Everyone is going crazy right now. Coronavirus has killed over half a million people worldwide, the economy is struggling tremendously, many are out of work, the US government appears to be militarizing against citizens, and the media’s agenda of shock and awe tactics are working. How we respond to such crises defines us as individuals, societies, and as a supposedly rational species. To respond to these events appropriately and in a unified way, we need to manage stress in healthy ways both consciously and unconsciously.
Introduction
Stress is a part of life, and all of us deal with it everyday. Some people can handle tremendous amounts of stress, while others seem to collapse under what appear to be simple problems. Why does such a difference exist between people and their ability to handle stress? The full answer is complicated, multifactorial, and beyond the scope of current human knowledge. However it is widely believed that there are positive and negative ways of dealing with stress. Talking about our problems, exercising, and pursuing creative outlets like art and music are all considered healthy ways of dealing with stress.
The above tactics are what people consciously do to calm down and manage stress. However, most people do not realize that our unconscious minds have come up with strategies to protect us from stress as well. The unconscious mind works automatically in all of us. It includes things like memories, interests, motivations, and even how we think. It works even when we do not want it to. For instance, someone with a painful memory may periodically be harmed by that memory. This person may want to get rid of the memory all together, but getting rid of a past memory is not something under our control. We do not have a delete button. Another example is our inability to really control what motivates us. We cannot choose our motivations, they simply happen and we then consciously act on them.
All of us constantly have unacceptable thoughts, emotions, and impulses, which would be unacceptable to act on. This includes things like hating certain people, profound jealousy, sexual attractions, perversions, and even much darker thoughts. To deal with this, our brains deploy a number of different tactics to defend our rational minds from the anxiety that these unacceptable impulses produce. This is why it can be very hard when one realizes that they are using immature defense mechanisms. Remember, we are talking about our unconscious brain. As such, we do not have control. However, I believe that with practice and knowledge, all of us can reflect on our own defense mechanisms. With great discipline, I believe people can even use their conscious brain to help their unconscious brain utilize more mature defense mechanisms.
This mental health can get really complicated. Even as a physician, I find myself confused at times. It is important to keep in mind that psychiatry, medicine, and even science in general is theoretical. It appears to be true based on our observations and experiments. However, it is possible that even our most fundamental beliefs about the world may change as new information arises in the future. However, at this time most doctors and therapists believe in defense mechanisms. We see them used by our patients all the time. With profound introspection, we can even see them in ourselves. However, when we start recognizing the use of immature defense mechanisms in ourselves, it can be difficult for us. Importantly, recognition of immature defense mechanisms in both others and ourselves is necessary for personal betterment. Recognition will also help us understand the actions of others.
Our understanding of defense mechanisms is probably very old. I suspect smart people were probably aware of such phenomena even thousands of years ago. But the first person to really write about them and define them was Sigmund Freud. Since Freud, numerous writings have been done on defense mechanisms. There are many different ways to categorize defense mechanisms, and the list of them seems to keep growing with time. For the purpose of this article, I am going to use just three categories, pathological, immature, and mature.
Pathological Defense Mechanisms
In the medical field, pathology is defined as the study of disease. As such, pathological defense mechanisms are only utilized by mentally ill individuals who appear to most as insane or at least profoundly irrational. They are the most harmful defense mechanisms one can utilize, allowing individuals to shape reality in such a way that allows them to avoid harmful stimuli altogether. Their use makes it nearly impossible for individuals to function in society. Three common examples are:
Delusional Projection – Delusions are fixed beliefs that have no basis in reality and for which there is no real evidence. A frequent manifestation of this defense mechanism is the belief that one is being persecuted unjustly. This allows a person to shape reality in any way they see fit, as they are the victim of unjust actions from others or society. As the victim, they cannot be at fault.
Denial and Distortion– People in denial refuse to accept external reality entirely. In contrast to someone lying, these people truly believe that a given circumstance did not happen. Distortion is a gross reshaping of reality, where some events are recognized, but the parts, which bring anxiety, are omitted entirely.
