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December 15, 1993

The Wisdom of the Ego

Author Affiliations

University of Texas at Austin

JAMA. 1993;270(23):2878. doi:10.1001/jama.1993.03510230120054

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Many of us enter medicine with the hope that facing and caring for suffering people will make us not only good (and rich) but wise. In reality, few physicians enjoy the systematic experience or the support for reflection that might allow them to develop more than curbside wisdom about human nature and what gives life meaning. George Vaillant, a widely acclaimed researcher on adult development and on alcoholism, is one of a handful of master clinician-researchers whose work enhances our understanding not only of disease, but of human character in all its vulnerability and resilience.

Vaillant's latest book, The Wisdom of the Ego, focuses on the nature and evolution of psychological defenses over the course of adult life. In the tradition of Sigmund Freud, Anna Freud, and Erik Erikson, Vaillant defines defenses as mental operations that mediate between neurological impulse, learned cultural precepts, social interaction, and the material world. These