Vaillant classified defence mechanisms into four hierarchical levels. Match: 'Altruism' and 'humour' belong to which level, and 'denial' belongs to which level?
- A Altruism and humour — mature defences; denial — narcissistic/psychotic defence
- B Altruism and humour — mature defences; denial — immature defence (in non-psychotic context) or psychotic (in psychotic denial of external reality) ✓
- C Altruism and humour — neurotic defences; denial — immature defence
- D Altruism and humour — immature defences; denial — mature defence
Explanation
Vaillant's hierarchy: Level I (psychotic/narcissistic): delusional projection, psychotic denial, distortion; Level II (immature): acting out, passive aggression, projection, fantasy, somatisation; Level III (neurotic): displacement, intellectualisation, repression, reaction formation, isolation of affect, rationalisation; Level IV (mature): altruism, anticipation, humour, sublimation, suppression. Denial is context-dependent — psychotic denial (denying an objectively verifiable reality like a terminal diagnosis when delusional) is Level I; non-psychotic denial (e.g., brief denial of grief) is Level II. Altruism and humour are Level IV mature defences — they transform unacceptable impulses into socially adaptive and even creative behaviours.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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