in fact, reflect the brain’s homeostatic effort to cope with sudden changes in the brain’s internal and external environment. In both deafness and traumatic brain injury, the usually maladaptive defense of projection helps to provide subjective order to a disordered brain. The difficulty is that, often, as with hypnosis, defenses like my grandson’s denial of danger compromise other facets of cognition.

Perhaps Freud’s most, original contribution to human psychology Inhibitors,research,lifescience,medical was his inductive postulation in 1894 that, unconscious “defense mechanisms” protect, the individual from painful emotions, ideas, and realities.2 Freud observed that not only could emotion be “dislocated or transposed” from ideas (by the mechanism Freud would later call isolation) Inhibitors,research,lifescience,medical but, also that emotion could be “reattached” to other ideas (by displacement) and that the idea accompanying the emotion could be “forgotten” by repression. Consider, for example the different responses of different people to the immediate aftermath of 9/11. Classification of defenses Defenses have six important properties3:

They mitigate the distressing effects of both emotion and cognitive dissonance They are unconscious (or, otherwise stated, involuntary) They are discrete from one another Although often the hallmarks Inhibitors,research,lifescience,medical of major psychiatric syndromes, they are dynamic and, unlike the brain disease they mimic, are reversible They can be adaptive, even creative, as well as pathological If to the user defenses are invisible, to the observer defenses appear odd, even annoying. Clinicians must learn to perceive a patient’s often irritating, even disgusting, defenses as lifesaving, as the Viennese hematologist Julius Cohnheim learned Inhibitors,research,lifescience,medical to perceive disgusting pus as “laudable.” For example, hypochondriacal help-rejecting complaints Inhibitors,research,lifescience,medical often seen in inarticulate trauma victims lead to anger and unwitting retaliation on the

part of the clinician. Like IWP2 understanding a foreign language, the discovery of past trauma not, in the chart permits the clinician to be empathie towards the patient’s unconsciously angry demands. Although in every effort to produce a comprehensive list of defenses, there will be enormous semantic Endonuclease disagreement,4 over the last 30 years several longitudinal studies at Berkeley5 and at Harvard6 have clarified our understanding. Empirical studies reviewed by Cramer7 and Skodol and Perry8 finally organized defenses into a consensual hierarchy of relative psychopathology. By offering a tentative hierarchy and glossary of consensually validated definitions, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV),9 hardly a psychoanalytic document, has included a Defensive Functioning Scale (pp 751-753) adapted from Vaillant, 1971 ,10 as a proposed diagnostic axis. The hierarchy has four levels.