Immature Defense Mechanisms
These mechanisms are seen more commonly than pathological defense mechanisms. They are frequently seen in all humans, especially when we are younger and less mature. One of the hallmarks of personality disorders is frequent use of immature defense mechanisms. Some of these things may sound far-fetched. But I encourage you to look out for them in the people you know and meet. I have seen every single one of these defense mechanisms used, sometimes even in mature individuals you would not expect them from.
Our brains do very powerful things to protect us. Defense mechanisms are a manifestation of our need to be protected from our harmful thoughts, memories and impulses. Knowing and understanding defense mechanisms, allows us to better make sense of the actions of other people and ourselves. Even normal people use immature defense mechanisms commonly. However when used frequently they can severely strain relationships with others, causing substantial harm to the user.
Idealization – This is when a person perceives another person as having more desirable qualities then they really have. They essentially project perfection on that individual. I have met people who do this with their intimate relationships. This makes it easier for one to find a partner, but typically the bubble eventually bursts!
Introjection – This is when a person projects positive characteristics of another person onto themselves. For instance a person struggling in their training to become a doctor, may project qualities of another person doing much better in their doctor training onto themselves. This can get weird when they start to try and resemble that person physically.
Passive Aggressive – This is a familiar term and a very commonly utilized defense mechanism. It occurs when a person is angry or irritated with another person and instead of direct confrontation, they find more passive ways of expressing their aggression. A common example is taking a really long time to respond to someone you are irritated with.
Withdrawal – This is when a person removes themself from a situation, stimulus, or location which has caused them harm in the past. An example would be a person that does not go into parking garages because they were robbed in one in the past.
Social Comparisons – This is when an individual takes a more favorable view of themself, by comparing themself to another group or individual, which they perceive as inferior.
Regression – This is so common in children. It is when an individual temporarily reverts to an earlier developmental stage. For example a 7-year-old child gets sick. They then refuse to talk, cry when spoken to, and then wet the bed. Adults unfortunately do this as well.
Acting Out – This is more commonly referred to as a temper-tantrum. It needs no more explanation. The angry surgeon yelling at everyone else in the operating room after making a mistake is a classic example.
Projection – This is when a person has traits or characteristics which are too anxiety provoking for them to see in themselves. Instead, they project these traits onto other people they know. An example would be a person who thinks they know everything, telling other people, “you think you know everything don’t you”.
Fantasy – Instead of dealing with reality. Some people will escape to a fantasy land in their own minds. This is very common in children.
Somatization – This is when a person takes their anxiety and stress and manifests it as real bodily pain. Abdominal pain, sexual organ pain, pain with intercourse, and headaches are common examples. They come see me looking for treatment for belly pain, when really what they need is better stress management. I see this all the time in my medical practice.
Conversion – This is when a person manifests stress as a real neurological (brain and nerves) symptom such as numbness, loss of the ability to move a body part, blindness, and deafness. This is common in my medical practice as well and can sometimes be concerning for a stroke. It really does appear real at times and the person truly believes it is a problem with their nervous system.
Repression – This occurs when a person tries to bury a harmful memory or thought deep in their brain, such that they cannot even remember it. This often backfires as the stress often comes out in other ways or eventually the memory surfaces. An example is a person who was repeatedly raped, being completely unaware of the event, until something triggers these harmful memories, and they have a breakdown.
Intellectualization – This occurs when a person focuses on the intellectual components of a situation and completely ignores or represses the emotional aspects of it. A common example is a killer describing a murder in detail while expressing zero emotion.
Dissociation – This occurs when an individual removes themself from their own identity to protect themself from harmful emotions they are unable to deal with. People have described feeling outside of their bodies to me.
Reaction Formation – This is when a person takes an unacceptable desire, which they perceive as dangerous, and act on the exact opposite. A sad example of this is a homosexual individual who publicly denounces homosexuality and even persecutes such individuals.
