Psychiatry 101- Defense Mechanisms

In reading back over my posts, I notice that I talk frequently about "psychological defense mechanisms". I thought it might be a good idea to review that topic--both for my own clarity and to make sure everyone understands what I mean. My own thinking about defense mechanisms has been heavily influenced by two books I read at the beginning of my psychiatric career many years ago: George Vaillant's "Adaptation to Life"; and Anna Freud's "The Ego and Mechanisms of Defense". You will have to forgive me: I am a professor, and I like to lecture-- as if you haven't been able to tell that from reading my posts!

What are psychological defense mechanisms?
They are psychological strategies used individuals (and by extension--groups of indidivuals and even entire nations at times) to cope with reality and to maintain his/her self -image intact.

A healthy person will use many different defenses throughout life. A defense mechanism becomes pathological when it is used persistantly and leads to maladaptive behavior that will eventually threaten the physical and/or mental health of the individual. Having said that, there are psychological defenses that are:
1) almost always pathological - when they prevent the individual from being able to cope with a real threat and obscure his/her ability to perceive reality;
2) immature - used in childhood and adolescence, but mostly abandoned by adulthood, since they lead to socially unacceptable behavior and/or prevent the adult from optimal coping with reality;
3) neurotic - common in everyone, but clearly not optimal for coping with reality since they lead to problems in relationships; work; and problems in enjoying life; and finally,
4) mature defense mechanisms - used by "healthy" adults, they optimize one's ability to have normal relationships; enjoy work, and to take pleasure in life.

Let's look at these different types of defense mechanisms, which as you see above I have listed in a heirarchy from least effective to most effective. The defenses I have selected to discuss are the most typical, and are frequently discussed in the psychiatric and psychological literature.

Level 1 Defense Mechanisms - Almost always pathological; for the user these three defenses permit someone to rearrange external reality (and therefore not have to cope with reality); for the beholder, the users of these mechanisms frequently appear crazy or insane. These are the "psychotic" defenses, common in overt psychosis, in dreams, and throughout childhood. They include:

Denial - a refusal to accept external reality because it is too threatening. There are examples of denial being adaptive (for example, it might be adaptive for a person who is dying to have some denial (EXAMPLE, EXAMPLE )
Distortion - a gross reshaping of external reality to meet internal needs (EXAMPLE, EXAMPLE, EXAMPLE)
Delusional Projection - frank delusions about external reality, usually of a persecutory nature (EXAMPLE, EXAMPLE)

Level 2 Defense Mechanisms are seen frequently in adults and are common in adolescents. For the user these mechanism alter distress and anxiety caused by reality or other people; while for the beholder, people who use such defenses are seen as socially undesirable, immature, difficult and out of touch. They are considered "immature" defenses and almost always lead to serious problems in a person's ability to cope with the world. These defenses are seen in severe depression, personality disorders, and adolescence. They include:

Fantasy - tendency to retreat into fantasy in order to resolve inner and outer conflicts (EXAMPLE)
Projection - attributing one's own unacknowledged feelings to others; includes severe prejudice, severe jealousy, hypervigilance to external danger, and "injustice collecting". (EXAMPLE, EXAMPLE, EXAMPLE, EXAMPLE, EXAMPLE , EXAMPLE (remember that projection is a primitive form of paranoia, so it is common in today's world)
Hypochondriasis - the transformation of negative feelings towards others into negative feelings toward self, pain, illness and anxiety (EXAMPLE)
Passive Agressive Behavior - aggression towards others expressed indirectly or passively (EXAMPLE)
Acting Out Behavior - direct expression of an unconscious wish or impulse to avoid being conscious of the emotion that accompanies it (EXAMPLE, EXAMPLE)

Level 3 Defense Mechanisms are often considered "neurotic" but are fairly common in adults. They can have short-term advantages in coping, but they often cause long-term problems in relationships, work, and enjoyment of life for people who primarily use them as their basic style of coping with the world. They include:

