Coping and defense mechanisms are a subject of debate as to what exactly do, they describe, as mental processes, and what is the relation between them1.
Traditionally, it is considered that coping mechanisms are based on cognition2, while defense mechanisms are described as unconscious processes3. Defense mechanisms are patterns of relatively involuntary responses to external or internal factors and they involve feelings, thoughts and behaviours4. Lazarus suggests that coping and defense mechanisms must be studied together, thus not limiting coping to deliberate and conscious processes5.
Coping mechanisms are conscious and purposeful processes which are not as inflexible as defense mechanisms6. Many studies show some relation between coping and defense mechanisms7, 8.
New trends show that both mechanisms evaluate different facets of the same background processes1, as opposed to earlier statements that suggest totally different background processes3.
The vulnerability-stress psychopathology model outlines two underlying components9 that may be extended to other dysfunctions10,11 than the original proposed model12,13. The internal component is represented by vulnerability, all mechanisms and processes that arise and are non-adaptive, and the external component is stress which is based on life events14; the two are influenced by each other, and they create a threshold for disorders to arise15.
There are numerous studies reporting high levels of burnout in the medical profession16,17, along with high rates of depression and suicide among physicians and medical students18,19. The prevalence of depression and depressive symptoms among medical students is around 27.2% with a prevalence of suicide ideation at 11.1%20.
Psychiatry is a stressful medical field21, psychiatrists being prone to suicide and burnout22, 23. Younger psychiatrists tend to be more stressed that older ones24 and women more than men22, 25.
A major, frequent stress factors is patient suicide, younger psychiatrists being more affected than their senior colleagues22,24.
Other sources of stress reported are negative attitudes of patients and careers, administrative and management shortcomings, overload and poor resources22, 26, 27.
Whilst emerging evidence shows that debriefing a traumatic event may not be of help for all patients28, 29, in all circumstances30, this remains the standard procedure in many clinical settings29. Hearing patients’ traumatic history can also cause stress among medical doctors31.
There is currently a debate in how this type of exposure influences coping or defense mechanisms. Some argue that it can either increase the risk for psychiatrists to develop mental health issues32, 33, 34, or it could facilitate the development of better coping and defense mechanisms in certain circumstances35. Factors that contribute to one or the other need more studies35.
A small study, similar to this one, was published36 with results that suggest a similar pattern of defense and coping for this particular population.
The main focus on psychiatrists training is on patient care with no specific attention paid to psychiatrists coping skills or defense mechanisms. Whilst there is supervision, reflective practices and staff meetings that offer some support, there is no specific training in how to care for the actual psychiatrist. Some studies have shown that having a stable and satisfactory personal life is significantly important for the doctor’s wellbeing35.