Journal of Abnormal Psychology Copyright 1994 by the American Psychological Association Inc

1994, Vol. 103, No. 1.44-50 0021-843X/94/S3.00

Ego Mechanisms of Defense and Personality Psychopathology

George E. Vaillant

It is often not just life stress but also a person's idiosyncratic response to life stress that leads to
psychopathology. Thus, despite problems in reliability, the validity of defenses makes them a valu-
able diagnostic axis for understanding psychopathology. By including a patient's defensive style as
part of the diagnostic formulation, the clinician is better able to comprehend what seems initially
most unreasonable about the patient and to appreciate what is adaptive as well as maladaptive about
the patient's defensive distortions of inner and outer reality. Clinical appreciation of the immature
defenses (e.g., hypochondriasis, fantasy, dissociation, acting out, projection, and passive aggression)
is particularly useful in classifying and caring for individuals with personality disorders.

In no area of psychology is the need for a synthesis of frames the International Classification of Diseases, Norman Sartorius
of reference greater than in the field of personality psychopa- (Sartorius, Jablensky, & Regier, 1990), the director of the Divi-
thology. Two vantage points are in special need of integration. sion of Mental Health of the World Health Organization, wrote
First, there is the descriptive, categorical classification system of that
personality disorder, epitomized by Axis II of the third edition
research during the past two decades failed to provide evidence
of the Diagnostic and Statistical Manual of Mental Disorders that could help to create disease concepts and disease entities in
(DSM-III; American Psychiatric Association, 1980). Second, p s y c h i a t r y . . . . Other ways of thinking about health and disease,
there is the more inferential, psychodynamic viewpoint of per- mind and body, mental and physical, individual and social are
sonality shaped by mental conflict and ego mechanisms of de- needed . . . . I believe that in selected instances a return to the
allegedly outdated Meyerian reaction patterns and Freudian de-
fense. After all, if both phenomenology and pathophysiology are fense mechanisms is warranted, (p. 2)
important in the understanding of disease, they are both crucial
in the understanding of personality disorder. Nineteenth-cen- Defense mechanisms refer to innate involuntary regulatory
tury medical phenomenologists viewed pus, fever, pain, and processes that allow individuals to reduce cognitive dissonance
coughing as evidence of disease; 20th-century pathophysiolo- and to minimize sudden changes in internal and external envi-
gists regard these same symptoms as evidence of the body's ronments by altering how these events are perceived. Defense
healthy efforts to cope with physical or infectious insult. In sim- mechanisms can alter our perception of any or all of the follow-
ilar fashion, much of what modern phenomenologists classify as ing: subject (self), object (other), idea, or feeling (Vaillant,
mental disorders may be reclassified as the outward manifesta- 1971). There is increasing evidence that the choice of defensive
tions of the mind's adaptive efforts to cope with psychological style makes a major contribution to individual differences in
stress. responses to stressful environments (Vaillant, 1992b). Nowhere
For example, hypochondriasis and somatization are treated is Sartorius's "return to allegedly outdated defense mecha-
as discrete disorders in the DSM-III. According to the DSM- nisms" as warranted as in the domain of personality disorders
III the hypochondriacal individual complains of an illusory dis- (Skodol & Perry, 1993). Thus, as an aid to describing personal-
ease, and the individual afflicted with somatization disorder ity disorders, the revised third edition of the DSM-III (DSM-
complains of illusory symptoms—a hair-splitting distinction III-R; American Psychiatric Association, 1987) has included a
without justified empirical foundation. It may be more useful glossary of defense mechanisms, and the DSM-IVwi\\ proba-
to view both reactions as reflecting defense mechanisms, not bly contain hierarchically arranged defenses as an optional axis.
diseases. Hypochondriasis and its associated help-rejecting S. Freud (1894/1964) observed that affect could be dislocated
complaining often conveys unconscious reproach and devalua- or transposed from ideas (by the unconscious mechanisms that
tion. Hypochondriasis makes the observer annoyed. In contrast, he would later call dissociation, repression, and isolation) and
somatization characterized by the defense mechanism of dis- that affect could be reattached to other ideas (by the mechanism
placement often results in secondary gain and may serve as a of displacement). He also noted that subject and object could
means of communicating an unconscious, or at least unverbal- be reversed by the process that he called projection. Over a pe-
ized, affective state. Somatization often captures the observer's riod of 40 years, Freud and his daughter (A. Freud, 1937) out-
attention. When the distinction between somatization and hy- lined most of the defense mechanisms of which we speak today
pochondriasis is made in this way, it becomes clinically useful. and identified five of their important properties: (a) Defenses
In his efforts to lay the groundwork for the 10th edition of are a major means of managing conflict and affect; (b) defenses
are relatively unconscious; (c) defenses are discrete from one
another; (d) although often the hallmarks of major psychiatric
Correspondence concerning this article should be addressed to syndromes, defenses are reversible; and (e) defenses are adaptive
George E. Vaillant, Division of Psychiatry, Brigham and Women's Hos- as well as pathological.
pital, 75 Francis Street, Boston, Massachusetts 02115. Some defenses (e.g., altruism and suppression) appear much
44
 DEFENSE AND PERSONALITY 45

