Denial is the refusal to acknowledge the existence or severity of unpleasant external realities or internal thoughts and feelings.
Theory of denial
In psychology, denial is a concept originating with the psychodynamic theories of Sigmund Freud. According to Freud, three mental dynamics, or motivating forces, influence human behavior: the id, ego, and superego. The id consists of basic survival instincts and what Freud believed to be the two dominant human drives: sex and aggression. If the id were the only influence on behavior, humans would exclusively seek to increase pleasure, decrease pain, and achieve immediate gratification of desires. The ego consists of logical and rational thinking. It enables humans to analyze the realistic risks and benefits of a situation, to tolerate some pain for future profit, and to consider alternatives to the impulse-driven behavior of the id. The superego consists of moralistic standards and forms the basis of the conscience. Although the superego is essential to a sense of right and wrong, it can also include extreme, unrealistic ideas about what one should and should not do.
These three forces all have different goals (id, pleasure; ego, reality; superego, morality) and continually strive for dominance, resulting in internal conflict. This conflict produces anxiety. The ego, which functions as a mediator between the two extremes of the id and the superego, attempts to reduce this anxiety by using defense mechanisms. Defense mechanisms are indirect ways of dealing or coping with anxiety, such as explaining problems away or blaming others for problems. Denial is one of many defense mechanisms. It entails ignoring or refusing to believe an unpleasant reality. Defense mechanisms protect one's psychological wellbeing in traumatic situations, or in any situation that produces anxiety or conflict. However, they do not resolve the anxiety-producing situation and, if overused, can lead to psychological disorders. Although Freud's model of the id, ego, and superego is not emphasized by most psychologists today, defense mechanisms are still regarded as potentially maladaptive behavioral patterns that may lead to psychological disorders.
Examples of denial
Death is a common occasion for denial. When someone learns of the sudden, unexpected death of a loved one, at first he or she may not be able to accept the reality of this loss. The initial denial protects that person from the emotional shock and intense grief that often accompanies news of death. Chronic or terminal illnesses also encourage denial. People with such illnesses may think, "It's not so bad; I'll get over it," and refuse to make any lifestyle changes.
Denial can also apply to internal thoughts and feelings. For instance, some children are taught that anger is wrong in any situation. As adults, if these individuals experience feelings of anger, they are likely to deny their feelings to others. Cultural standards and expectations can encourage denial of subjective experience. Men who belong to cultures with extreme notions of masculinity may view fear as a sign of weakness and deny internal feelings of fear. The Chinese culture is thought to discourage the acknowledgment of mental illness, resulting in individuals denying their psychological symptoms and often developing physical symptoms instead.
Certain personality disorders tend to be characterized by denial more than others. For example, those with narcissistic personality disorder deny information that suggests they are not perfect. Antisocial behavior is characterized by denial of the harm done to others (such as with sexual offenders or substance abusers).
Denial can also be exhibited on a large scale— among groups, cultures, or even nations. Lucy Bregman gives an example of national denial of imminent mortality in the 1950s: school children participated in drills in which they hid under desks in preparation for atomic attacks. Another example of large-scale denial is the recent assertion by some that the World War II Holocaust never occurred.
Treatment of denial
Denial is treated differently in different types of therapy. In psychoanalytic therapy, denial is regarded as an obstacle to progress that must eventually be confronted and interpreted. Timing is important, however. Psychoanalytic therapists wait until clients appear emotionally ready or have some degree of insight into their problems before confronting them. In the humanistic and existential therapies, denial is considered the framework by which clients understand their world. Not directly confronting denial, therapists assist clients in exploring their world view and considering alternative ways of being. In cognitive-behavioral therapies, denial is not regarded as an important phenomenon. Rather, denial would suggest that an individual has not learned the appropriate behaviors to cope with a stressful situation. Therapists assist individuals in examining their current thoughts and behaviors and devising strategic ways to make changes.
Traditional treatment programs for substance abuse and other addictions view denial as a central theme. Such programs teach that in order to overcome addiction , one must admit to being an alcoholic or addict. Those who are unable to accept such labels are informed they are in denial. Even when the labels are accepted, individuals are still considered to be in denial if they do not acknowledge the severity of their addictions. From this perspective, progress cannot be made until individuals recognize the extent of their denial and work toward acceptance. However, there is much controversy in the field of addictions regarding the role of denial and how it should be addressed. Traditional programs stress direct confrontation. Other professionals do not insist on the acceptance of labels. They believe that denial should be worked through more subtly, empathically focusing on the personal reasons surrounding denial and seeking to strengthen the desire to change. This subtle form of addressing denial is known as motivational enhancement therapy, and can be used with other types of disorders as well.
Bregman, Lucy. Beyond Silence and Denial: Death and Dying Reconsidered. Louisville, Kentucky: Westminster John Knox Press, 1999.
Millon, Theodore and Roger Davis. Personality Disorders in Modern Life. New York: John Wiley and Sons, 2000.
Cramer, Phebe, and Melissa A. Brilliant. "Defense Use and Defense Understanding in Children." Journal of Personality 69, no. 2 (2001): 297–322.
Parker, Gordon, Gemma Gladstone, and Kuan Tsee Chee. "Depression in the Planet's Largest Ethnic Group: The Chinese." American Journal Of Psychiatry 158, no. 6 (2001): 857–864.
Schneider, Sandra L. and Robert C. Wright. "The FoSOD: A Measurement Tool for Reconceptualizing the Role of Denial in Child Molesters." Journal of Interpersonal Violence 16, no. 6 (2001): 545–564.
The American Psychoanalytic Association. 309 East 49th Street, New York, New York 10017. (212) 752-0450. <http://www.aapsa.org> .
Sandra L. Friedrich, M.A.