MEDICINE AND THE MANIC DEFENSE

Objective: The aim of this paper is to explore the relevance of the co ncept of the manic defence to understanding the treatment behaviours o f doctors, and psychiatrists in particular. Method: The manic defence and manic reparation are defined. Treatment approaches by doctors in p hysical and psychiatric medicine are examined within the perspective o ffered by these concepts. Results: Evidence for the operation of a man ic defence can often be discerned in treatment approaches to psycholog ical and psychosomatic disorders. Widespread reliance on the prescribi ng of antidepressant medication for depression provides an example. Co nclusions: In the face of psychological and psychosomatic presentation s, 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 mig ht otherwise be experienced by patient and/or practitioner.