Table 1 tion of both internal and external reality and often, as with hyp-
Ego Defenses Defined in the DSM-III-R, Arranged in Order nosis, the use of such mechanisms compromises other facets of
of Their Empirical Association With Global cognition. Like hypnosis, defense mechanisms involve far more
Assessments of Mental Health than a simple neglect or repression of reality. In short, defenses
reflect integrated dynamic psychological processes for coping
Category Defense with reality rather than either a deficit state or a learned volun-
Psychotic defenses Denial (of external reality) tary strategy.
Distortion (of external reality)" Table 2 summarizes how the defenses most closely associated
Immature defenses Passive aggression with personality disorders allow an individual to deal with sud-
Acting out den stress by discrete styles of denial or self-deception. The table
Dissociation offers brief operational definitions of defense and a means of
Projection
Autistic fantasy distinguishing them in a mutually exclusive manner. In real life,
Devaluation, idealization, splitting15 individuals characteristically deploy several defenses, not al-
Neurotic (intermediate) Intellectualization, isolation ways from the same level. Just as forests are not made up of just
defenses Repression one kind of tree, or rocks of just one element, of necessity, Table
Reaction formation
Displacement, somatization 2 oversimplifies. Nevertheless, the ability to identify trees, ele-
Undoing, rationalization ments, and defenses helps us to classify our complex world.
Mature defenses Suppression As Table 2 suggests, defenses also alter the relationship be-
Altruism' tween self and object and between idea and affect. In projection,
Humor8
Sublimation8 for example, "I hate him" becomes "He hates me." In addition,
defenses dampen awareness of and response to changes in
Note. DSM-I1I-R = revised third edition of the Diagnostic and Sta- drives, in conscience, in relationships with people, and in real-
tistical Manual of Mental Disorders. ity. First, defenses allow individuals a period of respite to master
' Altruism, humor, sublimation, and distortion are terms used in the text changes in self-image that cannot be immediately integrated, as
of this article but not in the DSM-III-R. b Devaluation and to a lesser
degree splitting are included under my term hypochondriasis, a term might result from puberty, an amputation, or a promotion (i.e.,
not included in the DSM-III-R glossary. changes in reality). Second, defenses can deflect or deny sudden
increases in biological drives. Awareness of instinctual wishes
is usually diminished; alternatively, antithetical wishes may be
healthier than others (e.g., projection and distortion). In the last passionately adhered to. Third, defenses enable individuals to
50 years Anna Freud (1937), George Engel (1962), Richard mitigate unresolved conflicts with important people, living or
Lazarus (1983), and Karl Menninger (1963), among others, de- dead. Finally, ego mechanisms of defense can keep anxiety,
serve special credit for underscoring the need to define a hierar- shame, and guilt within bearable limits during sudden conflicts
chy of defense mechanisms. Every one of these investigators, with conscience and culture.
however, presented a different nomenclature; no one supplied Unlike psychosis and neurosis, personality disorders almost
mutually exclusive definitions; and few sought rater reliability always occur within a social context. It is difficult to imagine a
or provided empirical evidence beyond clinical anecdotes. This hypochondriac or paranoiac becoming symptomatic on a desert
lack of empirical study has retarded the acceptance of defense island. Thus, if neurotic symptoms are a means of coping with
mechanisms by academic psychology. Because it offers a tenta- unbearable instincts, the symptoms of personality disorder are
tive glossary of consensually validated definitions, the DSM- a means of coping with reactions to unbearable people—in past
III-R is a step forward. or present time. Thus, the understanding of immature defenses
In the last 10 years, several empirical studies (reviewed by requires conceptual models that focus more on attachment the-
Cramer, 1991, and Skodol & Perry, 1993) finally avoided these ory, scripts, and role-relationship models (Horowitz, 1988)
limitations and replicated earlier studies showing that defenses than on drives and instinctual wishes.
could be organized into a hierarchy of relative psychopathology The projection used by a paranoid person, by which unac-
(Haan, 1977; Vaillant, 1977; Weinstock, 1967). Table 1 ar- knowledged feelings are attributed to others, is well known. So
ranges these defense mechanisms into four general classes of is the capacity of schizoid individuals to relieve loneliness by
relative psychopathology. The so-called immature defenses in creating fantasized human relationships within their own
Table 1 are the ones that underlie much of personality disorder. minds. The capacity of histrionic personalities to disassociate
Defense mechanisms of the class mentioned by Sartorius themselves from painful emotion and to replace unpleasant
must be distinguished from two other major classes of coping with pleasant affect, as if they were on stage, is familiar. So is the
response. One form of coping involves eliciting help from ap- fact that passive-aggressive and masochistic individuals turn
propriate others, for example, by mobilizing social support. A anger against themselves in a most annoying and provocative
second form of coping includes voluntary cognitive efforts, such manner.
as information gathering, anticipating danger, and rehearsing The mechanisms of acting out and hypochondriasis are less
responses to danger. But seeking social support and using con- familiar. In the antisocial personality, acting out reflects a pro-
scious cognitive strategies are quite distinct from the more in- cess through which the direct motor expression of an uncon-
voluntary adaptive mechanisms often subsumed under the scious wish or conflict allows the individual to remain unaware
term ego mechanisms of defense. of either the idea or the affect that the action accompanies.
The use of ego mechanisms of defense usually alters percep- Thus, acting out produces the clinical illusion that all socio-
46 GEORGE E. VAILLANT

