are:

  • “Why disclose the error? The patient was going to die anyway.”
  • “Telling the family about the error will only make them feel worse.”
  • “It was the patient’s fault. If he wasn’t so (sick, etc.), this error wouldn’t have caused so much harm.”
  • “Well, we did our best. These things happen.”
  • “If we’re not totally and absolutely certain the error caused the harm, we don’t have to tell.”
  • “They’re dead anyway, so there’s no point in blaming anyone.”

In 2018, Muel Kaptein and Martien van Helvoort developed a model, called the Amoralisations Alarm Clock, that covers all existing amoralisations in a logical way. Amoralisations, also called neutralisations, or rationalisations, are defined as justifications and excuses for deviant behaviour. Amoralisations are important explanations for the rise and persistence of deviant behaviour. There exist many different and overlapping techniques of amoralisations.

Collective

  • Collective rationalisations are regularly constructed for acts of aggression, based on exaltation of the in-group and demonisation of the opposite side: as Fritz Perls put it, “Our own soldiers take care of the poor families; the enemy rapes them”.
  • Celebrity culture can be seen as rationalising the gap between rich and poor, powerful and powerless, by offering participation to both dominant and subaltern views of reality.

Criticism

Some scientists criticise the notion that brains are wired to rationalise irrational decisions, arguing that evolution would select against spending more nutrients at mental processes that do not contribute to the improvement of decisions, such as rationalisation of decisions that would have been taken anyway. These scientists argue that rationalising causes one to learn less rather than learn more from their mistakes, and they criticise the hypothesis that rationalisation evolved as a means of social manipulation by noting that if rational arguments were deceptive, there would be no evolutionary chance for breeding individuals that responded to the arguments and therefore making them ineffective and not capable of being selected for by evolution.

Psychoanalysis

Refer to Psychoanalysis.

Ernest Jones introduced the term “rationalisation” to psychoanalysis in 1908, defining it as “the inventing of a reason for an attitude or action the motive of which is not recognized” – an explanation which (though false) could seem plausible. The term (Rationalisierung in German) was taken up almost immediately by Sigmund Freud to account for the explanations offered by patients for their own neurotic symptoms.

As psychoanalysts continued to explore the glossed of unconscious motives, Otto Fenichel distinguished different sorts of rationalisation – both the justifying of irrational instinctive actions on the grounds that they were reasonable or normatively validated and the rationalising of defensive structures, whose purpose is unknown on the grounds that they have some quite different but somehow logical meaning.

Later psychoanalysts are divided between a positive view of rationalisation as a stepping stone on the way to maturity, and a more destructive view of it as splitting feeling from thought, and so undermining the powers of reason.

Cognitive Dissonance

Leon Festinger highlighted in 1957 the discomfort caused to people by awareness of their inconsistent thought. Rationalisation can reduce such discomfort by explaining away the discrepancy in question, as when people who take up smoking after previously quitting decide that the evidence for it being harmful is less than they previously thought.

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An Overview of Antiprocess

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Introduction

Antiprocess is the pre-emptive recognition and marginalisation of undesired information by the interplay of mental defence mechanisms: the subconscious compromises information that would cause cognitive dissonance. It is often used to describe a difficulty encountered when people with sharply contrasting viewpoints are attempting (and failing) to discuss a topic.

In other words, when one is debating with another, there may be a baffling disconnect despite one’s apparent understanding of the argument. Despite the apparently sufficient understanding to formulate counter-arguments, the mind of the debater does not allow him to be swayed by that knowledge.

There are many instances on the Internet where antiprocess can be observed, but the prime location to see it is in Usenet discussion groups, where discussions tend to be highly polarised. In such debates, both sides appear to have a highly sophisticated understanding of the other position, yet neither side is swayed. As a result, the debate can continue for years without any progress being made.

Dynamics

Antiprocess occurs because:

  • The mind is capable of multitasking;
  • The mind has the innate capability to evaluate and select information at a preconscious level so that we are not overwhelmed with the processing requirements;
  • It is not feasible to maintain two contradictory beliefs at the same time;
  • It is not possible for people to be aware of every factor leading up to decisions they make;
  • People learn argumentatively effective but logically invalid defensive strategies (such as rhetorical fallacies);
  • People tend to favour strategies of thinking that have served them well in the past; and
  • The truth is just too unpalatable to the mind to accept.

The ramifications of these factors are that people can be engaged in a debate sincerely, yet the appearances suggest that they are not. This can lead to acrimony if neither party is aware of antiprocess and does not adjust his or her debating style accordingly.

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What is Parataxic Distortion?

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Introduction

Parataxic distortion is a psychiatric term first used by Harry S. Sullivan to describe the inclination to skew perceptions of others based on fantasy. The “distortion” is a faulty perception of others, based not on actual experience with the other individual, but on a projected fantasy personality attributed to the individual. For example, when one falls in love, an image of another person as the “perfect match” or “soul mate” can be created when in reality, the other person may not live up to these expectations or embody the imagined traits at all.

The fantasy personality is created in part from past experiences and from expectations as to how the person “should be”, and is formulated in response to emotional stress. This stress can originate from the formation of a new relationship, or from cognitive dissonance required to maintain an existing relationship. Parataxic distortion serves as an immature cognitive defence mechanism against this psychological stress and is similar to transference.

Parataxic distortion is difficult to avoid because of the nature of human learning and interaction. Stereotyping of individuals based on social cues and the classification of people into groups is a commonplace cognitive function of the human mind. Such pigeonholing allows for a person to gain a quick, though possibly inaccurate, assessment of an interaction. The cognitive processes employed, however, can have a distorting effect on the clear understanding of individuals. In essence, one can lose the ability to “hear the other” through one’s own projected beliefs of what the other person is saying.

Etymology

From the Greek παράταξις, “placement side by side”

Para – A Greek prefix which came to designate objects or activities auxiliary to or derivative of that denoted by the base word ( parody; paronomasia, paranoia) and hence abnormal or defective.

Taxic – indicating movement towards or away from a specified stimulus.

In this sense, Parataxic distortion, is a shift in perception away from reality.

Interpersonal Relationships and Emotions

Distorting one’s perception of others can often interfere with interpersonal relationships. In many cases, however, it may be beneficial to do so. Humans are constantly and subconsciously stereotyping. According to Paul Martin Lester, “our brains naturally classify what we see, we can’t help but notice the differences in physical attributes between one person and another”. Parataxic distortion runs parallel to stereotyping while it remains in the subconscious. As we make quick judgements, we are drawing from previous experiences stored in our memory.

Parataxic distortion can be a beneficial defence mechanism for the individual, allowing the individual to maintain relationships with others with whom he or she would otherwise be unable to interact or allowing the individual to endure difficult periods in relationships. A self-imposed blindness to certain personality traits can keep a relationship healthy, or it can also prove destructive. For instance, parataxic distortion can keep one in denial of the abusive nature of a spouse.

Attachment Theory

Parataxic distortion can begin in the early stages of development in infants. A mother’s nurturing personality and emotional warmth might be projected onto a lover later in life. This could initially generate stronger feelings for the woman than are warranted by her behaviour and character alone. This example of attachment theory correlates with Parataxic Distortion.