Using the above immature defense mechanisms will not win you friends, effectively influence people, and they are widely considered unhealthy ways of dealing with stress. However they are very common, and not just in children. I have noted many of these defense mechanisms used by my bosses, piers, and even myself.
Mature Defense Mechanisms
Mature defense mechanisms are utilized by mature individuals, who are often considered virtuous. They allow us to balance positive and negative feelings of stress, in positive ways that benefit both the individual as well as those around them. People who utilize these tactics will find welcome and respect from other mature members of society.
Altruism – This is when a person harnesses the negative stress, emotions, and impulses inside and manifests them through service to others. Essentially one unconsciously feels remorse for the bad deep inside. They then counteract the bad by doing good for others. Not only is this mature, it also just makes sense. When our conscious brains do something bad, we try to do something good to make up for it. A healthy brain does the same thing unconsciously. After all those years of cut-throat business practices and charging huge amounts for computer software, Bill Gates is now giving back nearly everything he has made for the greater good of humanity.
Humor – I personally hide behind humor all the time, making jokes at my own expense. This is when we talk about something that would normally bring severe anxiety, in a roundabout way using wit or humor. For instances, after missing a very easy question on a test, one makes jokes about how stupid they are. This allows a person to express their shortcomings in a way, which is much less deleterious, which others find funny.
Sublimation – This is when a person transforms negative impulses or urges into healthy, more acceptable outlets. For example, writing a novel about a serial killer, instead of actually killing a bunch of people. Or joining a boxing league instead of fighting people at the bar.
Suppression – The decision, made consciously, to delay dealing with stress until a more appropriate time. I do this all the time in my hospital work. For example, a patient dies, I have other patients that need care immediately after, so I wait until after my shift is over to think more about and process this traumatic event.
Discussion
The above list represents many of the most common defense mechanisms utilized. However there are many more documented and described defense mechanisms. I have explained the above mechanisms in very simple terms to make them easy to understand. However they all have many more layers, and much more can be said about each one. If you are interested, there are a lot of other great free resources about defense mechanisms online. Wikipedia.org is always a good place to start.
Using pathological and immature defense mechanisms cause harm for both the user and the people around them. Mature defense mechanisms allow the individual protection from their inappropriate emotions, thoughts and impulses, while allowing them to gain respect and admiration from the people around them.
I encourage readers to think deeply about the interactions they have with other people everyday. Try and pick out the use of defense mechanisms both in yourself and others. If possible, bring the use of negative defense mechanisms by others to their attention in a compassionate and caring way. Particularly if you care about the other individual. But keep in mind that people will most often respond very negatively to a pathological or immature defense mechanism being brought to their attention. If you do it to your boss, you could lose your job.
If you are brave, think about immature defense mechanisms which you utilize. We all utilize an immature defense mechanism, I promise! Try and use your conscious brain to manipulate your unconscious self into using more mature defense mechanisms. If immature defense mechanisms are a problem in your life, I strongly encourage you to pursue mental health therapy. If this is not possible, at least find someone you trust to talk to about this stuff. Avoiding the problem is a bad strategy. Honestly avoiding any problem is a bad strategy.
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Author
William Brandenburg, MD, owner of Wonder Medicine clinic and full time rural hospitalist.
Editor
Karlee Brandenburg, RN-BSN, owner of Wonder Medicine.
Conflict of Interest
This article promotes Wonder Medicine clinic, which the author and editor own.
Disclaimer
This article was written for educational purposes only. It is not intended to serve as formal medical advice. Please talk with your healthcare provider if you are having a medical problem.
References
First Aid for Step 1, Medical Board Exam Review Book
Sigmund Freud
Utah Psych Defense Mechanisms. Available at: http://www.utahpsych.org/defensemechanisms.htm
DSM5, personality disorder section
Wikipedia, defense mechanisms
Personal experience treating and dealing with crazy people
The crazy inside me