Table 2
Scheme for a Differential Identification of Immature Defenses
Source of conflict Expression of impulse
Conscience Relationships Self or
Style of defense Affect or drive or culture or people Reality subject Idea Affect Object
Projection Externalized Distorted Exaggerated Made object Made self
Fantasy Ignored Taken inside Omnipotent Diminished Within self
Hypochondriasis Distorted Devalued Distorted Altered Anger becomes pain Displaced
Passive Turned on self Exaggerated Exaggerated Made object Ignored
aggression
Acting out Disinhibited Ignored Displaced Omnipotent Ignored Ignored Generalized
Dissociation Altered Altered Exaggerated Altered
Note. From The Wisdom of Ego (pp. 36-37) by G. E. Vaillant, 1993, Cambridge, MA: Harvard University Press. Copyright 1993 by Harvard
University Press. Adapted by permission.

paths do not experience the painful affects of guilt, anxiety, or Empirical Evidence
depression. In fact, nothing could be further from the truth
Too often, different frames of reference or different nosolo-
(Vaillant, 1975).
gies are contrasted by studying them in different groups of indi-
Hypochondriasis disguises reproach (Brown & Vaillant,
viduals. This technique makes real comparison of vantage
1981). The help-rejecting complaints of a person with border-
points impossible. For this reason, I discuss a single sample
line personality that clinicians make him or her worse may con-
studied from multiple vantage points. A cohort of relatively un-
ceal grief and unacceptable aggressive impulses. By exaggerated
selected junior high school boys (Glueck & Glueck, 1950) were
focus on current somatic or psychic pain that cannot be re-
followed for 35 years (Vaillant, 1983). The sample originally in-
lieved, the hypochondriac attempts to manage past unbearable
cluded 456 boys studied by the Gluecks between 1940 and 1963
grief or abuse. This point is more fully elaborated elsewhere
as a control group for their well-known investigations of juve-
(Vaillant, I992a).
nile delinquency (Glueck & Glueck, 1968). The boys had been
Table 3 puts the defenses underlying Axis II disorders in the
carefully matched with a sample of Boston youths remanded to
perspective of both the psychodynamic and the genetic and tem-
reform school for age, IQ, ethnicity, and high crime neighbor-
peramental domains. When conceptualized in terms of revers-
hood. Their mean age was 14 years (SD = 2), and their average
ible defenses, rather than as the result of a largely irreversible,
IQ was 95 (SD = 12). They attended inner-city schools. None of
genetically ordained temperament, personality disorders can be
the boys was African American, but 278 (61%) had at least one
viewed as potentially more plastic and more dynamic. Such
parent who was foreign born.
plasticity is supported by prolonged follow-up studies (Perry, Approximately 80% of the surviving subjects received semi-
1993; Stone, 1990; Thomas & Chess, 1984; Vaillant, 1993).
structured interviews at age 25 (n = 360), age 31 (« = 349), and
