Monday, January 15, 2007


Over the years it has occurred to me that one of the principal not-quite-conscious reasons I decided to specialize in psychiatry was my attempt to understand and cope with the chaos and unhappiness that many people experience when they are young.

What fascinated me about psychiatry and psychology were the many ingenious ways that people (myself included) attempted to restructure reality and truth to make the world around them a more comfortable and less threatening place. That this was a basic survival strategy for some people seemed very obvious to me.

This is why I have always been particularly interested in psychological defenses, both the mature and immature varieties.

In Narcissism and Society, I discussed the normal and pathological development of the Self, and how defects in narcissism have a profound impact on the both the individual and society.

This essay begins with a somewhat related topic: the EGO and its relationship to the SELF and to interpersonal relationships. It is important to understand these relationships if you hope to understand why some individuals and groups routinely use immature psychological defenses, instead of the mature variety. The former are, at best, only temporarily successful against the onslaught of a relentless reality, and thus are only used by very young children or by adults whose sense of self is so threatened that they revert to earlier and more primitive coping strategies.

Often the concept of the SELF is confused with that of the EGO, but the two are significantly different--in much the same way that the body differs from a particular organ system.

The SELF is able to experience subjective thoughts, feelings and physical sensations. It is represented in the mind in the same way that a person's significant others are represented.

In contrast, the EGO can be thought of as a dispassionate, organizing mental apparatus (sort of like how the immune system is conceptualized as an organizing “anti-infection” apparatus). The EGO is a system of the SELF that deals with external and internal reality. It is merely an abstraction and does not have a physical reality ; and it is concerned with the adaptation of the SELF and coping with the world. As such, the EGO integrates central nervous system functioning for the SELF, and is automatically deployed to cope with stress (much the same way that the immune system is automatically deployed to combat infection).

The EGO's job is to deal with stress for the SELF and it does this through the use of unconscious, involuntary psychological processes which are referred to as "defense" mechanisms". These psychological defenses seek to obscure or distort reality in order to protect the SELF from psychological trauma; and it is able to achieve this by altering the individual’s thoughts, feelings and behaviors in order to keep the offending or threatening reality at bay.

Psychological defenses may be difficult to detect by the user unless conscious thought and emotional honesty are applied to the problem; but they are often fairly obvious to a disinterested observer who can clearly see the distortion of reality that is being displayed. Sometimes the observer may be truly flabbergasted by the degree to which an individual is able to deceive him or herself.

One example of this self deception is the extremely paranoid and bizarre individual with complicated and convoluted conspiracy theories that explain some aspect of his or her life that is intolerable. You might think the fear induced by the paranoia would be counterproductive, but the individual's ego has weighed the balance and found the paranoia is far preferable to the aspect of the person's life being avoided. In fact, the very existence of the paranoia itself may be gratifying--imagine how important a person would have to be to have the CIA in hot pursuit; or to have super powerful aliens from another planet singling them out for special treatment.

I have witnessed this type of paranoia many times in my career. Paranoia (and it's little brother psychological projection) become bizarre and completely out of touch with the real world (say what you will, the CIA is at least a real entity as opposed to aliens who put secret bugging devices in your brain to listen to your thoughts!), when an individual’s brain physiology is abnormal (either because of genetics, toxins, infection, etc.). In such a case, the EGO must rely on a defective brain to deploy its defenses.

Yet, there are people considered perfectly normal who firmly believe that the Protocols of the Elders of Zion is a blueprint for an International Jewish Conspiracy to take over the world. In fact, there are large populations and nations that believe this as a matter of national policy. This kind of projection and paranoia on a large scale is an extremely interesting phenomenon and will be discussed later.

Psychological defense mechanisms are important because they help people to deal with--and defend against--otherwise unacceptable internal and external thoughts, feelings, and behaviors. In other words, they are psychological strategies to preserve the SELF. These defenses can be observed being used by groups of individual and even nations. Group factors (such as group identity and cohesiveness) can encourage the development of certain defenses--especially the immature/primitive ones which are incredibly infectious--and lead to groups of individuals and even entire nations or religions adopting paranoia or projection or denial in order to cope with an unacceptable reality that threatens the group image. We see this group phenomenon clinically in "Folie a deux" or in mass hysteria, for example.

