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.
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, when we have a host of other worries running in the background and when we're nearing the tipping point for burnout, one more unexpected stress can blow us away.
Our baseline levels of stress influence our response to life's unpredictable challenges.
A strong sense of self and self-worth 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 am often moved by the courage and strength of my patients. They may feel overwhelmed with a diagnosis or distraught with the loss of a loved one, but many are able to re-create a sense of self and trust.
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.
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.
Dr. Vaillant focused on adaptations or defense mechanisms - unconscious responses to stressors. 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.
Neurotic adaptations include intellectualization, dissociation (separating from our feelings) and repression.
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 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. We can gain insights by reflecting on the patterns of our behaviour and our relationships. What mistakes do we keep making?
Dr. Davidicus Wong is a physician and writer. You can find his posts at davidicuswong.wordpress.com.
