The role of defensive functioning in positive deviance in psychological wellbeing amongst young women living in Soweto, South Africa

This qualitative study explored how mature defence mechanisms support positive deviance in health and wellbeing among young women facing adversity in Soweto, South Africa. Drawing from the Bukhali randomized controlled trial in Soweto, which targets improved health trajectories for young women, this study focused on a group of participants who exhibited positive deviance in the trial by being employed or studying, engaging actively in the trial, and showing favourable physical and mental health indicators despite living in a context marked by poverty, inequality, and trauma. Eight in-depth interviews were conducted with participants who met selection criteria, and data were analysed using a codebook thematic approach, incorporating a psychoanalytic framework of defensive functioning. Participants demonstrated frequent use of high adaptive defences, such as anticipation, self-observation, sublimation, and self-assertion, which enabled emotional regulation, agency, and healthy coping. Self-isolation and low affiliation, often seen as withdrawal, were reframed as protective strategies when balanced with meaningful social connections. These findings offer a psychologically rich understanding of how young women in challenging environments navigate complex social landscapes. By integrating positive deviance with defensive functioning, the study extends psychoanalytic theory to marginalized contexts, revealing how mature defence mechanisms contribute to resilience. The insights have implications for designing strength-based mental health interventions tailored to the realities and psychological capacities of marginalized populations.