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Denial is a defense mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and 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, dying and rape. 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[How to reference and link to summary or text] 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[How to reference and link to summary or text]. 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[How to reference and link to summary or text]. Critics reply (some seriously, some less so) that it is the proponents who are in denial about the tenuousness of their theories[How to reference and link to summary or text].
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.
Types of Denial
Denial of fact: This form of denial is where someone avoids a fact by lying. This lying can take the form of an outright falsehood (commission), leaving out certain details in order to tailor a story (omission), or by falsely agreeing to something (assent, also referred to as "yesing" behavior). Someone who is in denial of fact is typically using lies in order to avoid facts that they think may be potentially painful to themselves or others.
Denial of responsibility: This form of denial involves avoiding personal responsibility by blaming, minimizing or justifying. Blaming is a direct statement shifting culpability and may overlap with denial of fact. Minimizing is an attempt to make the effects or results of an action appear to be less harmful than they may actually be. Justifying is when someone takes a choice and attempts to make that choice look okay due to their perception of what is "right" in a situation. Someone using denial of responsibility is usually attempting to avoid potential harm or pain by shifting attention away from themselves.
Denial of impact: Denial of impact involves a person avoiding thinking about or understanding the harms their behavior have caused to themselves or others. By doing this, that person is able to avoid feeling a sense of guilt and it can prevent that person from developing remorse or empathy for others. Denial of impact reduces or eliminates a sense of pain or harm from poor decisions.
Denial of awareness: This type of denial is best discussed by looking at the concept of state dependent learning. People using this type of denial will avoid pain and harm by stating they were in a different state of awareness (such as alcohol or drug intoxication or on occasion mental health related). This type of denial often overlaps with denial of responsibility.
Denial of cycle: Many who use this type of denial will say things such as, "it just happened." Denial of cycle is where a person avoids looking at their decisions leading up to an event or does not consider their pattern of decision making and how harmful behavior is repeated. The pain and harm being avoided by this type of denial is more of the effort needed to change the focus from a singular event to looking at preceding events. It can also serve as a way to blame or justify behavior (see above).
Denial of denial: This can be a difficult concept for many people to identify in themselves, but is a major barrier to changing hurtful behaviors. Denial of denial involves thoughts, actions and behaviors which bolster confidence that nothing needs to be changed in one's personal behavior. This form of denial typically overlaps with all of the other forms of denial, but involves more self-delusion.
- Columbia Encyclopedia (2003).
- "When your patient uses denial", Journal of Practical Nursing, 48, 10-14.
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