Attachment theory would have it that the fantasy selves projected onto others in parataxic distortion are informed by our long-term attachment patterns. Not only are these imagined traits the resultant of our earliest bonds and unresolved emotional issues from past relationships, but they are recreated in these fantasy selves for the purpose of recreating that past attachment in the present.

Negative Effects

Dealing with current situations or people that relate to a past event, or remind someone of a person from the past, can have negative effects on a human from an emotional standpoint. If the person from the past was a negative figure or the past event had a negative influence on a person, the person may create a self-sense of identity for the new individual they met. The negative emotional response happens when the individual realises that they have been creating a fake identity for the new individual.

Parataxic distortion is most effective in the realm of interpersonal communication. Parataxic distortion is typically used to avoid coping with past events. For example, if a child is mistreated by his or her father, the child may not only attach the fear and anger towards the father but will also relate this fear and anger to other men that look, talk or act like the father. The human mind keeps track of situations that we have encountered in the past to help us deal with future situations. The unconscious memory, without our knowing, helps us understand and deal with situations in the present that we have dealt with in the past. Parataxic distortion and our unconscious mind make us act the same way in current situations as we did in the past, even without realising it.

Defence Mechanism

As a defence mechanism, parataxic distortion protects one from the emotional consequences of a past event. A person may not remember a certain event, or be acting on it consciously, but will act a certain way to protect themselves from an outcome with the use of parataxic distortion. This behaviour is a pathological attempt to cope with reality by using unreality.

Parataxic distortion is a commonly used psychological defence mechanism. It is not an illness or a disease, but a part of everyday, normal human psychology that can become maladaptive in certain situations. The cognitive abilities used to generate internal models of others are useful in interaction. As we can never truly internalise the full reality of another, we must interact with a shorthand version of them. It is only when we believe that the shorthand version is their reality that this ability can become maladaptive. One may also attempt to coerce or force another to ‘fit the mould’ and act more according to expectations, more like the idealised version they dream the other as being. This is also pathological.

However, all humans engage in parataxic distortion to one extent or another, in one realm or another. It may be to manage emotions within their family, to facilitate communication between them and their spouse, or to imagine a relationship between them and their nation-state.

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What is Introjection?

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Introduction

In psychology, introjection (also known as identification or internalisation) is the unconscious adoption of the thoughts or personality traits of others. It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defence mechanism in situations that arouse anxiety. It has been associated with both normal and pathological development.

Theory

Introjection is a concept rooted in the psychoanalytic theories of unconscious motivations. Unconscious motivation refers to processes in the mind which occur automatically and bypass conscious examination and considerations.

Introjection is the learning process or in some cases a defence mechanism where a person unconsciously absorbs experiences and makes them part their psyche.

In Learning

In psychoanalysis, introjection (German: Introjektion) refers to an unconscious process wherein one takes components of another person’s identity, such as feelings, experiences and cognitive functioning, and transfers them inside themselves, making such experiences part of their new psychic structure. These components are obliterated from consciousness (splitting), perceived in someone else (projection), and then experienced and performed (i.e. introjected) by that other person. Cognate concepts are identification, incorporation and internalisation.

As a Defence Mechanism

It is considered a self-stabilising defence mechanism used when there is a lack of full psychological contact between a child and the adults providing that child’s psychological needs. In other words, it provides the illusion of maintaining relationship but at the expense of a loss of self. To use a simple example, a person who picks up traits from their friends is introjecting.

Another straightforward illustration could be a youngster who is being bullied at school. Unknowingly adopting the bully’s behaviour, the victim youngster may do so to stop being picked on in the future.

Projection has been described as an early phase of introjection.

Historic Precursors

Freud and Klein

In Freudian terms, introjection is the aspect of the ego’s system of relational mechanisms which handles checks and balances from a perspective external to what one normally considers ‘oneself’, infolding these inputs into the internal world of the self-definitions, where they can be weighed and balanced against one’s various senses of externality. For example:

  • “When a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality.”
  • “Individuals with weak ego boundaries are more prone to use introjection as a defense mechanism.”

According to D.W. Winnicott, “projection and introjection mechanisms… let the other person be the manager sometimes, and to hand over omnipotence.”

According to Freud, the ego and the superego are constructed by introjecting external behavioural patterns into the subject’s own person. Specifically, he maintained that the critical agency or the super ego could be accounted for in terms of introjection and that the superego derives from the parents or other figures of authority. The derived behavioural patterns are not necessarily reproductions as they actually are but incorporated or introjected versions of them.

Torok and Ferenczi

However, the aforementioned description of introjection has been challenged by Maria Torok as she favours using the term as it is employed by Sándor Ferenczi in his essay “The Meaning of Introjection” (1912). In this context, introjection is an extension of autoerotic interests that broadens the ego by a lifting of repression so that it includes external objects in its make-up. Torok defends this meaning in her 1968 essay “The Illness of Mourning and the Fantasy of the Exquisite Corpse”, where she argues that Sigmund Freud and Melanie Klein confuse introjection with incorporation and that Ferenczi’s definition remains crucial to analysis. She emphasized that in failed mourning “the impotence of the process of introjection (gradual, slow, laborious, mediated, effective)” means that “incorporation is the only choice: fantasmatic, unmediated, instantaneous, magical, sometimes hallucinatory…’crypt’ effects (of incorporation)”.

Fritz and Laura Perls

In Gestalt therapy, the concept of “introjection” is not identical with the psychoanalytical concept. Central to Fritz and Laura Perls’ modifications was the concept of “dental or oral aggression”, when the infant develops teeth and is able to chew. They set “introjection” against “assimilation”. In Ego, Hunger and Aggression, Fritz and Laura Perls suggested that when the infant develops teeth, he or she has the capacity to chew, to break apart food, and assimilate it, in contrast to swallowing before; and by analogy to experience, to taste, accept, reject or assimilate. Laura Perls explains: “I think Freud said that development takes place through introjection, but if it remains introjection and goes no further, then it becomes a block; it becomes identification. Introjection is to a great extent unawares.”

Thus Fritz and Laura Perls made “assimilation”, as opposed to “introjection”, a focal theme in Gestalt therapy and in their work, and the prime means by which growth occurs in therapy. In contrast to the psychoanalytic stance, in which the “patient” introjects the (presumably more healthy) interpretations of the analyst, in Gestalt therapy the client must “taste” with awareness their experience, and either accept or reject it, but not introject or “swallow whole”. Hence, the emphasis is on avoiding interpretation, and instead encouraging discovery. This is the key point in the divergence of Gestalt therapy from traditional psychoanalysis: growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst.

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What is Projective Identification?

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Introduction

Projective identification is a term introduced by Melanie Klein and then widely adopted in psychoanalytic psychotherapy. Projective identification may be used as a type of defence, a means of communicating, a primitive form of relationship, or a route to psychological change; used for ridding the self of unwanted parts or for controlling the other’s body and mind.

According to the American Psychological Association, the expression can have two meanings:

  1. In psychoanalysis, projective identification is a defence mechanism in which the individual projects qualities that are unacceptable to the self onto another person, and that person introjects the projected qualities and believes him/herself to be characterised by them appropriately and justifiably.
  2. In the object relations theory of Melanie Klein, projective identification is a defence mechanism in which a person fantasises that part of their ego is split off and projected into the object in order to harm or to protect the disavowed part. In a close relationship, as between parent and child, lovers, or therapist and patient, parts of the self may, in unconscious fantasy, be forced into the other person.

