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12 Unit 1 Foundations of Mental Health Nursing
TABLE 1.2 Defense Mechanisms
Defense Mechanism
Compensation Covering up weaknesses
by emphasizing a more desirable trait or
by overachievement in a more
comfortable area
Denial An attempt to screen or ignore
unacceptable realities by refusing to
acknowledge them
Displacement The transferring or
discharging of emotional reactions from
one object or person to another object
or person
Identification An attempt to manage
anxiety by imitating the behavior of
someone feared or respected
Intellectualization A mechanism by which
an emotional response that normally
would accompany an uncomfortable or
painful incident is evaded by the use of
rational explanations that remove from
the incident any personal significance
and feelings
Introjection A form of identification that
allows for the acceptance of others
norms and values into oneself, even
when contrary to ones previous
assumptions
Minimization Not acknowledging the
significance of ones behavior
Projection A process in which blame is
attached to others or the environment
for unacceptable desires, thoughts,
shortcomings, and mistakes
Rationalization justification of certain
behaviors by faulty logic and ascription
of motives that are socially acceptable
but did not in fact inspire the behavior
Reaction formation A mechanism that
causes people to act exactly opposite
to the way they feel
Regression Resorting to an earlier, more
comfortable level of functioning that is
characteristically less demanding and
responsible
Repression An unconscious mechanism
by which threatening thoughts, feelings,
and desires are kept from becoming
conscious; the repressed material is
denied entry into consciousness
100366 C P Ed /NJ/CHET
Example(s)
A high school student too small to play
football becomes the star long distance
runner for the track team.
A woman, though told her father has
metastatic cancer, continues to plan a
family reunion 18 months in advance.
A husband and wife are fighting, and the
husband becomes so angry he hits a
door instead of his wife.
A student gets a C on a paper she
worked hard on and goes home and
yells at her family.
A student nurse imitates the nurturing
behavior she observes one of her
instructors using with clients.
The pain over a parents sudden death is
reduced by saying, He wouldnt have
wanted to live disabled.
A 7-year-old tells his little sister, Dont
talk to strangers. He has introjected this
value from the instructions of parents
and teachers.
A person says, Dont believe everything
my wife tells you. I wasnt so drunk I
couldnt drive.
A mother is told her child must repeat a
grade in school, and she blames this on
the teachers poor instruction. A
husband forgets to pay a bill and blames
his wife for not giving it to him earlier.
A mother spanks her toddler too hard
and says it was all right because he
couldnt feel it through the diapers
anyway.
An executive resents his bosses for
calling in a consulting firm to make
recommendations for change in his
department but verbalizes complete
support of the idea and is exceedingly
polite and cooperative.
An adult throws a temper tantrum when
he does not get his own way. A critically
ill client allows the nurse to bathe and
feed him.
A teenager, seeing his best friend killed
in a car accident, becomes amnesic
about the circumstances surrounding
the accident.
A F i P N 12 C/M/Y/K/PMS
Use/Purpose
Allows a person to overcome weakness
and achieve success
Temporarily isolates a person from the full
impact of a traumatic situation
Allows for feelings to be expressed
through or to less dangerous objects or
people
Helps a person avoid self-devaluation
Protects a person from pain and traumatic
events
Helps a person avoid social retaliation and
punishment; particularly important for the
childs development of superego
Allows a person to decrease responsibility
for own behavior
Allows a person to deny the existence of
shortcomings and mistakes; protects self-
image
Helps a person cope with the inability to
meet goals or certain standards
Aids in reinforcing repression by allowing
feelings to be acted out in a more
acceptable way
Allows a person to return to a point in
development when nurturing and
dependency were needed and accepted
with comfort
Protects a person from a traumatic
experience until he or she has the
resources to cope
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Chapter 1 Introduction to Mental Health Nursing 13

TABLE 1.2 Defense Mechanisms (continued)

Defense Mechanism Example(s) Use/Purpose

Sublimation Displacement of energy
associated with more primitive sexual or
aggressive drives into socially
acceptable activities
Substitution The replacement of a highly
valued, unacceptable, or unavailable
object by a less valuable, acceptable, or
available object
Undoing An action or words designed to
cancel some disapproved thoughts,
impulses, or acts in which the person
relieves guilt by making reparation
A person with excessive, primitive Protects a person from behaving in
sexual drives invests psychic energy into irrational, impulsive ways
a well-defined religious value system.
A woman wants to marry a man exactly Helps a person achieve goals and
like her dead father and settles for minimizes frustration and disappointment
someone who looks a little bit like him.
A father spanks his child and the next Allows a person to appease guilty feelings
evening brings home a present for him. and atone for mistakes
A teacher writes an examination that is
far too easy, then constructs a grading
curve that makes it difficult to earn a
high grade.

Erikson believed that the ego is much more important
than the id or superego in determining personality. He saw
the ego as the mediating factor between the individual and
society and felt that this relationship is at least as important
as the influence of the basic drives. He also believed in the
importance of social relationships in the development of in-
dividuals. Erikson expanded the determinants of personality
development from merely instinctual and biological to social
and cultural.
Erikson also expanded intrapersonal theory in his view
of the future. Where Freud saw the most significance in
past events, Erikson felt there was more significance in the
future. He believed peoples abilities to anticipate future
events made a difference in the way they acted in the pres-
ent. Many believe Eriksons theory is more hopeful and pos-
itive than Freuds theory. By expanding the intrapersonal
perspective, Erikson acknowledged the chance to develop
through the life span and to grow in a variety of ways.
According to Erikson, every person passes through eight
developmental stages (see Table 1.4 and Figure 1.3 ). Each
stage is characterized by conflicts and a set of tasks a person
must accomplish before moving on to the next developmental
stage. Erikson believed that people had difficulty developing
normally if they were unable to accomplish the tasks of the
previous stage. He believed that psychotherapy could help
people return to a developmental task that had not been ac-
complished and relearn it (Erikson, 1963).
SocialInterpersonal Theory
The theories of Freud started a revolution in the field of
psychology. During the late nineteenth century, other disci-
plines began to emerge and develop their own scientific
bodies of knowledge. Sociologists and anthropologists
started to believe that human development was more com-
plex than previously thought, and it was not long before
these beliefs started filtering into the knowledge gleaned

TABLE 1.3 Stages of Psychosexual Development According to Freud

Stages of
Development Period Defining Characteristics
Oral Birth18 months Principal source of pleasure from mouth, lips, and tongue. Dependent on mother for
care, so feelings of dependency are developed.
Anal 18 months3 years Focus on muscle control necessary to control urination and defecation. Expulsion of
feces gives a sense of relief. Learns to postpone gratification by postponing the
pleasure that comes from anal relief.
Phallic 36 years Develops an awareness of the genital area. Sexual and aggressive feelings
associated with functioning of the sexual organs are emphasized. Learns sexual
identity during this stage. Masturbation and sexual fantasy are common.
Latency 612 years Sexual development dormant. Focus of energy on cognitive development and
intellectual pursuits.
Genital 12 yearsearly Abundance of sexual drive. Primary goal is to develop satisfying relationships with
adulthood members of the opposite sex.

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100366 C P Ed /NJ/CHET A F i P N 13 C/M/Y/K/PMS