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