While based on Freud’s concept of psychological projection, projective identification represents a step beyond. In R.D. Laing’s words, “The one person does not use the other merely as a hook to hang projections on. He/she strives to find in the other, or to induce the other to become, the very embodiment of projection”. Feelings which cannot be consciously accessed are defensively projected into another person in order to evoke the thoughts or feelings projected.

Experience

Though a difficult concept for the conscious mind to come to terms with, since its primitive nature makes its operation or interpretation seem more like magic or art than science, projective identification is nonetheless a powerful tool of interpersonal communication.

The recipient of the projection may suffer a loss of both identity and insight as they are caught up in and manipulated by the other person’s fantasy. One therapist, for example, describes how “I felt the progressive extrusion of his internalized mother into me, not as a theoretical construct but in actual experience. The intonation of my voice altered became higher with the distinctly Ur-mutter quality.” However, should one manage to accept and understand the projection, one will obtain much insight into the projector.

Projective identification differs from the simple projection in that projective identification can become a self-fulfilling prophecy, whereby a person, believing something false about another, influences or coerces that other person to carry out that precise projection. In extreme cases, the recipient may lose any sense of their real self and become reduced to the passive carrier of outside projections as if possessed by them. This phenomenon has been noted in gaslighting.

Objects Projected

The objects (feelings, attitudes) extruded in projective identification are of various kinds – both good and bad, ideal and abjected.

Hope may be projected by a client into their therapist, when they can no longer consciously feel it themselves; equally, it may be a fear of (psychic) dying which is projected.

Aggression may be projected, leaving the projector’s personality diminished and reduced; alternatively it may be desire, leaving the projector feeling asexual.

The good/ideal parts of the personality may be projected, leading to dependence upon the object of identification; equally it may be jealousy or envy that are projected, perhaps by the therapist into the client.

Intensity

Projective identification may take place with varying degrees of intensity. In less disturbed personalities, projective identification is not only a way of getting rid of feelings but also of getting help with them. In narcissism, extremely powerful projections may take place and obliterate the distinction between self and other.

Types

Various types of projective identification have been distinguished over the years:

  • Acquisitive projective identification – where someone takes on the attributes of someone else – versus attributive projective identification, where someone induces someone else to become one’s own projection.
  • Projective counter-identification – where the therapist unwittingly assumes the feelings and roles projected outward by the patient, to the point where they identify or unwittingly act out this role within the therapeutic setting.
  • Dual projective identification – a concept introduced by Joan Lachkar. It primarily occurs when both partners in a relationship simultaneously project onto one another. Both deny the projections, both identify with those projections.

A division has also been made between normal projective identification and pathological projective identification, where what is projected is splintered into minute pieces before the projection takes place.

In Psychotherapy

As with transference and countertransference, projective identification can be a potential key to therapeutic understanding, especially where the therapist is able to tolerate and contain the unwanted, negative aspects of the patient’s self over time.

Transactional analysis emphasizes the need for the therapist’s “Adult” (an ego state directed towards an objective appraisal of reality) to remain uncontaminated if the experience of the client’s projective identification is to be usefully understood.

A prior study demonstrated how counsellors may identify and clinically use client projective identification. Additionally, the study specified that splitting and projective identification happen one after the other. Also, the three connected phenomena of transference, countertransference, and projective identification are addressed as the foundation for the therapist’s successful application of the self as a tool in treatment. This is a three-phase therapy procedure that highlights the significance of the timing of treatments.

Wounded Couple

Relationship problems have been linked to the way there can be a division of emotional labour in a couple, by way of projective identification, with one partner carrying projected aspects of the other for them. Thus one partner may carry all the aggression or all the competence in the relationship, the other all the vulnerability.

Jungians describe the resultant dynamics as characterising a so-called “wounded couple” – projective identification ensuring that each carries the most ideal or the most primitive parts of their counterpart. The two partners may initially have been singled out for that very readiness to carry parts of each other’s self; but the projected inner conflicts/division then come to be replicated in the partnership itself.

Responses

Conscious resistance to such projective identification may produce on the one side guilt for refusing to enact the projection, on the other bitter rage at the thwarting of the projection.

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What is Sublimation (in Psychology)?

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Introduction

In psychology, sublimation is a mature type of defence mechanism, in which socially unacceptable impulses or idealisations are transformed into socially acceptable actions or behaviour, possibly resulting in a long-term conversion of the initial impulse.

Sigmund Freud believed that sublimation was a sign of maturity and civilisation, allowing people to function normally in culturally acceptable ways. He defined sublimation as the process of deflecting sexual instincts into acts of higher social valuation, being “an especially conspicuous feature of cultural development; it is what makes it possible for higher psychical activities, scientific, artistic or ideological, to play such an ‘important’ part in civilized life.” Wade and Travis present a similar view, stating that sublimation occurs when displacement “serves a higher cultural or socially useful purpose, as in the creation of art or inventions.”

Nietzsche

In the opening section of Human, All Too Human entitled “Of first and last things”, Nietzsche wrote:

There is, strictly speaking, neither unselfish conduct, nor a wholly disinterested point of view. Both are simply sublimations in which the basic element seems almost evaporated and betrays its presence only to the keenest observation. All that we need and that could possibly be given us in the present state of development of the sciences, is a chemistry of the moral, religious, aesthetic conceptions and feeling, as well as of those emotions which we experience in the affairs, great and small, of society and civilization, and which we are sensible of even in solitude. But what if this chemistry established the fact that, even in its domain, the most magnificent results were attained with the basest and most despised ingredients? Would many feel disposed to continue such investigations? Mankind loves to put by the questions of its origin and beginning: must one not be almost inhuman in order to follow the opposite course?

Freud and Psychoanalytic Theory

In Freud’s psychoanalytical theory, erotic energy is allowed a limited amount of expression, owing to the constraints of human society and civilisation itself. It therefore requires other outlets, especially if an individual is to remain psychologically balanced. The ego must act as a mediator between the moral norms of the super-ego, the realistic expectations of reality, and the drives and impulses of the id. One method by which the ego lessens the stress that unacceptably strong urges or emotions can cause is through sublimation.

Sublimation (German: Sublimierung) is the process of transforming libido into “socially useful” achievements, including artistic, cultural, and intellectual pursuits. Freud considered this psychical operation to be fairly salutary compared to the others that he identified, such as repression, displacement, denial, reaction formation, intellectualisation, and projection. In The Ego and the Mechanisms of Defence (1936), his daughter, Anna, classed sublimation as one of the major ‘defence mechanisms’ of the psyche.

Freud got the idea of sublimation while reading The Harz Journey by Heinrich Heine. The story is about Johann Friedrich Dieffenbach who cut off the tails of dogs he encountered in childhood and later became a surgeon. Freud concluded that sublimation could be a conflict between the need for satisfaction and the need for security without perturbation of awareness. In an action performed many times throughout one’s life, which firstly appears sadistic, thought is ultimately refined into an activity which is of benefit to mankind.

