Any behavior or psychological strategies employed (often unconsciously) to protect a person (the real self or 'ego') from discomfort, uncomfortable emotions, anxiety, or tension that may result from unacceptable thoughts or feelings is considered a defense mechanism. Most individuals use defense mechanisms from time to time, but problems may occur when they are used exclusively or in place of healthier coping mechanisms. Therefore, recognition and nursing interventions focused on adaptive coping strategies should be implemented before working to replace the person's usual defense mechanisms. Defense mechanisms are behaviors that an individual uses to deal with stressors. Defense mechanisms can be beneficial and protective for the patient, or they can be counterproductive and maladaptive. Table 2. Defense mechanisms provides an overview of commonly utilized defense mechanisms; a brief discussion of some of these defense mechanisms follows (https://www.ncbi. nlm.nih.gov/books/NBK559106/)
During the evaluative process, the nurse will assess the use of defense mechanisms that may indicate the need for ongoing revision of the plan of care. Consistent evaluation of goals and progress is integral for successful nursing care of the patient with a psychiatric-mental health disorder. Sigmund Freud, the grandfather of psychotherapy, believed that most psychiatric disturbances arise out of childhood experiences and the way human beings respond to their environment, and are based on unconscious drives or motivations (Halter, 2018). Freudian therapy, developed in 1936 and referred to as psychoanalysis, attempts to bring the unconscious into consciousness to allow individuals to work through past issues and develop insight into present behaviors. Although classic psychoanalysis as developed by Freud is rarely used today, Freud’s understanding of anxiety as well as the unconscious mind are significant drivers in understanding the human response with defense mechanisms (Halter, 2018).
Table 2. Defense Mechanisms Defense Mechanism Definition
Example
Repression
Involuntarily forgetting painful events.
A woman who was sexually abused as a child cannot remember that it occurred. An emergency room nurse refuses to think about the child who is dying from injuries sustained in an auto accident. An alcoholic man refuses to believe that he has a problem, in spite of evidence otherwise. A student insists that poor academic advice is the reason he cannot graduate on time. A father analyzes why his son is depressed without expressing any emotions of concern. An adolescent tries to look and dress like his favorite musician to feel stronger and more in control. A child who is yelled at by her parents goes outside and kicks the dog. A jealous man states that his wife is at fault for his abuse of her. A rape victim “goes numb” and feels like she is floating outside of her body. A 7-year-old child starts talking like a baby after the birth of a sibling. A skinny, nonathletic child becomes a chess champion. A man acts homophobic when he secretly believes he is gay. A 12-year-old girl acts like her teacher when the teacher is out of the room. An angry woman joins a martial arts club and takes lessons. A lonely, elderly woman develops vague aches and pains all over. A man who yells at his boss sends her flowers the next day to “make up.”
Suppression
Voluntarily refusing to remember events.
Denial
Refusing to admit certain things to oneself.
Rationalization
Trying to prove one’s actions are justifiable.
Intellectualization
Using logic without feelings.
Identification
Attempting to model one’s self after an admired other. Discharging pent-up feelings (usually anger) on another. Blaming someone else for one’s thoughts or feelings. Unconsciously separating painful feelings and thoughts from awareness. Returning to an earlier developmental level.
Displacement
Projection
Dissociation
Regression
Compensation
Covering up for a weakness by overemphasizing another trait.
Reaction formation Acting exactly opposite to an unconscious desire or drive.
Introjection
Taking on values, qualities, and traits of others.
Sublimation
Channeling unacceptable drives into acceptable outlets. Converting psychiatric conflict into physical symptoms. Trying to counteract or make up for something.
Conversion
Undoing
(Boyd, 2018) Denial
marriage. Denial provides protection by allowing the psyche to slowly grasp traumatic events (e.g., death of a loved one), but it becomes maladaptive when the person can’t move on. Understanding denial as a psychological process is important, especially when it may seem that a patient is not adhering to a plan of care (https://www.ncbi.nlm.nih.gov/books/NBK559106/).
Denial indicates an inability to believe or act on some type of news or information. This may be attributed to unconscious forces that override a person’s rational thoughts or the premise that changing a behavior is more difficult and anxiety provoking than continuing the behavior. For example, a man with lung cancer may continue to smoke because quitting smoking may mean acknowledging a life-threatening illness, or a woman with alcoholism may continue to drink to avoid facing a dysfunctional
Book Code: ANCCUS3023
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