manic defence

Most of diagnosis in psychiatry is based on description of symptoms, and not on pathology of brain as we wish. We diagnose a disorder (we call it a disorder and not a disease cause we don't know the etiology in most of the cases) by finding a special combinations of symptoms for a special period of time and we call their rules as CRITERIA to diagnose a disorder…

I find myself lost in these criteria sometimes, not able of reaching a diagnosis when I meet some patients (patients?)..

Before some days a man came having all the criteria to diagnose him with a major depressive disorder which include in the criteria, feeling of worthlessness and inadequacy..

But he also noted that he WILL be the Iraq presedent!! He says that he must and he will be the Iraq presedent and that he made a plan for that but waiting for the appropriate time to put his plan into action…

I asked him about the plan he answered with a smile that it is too complex to be told….and that he did not tell anybody about it till he met me…(he told me about that plan after an hour of conversation and after I encouraged him to speak)…

At that point I started to search for other symptoms and signs of mania, but I failed, I was thinking of Bipolar disorder (manic-depressive disorder) mixed episode…but there was no other criteria of mania but this grandious delusion…(was it an overvalued idea?)…

He got family history of bipolar I disorder in 2 of his aunts… so the diagnosis ended as bipolar disorder mixed episode..

That evening I met a colleague of mine and told him about the case he smiled and stand up and asked me: what would Freud call his believe that he will be Iraq presedent?

I did not know…

My friend continued: he would call it a manic defense…sami….it is a manic defense…

A manic defense is when you feel grandiose due to your more deep feeling of worthlessness and inadequacy….