Denial

Denial is a psychological defense mechanism in which a person faced with a fact that is uncomfortable or painful to accept rejects it instead, insisting that it is not true despite what may be overwhelming evidence. The subject may deny the reality of the unpleasant fact altogether (simple denial), admit the fact but deny its seriousness (minimisation) or admit both the fact and seriousness but deny responsibility (transference). The concept of denial is particularly important to the study of addiction.

The theory of denial was first researched seriously by Anna Freud. She classified denial as a mechanism of the immature mind, because it conflicts with the ability to learn from and cope with reality. Where denial occurs in mature minds, it is most often associated with death and dying. More recent research has significantly expanded the scope and utility of the concept. Elisabeth Kübler-Ross used denial as the first of five stages in the psychology of a dying patient, and the idea has been extended to include the reactions of survivors to news of a death. Thus, when parents are informed of the death of a child, their first reaction is often of the form, "No! You must have the wrong house, you can't mean our child!"

Unlike some other defense mechanisms postulated by psychoanalytic theory (for instance, repression), the general existence of denial is fairly easy to verify, even for non-specialists. On the other hand, denial is one of the most controversial defense mechanisms, since it can be easily used to create unfalsifiable theories: anything the subject says or does that appears to disprove the interpreter's theory is explained, not as evidence that the interpreter's theory is wrong, but as the subject's being "in denial".

A commonly-cited example of spurious denial is the psychologist who insists, against all evidence, that his patient is homosexual: any attempt by the patient to disprove the theory (as by pointing out his strong desire for women) is evidence of denial and thus evidence of the underlying theory. This tension can become serious, especially in areas such as child abuse and recovered memory. Proponents often respond to allegations of false memory by asserting that the subjects are genuine victims who have reverted to denial. Critics reply (some seriously, some less so) that it is the proponents who are in denial about the tenuousness of their theories.

The concept of denial is important in twelve-step programs, where the abandonment or reversal of denial forms the basis of the first, fourth, fifth, eighth and tenth steps. The ability to deny or minimize is an essential part of what enables an addict to continue his or her behavior in the face of evidence that, to an outsider, appears overwhelming. This is cited as one of the reasons that compulsion is seldom effective in treating addiction — the habit of denial remains.

Understanding and avoiding denial is also important in the treatment of various diseases. The American Heart Association cites denial as a principal reason that treatment of a heart attack is delayed. Because the symptoms are so varied, and often have other potential explanations, the opportunity exists for the patient to deny the emergency, often with fatal consequences. It is common for patients to delay mammograms or other tests because of a fear of cancer, even though this is clearly maladaptive. It is the responsibility of the care team, and of the nursing staff in particular, to train at-risk patients to avoid such behavior.