How Does Our Brain Constitute Defense Mechanisms? First-Person Neuroscience and Psychoanalysis

Innovations Psychother Psychosom 2007;76:141–153 DOI: 10.1159/000099841 How Does Our Brain Constitute Defense Mechanisms? First-Person Neuroscience and Psychoanalysis a, c c b d Georg Northoff Felix Bermpohl Frank Schoeneich Heinz Boeker a Department of Psychiatry, Psychotherapy and Psychosomatics, University of Magdeburg, Magdeburg , and b c Department of Psychosomatics, Humboldt University Charité, Department of Psychiatry and Psychotherapy, d Charité-University Medicine Berlin, Berlin , Germany; Department of Psychiatry, University of Zurich, Zurich , Switzerland Key Words tion in the neural network including the orbitofrontal, the Psychoanalysis Neuroscience Defense mechanisms medial prefrontal and the premotor cortices. In general sen- Neuronal integration Catatonia sorimotor regression and other defense mechanisms are psychoanalytic constructs that are hypothesized to be complex emotional-cognitive constellations. In this paper we Abstract suggest that specific functional mechanisms which inte- Current progress in the cognitive and affective neuroscienc- grate neuronal activity across several brain regions (i.e. neu- es is constantly influencing the development of psychoana- ronal integration) are the physiological substrates of defense lytic theory and practice. However, despite the emerging mechanisms. We conclude that first-person neuroscience dialogue between neuroscience and psychoanalysis, the could be an appropriate methodological strategy for open- neuronal processes underlying psychoanalytic constructs ing the door to a better understanding of the neuronal pro- such as defense mechanisms remain unclear. One of the cesses of defense mechanisms and their modulation in psy- main problems in investigating the psychodynamic-neuro- choanalytic psychotherapy. Copyright © 2007 S. Karger AG, Basel nal relationship consists in systematically linking the individual contents of first-person subjective experience to third-person observation of neuronal states. We therefore introduced an appropriate methodological strategy, ‘first- Introduction person neuroscience’, which aims at developing methods for systematically linking first- and third-person data. The The term ‘defense mechanisms’ was coined over 100 utility of first-person neuroscience can be demonstrated by years ago to describe a construct of psychological mecha- the example of the defense mechanism of sensorimotor re- nisms for coping with intrapsychic conflicts [1] (table 1). gression as paradigmatically observed in catatonia. Com- Defense mechanisms and conflict are two hypothetical bined psychodynamic and imaging studies suggest that constructs that have remained at the core of psychody- sensorimotor regression might be associated with dysfunc- namic approaches to understanding and treating clinical © 2007 S. Karger AG, Basel Georg Northoff, MD, PhD, Laboratory for Neuroimaging and Neurophilosophy 0033–3190/07/0763–0141$23.50/0 Department of Psychiatry, Psychotherapy and Psychosomatics Fax +41 61 306 12 34 Otto von Guericke University Magdeburg, Leipzigerstrasse 44 E-Mail [email protected] Accessible online at: DE–39120 Magdeburg (Germany) www.karger.com www.karger.com/pps Tel. +49 391 671 4234, Fax +49 391 671 5223, E-Mail [email protected] Table 1. Defense mechanisms: hierarchy of mature/cognitively oriented and immature/emotionally driven mechanisms of defense ac- cording to psychoanalytic theory Mature/cognitively oriented mechanisms of defense Immature/emotionally driven mechanisms of defense Intellectuali- Dealing with emotional stressors by excessive Somatization Dealing with emotional stressors by physical zation use of abstract thinking or complex explanations symptoms involving parts of the body innervat- to control or minimize disturbing feelings. ed by the sympathetic and parasympathetic sys- tems. Rationalization Dealing with emotional stressors by inventing a socially acceptable or logical reason to justify an Derivatives of self/nonself loss of boundaries already taken unconscious emotional action. Dissociation Temporary and drastic modification of one’s self-image to avoid emotional distress. Discon- Repression Moving thoughts unacceptable to the ego into nection from full awareness of self, time and/or the unconscious, where they cannot be easily ac- external circumstances. Often connected with cessed. childhood trauma and posttraumatic stress dis- Displacement Dealing with emotional stressors by redirecting order. emotion from a ‘dangerous’ object to a ‘safe’ ob- Projective Repeated cycle of projection and introjection: ject. identification hateful impulses are projected onto the signifi- Isolation Dealing with emotional stressors by splitting off cant other who becomes the bad object. Some of the