Meetings of the New York Psychoanalytic Society

January 26, 1982. ON THE CONCEPT OF PRIMITIVE DEFENSES. Martin S. Willick, M.D.

Dr. Willick stated that "the term 'primitive,' when applied to defensive processes, currently carries with it assumptions which may interface with our clinical work and theoretical understanding. One assumption is that a so-called primitive defense used by adults is the same as a defense used by a young child. Another is that the use of such primitive defense means that the patient's pathology can be traced back to an early period of childhood when the defensive operation is presumed to be predominant. A third is that the presence of such a defense is indicative of serious psychopathology." Dr. Willick proposed an alternate view: "defense should not be designated as being primitive or mature without an evaluation of the total ego organization. What appears to be the operation of a primitive defense in an adult depends not merely on the type of defense which is employed but on the nature of the ego involved. The sicker a patient is, the more we see poor ego integration, poor organization and breakdown of ego functions. The defensive processes called into service in such patients appear primitive primarily because of the low level of ego functioning." Dr. Willick reviewed the history of the concept of a hierarchy of defense mechanisms and concluded that the most common primitive defenses are denial and projection. "More recently splitting and projective identification, along with projective-introjective techniques, are often included under this heading. In contrast, repression, displacement, reaction formation, isolation, conversion and sublimation are thought of as defenses used by neurotic patients [which] come into use later in a child's development."

Dr. Willick sought to clarify the concept of primitive defenses and to deal with what he believes to be mistaken assumptions in its application. In regard to reconstruction, Dr. Willick asserted that "in all likelihood … defens