Intellectualization - separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them (EXAMPLE)
Repression - seemingly inexplicable naivete, memory lapse, or lack of awareness of physical status; the emotion is conscious, but the idea behind it is absent (EXAMPLE, EXAMPLE, and, of course, Scarlet "I won't think about that today" O'Hara from Gone With The Wind)
Reaction Formation - behavior that is completely the opposite of what one really wants or feels (e.g, taking care of someone when what one really wants is to be taken care of; studying to be a pilot to cover-up being afraid to fly). Note - this can work in the short term as an effective strategy to cope, but will eventually break down. (EXAMPLE, EXAMPLE)
Displacement - separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening (EXAMPLE, EXAMPLE, EXAMPLE)
Dissociation - temporary and drastic modification of one's personal identity or character to avoid emotional distress (EXAMPLE)

Level 4 Defense Mechanisms are common among most "healthy" adults and are considered the most "mature". Many of them have their origins in the "immature" level, but have been honed by the individual to optimize his/her success in life and relationships. Use of these defenses gives the user pleasure and feelings of mastery. For the user, these defenses help them to integrate many conflicting emotions and thoughts and still be effective; and for the beholder their use by someone is viewed as a virtue. They include:

Sublimation - transformation of negative emotions or instincts into positive actions, behavior, or emotion (EXAMPLE, EXAMPLES, art, sports, hobbies, or even one's choice of profession)
Altruism - constructive service to others that brings pleasure and personal satisfaction (EXAMPLE, EXAMPLE)
Suppression - the conscious decision to delay paying attention to an emotion or need in order to cope with the present reality; able to later access the emotion and accept it. (EXAMPLE)
Anticipation - realistic planning for future discomfort (EXAMPLE)
Humor - overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about) that gives pleasure to others; (humor lets you call a spade a spade, while "wit" is actually a form of displacement) (EXAMPLE, EXAMPLE)

Since all of these defense mechanisms can be used by adults to adapt to life, the question is:
When is a defense mechanism considered really "adaptive" and when is it considered "pathological"? What we call "mental illness" is actually a manifestation of an individual's pathological adaptive resposne to events in his/her life. Here is what makes a defense "pathological":

• the defense is used in a rigid, inflexible, and exclusive manner
• the motivation for using the defense comes more from past needs than present or future reality
• the defense severely distorts the present situation
• use of the defense leads to significant problems in relationships, functioning, and enjoyment of life
• use of the defense impedes or distorts emotions and feelings, instead of rechanneling them effectively

Research has shown (see Adaptation to Life) that use of the "mature defenses" (Level 4) I listed is related to:

1) excellent adjustment as an adult, 2) happiness(by self-report), 3) job satisfaction, 4) rich friendships, 5) fewer hospitalizations over life, 6) better overall health, 7) a lower incidence of mental illness.

Use of the "immature Defenses" (Levels 1, 2, 3) is related to:

1) poor adjustment as an adult; 2) higher divorce rates and marital discord, 3) poor friendship patterns, 4) higher incidence of mental illness, 5) greater number of sick leave days taken, 6) poorer health generally.

You can see from some of the examples of these defenses I have chosen that defense mechanisms are not limited to individuals. Societies also sometimes need to protect their self-images and cope with events in the world. They need to explain why their society is failing; why they are not as important in the world as they feel they should be, etc. etc. Why the ideologies they embrace aren't successful.

Societies, like individuals, can adopt mature defenses and deal with reality; or they can deny reality and look elsewhere for the source of their problems. Many countries, like individuals, prefer to put the blame for their own failures onto an outside source, since that is safer for the self-image. A "healthy" country, like a healthy individual will evaluate the facts and utilize mature defenses to cope with and change the situation they find themselves in. They are not afraid of their aggressive impulses because those impulses are reigned in by reason and not indulged in lightly. When necessary, healthy societies look inward. When necessary, they focus outward.

By the way, if you don't like my examples and claim that they reflect my conservative bias, well too bad. They also reflect the defense mechanisms I describe.