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Defense Mechanisms
Our minds may deceive us but our bodies never lie. Theautonomic nervous system has a life of its own and paysno attention to what the mind wants to project to the outside world. When it feels like blushing, it blushes.When it feels like crying, it cries. When it's alarmed, itbreaks out in gooseflesh. Because of this truth-tellingdisparity between mind and body, when people first come to Janet Greeson's "A Place For Us" we watch as much aswe listen. Their actions speak so loudly we can hardlyhear a word they're saying, and we know that no matterwhat they try to convey to us with words, their nonverballanguage tells the truth.
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Some are full of shame. Their eyes are cast down,they readily weep, they cover their face with their handswhen they talk as if they had something to hide, they areangry at themselves and feel empty or numb. The very obese are often suicidally depressed. Nothing seems towork for them now, and they have completely submergedtheir identity under layers of fat. The heaviest patient Ihad weighed 470 pounds. She was barely able to getherself dressed and thought she had no reason for livingexcept to eat herself to death.
Most people come in depressed. Some are hostile, blaming others for their problems, angry at everyone but themselves and full of complaints. Gerald G. Jampolsky,MD, author ofTeach Only Love, remarks, "The mostoffensive patients are the ones who need the most love."Sometimes that's difficult to remember, but I've never failed to acknowledge the truth of that statement.
Still other people are placid. They will calmly tell youthere's nothing the matter with them except a need to control their weight. They will go out of their way toplease people and do whatever they can to get approval.
Surprisingly, the passive people are the most difficultto treat, for there is no struggle. The shame-based peopleare struggling with themselves, the anger-based peopleare struggling against the world, but the passive people-pleasers are not struggling against anything. They wantsomebody to fix them without taking action themselves.
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In order to get the passive types to work, we have toshake them up a bit. We don't respond to their need toplease. Getting them to drop their defensive behavior isno game; if we can't shake them out of their passivity,they usually go home without doing any real work ontheir emotions and don't get better. What 1 do is makethem into bad patients. I'm always glad when I see theiranger and feistiness begin to come out. My nurses saythey don't like them as well as they did when they first came on the unit, but that's okay by me. They're learning to challenge and create boundaries, developing an identity beyond just being nice.
