Thursday, August 31, 2006


I'm going to be extremely busy most of the day with patients and teaching; so I thought I'd share some of what I have lined up for my students: How Psychological Defense Mechanisms work.

George Vaillant in The Wisdom of the Ego summarizes the different ways that defense mechanisms might disguise an internal conflict. I will paraphrase his example:

Let us suppose that the underlying conflict (expressed as a conscious idea, feeling or behavior) is, "I hate my father." The following examples are how that specific feeling might be altered when different defense mechanisms are used by the person experiencing it:

DEFENSE / Conscious Representation of thoughts, feelings or behaviors

No defense - I hate my father

Psychotic Defenses
Denial - I was born without a father.

Immature Defenses
Projection - My father hates me.
Passive Aggression - I hate myself (or, a suicide attempt).
Acting Out - Gets into fights with authority figures
Fantasy - Daydreams about killing giants or monsters

Neurotic (Intermediate) Defenses
Dissociation - I tell my father jokes.
Displacement - I hate my father's dog.
Intellectualization - I disapprove of my father's behavior.
Repression - I don't know why I feel so upset and angry.
Reaction Formation - I love my father; or, I hate my father's enemies .

Mature Defenses
Suppression - I am angry at my father, but I won't tell him.
Sublimation - I beat my father at tennis.
Altruism - I comfort father-haters
Humor - I make fun of fathers with jokes that make others laugh!
(note that not all humor is mature, but when used appropriately it is one of the most effective coping skills. Sadistic humor, for example arises from projection and is immature)

Each one of the above defense mechanisms (except the "mature" ones) can, under the right circumstances, be taken to pathological extremes and result in a psychiatrically diagnosable condition.

For example, the use of projection ("My father hates me") if used persistently as a coping mechanism can lead to a paranoid personality disorder. Or, use of the passive aggression defense (I hate myself) can lead to dysthymia or depression. Repression might lead to an anxiety disorder.

There is a clinical correlate for each of the defenses listed above, and the expression of that clinical disorder is dependent on a variety of factors such as the age/developmental stage of the user; the genetic, biological or physiological vulnerabilities of the user; the environment of the user, etc.

Valliant observes:
It is noteworthy that the denials and self-deceptions that result from the deployment of mature defenses result in no diagnosis--not everyone who practices self-deception appears ill to others. The oyster, after all, deals with the irritation of a grain of sand by creating a pearl.

Many people seem to think that ALL stress is bad for you and must be eliminated from your life. But this position fails to understand the importance and necessity of stress in our lives.

Where once our stress response existed merely to protect us from extreme danger (and still does); today it is a key biological element that can promote and and encourage psychological growth and development and help us to learn mastery over ourselves and our environment.

So this is the good thing about stress. Stress and our response to it can help us to mature and expand our capabilities. Without stress, there is little motivation to change or improve either ourselves or our environment. Too little stress and we stagnate. Too much, and we are at risk of falling apart. But just the right amount of irritation can encourage us to create a pearl!

Perhaps the greatest stress an individual can feel comes when they must deal with the loss of a loved one. Sadly, such an occurrence is inevitable in the course of life, and how each person deals with the losses he or she experiences has a significant impact on the psychological defense mechanisms they will use.

Love--in fact, most interactions with other people--are not pain free. Frequently the pain involved in interpersonal relationships can be the impetus that helps us to psychologically assimilate others, a process integral to human development.

Vaillant again:
We, too, sometimes forget that, contrary to folklore and psychiatric myth, loss in itself does not cause psychopathology. We forget that healthy grief hurts but does not make us ill. Grief produces tears, not patienthood. It is never having anyone at all to love that cripples us. It is the inconstant people who stay in our lives who drive us mad, not the constant ones who die. It is failure to internalize those whom we have loved, not their loss, that impedes adult development.(emphasis mine)

I say this over and over, but it bears repeating: psychological defense mechanisms (which include some relatively primitive psychological responses like projection - the mechanism involved in most forms of racism, for example) are not diagnoses.

You might think of the immature and dysfunctional ones as a psychological process utilized by the self/psyche that is parallel to the physical experience of a fever.

A mild fever suggests that the body is coping with an intrusion into its physical defenses. Most often the fever itself becomes self-correcting, setting off a series of defensive actions that lead to a return to normal functioning. If the fever persists and becomes too high, it becomes a red flag that something serious might be going on and the underlying cause needs to be found.

It is likewise when the ego deploys a psychological defense (especially one that persists despite reality; or one that is severely dysfunctional and causes great problems in the person's life). We do not say that "fever" is a diagnosis. It is a symptom that, particularly when it persists, makes us take action.

It is important to remember that psychological defenses are, for the most part, unconsciously deployed--i.e., people don't say, "Oh, I feel threatened, I think I will displace my fear about what is threatening me onto someone I'm not really afraid of." Their self, in a creative attempt at protecting the individual from feeling a paralyzing fear, automatically does it for them as a temporary strategy to deal with the frightening situation. It is up to every individual to monitor his or her reactions to life and use the conscious mind to find successful, long-term, non-pathological strategies to cope.

A defense mechanism is a symptom that suggests our psychological self is trying to cope with a disturbing reality. If an individual has insight and self-awareness (the ability to objectively observe and be conscious of one's own thoughts, feelings, and behaviors and their meaning), then the defense mechanism can become a valuable tool with which to understand one's own fears and prejudices - just as a fever becomes the red flag that leads us to look for an underlying problem.

As I said in an earlier post:
We may not be able to help which defenses our egos deploy in every situation. Sometimes, when reality is threatening enough or our conflicts are intense enough, even the most mature individual may find him or herself using the more immature defenses like denial and projection. What matters is that we make a practice of examining our own behavior and appreciating the underlying issues and motivations that drive it. Or to put it another way, we reflect on those subtle factors that may be controlling our behavior outside our completely conscious awareness (and therefore our control) and make them fully conscious. This is called developing insight and self-awareness. It is probably the equivalent of the "holy grail" in psychiatric practice, and we psychiatrists are forever encouraging our patients to go on such quests of self-discovery.

By making the unconscious conscious, we gain control over our lives and are able to make choices and attack problems based on a clear view of reality. Yes, we may make the wrong choice, or screw up in dealing with the problem even so; we may even discover some unpleasant truths about ourself. But when our psychological defenses are distorting or obscuring reality to begin with, we are far more likely to ignore a problem or pretend that it doesn't exist and then suffer even more serious consequences.

Maladaptive psychological defenses that bring ourselves and others a great deal of unhappiness and misery, can evolve into mature and adaptive responses to the world that both enhance and protect our lives. Human beings are remarkable creatures. Sometimes their capacity for self-deception and delusion seems unlimited; and sometimes their incredible creativity and ingenuity in coping with all the trials and travails that life throws at them is worthy of appreciation and even awe.

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