Aspects of Defence in Neurosis and Psychosis

The purpose of this paper is to examine certain aspects of the defensive process in psychoneurotic states and in psychotic reactions. To achieve this end excerpts from the treatment of a number of psychoneurotic and psychotic patients will be presented. Three of these patients were undergoing psycho-analytical therapy, whereas the remainder were treated by analytically orientated psychotherapy. It is, of course, quite artificial to isolate particular defence mechanisms from the general defensive activity of the ego, but this is essential for the present investigation. The clinical phenomena which are to be described developed within the framework of the transference situation. It is here that object relationships and the interplay of impulse and defence can be most readily observed.

In view of the importance which is currently attached to the concepts of introjection and projection, it seems appropriate to study them once again in the light of observations derived from both psychoneurotic and psychotic states. Such an enquiry cannot be undertaken without the inclusion of the concept of identification, which has such close links with introjection and projection. Introjection describes a dynamic process. It is the psychical correlate of the incorporative aim of the oral drives. From a topographical standpoint it operates in relation to the ego. Projection also relates to the ego and dynamically it is concerned with the extrusion of any influences which might disturb the ego in its relations with the environment and the super-ego. Identification has been described by Fenichel (7) as an instinctual vicissitude. The changes which occur in the aim and object of the drive lead to identification. In the introduction to the structural formulations Freud (18) pointed out that '… the ego is a precipitate of abandoned object cathexes and that it contains a record of past object choices'. Identification leads to the characteristic traits by which the ego will later