Psychological Defence Mechanisms

Psychological Defence Mechanisms‘ is an award programme we made to help students understand the concept of defence mechanisms. This is an important concept that is useful to any healthcare student.

The programme opens with a funeral, and the subject of denial – a normal reaction to loss. A wife cannot believe that her husband is dead, and discusses her feelings with a medical professional.  Another example of denial provided shows a smoker in a hospital bed. He has gangrene of the right foot, and unfortunately this means he will require an amputation below the knee. As many in this situation would, the patient denies that he needs the amputation and insists that his foot is getting better. The patient has to come to terms with the fact that this case of gangrene is too severe to be treated with antibiotics and amputation is the only option.  The last example of denial is shown to be a woman suffering with anorexia. She insists that she needs to be six or seven pounds lighter, when truthfully that would put her in a lot of danger.

A ‘difficult’ patient becomes argumentative in her doctor’s appointment; when she storms out of the room and into the waiting area, she starts to feel people are looking at her and talking about her. The paranoia builds up and she is experiencing psychosis, another defence mechanism.

A young boy has started to wet the bed again, at an age that this is considered abnormal. A discussion is had with a medical professional, who asks if the boy has been through any kind of stress. It comes to light that the boy’s mother passed away recently. Bereavement is extremely difficult for a young child to understand or process, and can cause them to regress back into their early years. In this case, it meant that he had started to wet the bed at night again.

A man speaks about his parents’ divorce, from when he was a child – he starts to cry, despite thinking that he was ‘over it’. This is an example of repression.

This programme was designed to be used for either live lecture settings or private study time. It’s concise and easy to follow, and is a great introduction to  teaching psychological defence mechanisms.


Different Types of Depression and Treatments

Over the years, here at Mental Health Television, we have learnt that letting the patient tell their story can be the best way to illustrate many aspects of psychiatric disorders.  We all feel depressed from time to time and this is part of the human condition.  There is often an overlap with bereavement, which is more helpfully seen as a separate life experience.   


So what is the difference between unhappiness and a depressive illness?  In order to answer this question, it can be useful to know how an individual has responded to misfortune in the past.  So it can be normal to feel low in mood with not much interest or enthusiasm in day to day activities, such as meeting friends and sometimes irritability can be an issue.  A reactive depression can also lead to other maladaptive behaviours, such as drinking too much alcohol, smoking or taking drugs.  When severe, reactive depression can benefit from intervention from a psychologist or from medication.  Sometimes, depression can come on without there being any precipitating factors and with severe depression, this can affect the way an individual thinks about life; they can develop suicidal thoughts and at times, depressive delusions.  At the severe end of depression, it is easy enough to see that this is best understood as an illness.   


We are fortunate in being able to bring you a number of examples of depression.  Do have a look at the clips and make a note of the symptoms you feel are important.   


Treatment often includes anti-depressants. There is good evidence that these drugs are effective, however it is important to recognise that they are by no means perfect and some have troubling side-effects.  In addition, some individuals respond well to one anti-depressant and not another.  Psychiatry has no real explanation for this observation which can make it extremely frustrating and challenging for the patient and their families.  Recovery is never smooth with progress being somewhat up and down. It is important to take medication for a long time; indeed the average length of time is about 18 months.   


In addition to medication, talking therapy can be extremely helpful, particularly as an individual begins to improve and is able to benefit.  There are many flavours of talking therapy; we often talk about the benefits of cognitive therapy.  However, sometimes an individual will benefit more from looking at some early life experiences.  Often therapy can help a family through a crisis. 


Severe depression, of course, is associated with deliberate self-harm, attempted suicide and suicide.  All those involved in treatment of individuals with mental health problems are only too well aware of such risks.  Sometimes admission to hospital can be appropriate as a place of safety and to allow intensive treatment.   


The installation of hope is a phrase we use a lot.  It is only to easy for an individual and their families to despair that nothing can change.  So do have a look at some of the patient interviews and you will see that indeed recovery is possible.  At the early stages of treatment, this is a most important message to give the family and the individual struck down with severe depression.