In a previous post on psychological defenses , I wrote:
A healthy person will use many different defenses throughout life. A defense mechanism becomes pathological when it is used persistently 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 me make one thing perfectly clear: everyone uses defense mechanisms. We can no more prevent their use by the EGO to respond to a psychological threat, than we can prevent our immune system from responding to a physiological threat. A perfect example that almost everyone can relate to is the natural response people have when they hear some really painful news—such as the death of a loved one. “NO!” is the involuntary response. “It’s not true!”

This is DENIAL, and its purpose in this situation is to give an individual time to come to grips with a terrible, painful reality. As an initial response, it is completely normal. But, if six months go by and the person still refuses to believe that their loved one is dead and behaves as if that loved one is still alive; then it becomes pathological.

An individual’s level of development; the depth and breadth of his interpersonal relationships, and the intensity of the perceived threat both combine to determine which psychological defense the EGO might deploy in a given situation. A child, for example, does not generally have either the life experiences or the internal wisdom to use one of the more mature defenses in a traumatic situation. But as life is lived and mild, moderate and severe trauma is survived; as the individual learns from his or her mistakes and gains mastery over the world; then the EGO has more options (i.e., more possible defense mechanisms available—from the most immature to the most mature) that can be utilized.

As a child matures, he or she also must deal with the quite natural pain and trauma associated with all interpersonal relationships. Even the most loving relationship can have tremendous pain associated with it, particularly when it is abruptly taken away due to the inevitability of separation and death. The child not only must learn to cope with physical trauma, but must learn to cope with this type of inevitable emotional trauma, also. Those whom he loves must be taken in psychologically and incorporated--both the bad and the good parts-- and fully digested into his own self. Thus, does a person learn to accept that those they love and tend to idealize are not perfect and are "good enough." Such fully digested individuals are never completely lost when death or separation happens, and the pain is mitigated so that the grieving process ultimately leads to a person's individual growth, rather than threatening his very sense of self.

The loss of someone who has not been fully psychologically digested and processed (i.e., someone who is loved but whose bad qualities are so overwhelming that full digestion is difficult, if not impossible) can thus lead to so much internal conflict and misery that the grieving person's life and maturation may be severely impeded from going forward.

By the time adulthood is reached, psychological maturity requires that a modicum of self-awareness, self-reflection and insight have been achieved; and that the individual is aware of their own vulnerabilities and biases--which might impair an optimal response to reality.

There can be profound consequences for the individual-–up to and including even death—-if reality is denied or distorted; so this is a powerful motivator to acknowledge it as it really is. when it is denied or distorted by religious beliefs or dogma, it is an incredibly powerful motivation--but that is the topic of another post). We are all aware, however, of those individuals whose unwillingness to deal with reality surpasses even the basic survival instinct. The suicide bomber who expects to be rewarded with 72 virgins comes to mind; so does the alcoholic who insists his reflexes are fine as he gets into his car intoxicated. Both not only are willing to sacrifice themselves, but also others for their delusion.

A question that comes up all the time is, "Why do grown people use immature defenses?"

In reality, people vary considerably on the degree of psychological maturity that is reached even after physical maturity. In order to answer the question we must first understand how and why people use psychological defenses to begin with.


These days we hear a lot about "coping with stress"; and about how "stress" is behind all sorts of medical and psychological problems. Of course, what is really meant by this is that there are many situations in life--some of the common and some not so--that we must respond to in order to live our lives. Stress can be understood as a frustrated "fight or flight" response.

Our bodies, which have not changed much since the days of the caveman, are hardwired to respond to danger in certain ways. Either we gird our loins and fight (Republicans?); or we take flight and run away (Democrats?). These two strategies covered pretty much everything for our ancient ancestors had to deal with to survive, and they lived or died depending on how effectively these strategies were utilized.

In our modern world, it is no longer appropriate or even civilized--most of the time and in most situations--to do either. Imagine if you will, the office worker called on the carpet by the boss, who reacts to this threat to his livelihood by punching the boss; or by running screaming from the boss's office. Neither response would be considered very stable.