emotional components from a difficult the bad impulses are still retained in the self; they thought. The mechanism of isolation is com- are reinforced by taking into one’s self, introject- monly overutilized by people with obsessive- ing, what has originally been projected onto the compulsive personalities. object. Reaction Dealing with emotional stressors by converting Psychotic Psychotic internalization of the object to over- formation an uncomfortable feeling into its opposite. introjection come overwhelming anxieties of loss. Identification Occurs in various stages of development, in par- Psychotic Hallucinatory and paranoid externalization of ticular in its role as an intrinsic part of object projection inaccessible thoughts and their connected af- relationships. Serves the function of structure fects. building and makes it possible to deal with sepa- Splitting Splitting off and rejecting parts of the object im- rations from loved objects. Plays a role in some age and/or of one’s own body. types of conversion. Fragmentation Reflects a primitive stage in psychic develop- Identification By becoming an aggressor towards others, one ment, preceding the formation of part self and (with the avoids becoming a victim of aggression. part object images. Breaking up of the self or the aggressor) object image into components which may oper- Idealization Dealing with emotional stressors by overesti- ate independently. mating the desirable qualities and underestimat- Denial Dealing with emotional stressors by failing to ing the limitations of a desired object. recognize obvious implications or consequences Introjection Dealing with emotional stressors by internaliz- of a thought, act or situation. ing the values or characteristics of another per- Catatonia Psychomotor syndrome showing a specific con- son; usually someone who is significant to the stellation of affective, behavioral and motor individual in some way. symptoms. Sensorimotor regression reflecting Projection The opposite of introjection. Attributing one’s an immature mechanism against the uncontrol- own emotions or desires to an external object or lable overflow of anxieties. person. Autism Extreme withdrawal and avoidance of contact and interpersonal relationships to overcome overwhelming anxieties of losing one’s own self when near the object. psychopathology. From a psychoanalytical perspective, other. Through specific constellations of affective and defense mechanisms mediate between an individual’s cognitive function, defense mechanisms help resolve wishes, needs and affects on the one hand, and both in- conf licts, whether triggered by internal or external stress- ternalized object relations and external reality on the ors. One could therefore hypothesize that defense mech- 142 Psychother Psychosom 2007;76:141–153 Northoff /Bermpohl /Schoeneich /Boeker anisms are complex emotional-cognitive constellations. in emotional-cognitive interaction, which Westen and As such, the recent progress in affective and cognitive Gabbard [13, 14] consider to be crucial in conflict and neuroscience [2–5] raises the question of their underlying compromise. However, despite these studies and the cru- neuronal processes, which, in turn, could also contribute cial role of defense mechanisms in psychoanalytic theory to a more refined and detailed definition of the construct and practice, their underlying neuronal mechanisms re- of defense mechanisms. However, the dialogue between main yet to be explored. psychoanalysis and neuroscience has only recently One of the main methodological challenges in inves- emerged [6–21] . tigating the neuronal processes underlying defense mech- The reception of neuroscience by psychoanalysts rang- anisms is to link first- and third-person data. Being based es from strong skepticism to equally strong enthusiasm. upon subjective experience, psychoanalysis relies on first- Skeptics [22–24] doubt that there can be common con- person data. This contrasts with neuroscience, which re- ceptual grounds for linking the hypothesis about uncon- quires third-person observation of neuronal states. Due scious aspects of the mind (as advanced by psychoanaly- to the neglect of subjective first-person experience, neu- sis) and knowledge about the brain (as framed by neuro- ronal states as third-person data can be quantified and science). They claim that the complexity and richness of objectified. This, in contrast, remains impossible in the subjective human experience can become lost in empiri- case of first-person data (see below for discussion of po- cal neuroscientific investigation. Another argument, as tential criticisms of the concept of first-person data), put forward by Gruenbaum [25] , is that possible psycho- which are rather qualitative and subjective. If, however,

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