Growing
up, parents always keep reminding their children to take care of their well
being by practicing healthy habits and avoiding detrimental ones with the focus
usually on physical health. But health goes beyond the physical aspect of the
person, to be well also means having a good mental health. When an individual
has mental health concerns, the field of psychiatry comes into the picture.
Geddes defines psychiatry as the branch of medicine that specializes in the
treatment of brain disorders which primarily cause disturbance of thought, behavior and emotion (3).
Clients who have such problems are called psychiatric patients.
In
dealing with psychiatric patients health care providers who directly interact
with patients will find that knowledge about defense mechanisms can come in
handy. According to Levenson, a basic understanding of defense mechanisms can
provide the psychiatrist with another perspective in the process of examining a
patient, it will aid in predicting or explaining the patient’s emotional or
behavioral response to medical illness (56). Among nurses, familiarization of
defense mechanisms helps in the provision of care as they establish therapeutic
relationships with patients. Defense mechanisms which may be also known as
coping styles are the automatic psychological processes protecting the
individual against anxiety and from the awareness of internal and external
dangers or stressors (Boyd 144). Since defense mechanisms are automatic
responses, individuals are often unaware that they are using certain defense
mechanisms already. Defense mechanisms may be adaptive or maladaptive and
psychiatric patients use such processes excessively to a point that it becomes
invariably maladaptive and becomes a problem. There are a number of defense mechanisms
that a patient may use and one, two or more at a time which may differ
depending on the situation and level of stress that they encounter. Some
examples of common defense mechanisms include denial, suppression, repression,
displacement, rationalization and reaction formation among others. Vaillant
grouped defense mechanisms according to the degree to which each defense
distorts reality and how effectively it enables the expression of wishes or
needs without untoward external consequences in his hierarchy of defense
mechanisms (qtd. in Levenson 56).
In the proposed hierarchy by Vaillant, there are four levels of adaptivity namely psychotic, immature, neurotic and mature. Psychotic defenses are characterized by their extreme degree of distorting reality wherein patients may need to take in psychotic medications to alter such defenses. Psychotic defenses include psychotic denial, delusional projection and schizoid fantasy. Immature defenses may be irritating and are often observed in patients with personality disorders. The immature defenses include the following: splitting, idealization, devaluation, projection, projective identification, acting-out, passive aggression and intermediate denial. Neurotic defenses are privately experienced or less interpersonal which often involve mental inhibitions. The list of neurotic defenses includes repression, control, displacement, reaction formation, intellectualization, rationalization, isolation of affect, and undoing. Mature defenses when observed in patients are appreciated by health care providers; it enables the individual to express himself/herself without negative consequences. Mature defenses include suppression, altruism, humor, sublimation, and anticipation. Each kind of defense has its own unique qualities that distinguish them from each other. For the psychiatrists or nurses to detect what defense mechanisms the patients are using they need to interact with their patients and observe keenly so that they may employ the appropriate interventions needed.
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In the proposed hierarchy by Vaillant, there are four levels of adaptivity namely psychotic, immature, neurotic and mature. Psychotic defenses are characterized by their extreme degree of distorting reality wherein patients may need to take in psychotic medications to alter such defenses. Psychotic defenses include psychotic denial, delusional projection and schizoid fantasy. Immature defenses may be irritating and are often observed in patients with personality disorders. The immature defenses include the following: splitting, idealization, devaluation, projection, projective identification, acting-out, passive aggression and intermediate denial. Neurotic defenses are privately experienced or less interpersonal which often involve mental inhibitions. The list of neurotic defenses includes repression, control, displacement, reaction formation, intellectualization, rationalization, isolation of affect, and undoing. Mature defenses when observed in patients are appreciated by health care providers; it enables the individual to express himself/herself without negative consequences. Mature defenses include suppression, altruism, humor, sublimation, and anticipation. Each kind of defense has its own unique qualities that distinguish them from each other. For the psychiatrists or nurses to detect what defense mechanisms the patients are using they need to interact with their patients and observe keenly so that they may employ the appropriate interventions needed.
Although
the use of defense mechanisms is highlighted in psychiatry, it does not mean
that only psychiatric patients use them. Even mentally healthy people use
defense mechanisms from time to time when anxious or under stress. But the difference lies in the severity and
the context where defense mechanisms are used. Knowing what defense mechanisms
certain psychiatric patients employ with the context in mind, helps health care
providers in psychiatric institutions or in communities manage their patients
appropriately and promote their well being.
Boyd, Mary Ann. Psychiatric
Nursing: Contemporary Practice, 4th edition. Philadelphia,Pa.: Wolters
Kluwer/Lippincott Williams & Wilkins, 2008.
Geddes, John, et al. Psychiatry, 4th edition. Oxford;New York: Oxford University Press,
2012.
Levenson, James L. The American Psychiatric Publishing Textbook of Psychosomatic
medicine: Psychiatric Care of the Medically
Ill, 2nd edition. Washington, D.C:
American
Psychiatric Pub., 2011.
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