We hear on the news fairly frequently of such occurrences; e.g., the postal worker who comes in and shoots his superior, and--as long as he's at it--a few coworkers he holds grudges against.

The point is, that our body's hardware is designed to respond to perceived danger in this way, whether we like it or not. Of course, the boss yelling at us is not the same degree of danger our ancestors used to deal with, but our bodies aren't able to tell the difference and our physiological repertoire is limited. Hence, as we became civilized and our interactions with others and with our environment became more complex, the normal physiological responses of our bodies to danger remained the same, but the behavioral expectations -- i.e., how we acted on the physiological imperative -- changed significantly.

And so, the concept of "stress" was born. We can't often fight; and we can't often run away; and when we do, significant problems can arise for us and for society. Our bodies still physiologically respond, but the usual behaviors that discharge the built-up toxins and return us to physiological normality are gone. Psychologically and physiologically, this tends to take a toll on our bodies; either as physical or emotional problems.

Most people are aware when they are experiencing stress and the physical and emotional discomfort can be a powerful reason to change whatever behavior is causing the sensation. Stress can also be a source of extra energy (for example in sports; or exercise of any kind, which are socially acceptable ways to manage stress) if the physical and emotional aspects of it can be converted to a less destructive form. This is where the concept of psychological defense mechanisms comes in.

From George Vaillant’s The Wisdom of the Ego: Sources of Resilience in Adult Life:
The "right stuff" epitomized by the famous American test pilot Chuck Yeager was
not just a function of willpower, stress management, and skillful flight instruction. Many of us could never tolerate becoming pilots, and many pilots could not tolerate becoming test pilots. Even test pilots marveled at Yeager's reflex "cool." For had Yeager paid full attention to his inner and outer reality, he too would have been afraid. But had he ignored such reality for even a moment, he would have died. The wisdom of his ego lay in creating an optimal balance between self deception and accurate appreciation of inner and outer reality. In the language of every day such a delicate balance is called coping, but it is coping of a very special kind.

Before we turn to the defense mechanisms, it is important to realize that there are other ways (i.e., non-psychological ways) of coping with stress. The first are the myriad of cognitive and conscious coping strategies that are available to us. The office worker yelled at by the boss can decide consciously that he will correct whatever it is that is upsetting the boss. He can deliberately and consciously decide to look for another job, if he thinks the boss is being unreasonable. He can decide to go back to school and obtain the skills necessary to be promoted to somewhere else in the company; or to another job inside or out of the company. He can consciously place "work" lower on his priorities. He can read books on how to deal with difficult bosses. As you can see, there are many cognitive and conscious options or choices open to him. All of the strategies above can be effective in the right situations.

But let us say that our worker--let us call him Mr. Smith--lacks the resources to go to school; or that he cannot afford to lose his job; or doubts he could find a better one. Well, in that case, Mr. Smith can use a second powerful way to cope with the stress in his life: he can use his social support network. He can go home and complain to his wife. He can complain and bitch about his situation with his buddies. He can spend more time with his children. He can submerse himself in his friendships and clubs. In short, he can find support and empathy from the interpersonal relationships he has surrounded himself with. (This is why married people in general are reported happier, and tend to live longer).

But, what if Mr. Smith doesn't have many friends; doesn't have a wife or much of a social life at all. Well, if both the cognitive and social strategies of coping with stress are not used, then there is a third way, and that way is using involuntary, unconscious psychological strategies to cope.


Vaillant 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 don't have 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 hot and bothered.
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 gentle 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, bringing no pleasure)

Each one of the above defense mechanisms (except for 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 against all "father" figures in a person's life 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 less mature 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, our perception of it 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 and interacting with other people are not pain or stress-free. Frequently the pain involved in interpersonal relationships can be the impetus that helps us learn to psychologically assimilate (as in digest) others, a process that is integral to healthy 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.)

Basically, the elusive process of psychological maturation requires the capacity to sustain and tolerate paradox, or ambiguity.

In Part II, I will show how the mature psychological defenses--humor, anticipation, suppression, sublimation and altruism--do exactly that: help the individual achieve a reconciliation with the painful ambiguities and paradoxes of his life by maintaining "a creative and flexible tension between irreconcilables" and by allowing "conscience, impulse, reality, and attachment all to have places at center stage."

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