A male patient diagnosed with paranoid schizophrenia typically relates effectively with female staff but angrily tells the male nurse, "You act like a homosexual. None of the men trust you or want to be around you."
The nurse, who is heterosexual, is perplexed by the patient's statements and discusses the event with his mentor. Which explanation most likely underlies the patient's behavior? a. The patient was unleashing unconscious, hostile feelings toward the nurse.
b. The patient feared the nurse would reject him, so he coped by rejecting the nurse first.
c. It was the patient's way of distancing himself from potential emotional intimacy.
d. The patient was coping with homosexual urges by projecting them onto the nurse.
D
Patients with paranoid ideation unconsciously use the defense mechanism projection to deal with unacceptable, anxiety-producing ideas and impulses, in this case homosexual urges. Although the behavior seems hostile, the root cause of the behavior is the patient's homosexual urges rather than hostility. Patients who exhibit paranoid ideation may fear rejection or abandonment, but the data here do not indicate fear of rejection, and the patient's relationships with female staff suggest he does not fear rejection. Although the patient may be uncomfortable with intimacy, the focus on sexual identity of a same-sex staff member suggests the bigger issue involves the patient's own sexuality or sexual urges.
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