Sexual Sublimation

Sexual sublimation was according to Freud a deflection of sexual instincts into non-sexual activity, based upon a principle akin to the conservation of energy in physics. There is a finite amount of activity, and it is converted, in a mechanistic fashion like a mechanical engine, from sexual activity to non-sexual. One such example is the case of Wolf Man, a case in which a young boy’s sexual attraction to his father was redirected towards Christianity and eventually led the boy to obsessional neurosis in the form of uncontrollable sacrilegious reverence. Freud travelled to Clark University to speak about instances of sexual sublimation, but he was not wholly convinced of his own theories. 20th century psychological thought by the likes of Melanie Klein has largely relegated the idea and replaced it with subtler ideas. One such idea is that the sexual desires are not made totally non-sexual, but rather transformed into a more appropriate desire.

Although superficially valid, with anecdotal examples from non-psychologists of civilizations at large and specific great achievers repressing sexual urges (e.g. Renoir “painting with his cock”, Wayland Young stating that “love’s loss is empire’s gain”, Lawrence Stone’s view that Western civilisation has achieved so much because of sublimation, and the claims by biographers of many people from Higgins on Rider Haggard to Sinclair on George Grey), it is ill-defined[11] and comes with the caveats that it rarely happens in practice, that many things attributed to it are actually the results of something else, and that it is most definitely not some quasi-physical transfer of some sort of “sexual energy” in the modern psychoanalytical view but rather an internal thought process.

Jung

C.G.Jung argued that Freud’s opinion:

…can only be based on the totally erroneous supposition that the unconscious is a monster. It is a view that springs from fear of nature and the realities of life. Freud invented the idea of sublimation to save us from the imaginary claws of the unconscious. But what is real, what actually exists, cannot be alchemically sublimated, and if anything is apparently sublimated it never was what a false interpretation took it to be.

In the same article, Jung went on to suggest that unconscious processes became dangerous only to the extent that people repress them. The more people come to assimilate and recognise the unconscious, the less of a danger it becomes. In this view sublimation requires not repression of drives through will, but acknowledgement of the creativity of unconscious processes and a learning of how to work with them.

This differs fundamentally from Freud’s view of the concept. For Freud, sublimation helped explain the plasticity of the sexual instincts (and their convertibility to non-sexual ends) – see libido. The concept also underpinned Freud’s psychoanalytical theories, which showed the human psyche at the mercy of conflicting impulses (such as the super-ego and the id). In his private letters, Jung criticised Freud for obscuring the alchemical origins of sublimation and for attempting instead to make the concept appear scientifically credible:

Sublimation is part of the royal art where the true gold is made. Of this Freud knows nothing; worse still, he barricades all the paths that could lead to true sublimation. This is just about the opposite of what Freud understands by sublimation. It is not a voluntary and forcible channeling of instinct into a spurious field of application, but an alchymical transformation for which fire and prima materia are needed. Sublimation is a great mystery. Freud has appropriated this concept and usurped it for the sphere of the will and the bourgeois, rationalistic ethos.

Lacan

Das Ding

The French psychoanalyst Jacques Lacan’s exposition of sublimation is framed within a discussion about the relationship of psychoanalysis and ethics within the seventh book of his seminars. Lacanian sublimation is defined with reference to the concept Das Ding (later in his career Lacan termed this objet petit a); Das Ding is German for “the thing” though Lacan conceives it as an abstract notion and one of the defining characteristics of the human condition. Broadly speaking it is the vacuum one experiences as a human being and which one endeavours to fill with differing human relationships, objects and experiences, all of which are used to plug a gap in one’s psychical needs. Unfortunately, all attempts to overcome the vacuity of Das Ding are insufficient in wholly satisfying the individual. For this reason, Lacan also considers Das Ding to be a non-Thing or vacuole.

Lacan considers Das Ding a lost object ever in the process of being recuperated by Man. Temporarily the individual will be duped by his or her own psyche into believing that this object, this person or this circumstance can be relied upon to satisfy his needs in a stable and enduring manner when in fact it is in its nature that the object as such is lost—and will never be found again. Something is there while one waits for something better, or worse, but which one wants, and again Das Ding “is to be found at most as something missed. One doesn’t find it, but only its pleasurable associations.” Human life unravels as a series of detours in the quest for the lost object or the absolute Other of the individual: “The pleasure principle governs the search for the object and imposes detours which maintain the distance to Das Ding in relation to its end.”

Lacanian Sublimation

Lacanian sublimation centres to a large part on the notion of Das Ding. His general formula for sublimation is that “it raises an object … to the dignity of The Thing.” Lacan considers these objects (whether human, aesthetic, credal, or philosophical) to be signifiers which are representative of Das Ding and that “the function of the pleasure principle is, in effect, to lead the subject from signifier to signifier, by generating as many signifiers as are required to maintain at as low a level as possible the tension that regulates the whole functioning of the psychic apparatus.” Furthermore, man is the “artisan of his support system”, in other words, he creates or finds the signifiers which delude him into believing he has overcome the emptiness of Das Ding.

Lacan also considers sublimation to be a process of creation ex nihilo (creating out of nothing), whereby an object, human or manufactured, comes to be defined in relation to the emptiness of Das Ding. Lacan’s prime example of this is the courtly love of the troubadours and Minnesänger who dedicated their poetic verse to a love-object which was not only unreachable (and therefore experienced as something missing) but whose existence and desirability also centred around a hole (the vagina). For Lacan such courtly love was “a paradigm of sublimation.” He affirms that the word ‘troubadour’ is etymologically linked to the Provençal verb trobar (like the French trouver), “to find”. If we consider again the definition of Das Ding, it is dependent precisely on the expectation of the subject to re-find the lost object in the mistaken belief that it will continue to satisfy him (or her).

Lacan maintains that creation ex nihilo operates in other noteworthy fields as well. In pottery for example vases are created around an empty space. They are primitive and even primordial artifacts which have benefited mankind not only in the capacity of utensils but also as metaphors of (cosmic) creation ex nihilo. Lacan cites Heidegger who situates the vase between the earthly (raising clay from the ground) and the ethereal (pointing upwards to receive). In architecture, Lacan asserts, buildings are designed around an empty space and in art paintings proceed from an empty canvas, and often depict empty spaces through perspective.

In myth, Pan pursues the nymph Syrinx who is transformed into hollow reeds in order to avoid the clutches of the god, who subsequently cuts the reeds down in anger and transforms them into what we today call panpipes (both reeds and panpipes rely on their hollowness for the production of sound).

Lacan briefly remarks that religion and science are also based around emptiness. In regard to religion, Lacan refers the reader to Freud, stating that much obsessional religious behaviour can be attributed to the avoidance of the primordial emptiness of Das Ding or in the respecting of it. As for the discourse of science this is based on the notion of Verwerfung (the German word for “dismissal”) which results in the dismissing, foreclosing or exclusion of the notion of Das Ding presumably because it defies empirical categorisation.

Empirical Research

A study by Kim, Zeppenfeld, and Cohen studied sublimation by empirical methods. These investigators view their research, published 2013 in the Journal of Personality and Social Psychology, as providing “possibly the first experimental evidence for sublimation and [suggesting] a cultural psychological approach to defense mechanisms.”

Religious and Spiritual Views

As espoused in the Tanya, Hasidic Jewish mysticism views sublimation of the animal soul as an essential task in life, wherein the goal is to transform animalistic and earthy cravings for physical pleasure into holy desires to connect with God.

