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mechanisms are unconscious and anxiety relieving processes that help to restore a
patient's psychological equilibrium and normalize emotional functioning. Defence
mechanisms can be protective and transient forms ofadaptation to the trauma or can be
chronic and pathological adaptations to the residual disability. Some of the defence
mechanisms that are used are denial regression acting out and traumatization (Captain,
1991:487).
Denial allows the patient to integrate realities ofthe disability at an acceptable pace and
prevents excessive anxiety and severe depression. In the case of amputees, the patient
becomes well motivated towards rehabilitation. In other cases a patient may be insightful
and well motivated initially but when faced with overwhelming tasks of rehabilitation
and awareness ofthe permanent barriers to life plans and satisfactions, may start denying
again. This becomes a problem in rehabilitation, and denial may even reach psychotic
proportions or may be combined with fantasy and delusion, which requires psychiatric
consultation (Felton & Revenson, 1994:687).
Regression refers to an emotional and physical retreat from adult standards of
independence to an earlier and less mature level of adaptation. This behaviour includes
persistent dependency, lack of motivation and passivity. Regression is usually
precipitatedby inability ofthe patient to have personal control over his actions because of
loss ofa body part, for instance, getting into a wheelchair on his own, or a therapist who
is too assertive and eager for results, pushing the patient too fast in the treatment and
misses the signs that the patient is becoming overwhelmed. The patient will not like to do
anything and insist on discharge before he is ready and not yet fully prepared for
discharge by the rehabilitation team. This becomes a problem as patient becomes
dependent as soon as he reaches home and less motivated for rehabilitation. This goes
together with acting out at times, where the patient uses verbal or physical aggression to
avoid conscious recognition of feelings of fear, sadness and anxiety, which creates a
problem for rehabilitation because family members become less supportive (Caplan &
Sadock, 1992:377).
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