age 47 (SD = 2,n= 369). Questions regarding alcohol use and
social and occupational functioning were specifically included
Table 3 in these interviews. In addition to interview data, psychiatric,
Congruence of Different Domains of Classification medical, and arrest records were obtained over the 33-year fol-
of the Personality Disorders low-up period. In addition, estimates of both childhood social
class (Hollingshead & Redlich, 1958) and ratings of multiprob-
Classification domain
lem family membership were made by raters unaware of adult
DSM-IIIandlCD-9 Genetic or Psychodynamic or adjustment (Vaillant, 1983).
diagnostic domain temperament adaptive The entire sample of men was assessed by independent sets of
raters along three contrasting diagnostic axes. The first axis was
Paranoid, schizoid, Schizophrenic Projection, schizoid each man's global psychiatric impairment as measured by the
schizotypal spectrum, fantasy
psychoticism Health Sickness Rating Scale of Luborsky (1962), the prototype
Antisocial, narcissistic, Psychopathic Acting out, of Axis V of the DSM-III-R. The second axis was the DSM-
borderline, spectrum, splitting, HPs Axis II: Which diagnoses, if any, did each man meet? The
histrionic, explosive extra version devaluation, third axis was the maturity and nature of each man's predomi-
dissociation
Avoidant, dependent, Introversion, Passive aggression, nant defense mechanisms as outlined in Tables 1-3. The asses-
compulsive, neuroticism hypochondriasis sors of each axis were kept unaware of both the men's ratings
passive-aggressive, on the other two axes and their childhoods (Drake & Vaillant,
affective, anankastic 1985; Vaillant & Drake, 1985).
Over the 33-year follow-up period, attrition was modest. Of
Note. DSM-Iff = third edition of the Diagnostic and Statistical Man-
ual of Mental Disorders; ICD-9 = ninth revision of the International the original 456 subjects, 33 (7%) had died, 29 (6%) had with-
Classification of Diseases. drawn from the study, and 25(5%) were not interviewed directly
 DEFENSE AND PERSONALITY 47

Table 4
Association of Individual Defenses With Axis H Personality Disorders
Immature
defenses Acting Passive
Category N predominate Hypochondriasis Fantasy Dissociation out Projection aggression
No personality disorder 233 10 2 2 7 12 7 12
Personality disorder 74 66 17 15 32 27 27 34
Cluster A
Schizoid 12 39 17 21 17 6 17 11
Paranoid 6 100 33 17 33 75 100 33
Cluster B
Narcissistic 18 78 11 17 £3. 61 39 33
Antisocial 8 75 0 0 63 25 39 25
Cluster C
Avoidant 12 58 17 8 25 17 17 25
Passive-aggressive 14 71 0 7 43 21 14 61
Dependent 23 78 26 17 56 30 26 30
Note. Values presented are percentages. Numbers of Axis II diagnoses add up to 99, not 74, because in 25 cases men met criteria for two diagnoses.
Underlined cells highlight the association of Axis II categories with an individual's dominant use of the defense considered characteristic of that
category. Defense choice and Axis II diagnosis were determined by independent raters.