Different schools of thought describe general sexual urges as carriers of spiritual essence, and have the varied names of vital energy, vital winds (prana), spiritual energy, ojas, shakti, tummo, or kundalini.

In Fiction

  • One of the best-known examples in Western literature is in Thomas Mann’s novella, Death in Venice, where the protagonist Gustav von Aschenbach, a famous writer, sublimates his desire for an adolescent boy into writing poetry.
  • In The Diamond Age by Neal Stephenson, sublimation is presented as the source of the Neo-Victorians’ dominance: “…it was precisely their emotional repression that made the Victorians the richest and most powerful people in the world. Their ability to submerge their feelings, far from pathological, was rather a kind of mystical art that gave them nearly magical power over Nature and over the more intuitive tribes. Such was also the strength of the Nipponese.”

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What is Experiential Avoidance?

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Introduction

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences – even when doing so creates harm in the long run.

The process of EA is thought to be maintained through negative reinforcement – that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behaviour will persist. Importantly, the current conceptualisation of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.

Background

EA has been popularised by recent third-wave cognitive-behavioural theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defence mechanisms were originally conceptualised as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.

Process-Experiential

Process-experiential therapy merges client-centred, existential, and Gestalt approaches. Gestalt theory outlines the benefits of being fully aware of and open to one’s entire experience. One job of the psychotherapist is to “explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid”. Similar ideas are expressed by early humanistic theory:

“Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness.”

Behavioural

Traditional behaviour therapy utilises exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.

Third-Wave Cognitive-Behavioural

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP), and behavioural activation (BA).

Associated Problems

  • Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.
  • Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.
  • Sustaining avoidance often requires effort and energy.
  • Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
  • Avoidance may get in the way of other important, valued aspects of life.

Empirical Evidence

  • Laboratory-based thought suppression studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
  • Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing the unpleasant emotions can lead to improvements in the long term, even though it increases negative reactions in the short term.
  • Exposure-based therapy techniques have been shown to be effective in treating a wide range of psychiatric disorders.
  • Numerous self-report studies have linked EA and related constructs (avoidance coping, thought suppression) to psychopathology and other forms of dysfunction.

Relevance to Psychopathology

Seemingly disparate forms of pathological behaviour can be understood by their common function (i.e., attempts to avoid distress). Some examples include:

DiagnosisExample BehavioursTarget of Avoidance
Major Depressive Disorder (MDD)Isolation/SuicideFeelings of sadness, guilt, and low self-worth.
Posttraumatic Stress Disorder (PTSD)Avoiding trauma reminders and hypervigilanceMemories, anxiety, and concerns of safety.
Social PhobiaAvoiding social situationsAnxiety and concerns of judgement of others.
Panic DisorderAvoiding situations that might induce panicFear and physiological sensations.
AgoraphobiaRestricting travel outside of home or other ‘safe areas’Anxiety and fear of having symptoms of panic.
Obsessive-Compulsive DisorderChecking/RitualsWorry of consequences (e.g. ‘contamination’).
Substance Use DisordersAbusing alcohol/drugsEmotions, memories, and withdrawal symptoms.
Eating DisordersRestricting food intake and purgingWorry about becoming overweight and fear of losing control.
Borderline Personality DisorderSelf-harm (e.g. cutting)High emotional arousal.

Relevance to Quality of Life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:

  • Putting off an important task because of the discomfort it evokes.
  • Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
  • Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
  • Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
  • Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
  • Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
  • Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
  • Staying in a “bad” relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
  • Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g. achieved through drug or alcohol abuse) or symptoms of withdrawal.
  • Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.
  • Engaging in self-destructive behaviours in an attempt to avoid feelings of boredom, emptiness, worthlessness.
  • Not functioning or taking care of basic responsibilities (e.g. personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
  • Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.

Measurement

Self-Report

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualised as a measure of “psychological flexibility”. The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.

What is Psychological Flexibility?

Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. This trait is used when stressors or unexpected events occur, requiring a person to change their stance, outlook, or commitment. Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, as well as simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one’s thinking and attention between tasks. Flexibility, or psychological flexibility, as it is sometimes referred to, is the ability to adapt to situational demands, balance life demands, and commit to behaviours.

  • Refer to:
  • Opposite concepts:
    • Acceptance.
    • Distress tolerance.
    • Psychological flexibility.
  • Related concepts:
    • Denial.
    • Expressive suppression.

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What is Dissociative Disorder?

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Introduction

Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

People with dissociative disorders use dissociation as a defence mechanism, pathologically and involuntarily. The individual experiences these dissociations to protect themselves. Some dissociative disorders are triggered by psychological trauma, but depersonalisation–derealisation disorder may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.

The dissociative disorders listed in the American Psychiatric Association’s DSM-5 are as follows:

  • Dissociative identity disorder (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities can be aware of all the existing personalities.
  • Dissociative amnesia (formerly psychogenic amnesia): the temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient. Dissociative fugue was previously a separate category but is now treated as a specifier for dissociative amnesia.
  • Depersonalisation-derealisation disorder: periods of detachment from self or surrounding which may be experienced as “unreal” (lacking in control of or “outside” self) while retaining awareness that this is only a feeling and not a reality.
  • The old category of dissociative disorder not otherwise specified is now split into two: other specified dissociative disorder, and unspecified dissociative disorder. These categories are used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders; or if the correct category has not been determined; or the disorder is transient.

The ICD 11 lists dissociative disorders as:

  • Dissociative neurological symptom disorder.
  • Dissociative amnesia.
  • Dissociative amnesia with dissociative fugue.
  • Trance disorder.
  • Possession trance disorder.
  • Dissociative identity disorder.
  • Partial dissociative identity disorder.
  • Depersonalisation-derealisation disorder.

Cause and Treatment

Dissociative Identity Disorder

Cause

Dissociative identity disorder is caused by ongoing childhood trauma that occurs before the ages of six to nine. People with dissociative identity disorder usually have close relatives who have also had similar experiences.

Treatment

Long-term psychotherapy to improve the patient’s quality of life.

Dissociative Amnesia

Cause

A way to cope with trauma.

Treatment

Psychotherapy (e.g. talk therapy) counselling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviours); and medications (antidepressants, anti-anxiety medications, or sedatives). These medications help control the symptoms associated with the dissociative disorders, but there are no medications yet that specifically treat dissociative disorders. However, the medication pentothal can sometimes help to restore the memories. The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation. Dissociative fugue was a separate category but is now listed as a specifier for dissociative amnesia.

Depersonalisation-Derealisation Disorder

Cause

Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one.

Treatment

Same treatment as dissociative amnesia. An episode of depersonalisation–derealisation disorder can be as brief as a few seconds or continue for several years.

Dissociative disorders, especially dissociative identity disorder (DID), while being the result of extraordinary abuse and trauma in childhood, it should not be attributed exotic status. DID would be better examined through a more holistic lens, taking into considering the social, cognitive, and neural components, and how they interact with one another.

Medications

There are no medications to treat dissociative disorders, however, drugs to treat anxiety and depression that may accompany the disorders can be given.

