Friday, 27 June 2014

Denial, is it always bad?

     When I  was at home recovering from stent placement and my son was away, he had a close friend drop by to see how I was doing.  He arrived with two bowls of an exotic Oriental soup, that he had told me about at a barbeque in the summer. I thanked him for the soup and when  he asked me how I  was I told him I was doing just fine.
     " Well, I was told you would say that anyway, that you minimize these things.  How are you really?"
      When I challenged my son  about branding me as a minimizer, his response was, "well, you are."
       I resisted the temptation to say "no, I'm not," followed by "well, that's better than being a maximizer,"  and decided to give the whole denial topic some thought.
        Denial is defined by Freud as a psychological defence mechanism in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting it is not true  despite what may be overwhelming evidence.
         Now this can be a very bad thing and result in  people not seeking needed investigation and attention, but take out 'overwhelming' and the whole denial concept may serve a valuable service.This is particularly so for folks in the Health Care Professions who are dealing with depressing diseases and disabilities much of the time..  As a medical student, healthy doses of denial kept me going, because when I saw and  looked after people with horrible diseases and even shared some of their symptoms  I knew it really couldn't happen to me.  THAT's denial and that's what enables most of us to carry on without becoming hypochondriacs.  Without denial, it would have been harder to carry on and may have resulted in unnecessary investigation and worry.
           When I  got older and became a victim of the ravages of time I continued to benefit from that defense mechanism and knew the various vague symptoms I experienced from time to time were just the normal consequences of aging.  I was not so stupid as to continue the denial when  it became difficult to carry on  my normal activities and it was at such a time that I  would involve my family doctor.  Then it became her problem, and I (for the most part) would do what I  was told.   I think that this approach has served me well and never felt that the denial  phase resulted  in any  adverse  outcome.  To put it another way it enabled me to minimize the situation until it went away or until it became apparent that I ought to do something about it.  This saved me much investigation during an era when investigation was often excessive and the results were not always without harm.  Attitudes regarding investigation are changing and initiatives are already under way to rationalize investigations and avoid fishing expeditions as in the 'Choosing Wisely' program, where the risk of too early and too extensive investigation is currently being examined. The risk of denial is that it may go on too long, resulting in delay in diagnosis and treatment.
         There are forms of denial not related to personal health that people use as a temporary defence that allows them to deal with a situation while they are developing the strength and skills to deal with a catastrophic situation.  I have seen many patients over the years who used this mechanism to their advantage.I have also seen many over the years who have been more disabled by being 'maximizers' than by being 'minimizers'.

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