Defense mechanisms: Defense mechanisms are coping strategies the ego uses to manage internal conflict and stressful situations. They operate unconsciously. The following types are seen:
Projection: Attributing (projecting) your own thoughts or feelings onto someone else.
e.g. an adulterous man accuses his wife of adultery, without there being any evidence of it.
Denial: Refusing to accept reality because it feels too difficult to face.
e.g. not accepting a terminal diagnosis like advanced cancer.
Splitting: Seeing people or situations in extremes (all good or all bad).
e.g. a patient says that the nurses are very bad while the doctors are very good.
Blocking: A temporary inability to remember something.
e.g. a student is not able to recall an answer although they can remember it at some other time.
Regression: Returning to an earlier stage of development.
e.g. a 12 year old starts bedwetting, without a prior history of doing so.
Somatization: Emotional distress is expressed as physical (somatic) symptoms.
e.g. abdominal pain when stressed or headache during an exam.
Displacement: Redirecting an emotion from its original target to a safer or more acceptable one.
e.g. banging on the door when upset at a person, or an attending yells at a nurse when a patient upsets him.
Repression: Unconsciously pushing an unpleasant feeling, idea, or memory out of awareness.
e.g. an adult who was abused as a child has no memory of it.
Isolation of affect: Separating an event or idea from the expected emotional response.
e.g. a father identifies his son’s dead body and shows no emotions.
Intellectualization: Using facts and logic to avoid emotional distress.
e.g. a physician explains his mother's cancer diagnosis with great detail of the sensitivity and specificity of a test used for diagnosis or about the pathogenesis of cancers, without being evidently affected by it.
e.g. an insecure teen starts abusing drugs to feel better about themselves or a sad child throws temper tantrums.
e.g. a mother who bears an unwanted child becomes overprotective of the child to convince herself that she is a good mother.
e.g. saying you will complete the work in 2 days and then deliberately wasting your time so that the work cannot be completed on time.
e.g. seen in daydreaming, zoning out, or an accident survivor feels as if she was watching it from afar.
e.g. a soldier who works for a dictator starts behaving cruel to his subordinates.
e.g. giving excuses, or a woman justifies having oral sex with a married man by saying that it is not actual or conventional sex.
e.g. a teenager idolizes a rockstar even though he is a known drug addict.
Humor, sublimation, suppression and defensive altruism are the mature defense mechanisms.
Humor: Expressing thoughts or feelings in a way that reduces discomfort, often through jokes.
e.g. a man smiles when he loses his job.
Sublimation: Channeling an unacceptable impulse into a socially acceptable activity.
e.g. an aggressive man starts playing ice hockey.
Suppression: Consciously choosing to set aside a painful or unpleasant thought or feeling.
e.g. a wife may be upset at her husband but she decides to suppress her feelings in front of guests.
Defensive altruism: Helping others with the unconscious motivation of reducing your own distress or improving how you feel about yourself.
e.g. a previously anti-immigrant lawyer sets up a charity to help immigrants.
Transference and countertransference: This refers to the unconscious transfer of feelings and attitudes from one person or situation to another. These reactions often arise from unresolved or unsatisfactory childhood relationships with parents and other authority figures.
Transference is when the patient projects feelings onto the physician/nurse etc.
e.g. an old female physician reminds a teenager of his strict mother, invoking feelings of resentment due to which he fails to follow her advice or adhere to therapy.
Transference can also be positive.
e.g. if the physician reminds the patient of an authority figure in his life that he likes, then he is more likely to follow the physician’s advice.
Countertransference is when the healthcare provider/physician/nurse etc projects their feelings onto the patient.
e.g. if the female physician in the example above sees her defiant teenage son in the patient, and she responds by being stern with him, then that is countertransference.
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