Diagnosis and Prevalence

The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients. Diagnosis can be made with the help of structured clinical interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), and behavioural observation of dissociative signs during the interview. Additional information can be helpful in diagnosis, including the Dissociative Experiences Scale or other questionnaires, performance-based measures, records from doctors or academic records, and information from partners, parents, or friends. A dissociative disorder cannot be ruled out in a single session and it is common for patients diagnosed with a dissociative disorder to not have a previous dissociative disorder diagnosis due to a lack of clinician training. Some diagnostic tests have also been adapted or developed for use with children and adolescents such as the Adolescent Dissociative Experiences Scale, Children’s Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), Child Behaviour Checklist (CBCL) Dissociation Subscale, and the Trauma Symptom Checklist for Children Dissociation Subscale.

Dissociative disorders have been found to be quite prevalent in outpatient populations, as well as within low-income communities. One study found that in a population of poor inner-city outpatients, there was a 29% prevalence of dissociative disorders.

There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which can be understood by the historic context of hysteria. Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined. In most cases mental health professionals are still hesitant to diagnose patients with Dissociative Disorder, because before they are considered to be diagnosed with Dissociative Disorder these patients have more than likely been diagnosed with major depressive disorder, anxiety disorder, and most often post-traumatic stress disorder (PTSD). It has been found from interviews with those who may be afflicted with dissociative disorders may be more effective at getting an accurate diagnosis than self-scoring assessments and scales.

The prevalence of dissociative disorders is not completely understood due to the many difficulties in diagnosing dissociative disorders. Many of these difficulties stem from a misunderstanding of dissociative disorders, from an unfamiliarity diagnosis or symptoms to disbelief in some dissociative disorders entirely. Due to this it has been found that only 28% to 48% of people diagnosed with a dissociative disorder receive treatment for their mental health. Patients who are misdiagnosed are often those more likely to be hospitalised repeatedly, and lack of treatment can result in intensive outpatient treatment and higher rates of disability.

An important concern in the diagnosis of dissociative disorders in forensic interviews is the possibility that the patient may be feigning symptoms in order to escape negative consequences. Young criminal offenders report much higher levels of dissociative disorders, such as amnesia. In one study it was found that 1% of young offenders reported complete amnesia for a violent crime, while 19% claimed partial amnesia. There have also been cases in which people with dissociative identity disorder provide conflicting testimonies in court, depending on the personality that is present. The world-wide prevalence of dissociative disorders is not well understood due to different cultural beliefs surrounding human emotions and the human brain

Children and Adolescents

Dissociative disorders (DD) are widely believed to have roots in adverse childhood experiences including abuse and loss, but the symptoms often go unrecognised or are misdiagnosed in children and adolescents. However, a recent western Chinese study showed an increase in awareness of dissociative disorders present in children These studies show that DD’s have an intricate relationship with the patient’s mental, physical and socio-cultural environments. This study suggested that dissociative disorders are more common in Western, or developing countries, however, some cases have been seen in both clinical and non-clinical Chinese populations. There are several reasons why recognising symptoms of dissociation in children is challenging: it may be difficult for children to describe their internal experiences; caregivers may miss signals or attempt to conceal their own abusive or neglectful behaviours; symptoms can be subtle or fleeting; disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders.

Another resource, Beacon House, informs us of dissociative disorder in children, suggesting that it is a survival mechanism that often goes unnoticed in children that have been traumatised. Dr. Shoshanah Lyons suggests that traumatised children often continue to dissociate even though they might not be in any danger, and that they are often unaware that they are dissociating. In addition to developing diagnostic tests for children and adolescents (see above), a number of approaches have been developed to improve recognition and understanding of dissociation in children. Recent research has focused on clarifying the neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma. Others in the field have argued that recognising disorganised attachment (DA) in children can help alert clinicians to the possibility of dissociative disorders. In their 2008 article, Rebecca Seligman and Laurence Kirmayer suggest the existence of evidence of linkages between trauma experienced in childhood and the capacity for dissociation or depersonalisation. They also suggest that individuals who are able to utilise dissociative techniques are able to keep this as an extended strategy to cope with stressful situations.

Clinicians and researchers stress the importance of using a developmental model to understand both symptoms and the future course of DDs. In other words, symptoms of dissociation may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed. Related to this developmental approach, more research is required to establish whether a young patient’s recovery will remain stable over time.

Current Debates and the DSM-5

A number of controversies surround DD in adults as well as children. First, there is ongoing debate surrounding the aetiology of dissociative identity disorder (DID). The crux of this debate is if DID is the result of childhood trauma and disorganized attachment. A proposed view is that dissociation has a physiological basis, in that it involves automatically triggered mechanisms such as increased blood pressure and alertness, that would, as Lynn contends, imply its existence as a cross-species disorder. A second area of controversy surrounds the question of whether or not dissociation as a defence versus pathological dissociation are qualitatively or quantitatively different. Experiences and symptoms of dissociation can range from the more mundane to those associated with PTSD or acute stress disorder (ASD) to dissociative disorders. Mirroring this complexity, the DSM-5 workgroup considered grouping dissociative disorders with other trauma/stress disorders, but instead decided to put them in the following chapter to emphasize the close relationship. The DSM-5 also introduced a dissociative subtype of PTSD.

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states. However, experimental research in cognitive science continues to challenge claims concerning the validity of the dissociation construct, which is still based on Janetian notions of structural dissociation. Even the claimed etiological link between trauma/abuse and dissociation has been questioned. Links observed between trauma/abuse and DD are largely only present from a Western cultural context. For non-Western cultures dissociation “may constitute a “normal” psychological capacity”. An alternative model proposes a perspective on dissociation based on a recently established link between a labile sleep-wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality.

Debates around DD also stem from Western versus non-Western lenses of viewing the disorder, and associated views of causes of DD. DID was initially believed to be specific to the West, until cross-cultural studies indicated its occurrence worldwide. Conversely, anthropologists have largely done little work on DD in the West relating to its perceptions of possession syndromes that would be present in non-Western societies. While dissociation has been viewed and catalogued by anthropologists differently in the West and non-Western societies, there are aspects of each that show DD has universal characteristics. For example, while shamanic and rituals of non-Western societies may hold dissociative aspects, this is not exclusive as many Christian sects, such as “possession by the Holy Ghost” share similar qualities to those of non-Western trances.

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What is Introjection?

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Introduction

In psychology, introjection is the unconscious adoption of the thoughts or personality traits of others.

It occurs as a normal part of development, such as a child taking on parental values and attitudes. It can also be a defence mechanism in situations that arouse anxiety.

The tendency is also known as identification or internalisation. It has been associated with both normal and pathological development.

Theory

Introjection is a concept rooted in the psychoanalytic theories of unconscious motivations. Unconscious motivation refers to processes in the mind which occur automatically and bypass conscious examination and considerations.

Introjection is the learning process or in some cases a defence mechanism where a person unconsciously absorbs experiences and makes them part their psyche.

Introjection in Learning

In psychoanalysis, introjection (German: Introjektion) refers to an unconscious process wherein one takes components of another person’s identity, such as feelings, experiences and cognitive functioning, and transfers them inside themselves, making such experiences part of their new psychic structure. These components are obliterated from consciousness (splitting), perceived in someone else (projection), and then experienced and performed (i.e. introjected) by that other person. Cognate concepts are identification, incorporation and internalisation.

