Protecting the Self: Defense Mechanisms in Action
Szajnberg, Nathan, International Journal of Psychoanalysis
Protecting the Self: Defense Mechanisms in Action by Phebe Cramer Guilford Press, New York, 2006; 384 pp; $45
Protecting the Self: Defense Mechanisms in Action summarizes a lifetime of research on defense mechanisms. This book will be one in a series of conceptual milestones on defenses including Anna Freud's Ego and the Mechanisms of Defence (1936) and Vaillant's Ego Mechanisms of Defense (1992). Cramer marks the growth of our knowledge about the way defenses develop and work. She updates our understanding of some defenses, their development and functions, and offers various research measures to assess defense mechanisms. In addition, she shows how treatment outcome can be measured in terms of defense maturation.
Cramer has studied three defenses extensively: denial, projection and identification. Observing that these three defenses have generally been seen as occupying a range of positions along the axis of maturity, with denial at the immature end and identification at the mature end, she hypothesized that we should be able to document this sequence developmentally in children and adolescents; that is, in the course of development, denial should make its appearance first, then projection, and then identification. Cramer's research has confirmed this, in itself a profound contribution.
Cramer has also explored the presence and frequency of the same three defenses in outpatients and inpatients, and their correlation with the severity of psychopathology. Again she confirms the predominance of less mature defenses in more severe psychopathology, and more mature defenses in less severe psychopathology, with some important exceptions in the case of identification, a more complex mental phenomenon.
Cramer's major method in assessing defenses is to rate the narratives from the Thematic Apperception Test (TAT), or Children's Apperception Test (CAT), using the Defense Mechanism Manual she has developed. An entire chapter is dedicated to describing this manual, which can also be downloaded. Cramer compares her method to others', such as the Defense Scale Questionnaire, Perry's Defense Mechanism Rating Scales (and the DSM-IV Defense Axis, derived from the DMRS), Vaillant's Clinical Vignette Ratings, and Laor's Comprehensive Assessment of Defense Style (for children). These other rating scales are highly inclusive, many additional to the defenses: Cramer has been able to achieve clearer results, particularly with regard to defense development and its interaction with gender and IQ, by selecting only three defenses along the developmental spectrum.
She dedicates one chapter to each of these three defenses, marshalling different classes of evidence: research assessment via the DMM, vignettes from projective stories, clinical vignettes, and 'folktales'. These three chapters are crisp. I found the different kinds of evidence most persuasive in the order in which I have listed them, with Cramer's research data strongest and the folktale material adding little. In fact, the illustrations that Cramer calls folktales comprise a very broad group, including fairytales, moralistic folktales and fables, and even, in the case of 'identification,' tales from Shakespeare. …