for a variety of reasons. The other 369 (87% of the survivors) attempted to select a most likely diagnosis among the 11 specific
were evaluated for personality disorder. Blind estimates of ma- Axis II diagnoses and to specify all of the specific diagnoses
turity of defenses were available for 307 of the 369 interviewed present rather than use the categories atypical and mixed.
subjects. Twenty-five of these men met criteria for more than one Axis
Relative immaturity of defenses was assessed with a 9-point II diagnosis. Diagnoses were skewed toward the interpersonally
scale (1 indicating mature and 9 immature). Examples of adap- withdrawn disorders, such as schizoid, avoidant, and depen-
tive behavior at times of crisis and conflict were excerpted as dent, and away from the acting-out disorders, such as antisocial.
vignettes. On the basis of a glossary (Vaillant, 1977), each vi- This distribution reflects the original sample-selection criterion
gnette was labeled as one.of 15 different defenses. These 15 de- of nondelinquency in early adolescence. Compulsive traits were
fense headings were grouped into immature (schizoid fantasy, not a predominant response mode in this sample of men from
projection, passive aggression, hypochondriasis, acting out, and lower class, less oversocialized backgrounds (Snarey & Vaillant,
dissociation); intermediate (intellectualization or isolation, re- 1985); thus, no subjects met criteria for diagnosis of compulsive
pression, displacement, and reaction formation); and mature personality disorder.
(sublimation, suppression, anticipation, altruism, and humor) Table 4 also depicts the relation of individual Axis II person-
categories. Interrater reliability for scaling of the maturity of ality disorder diagnoses to the use of individual defenses as a
the three groupings of defenses has ranged from .72 to .84. major style. (If one rater scored a given defense as major and the
Methods for identifying individual defenses, rationale, and reli- other scored it as either major or present, men were considered
ability are described in detail elsewhere (Perry & Cooper, 1989; to use that defense as a major style.) As might be expected, all
Skodol & Perry, 1993; Vaillant, 1992b). men meeting the criteria for paranoid character used projection
Although mature defenses are arguably more conscious and as a major defense. Both the narcissistic and antisocial charac-
certainly more successful as coping strategies than immature ters seemed to use projection, acting out, and dissociation.
defenses, to dichotomize defenses as either coping or defending However, narcissistic personalities did receive far lower scores
has proven both arbitrary and unhelpful. Both functions are on Robins's (1966) scale of deviant behaviors than did those
encompassed by each defense. The defense most highly associ- who met Axis II criteria for antisocial personalities. Two thirds
ated with mental health is suppression, by which individuals of the men meeting the criteria for passive-aggressive personal-
deal with emotional conflict or internal or external stressors ities tended to turn anger provocatively against themselves. A
through stoicism, by postponing but not ignoring wishes, and third of the men who met Axis II criteria for schizoid personal-
by subjectively minimizing but not ignoring disturbing prob- ity used fantasy—the least frequently identified defense—as a
lems, feelings, and experiences. dominant style. Avoidant personalities did not appear to spe-
The ratings of personality disorder were made on the basis of cialize in any one defense. These data lend support to the theo-
a 2-hr interview by two research psychiatrists when subjects retical outline presented in Table 3.
were 47 years old. Criteria from Axis II of the DSM-HI were Any scheme that classifies a community sample in terms of
used exclusively. Interrater reliability for the presence or ab- relative mental health will note that individuals with personality
sence of personality disorder resulted in a kappa of .77, but for disorders are concentrated among the least healthy and that
individual diagnoses the average kappa was .41. such individuals have difficulty in working and loving. Table 5
Table 4 shows the distribution of Axis II diagnoses. Seventy- shows the relationship of selected immature and mature defen-
four (24%) of the 307 men with available ratings for maturity of sive styles to global mental health as measured by the Health
defenses met DSM-HI criteria for personality disorder. Raters Sciences Rating Scale. Studies from a companion cohort of col-
48 GEORGE E. VAILLANT

