One of the reasons I love family practice is the uniquely personal story that every patient shares. I have learned a wealth of wisdom from my patients. I am often moved by their courage and strength. They may at first feel overwhelmed with the diagnosis of a serious disease or distraught with the loss of a loved one, but many are able to re-create and reaffirm a firm sense of self and trust in the universe.
Many couples separate after an affair, but I have seen determined partners accept their respective responsibilities, learn from their mistakes and remain together in a strengthened relationship.
Some individuals never find resolution after the loss of their loved ones. Others accept with grace the ways in which their loved ones enriched their lives and learn to live and be happy again.
During my psychiatry rotation in my internship, my preceptor instructed me to read his well-worn copy of George Vaillant’s “Adaptation to Life.” It outlined Dr. Vaillant’s interpretation of the Grant Study or the Harvard Study of Adult Development that was started in 1937 to study healthy Harvard men and has continued for over 70 years.
These men were followed regularly with interviews, questionnaires and physical examinations to study the factors that influence physical and mental health.
Dr. Vaillant focused on adaptations or defense mechanisms – unconscious responses to stressors, including conflict or pain. He classified these defense mechanisms into four categories.
“Psychotic” adaptations include paranoia and hallucinations, and theses were the unhealthiest. Above this, “immature” adaptations include acting out, passive aggression, hypochondriasis, fantasy and projection. One level up, “neurotic” adaptations include intellectualization, dissociation (separating from our feelings) and repression (unconsciously ignoring our feelings). Though it doesn’t mean that we are neurotic, most of us use these adaptations. The “mature” adaptations most associated with long-term health and wellbeing are altruism, humour, anticipation, suppression and sublimation.
Suppression differs from repression because the former is the conscious decision to defer attention on certain feelings until a better time is available to deal with them. Sublimation is the channeling of our emotions (including aggression and anger) through a positive outlet (such as fighting injustice, creativity or sport).
The adaptations or defense mechanisms that we personally use are not easily apparent to us. They operate on an unconscious level. We can gain insights by reflecting on the patterns of our behaviour and our relationships. What mistakes do we keep making?
A friend who knows you well may be helpful; your physician or a professional counselor may be even better.