Introjection as a Defence Mechanism

It is considered a self-stabilising defence mechanism used when there is a lack of full psychological contact between a child and the adults providing that child’s psychological needs. Here, it provides the illusion of maintaining relationship but at the expense of a loss of self. To use a simple example, a person who picks up traits from their friends is introjecting.

Projection has been described as an early phase of introjection.

Historic Precursors

Freud and Klein

In Freudian terms, introjection is the aspect of the ego’s system of relational mechanisms which handles checks and balances from a perspective external to what one normally considers ‘oneself’, infolding these inputs into the internal world of the self-definitions, where they can be weighed and balanced against one’s various senses of externality. For example:

  • “When a child envelops representational images of his absent parents into himself, simultaneously fusing them with his own personality.”
  • “Individuals with weak ego boundaries are more prone to use introjection as a defense mechanism.”

According to D.W. Winnicott, “projection and introjection mechanisms… let the other person be the manager sometimes, and to hand over omnipotence.”

According to Freud, the ego and the superego are constructed by introjecting external behavioural patterns into the subject’s own person. Specifically, he maintained that the critical agency or the super ego could be accounted for in terms of introjection and that the superego derives from the parents or other figures of authority. The derived behavioural patterns are not necessarily reproductions as they actually are but incorporated or introjected versions of them.

Torok and Ferenczi

However, the aforementioned description of introjection has been challenged by Maria Torok as she favours using the term as it is employed by Sándor Ferenczi in his essay “The Meaning of Introjection” (1912). In this context, introjection is an extension of autoerotic interests that broadens the ego by a lifting of repression so that it includes external objects in its make-up. Torok defends this meaning in her 1968 essay “The Illness of Mourning and the Fantasy of the Exquisite Corpse”, where she argues that Sigmund Freud and Melanie Klein confuse introjection with incorporation and that Ferenczi’s definition remains crucial to analysis. She emphasized that in failed mourning “the impotence of the process of introjection (gradual, slow, laborious, mediated, effective)” means that “incorporation is the only choice: fantasmatic, unmediated, instantaneous, magical, sometimes hallucinatory…’crypt’ effects (of incorporation)”.

Fritz and Peris

In Gestalt therapy, the concept of “introjection” is not identical with the psychoanalytical concept. Central to Fritz and Laura Perls’ modifications was the concept of “dental or oral aggression”, when the infant develops teeth and is able to chew. They set “introjection” against “assimilation”. In Ego, Hunger and Aggression, Fritz and Laura Perls suggested that when the infant develops teeth, he or she has the capacity to chew, to break apart food, and assimilate it, in contrast to swallowing before; and by analogy to experience, to taste, accept, reject or assimilate. Laura Perls explains: “I think Freud said that development takes place through introjection, but if it remains introjection and goes no further, then it becomes a block; it becomes identification. Introjection is to a great extent unawares.”

Thus Fritz and Laura Perls made “assimilation”, as opposed to “introjection”, a focal theme in Gestalt therapy and in their work, and the prime means by which growth occurs in therapy. In contrast to the psychoanalytic stance, in which the “patient” introjects the (presumably more healthy) interpretations of the analyst, in Gestalt therapy the client must “taste” with awareness their experience, and either accept or reject it, but not introject or “swallow whole”. Hence, the emphasis is on avoiding interpretation, and instead encouraging discovery. This is the key point in the divergence of Gestalt therapy from traditional psychoanalysis: growth occurs through gradual assimilation of experience in a natural way, rather than by accepting the interpretations of the analyst.

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What is Dissociation (Psychology)?

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Introduction

Dissociation, as a concept that has been developed over time, is any of a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.

The phenomena are diagnosable under the DSM-5 as a group of disorders as well as a symptom of other disorders through various diagnostic tools. Its cause is believed to be related to neurobiological mechanisms, trauma, anxiety, and psychoactive drugs. Research has further related it to suggestibility and hypnosis, and it is inversely related to mindfulness, which is a potential treatment.

Brief History

French philosopher and psychologist Pierre Janet (1859-1947) is considered to be the author of the concept of dissociation. Contrary to some conceptions of dissociation, Janet did not believe that dissociation was a psychological defence.

Psychological defence mechanisms belong to Sigmund Freud‘s theory of psychoanalysis, not to Janetian psychology. Janet claimed that dissociation occurred only in persons who had a constitutional weakness of mental functioning that led to hysteria when they were stressed. Although it is true that many of Janet’s case histories described traumatic experiences, he never considered dissociation to be a defence against those experiences. Quite the opposite: Janet insisted that dissociation was a mental or cognitive deficit. Accordingly, he considered trauma to be one of many stressors that could worsen the already-impaired “mental deficiency” of a hysteric, thereby generating a cascade of hysterical (in today’s language, “dissociative”) symptoms.

Although there was great interest in dissociation during the last two decades of the nineteenth century (especially in France and England), this interest rapidly waned with the coming of the new century. Even Janet largely turned his attention to other matters.

There was a sharp peak in interest in dissociation in America from 1890 to 1910, especially in Boston as reflected in the work of William James, Boris Sidis, Morton Prince, and William McDougall. Nevertheless, even in America, interest in dissociation rapidly succumbed to the surging academic interest in psychoanalysis and behaviourism.

For most of the twentieth century, there was little interest in dissociation. Despite this, a review of 76 previously published cases from the 1790s to 1942 was published in 1944, describing clinical phenomena consistent with that seen by Janet and by therapists today. In 1971, Bowers and her colleagues presented a detailed, and still quite valid, treatment article. The authors of this article included leading thinkers of their time – John G. Watkins (who developed ego-state therapy) and Zygmunt A. Piotrowski (famed for his work on the Rorschach test). Further interest in dissociation was evoked when Ernest Hilgard (1977) published his neodissociation theory in the 1970s. During the 1970s and 1980s an increasing number of clinicians and researchers wrote about dissociation, particularly multiple personality disorder.

Carl Jung described pathological manifestations of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic attitudes and functions in normal individual consciousness is the basis of Jung’s Psychological Types. He theorised that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite.

Attention to dissociation as a clinical feature has been growing in recent years as knowledge of post-traumatic stress disorder (PTSD) increased, due to interest in dissociative identity disorder (DID), and as neuroimaging research and population studies show its relevance.

Historically the psychopathological concept of dissociation has also another different root: the conceptualization of Eugen Bleuler that looks into dissociation related to schizophrenia.

Diagnosis

Refer to Dissociative disorder.

Dissociation is commonly displayed on a continuum. In mild cases, dissociation can be regarded as a coping mechanism or defence mechanism in seeking to master, minimise or tolerate stress – including boredom or conflict. At the non-pathological end of the continuum, dissociation describes common events such as daydreaming. Further along the continuum are non-pathological altered states of consciousness.

More pathological dissociation involves dissociative disorders, including dissociative fugue and depersonalisation disorder with or without alterations in personal identity or sense of self. These alterations can include: a sense that self or the world is unreal (depersonalisation and derealisation), a loss of memory (amnesia), forgetting identity or assuming a new self (fugue), and separate streams of consciousness, identity and self (dissociative identity disorder, formerly termed multiple personality disorder) and complex post-traumatic stress disorder (CPTSD). Although some dissociative disruptions involve amnesia, other dissociative events do not. Dissociative disorders are typically experienced as startling, autonomous intrusions into the person’s usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling.