Table 5 occurred by chance. Because all of the men had been raised in
Percentage of Individuals at Different Levels of Global Mental inner city neighborhoods and because parental social class did
Health Using Selected Defenses not affect defensive style, the association of low adult social class
with immature defense deployment seemed a result, not a
HSRS score
cause, of immaturity of defensive style. Although cross-cultural
0-65 66-70 71-84 85-99 studies are sorely needed, the absence of socioeconomic status
Major defense (n = 53) (n = 36) (n=143) (n = 74) as a predictor of maturity of adult defensive style has been con-
Projection
firmed by contrasting these inner city men with a sample of
30 17 7 0
Fantasy 19 11 1 0 Harvard graduates and with Lewis Terman's gifted women
Hypochondriasis 21 11 1 0 (Vaillant, 1992b). In other words, ego defenses, like the immune
Passive aggression 32 36 15 1 system, may represent an innate means by which humans pro-
Dissociation 55 36 15 1 tect themselves.
Altruism 0 3 6 35 Admittedly, pathophysiology is more difficult to study empir-
Suppression 2 14 27 59 ically than is phenomenology. Defenses are, after all, metaphors;
Note. Low scores on the HSRS indicate impaired mental health, and
they are a shorthand way of describing different cognitive styles
high scores indicate good mental health. HSRS = Health Sickness Rat- and mental modes of altering inner and outer realities. Like cre-
ing Scale. ativity and intelligence, defense mechanisms reflect integrated
mental processes and cannot be broken into component parts,
reliably measured, and uniformly labeled. Thus, like creativity,
lege-educated men has confirmed that maturity of defenses is defenses have not yielded easily to rating scales (Bond, Gardi-
as robust an indicator of adult mental health as any of the other ner, Christian, & Sigal, 1983; Gleser & Ihilevich, 1969), to ex-
adult outcome variables (Vaillant & Schnurr, 1988) and as good perimental analysis (Kline, 1972; Moos, 1974), to projective
a predictor of future mental health as any other single variable tests (Blum, 1956), or even to precise description (Siegel, 1968).
(Vaillant & Vaillant, 1990). In addition, the validity of defense assessment goes down as the
It is tempting to view mature defenses as a by-product of mid- ease of administration (e.g., multiple-choice questionnaire) and
dle-class socialization or at the very least of loving parents. reliability (e.g., Q-sort techniques) go up (Vaillant, 1992b; Vail-
However, there was not a strong association between the matu- lant, Bond, & Vaillant, 1986).
rity of defenses and the quality of the men's childhoods. Table 6 Defenses, however, can be consensually validated on the basis
illustrates that the correlation of maturity of defenses with of multiple observations or multiple observers or both. Thus,
global mental health, with the absence of sociopathic traits, with the clinical techniques used by Haan (1977), Vaillant (1977),
regular unemployment, and with adult social class were highly and especially Perry and Cooper (1989) appear most helpful in
significant (p < .001) but that the correlations with childhood identifying defenses. These techniques use the long view and
socioeconomic status and other childhood problems could have the strategies that Runyan (1982) outlined for qualitative, as

Table 6
Percentage of Individuals in Each Category ofMidlife-Defensive Maturity Manifesting
Selected Childhood and Midi ife Psychosocial Criteria
Maturity of defensive style

Neurotic or
Immature intermediate Mature
Criterion (n = 73) (n = 164) (n = 70)

Midlife"
HSRS score
Healthy (85- 100) 1 14 71
Impaired (0-65) 54 9 0
5+ on Sociopathic Traits Scale (Robins, 1966) 21 2 3
4+ years unemployed 44 10 4
Social Class V 21 4 1

Childhood"
Social Class V 26 24 32
Multiproblem family membership 14 10 12
Emotional problems 36 29 26
Less than 10 grades of school 42 26 30

Note. HSRS = Health Sickness Rating Scale.

"Age 47. b Age 14.
 DEFENSE AND PERSONALITY 49

opposed to quantitative, research in personality. Intrapsychic Blum, G. (1956). Defense preferences in four countries. Journal ofPro-
distortions (defenses) can also be inferred (triangulated) with jective Techniques, 20, 33-41.
some reliability by contrasting self-report (autobiography) with Bond, M., Gardiner, S. T., Christian, J., & Sigal, J. J. (1983). Empirical
study of self-rated defense styles. Archives of General Psychiatry, 40,
objective report (biographical record) with symptoms (creative
333-338.
product). With the use of such biographical methods, the sub-
Brown, H. N., & Vaillant, G. E. (1981). Hypochondriasis. Archives of
jectivity of clinical intuition is avoided, as is the artificiality of Internal Medicine, 141, 723-726.
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Conclusions Drake, R. E., & Vaillant, G. E. (1985). A validity study of Axis II of
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Despite problems in reliability, the validity of defenses makes Engel, G. L. (1962). Psychological development in health and disease.
them a valuable diagnostic axis for understanding psychopa- Philadelphia: W. B. Saunders.
thology. There are several reasons why. First, clinicians now ap- Freud, A. (1937). The ego and the mechanisms of defense. London: Ho-
preciate that the symptomatology of infectious disease is often garth.
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Luborsky, L. (1962). Clinicians' judgments of mental health. Archives
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Vaillant, G. E., Bond, M., & Vaillant, C. Q (1986). An empirically vali- Received April 15, 1993
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atry, 43, 786-794. Accepted July 28, 1993 •

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