The careful observation and analysis of behavior is what I do for a living. I am very good at it; and I enjoy my profession. By helping people become aware of what they are doing that wreaks so much havoc in their life, I help them to change their behavior and therefore their lives. By pointing out and helping them to understand some of the unconscious motivations and conflicts they have, I help them to understand the psychological defenses they have employed which may be getting in the way of their pursuit of happiness. By making the unconscious conscious, we begin to understand why they are behaving irrationally and why the have problems in their life. The goal is to get them to abandon those defenses that are distorting reality and holding them back; and to develop a new synthesis so that even their conflicts are put to a positive and productive use in their life. When there is a physiological component, I also from time to time, prescribe medication so that their nervous system can optimally cope with the real world. This levels the playing field, so to speak; but even when medication is prescribed, only by looking at all the factors that come into play in an individual life--Biological, psychological, and social--am I able to help individuals change the course of their life. It is rarely only a "chemical imbalance" (although sometimes it is). The example I use with my medical students is the following: A woman who comes to see me is profoundly depressed and suicidal because her husband beats her and her marriage is hell. She meets all the diagnostic criteria for a major depressive disorder, and it is clear that the prescription of an antidepressant might be very helpful. In fact, that is what the woman wants. However, even if I prescribe the medication, I must gently point out to her that no amount of medication for her is going to change her husband's behavior. Only by changing her own behavior can she change things in her marriage-- e.g., she can leave him; she can demand that he get help; she can suggest conjoint counseling--whatever. Or, she can accept that he will continue to behave a certain way (beating her) and accept that. But the medicine will not magically make any of these things happen. All it will do is give her the physiological strength to cope better. She can accept this reality. Or, she might use denial and continue to believe that medication for her will change her husband's behavior. She might use fantasy to pretend that when her "illness" is cured, her husband will realize what a wonderful person she is and stop beating her up; she might use hypochondriasis, developing migraine headaches or other more serious symptoms that keep her away from her husband; she could be passive-aggressive, buying her spouse his favorite alcoholic drink that is the frequent disinhibitor that leads to him hitting her; she might use displacement and blame her husband's employer --who doesn't appreciate him--for her husband's aggressive behavior toward herself. If she listens to what I am telling her, she might use anticipation and begin to plan to leave the situation at home an go someplace else. She might then find she has a knack for helping women who have abusive husbands and train to be a counselor (altruism); or find that she has acting ability and play the lead in a local production of "Cat on A Hot Tin Roof" (sublimation). In fact she could use ANY of the many psychological defenses to help her cope with her problem. Psychological defense mechanisms give people the psycholgoical strength to cope with the vissictitudes of an ever-changing and often unpredictable reality. Some defenses are more useful than others for that purpose and one of the goals of mature adult functioning is to abandon the immature and problematic strategies that can only ultimately make things worse and which provide little pleasure in their life. Probably the best description of defenses that I have ever read comes from George Vaillant, in his book The Wisdon of the Ego: (pg. 17 - 18)... Diagnosed by Dr. Sanity @ 5:37 PM 7:32 PM
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