Journal of the American Psychoanalytic Association: Karl A. Menninger. 'Psychological Aspects of the Organism Under Stress. Part II: Regulatory Devices of the Ego under Major Stress.'

Disease must be looked upon as a positive expression of the survival efforts of the organism. Whenever the ego is subjected to internal and external stresses of great intensity radical measures are introduced to maintain the homeostatic balance. Minor stresses are dealt with by relatively 'healthy devices', but these are inadequate in the face of major stress. The author describes five levels of stress-relieving devices which may be employed in the attempt to cope with the influx of stimulation arising from the aggressive and sexual instinctual drives or from environmental sources. Regulatory devices of the first order may be utilized in situations which overtax the ordinary or 'normal' devices. They consist essentially of exaggerations of normal functions, but are now accompanied by sensations of discomfort and unpleasantness. Amongst the most familiar are: hypersuppression, hyper-repression, hyperalertness, minor somatic dysfunctions, hyperkinesis, etc. The first order devices usually disappear once the pressure on the ego is removed. However, this is not invariable. When the first order devices fail to restore the homeostatic balance something further must be done by the ego. The ego is forced to accept a lowered level at which a new homeostatic equilibrium can be established, and it effects this by means of a second order of regulatory devices characterized by a partial detachment from the world of reality. Amongst these second order devices are: (1) dissociation, which includes amnesia, depersonalization, syncopes, etc.; (2) displacement, which includes prejudice, phobias, obsessions, etc.; (3) substitution of magic symbols and behaviour for more open hostility, e.g. compulsions, rituals, perverse sexuality, kleptomania, etc.; (4) substitution of self or part of self as object of displaced aggression. Regulatory devices of a third order are called into action by the emergence of uncontrollable instinctual impulses. The stress-relieving mechanisms