Medicine and the manic defence.
OBJECTIVE
The aim of this paper is to explore the relevance of the concept of the manic defence to understanding the treatment behaviours of doctors, and psychiatrists in particular.


METHODS
The manic defence and manic reparation are defined. Treatment approaches by doctors in physical and psychiatric medicine are examined within the perspective offered by these concepts.


RESULTS
Evidence for the operation of a manic defence can often be discerned in treatment approaches to psychological and psychosomatic disorders. Widespread reliance on the prescribing of antidepressant medication for depression provides an example.


CONCLUSIONS
In the face of psychological and psychosomatic presentations, doctors may resort to reductionist aetiological formulations which promote active but reductionist treatments. Such approaches represent the enactment of a manic defence against depressive anxieties that might otherwise be experienced by patient and/or practitioner.
Metta Clinic, Pymble, New South Wales, Australia.
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Schimmel
D000928:Antidepressive Agents / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000523:psychology*; D003379:Countertransference; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D006801:Humans; D010348:Patient Care Team; D010819:Physician's Role; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011570:Psychiatry; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000628:therapy; D011613:Psychotherapy
D000928:Antidepressive Agents