Persons with a mental disorder, as well as those without a mental illness, will each exhibit conscious and unconscious defense mechanisms. Conscious defense mechanisms are organized by, and act in service of the ego, and seek to preserve the integrity of the persona of the ego. Unconscious defense mechanisms are organized by the unconscious mind – the mind’s mind – and serve the integrity of the whole person. Rationalizations about the symptoms of a mental illness (for one wi

Derek is an 82-year-old man with symptoms of post-polio syndrome. Post-polio syndrome tends to develop decades after the childhood onset of illness, and can include progression of joint stiffness and pain, and muscle wasting, and fatigue. He currently resides in a nursing home where I meet with him for psychotherapy. He uses a wheelchair, and a slide board to transfer from bed to chair or chair to toilet. Derek has a chip on his shoulder the size of a woodpile. He is generous

Over the course of my career in nursing homes, I have spoken with a disturbingly large number of persons from their 30’s to 90’s, occasionally men, yet predominantly women, who have survived horrible sexual, physical, and mental abuse in childhood. When they were children, they did not approach a responsible adult to say, “Could you please help me with the bad feelings I have because the adults who should have loved me were awful to me.” Obviously, no child thinks or acts tha

“My mother literally made gin in the bathtub; it was part of how she made money. She also had men ‘guests’ in the apartment, and unfortunately, she didn’t always protect me from them,” Daphne remarked as she spoke of her childhood in Brooklyn, New York. “I never had, or knew, a father; it was always just me and my mother,” she said. “But I could sing, boy, could I sing! And that’s how I was able to fly away from Brooklyn.” “No matter the noise around me, I always had singing

Walking up the back stairs of the nursing home, I heard someone yelling and cursing loudly. I pressed the red button releasing the door lock and came onto the third-floor unit. The fire of her fury had burnt out rapidly, and a 32-year-old young woman—I’ll call her Gwen—now sat hunched and sobbing in the nook at the end of the hallway. I thought if I spoke or approached too closely she would dismiss me, so I sat quietly 10 feet away on the broad windowsill. Her breathing slowe

Sakura was born in 1931, in the Japanese city of Nagasaki, a major port city and centre for ship building. She enjoyed a pleasant childhood with many friends and family. The early years of her adolescence were overshadowed, though, by the increasingly grim circumstances of her country being at war. On August 9, 1945, the day seemed ordinary for the 14-year-old Sakura, until in a flash, nothing ordinary remained, after an atomic bomb was dropped on her city by the U.S., and 60

“I call them the persons of my mind, my pers,” Robin said, in reference to the split personalities she experiences due to trauma. “I talk out loud to them and I find it therapeutic, but I try to be careful because I know it can bother my roommate, and other people,” she said. Robin suffered severe and serial traumas, and was diagnosed with Dissociative Identity Disorder, and associated psychotic symptoms (voice-hearing and delusions). She currently resides in a nursing home,

(‘Alex’ gave permission for this brief sharing of his story; ‘TJ’ said not a word.) Alex is a tall, thin, 86-year-old former psychotherapist now living in a nursing home, and walking with a walker. He experiences mild anxiety and depression associated with adjustment to stage of life development, and he experiences mild cognitive issues. I meet with him for life review therapy. Alex loves music and theater, and he wrote and performed in plays, in addition to practicing and te

Originally published with psychotherapy.net. A frustrated and depressed nursing home resident recently described the facility as “a place where unwanted elders can be exiled.” Through our therapy conversation in that session, he came to acknowledge that he did have problems with his memory and his health, and that his facility residence was reasonable — even though unwanted — and was not a rejection by his son. “I know he’s only doing what he thinks is right for me.” The Em