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Denial

Is it dangerous? Or just a normal reaction to a cancer diagnosis?

by Suzanne M. Miller, PhD

Wellness image

Denial can be good. As one of the psyche’s primary defense mechanisms, denial is a natural way of distracting from or selectively editing out a painful reality. Since the late 19th century, however, when Sigmund Freud described denial in his psychodynamic theories as a maladaptive coping defense, the common wisdom has asserted that if we deny negative aspects of our lives, such as a threatening medical situation, we’re probably harming ourselves by not taking actions that could improve our health.

But there are times when denial is a useful strategy that allows people in overwhelming life situations to keep on going while still dealing with their circumstances.

While no one should deny a cancer diagnosis, it might be useful to deny the worst-case scenarios and focus on the fact that 95 percent of early stage cancers are manageable, that good treatments and skilled practitioners do exist, and that new treatments are being developed every day. Some might call this maintaining an optimistic perspective.

How do we know whether our denial is healthy?
Healthy denial involves being able to acknowledge the diagnosis, communicate with our family, discuss a plan with our healthcare team, and then having processed it, move on to other life tasks. While it might look to others that we’re in denial, what we’re really doing is “blunting” the impact of the diagnosis so that it has the least psychological effect on our life and our psyche. This is actually a positive way to deal with the challenges of needed medical procedures, office visits, and other interventions.

Unhealthy denial, on the other hand, runs the gamut from an individual refusing to acknowledge that there is anything wrong, to the person who is slowly taking in his cancer diagnosis but refusing to take any action, rationalizing that there is time, there are no symptoms, and there are things to address right now that are more important than cancer.

When we’ve just been hit with unexpected news about our health, it’s okay to take time to accept and understand it.

Author of Article photo

Dr. Suzanne Miller

For caregivers, it’s important to know whether a loved one who has been recently diagnosed is adhering to physician recommendations. If she has discussed the situation with her healthcare team, made her disease management decisions, and still decided to go ahead with an overseas vacation, for example, she is likely engaging in a healthy form of denial – allowing a distraction, engaging in her life, and being optimistic in a reasonable way.

Time can be the key to understanding whether denial is healthy or not. When we’ve just been hit with unexpected news about our health, it’s okay to take time to accept and understand it. Only then are we equipped to hear the options and make the best personal choices around our situation.

But for some, a serious diagnosis is such a shock to our self-image and sense of vulnerability that we need support to bridge the mental gap between thinking of ourselves as healthy, yet acknowledging we are ill. With this type of denial, a caregiver may be able to help the person who has just been diagnosed with cancer through the coping process, step by step.

Here are some steps that survivors can take to regain a sense of control over their lives:

  • Focus on the things over which you have control, such as medical actions and alternatives.
  • Look for support from those around you – seeking support is not a sign of weakness.
  • Only seek out information that is relevant to your diagnosis.
  • Build in time every day to relax and focus on parts of your life other than cancer.
  • Compartmentalize. Focus for one hour a day on what you need to do for your health, then put it aside and pursue other activities.
  • Surround yourself with images of positive role models, such as survivors who have continued to pursue their passions after a diagnosis.
  • Remember that you are still you; you are not defined by your diagnosis. Your life has meaning, and you don’t have to give up the activities you enjoy just because you have cancer.

In the case of cancer, we never know if the initial diagnosis is correct, or how it will play out in our specific case. Part of the psychological challenge is learning to cope with uncertainty. But with the help of loved ones, healthcare professionals, and other support systems, we can feel more in control of our options and our futures. And it is this sense of control that helps improve our quality of life and avoid an ongoing need for denial.

♦ ♦ ♦ ♦ ♦

Dr. Suzanne Miller is director of the Psychosocial and Behavioral Medicine Program and director of the Behavioral Research Core Facility at Fox Chase Cancer Center in Philadelphia, PA.

This article was published in Coping® with Cancer magazine, November/December 2009.

 

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