Psychiatric Defence Mechanisms

A defence mechanism is an unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli…

Psychiatrist George Eman Vaillant introduced a four-level classification of defence mechanisms:

• Level I – pathological defences (psychotic denial, delusional projection)
• Level II – immature defences (fantasy, projection, passive aggression, acting out)
• Level III – neurotic defences (intellectualization, reaction formation, dissociation, displacement, repression)
• Level IV – mature defences (humour, sublimation, suppression, altruism, anticipation)

Level 1: "Psychotic"

When predominant, the mechanisms on this level are almost always severely pathological. These six defences, in conjunction, permit one effectively to rearrange external experiences to eliminate the need to cope with reality. Pathological users of these mechanisms frequently appear irrational or insane to others. These are the "psychotic" defences, common in overt psychosis. However, they are normally found in dreams and throughout childhood as well. They include:

• Delusional projection: Delusions about external reality, usually of a persecutory nature.
• Denial: Refusal to accept external reality because it is too threatening; arguing against an anxiety-provoking stimulus by stating it doesn't exist; resolution of emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality.
• Distortion: A gross reshaping of external reality to meet internal needs.

Level 2: Immature

These mechanisms are often present in adults. These mechanisms lessen distress and anxiety produced by threatening people or by an uncomfortable reality. Excessive use of such defences is seen as socially undesirable, in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature" defences and overuse almost always leads to serious problems in a person's ability to cope effectively. These defences are often seen in major depression and personality disorders. They include:

• Acting out: Direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives the expressive behavior.
• Hypochondriasis: An excessive preoccupation or worry about having a serious illness.
• Passive-aggressive behavior: Indirect expression of hostility
• Projection: A primitive form of paranoia. Projection reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming consciously aware of them; attributing one's own unacknowledged, unacceptable, or unwanted thoughts and emotions to another; includes severe prejudice and jealousy, hypervigilance to external danger, and "injustice collecting", all with the aim of shifting one's unacceptable thoughts, feelings and impulses onto someone else, such that those same thoughts, feelings, beliefs and motivations are perceived as being possessed by the other.
• Schizoid fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts.

Level 3: Neurotic

These mechanisms are considered neurotic, but fairly common in adults. Such defences have short-term advantages in coping, but can often cause long-term problems in relationships, work and in enjoying life when used as one's primary style of coping with the world. They include:

• Displacement: defence mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet; 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. For example, a parent may yell at their child because they are angry with their spouse.
• Dissociation: Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that normally would accompany a situation or thought.
• Intellectualization: A form of isolation; concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions; separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable emotions by focusing on the intellectual aspects (isolation, rationalization, ritual, undoing, compensation, and magical thinking).
• Reaction formation: Converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites; behaviour that is completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety.
• Repression: The process of attempting to repel desires towards pleasurable instincts, caused by a threat of suffering if the desire is satisfied; the desire is moved to the unconscious in the attempt to prevent it from entering consciousness; seemingly unexplainable naivety, memory lapse or lack of awareness of one's own situation and condition; the emotion is conscious, but the idea behind it is absent.

Level 4: Mature

These are commonly found among emotionally healthy adults and are considered mature, even though many have their origins in an immature stage of development. They have been adapted through the years in order to optimise success in human society and relationships. The use of these defences enhances pleasure and feelings of control. These defences help to integrate conflicting emotions and thoughts, whilst still remaining effective. Those who use these mechanisms are usually considered virtuous. Mature defences include:

• Altruism: Constructive service to others that brings pleasure and personal satisfaction.
• Anticipation: Realistic planning for future discomfort.
• Humour: Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about directly) that gives pleasure to others. The thoughts retain a portion of their innate distress, but they are "skirted around" by witticism, for example self-deprecation.
• Sublimation: Transformation of unhelpful emotions or instincts into healthy actions, behaviours, or emotions, for example, playing a heavy contact sport such as football or rugby can transform aggression into a game.
• Suppression: The conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality; making it possible later to access uncomfortable or distressing emotions whilst accepting them.

Other Defence Mechanisms

Pathological

• Conversion: The expression of an intrapsychic conflict as a physical symptom; some examples include blindness, deafness, paralysis, or numbness. This phenomenon is sometimes called hysteria.
• Splitting: A primitive defence. Both harmful and helpful impulses are split off and unintegrated, frequently projected onto someone else. The defended individual segregates experiences into all-good and all-bad categories, with no room for ambiguity and ambivalence. When "splitting" is combined with "projecting", the undesirable qualities that one unconsciously perceives oneself as possessing, one consciously attributes to another.

