PubMed · 5958764
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G Devereux. 1966. Transference, screen memory and the temporal ego.. https://doi.org/10.1097/00005053-196610000-00003
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This paper argues that the authentic voice of suffering can be denied to people with serious illness. Anguish and expressions of grief are sometimes replaced by joviality. Amid suffering, voices of anguish become strange inner voices that challenge defences of cheeriness and so are avoided, go unheard or are ignored. Bolstered by the everydayness of ward events and hospital life, suppression, repression and denial mean that people with serious illness can suffer without a voice. Listening to others requires the ability to listen to one's own inner voices and recognize how they might guide exchanges. By avoiding conducting conversations in ways dictated by our own fears, worries and fantasies we can listen, and in doing so allow shifts in awareness. Silent suffering can change to expressive suffering allowing a person to reach an autonomous self and so an authentic voice. The seriousness of a situation can be grasped and so life appreciated for what it is. Decisions can be made, business finished and relationships esteemed or otherwise. Through the format of brief therapeutic conversations, listening has a role to play in helping people with serious illness discover their autonomous and authentic voice. The discussion concludes with the suggestion that the need for throughput and roles and tasks demanded on nurses in general settings limits time and resources, and so liaison mental health nursing has a role to play. A specialist practitioner might offer conversational therapies, support nursing and medical staff and teach psychological concepts, thus contributing to an environment in which uncertainty is tolerated.
We examined the validity of the construct of overall defensive functioning and its discrimination from standard diagnostic assessments. Within a multisite field trial, patients received intake diagnostic interviews by clinicians who made standard axis I through V diagnoses, then rated defense mechanisms using the Defense Mechanism Rating Scales (DMRS). Patients filled out self-report measures of distress and defenses, the SCL-90-R, and Defense Style Questionnaire (DSQ). Overall defensive functioning (ODF) scales were derived from both the DMRS and the DSQ. Overlap between clinical and self-report ratings of defenses was modest. By two different methods of factor analysis, followed by confirmatory factor analysis, clinical ratings of ODF were clearly discriminable from axis I, axis II personality disorders, current and usual global functioning, and subjective distress. ODF measured by the DSQ was not clearly discriminated from subjective distress ratings, consistent with the hypothesis that subjective distress may distort conscious derivatives of actual defensive processes. The DSQ alone probably should not be considered as a substitute for observer-rated assessment of defensive functioning, although further study of the issue is warranted.
This work is aimed at analysing the motivated reasoning underlying denial of some piece of information. Denial is first distinguished from both repression and biased interpretation; then an analysis is provided of the reasoning devices typical of denial. The rules on which reasoned denial is based are similar to those governing the individual's normal cognitive activity. Reasoned denial is here represented in the form of if-then implications, where the to-be-denied belief plays the role of a consequence drawn from a given premise. So, in order to deny such a consequence one may either deny its premise, or search an alternative consequence, or search an alternative premise, or deny the very relation of implication, and so on. Each type of reasoning is logically biased, while at the same time psychologically plausible and convincing. A typical feature shared by all the reasoning strategies considered is the identification of 'unproven' with 'false'.