Defense Mechanisms

Divided into immature, neurotic and mature, defense mechanisms are unconscious ways our ego tries to decrease anxiety and strong emotions in uncomfortable situations.

Idealization

• The attribution of overly exaggerated positive characteristics to other people in response to an internal conflict
• Example: A student who despises his teacher says, “Oh, well he is the absolutely the best teacher in the world.”

Devaluation

• The attribution of overly exaggerated negative characteristics to other people in response to an internal conflict
• Example: An attending physician says that his currently medical student is, “the worst medical student in the world” after the student had misspelled the word rhythm on his presentation for morning report.

Projection

• Inappropriate feelings or thoughts are attributed to another person.
• Example: A married man who is having an affair on his wife accuses his wife is cheating on him.
• Example: An employee who hates his boss accuses his boss of having negatives feelings towards him.

Somatization

• Mental conflicts, or stressful situations begin to manifest into physical symptoms.
• Example: A medical student studying for their board example begins to feel abdominal cramps.
• Example: A medical student preparing for a presentation during morning report, develops feelings of restlessness when trying to sleep.

Denial

• The avoidance of or failure to accept a disturbing reality.
• Example: A patient who is told she has breast cancer by her physician denies the fact that this is a possibility
• Example: A medical student who has failed their board exam believes that his report was incorrect.

Acting Out

• Turning an internal impulse into an unacceptable physical response.
• Example: A child throws a temper tantrum when his mother tells him he cannot have ice cream today
• Example: A medical student snaps his smartphone in half, throws it at the projector and storms out of the room during grand rounds.

Displacement

• “taking-it-out” on another person in response to an external conflict.
• Example: The medical student who is yelled at by his attending for incompetence while using a blood pressure cuff goes home and yells at his brother for making a “crappy” dinner.
• Example: The medical student who feels they are treated in a negative manner by the scrub nurse gets into an argument with his wife because she didn’t fix the bed sheets.

Dissociation

• The act of blocking thoughts of an undesirable thought or event from a persons memory.
• Example: The physician who had an exhausting and terribly busy day comes home and tells her husband she had an excellent day.

Rationalization

• Logical reasoning to justify inappropriate or unacceptable situations, thoughts or actions.
• Example: After being yelled at by the attending physician for forgetting to consult neurosurgery, the intern tells his peers, “believe me, anyone would have forgotten to consult neurosurgery, I had too many things on my mind and too many things to do, it’s normal to forget things consults.”

Intellectualization

• A mechanism in which a person deals with conflict by the use of exaggerated abstract reasoning
• Example: A patient diagnosed with cancer researches his diagnosis to a great extent from different forms of treatment, the different subtypes of his cancer and even pathology of his cancer but from a another person’s perspective he does not seem to be bothered by his diagnosis.

Reaction Formation

• When an unacceptable desire is turned into the opposite action or feeling.
• Example: A medical student who wants to leave his shift early without telling his attending or resident ends up working 5 hours more than he was suppose to that day.
• Example: A teenage girl who wants to sneak up at night to meet with her boyfriend, despite her parents enforcing a strict curfew, stays at home all night.

Repression

• A previously undesirable thought is pushed into the unconscious so that the person is now unaware that the event or thought had ever occurred.
• Example: A medical student who is kicked out of medical school and told never to come back, shows up the week after for class and doesn’t have any recollection of being dismissed by the school’s administration.

Altruism

• The act of turning an undesirable event into a way to help other people.

• Example: A physician who was addicted to prescription medications during residency speaks to medical students about substance abuse and addiction.

Sublimation

• A mechanism in which the person channels their unacceptable desire into something which is socially desirable.

• Example: A medical student who hates patients and people goes into radiology

• Example: A man who has a violent history pursues a career in boxing.

Suppression

• “Pushing something to the back of your mind”. The conscious act of refusing to think about an idea that causes the person stress.

• Example: A physician chooses not to think about paying his medical school loans but instead focuses on the surgery at hand.

Introjection

• When things from a person’s surroundings is incorporated into their life.

• Example: The medical student begins to conduct an interview like his resident.

Humor

• The act of turning an uncomfortable thought of situation into a “lighter situation”

• Example: A surgeon makes a joke about his co-surgeons OR cap before a complex surgery.