Immature

• Idealization: Tending to perceive another individual as having more desirable qualities than he or she may actually have.
• Introjection: Identifying with some idea or object so deeply that it becomes a part of that person. For example, introjection occurs when we take on attributes of other people who seem better able to cope with the situation than we do.
• Passive aggression: Aggression towards others expressed indirectly or passively, often through procrastination.
• Projective identification: The object of projection invokes in that person a version of the thoughts, feelings or behaviours projected.
• Somatization: The transformation of uncomfortable feelings towards others into uncomfortable feelings toward oneself: pain, illness, and anxiety.
• Wishful thinking: Making decisions according to what might be pleasing to imagine instead of by appealing to evidence, rationality, or reality.

Neurotic

• Isolation: Separation of feelings from ideas and events, for example, describing a murder with graphic details with no emotional response.
• Rationalization (making excuses): Convincing oneself that no wrong has been done and that all is or was all right through faulty and false reasoning. An indicator of this defence mechanism can be seen socially as the formulation of convenient excuses.
• Regression: Temporary reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way, for example, using whining as a method of communicating despite already having acquired the ability to speak with an appropriate level of maturity.
• Undoing: A person tries to 'undo' an unhealthy, destructive or otherwise threatening thought by acting out the reverse of the unacceptable. Involves symbolically nullifying an unacceptable or guilt provoking thought, idea, or feeling by confession or atonement.
• Upward and downward social comparisons: A defensive tendency that is used as a means of self-evaluation. Individuals will look to another individual or comparison group who are considered to be worse off in order to dissociate themselves from perceived similarities and to make themselves feel better about themselves or their personal situation.
• Withdrawal: Withdrawal is a more severe form of defence. It entails removing oneself from events, stimuli, and interactions under the threat of being reminded of painful thoughts and feelings.

Mature

• Acceptance: A person's assent to the reality of a situation, recognizing a process or condition (often a difficult or uncomfortable situation) without attempting to change it, protest, or exit. Religions and psychological treatments often suggest the path of acceptance when a situation is both disliked and unchangeable, or when change may be possible only at great cost or risk.
• Courage: The mental ability and willingness to confront conflicts, fear, pain, danger, uncertainty, despair, obstacles, vicissitudes or intimidation. Physical courage often extends lives, while moral courage preserves the ideals of justice and fairness.
• Emotional self-regulation: The ability to respond to the ongoing demands of experience with the range of emotions in a manner that is socially tolerable. Emotional self-regulation refers to the processes people use to modify the type, intensity, duration, or expression of various emotions.
• Emotional self-sufficiency: Not being dependent on the validation (approval or disapproval) of others.
• Forgiveness: Cessation of resentment, indignation or anger as a result of a perceived offence, disagreement, or mistake, or ceasing to demand retribution or restitution.
• Gratitude: A feeling of thankfulness or appreciation involving appreciation of a wide range of people and events. Gratitude is likely to bring higher levels of happiness, and lower levels of depression and stress. Throughout history, gratitude has been given a central position in religious and philosophical theories.
• Humility: A mechanism by which a person, considering their own defects, has a humble self-opinion. Humility is intelligent self-respect which keeps one from thinking too highly or too meanly of oneself.
• Identification: The unconscious modelling of one's self upon another person's character and behaviour.
• Mercy: Compassionate behavior on the part of those in power.
• Mindfulness: Adopting an orientation (characterized by curiosity, openness, and acceptance) toward one's experiences in the present moment.
• Moderation: The process of eliminating or lessening extremes and staying within reasonable limits. It necessitates self-restraint which is imposed by oneself on one's own feelings, desires etc.
• Patience: Enduring difficult circumstances (delay, provocation, criticism, attack etc.) for some time before responding negatively.
• Respect: Willingness to show consideration or appreciation. Respect can be a specific feeling of regard for the actual qualities of a person or feeling being and also specific actions and conduct representative of that esteem. Relationships and contacts that are built without the presence of respect are seldom long term or sustainable. The lack of respect is at the very heart of most conflict in families, communities, and nations.
• Tolerance: The practice of deliberately allowing or permitting a thing of which one disapproves.

https://en.wikipedia.org/wiki/Defence_mechanisms