Dissociative disorders are sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable trigger at all. The ICD-10 classifies conversion disorder as a dissociative disorder. The DSM groups all dissociative disorders into a single category and recognises dissociation as a symptom of acute stress disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder.

Misdiagnosis is common among people who display symptoms of dissociative disorders, with an average of seven years to receive proper diagnosis and treatment. Research is ongoing into aetiologies, symptomology, and valid and reliable diagnostic tools. In the general population, dissociative experiences that are not clinically significant are highly prevalent with 60% to 65% of the respondents indicating that they have had some dissociative experiences.

Diagnostic and Statistical Manual of Mental Disorders

Diagnoses listed under the DSM-5 are dissociative identity disorder, dissociative amnesia, depersonalisation/derealisation disorder, other specified dissociative disorder and unspecified dissociative disorder. The list of available dissociative disorders listed in the DSM-5 changed from the DSM-IV-TR, as the authors removed the diagnosis of dissociative fugue, classifying it instead as a subtype of dissociative amnesia. Furthermore, the authors recognised derealisation on the same diagnostic level of depersonalisation with the opportunity of differentiating between the two.

The DSM-IV-TR considers symptoms such as depersonalisation, derealisation and psychogenic amnesia to be core features of dissociative disorders. The DSM-5 carried these symptoms over and described symptoms as positive and negative. Positive symptoms include unwanted intrusions that alter continuity of subjective experiences, which account for the first two symptoms listed earlier with the addition of fragmentation of identity. Negative symptoms include loss of access to information and mental functions that are normally readily accessible, which describes amnesia.

Peritraumatic Dissociation

Peritraumatic dissociation is considered to be dissociation that is experienced during and immediately following a traumatic event. Research is on-going related to its development, its importance, and its relationship to trauma, dissociative disorders, and predicting the development of PTSD.

Measurements

Two of the most commonly used screening tools in the community are the Dissociative Experiences Scale and the Multiscale Dissociation Inventory. Meanwhile, the Structured Clinical Interview for DSM-IV – Dissociative Disorders (SCID-D) and its second iteration, the SCID-D-R, are both semi-structured interviews and are considered psychometrically strong diagnostic tools.

Other tools include the Office Mental Status Examination (OMSE), which is used clinically due to inherent subjectivity and lack of quantitative use. There is also the Dissociative Disorders Interview Schedule (DDSI), which lacks substantive clarity for differential diagnostics.

Peritraumatic dissociation is measured through the Peritraumatic Dissociative Scale.

Aetiology

Neurobiological Mechanism

Preliminary research suggests that dissociation-inducing events, drugs like ketamine, and seizures generate slow rhythmic activity (1-3 Hz) in layer 5 neurons of the posteromedial cortex in humans (retrosplenial cortex in mice). These slow oscillations disconnect other brain regions from interacting with the posteromedial cortex, which may explain the overall experience of dissociation.

Trauma

Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse. This is supported by studies which suggest that dissociation is correlated with a history of trauma.

Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatised, yet at the same time there are many people who have suffered from trauma but who do not show dissociative symptoms.

Adult dissociation when combined with a history of child abuse and otherwise interpersonal violence-related PTSD has been shown to contribute to disturbances in parenting behaviour, such as exposure of young children to violent media. Such behaviour may contribute to cycles of familial violence and trauma.

Symptoms of dissociation resulting from trauma may include depersonalisation, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defence mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.

Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as “sequelae to abuse”) include anxiety, PTSD, low self-esteem, somatisation, depression, chronic pain, interpersonal dysfunction, substance abuse, self-harm and suicidal ideation or actions. These symptoms may lead the victim to present the symptoms as the source of the problem.

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample, including amnesia for abuse memories. It has also been seen that girls who suffered abuse during their childhood had higher reported dissociation scores than did boys who reported dissociation during their childhood. A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15, and dissociation has also been correlated with a history of childhood physical and sexual abuse. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.

A 2012 review article supports the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states.

Psychoactive substances

Refer to Dissociative Drug.

Psychoactive drugs can often induce a state of temporary dissociation. Substances with dissociative properties include ketamine, nitrous oxide, alcohol, tiletamine, amphetamine, dextromethorphan, MK-801, PCP, methoxetamine, salvia, muscimol, atropine, ibogaine, and minocycline.

Correlations

Hypnosis and Suggestibility

There is evidence to suggest that dissociation is correlated with hypnotic suggestibility, specifically with dissociative symptoms related to trauma. However, the relationship between dissociation and hypnotic suggestibility appears to be complex and indicates further research is necessary.

Aspects of hypnosis include absorption, dissociation, suggestibility, and willingness to receive behavioural instruction from others. Both hypnotic suggestibility and dissociation tend to be less mindful, and hypnosis is used as a treatment modality for dissociation, anxiety, chronic pain, trauma, and more. Difference between hypnosis and dissociation: one is suggested, imposed by self or other, meaning dissociation is generally more spontaneous altering of awareness.

Mindfulness and Meditation

Mindfulness and meditation have shown an inverse relationship specifically with dissociation related to re-experiencing trauma due to the lack of present awareness inherent with dissociation. The re-experiencing episodes can include anything between illusions, distortions in perceived reality, and disconnectedness from the present moment. It is believed that the nature of dissociation as an avoidance coping or defence mechanism related to trauma inhibits resolution and integration.

Mindfulness and meditation also can alter the state of awareness to the present moment; however, unlike dissociation, it is clinically used to bring greater awareness to an individual’s present state of being. It achieves this through increased abilities to self-regulate attention, emotion, and physiological arousal, maintain continuity of consciousness, and adopt an approach to the present experience that is open and curious. In practice, non-judgmental awareness has displayed a positive relationship with lower symptoms of PTSD avoidance, which can relate to greater opportunities for success with exposure therapy and lowering PTSD symptoms of hypervigilance, re-experiencing, and overgeneralization of fears.

When using mindfulness and meditation with people expressing trauma symptoms, it is crucial to be aware of potential trauma triggers, such as the focus on the breath. Often, a meditation session will begin with focused attention and move into open monitoring. With severe trauma symptoms, it may be important to start the meditation training and an individual session at the peripheral awareness, such as the limbs. Moreover, trauma survivors often report feeling numb as a protection against trauma triggers and reminders, which are often painful, making it good practice to start all trainings at the limbs as a gradual exposure to body sensations. Doing so will also increase physical attachment to the present moment and the sense of grounding, thereby increasing tolerance to trauma reminders and decreasing the need and use of dissociation.

Treatment

When receiving treatment, patients are assessed to discover their level of functioning. Some patients might be higher functioning than others. This is taken into account when creating a patient’s potential treatment targets. To start off treatment, time is dedicated to increasing a patient’s mental level and adaptive actions in order to gain a balance in both their mental and behavioural action. Once this is achieved, the next goal is to work on removing or minimising the phobia made by traumatic memories, which is causing the patient to dissociate. The final step of treatment includes helping patients work through their grief in order to move forward and be able to engage in their own lives. This is done with the use of new coping skills attained through treatment. One coping skill that can improve dissociation is mindfulness due to the introduction of staying in present awareness while observing non-judgmentally and increasing the ability to regulate emotions. Specifically in adolescents, mindfulness has been shown to reduce dissociation after practicing mindfulness for three weeks.

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