Defense Mechanisms

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Defense mechanisms are unconscious resources used by the ego to reduce conflict between the id and superego and thereby reduced anxiety. For that reason they are more accurately referred to as ego defense mechanisms.
Defense mechanisms are methods of attempting to protect self and cope with the basic drives or emotionally painful thoughts, feelings or events. The purpose of defense mechanisms is to reduce or eliminate anxiety. They can be helpftll when used in very small doses, and if overused, become ineffective and can lead to a break-down of the personality. Most defense mechanisms operate at the unconscious level of awareness.
Ego Defense mechanisms:
Defense mechanisms
Example
Compensation
Covering up a real or perceived weakness by emphasizing a trait one considers more desirable
A physically handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.
Denial

Refusing to acknowledge the existence of a real situation or the feelings associated with it
A woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a roblem

Displacement
The transfer of feelings from one target to another that is considered less threatening or that is neutral  
A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

Identification
An attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires
A teenaged boy who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his ex eriences.
Intellectualization
An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis
Susan's husband is being transferred with his job to a city far away from her parents. She hides anxiety by explaining to her parents the advantages associated with the move.
Introjection
Integrating the beliefs and values of another individual into one's own ego structure

Children integrate their parents' value system into the process of conscience formation. A child says to friend, "Don't cheat. It's wrong.
Isolation
Separating a thought or memory from the feelin tone or emotion associated with it  
Without showing any emotion, a young woman describes being attacked and raped.

Projection
Attributing feelings or impulses unacceptable to one's self to another erson
A person who blames another for his own mistakes is using the projection mechanism. A surgeon whose atient does not responds as he anticipated, may tend to blame the theater nurse who helped the surgeon at the time of operation.

Rationalization
Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors
John tells the rehab nurse, "I drink because it's the only way I can deal with my bad marriage and my worse job."
Reaction formation
Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.
Regression
Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning
When 2-year-old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for 6 months.
Repression
Involuntarily blocking unpleasant feelings and experiaences from one's awareness
An accident victim can remember nothing about the accident.
Sublimation
Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive         
A mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of Mothers Against Drunk Drivers.
Suppression
The voluntary blocking of unpleasant feelings and experiences from one's awareness
Mr. Ram says, "l don't want to think about that now. I'll think about that tomorrow.'
Undoing
Symbolically negating or canceling out an experience that one finds intolerable
Joe is nervous about his new job and yells at his wife. On his way home, he stops and buys her some flowers.


Relevance to nursing practice: The nurse must recognize and understand maladaptive defense mechanisms that patients use. The nurse has to carefully point out these mechanisms and work with patients to discourage such behaviours and encourage adaptive ones.
References
1.Townsend MC. Psychiatric/ Mental Health Nursing. 5thedition. Philadelphia: F.A. Davis Company;  201

2.Sreevani R A Guide to Mental Health and Psvchiatric Nursing-yd ed. New Delhi: Jaypee brothers2010.


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