When it comes to our physical and emotional wellbeing, how we cope with the circumstances of our lives is as important as the circumstances themselves. What we end up with- happiness or unhappiness-depends on what we do with what we get.
In medical school, we learned that the disease caused by an infectious agent-viral or bacterial-depends on both infection and "host" factors. In general, those with compromised immune systems are at greater risk for a more severe infection. Bacteria that may cause a simple boil in one person could cause septic shock in another. Sometimes our own bodies react in ways that are harmful to us. This is analogous to the effects of stress and our reactions to it.
When our lives are already out of balance and we're nearing the tipping point for burnout, one more unexpected stress can blow us away.
That's why one employee may be able to brush off a negative review at work, another will accept it as useful feedback, and a third may be totally devastated. Our baseline levels of stress influence our response to life's unpredictable challenges.
A strong sense of self and selfworth and flexibility of thought can make you more resilient to adversity. They help us conceptualize our circumstances in more positive and life-affirming ways. Without such resilience, we may succumb to anxiety and depression. I love family practice for the uniquely personal stories 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, but many can recreate and reaffirm a firm sense of self and trust in the universe.
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 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 or a professional counsellor may be even better.
Dr. Davidicus Wong is a physician and writer.
