Denial

Denial, in ordinary English usage, is asserting that a statement or allegation is not true. The same word, and also abnegation, is used for a psychological 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 use:

• simple denial: deny the reality of the unpleasant fact altogether
• minimisation: admit the fact but deny its seriousness (a combination of denial and rationalization)
• projection: admit both the fact and seriousness but deny responsibility by blaming somebody or something else.

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". However, researchers note that in some cases of corroborated child sexual abuse, the victims sometimes make a series of partial confessions and recantations as they struggle with their own denial and the denial of abusers or family members. Use of denial theory in a legal setting therefore must be carefully regulated and experts' credentials verified. "Formulaic guilt" simply by "being a denier" has been castigated by English judges and academics.

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 despite 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.

When a family intervention is conducted to help a person engaged in self-destructive behavior such as alcohol or drug abuse to accept help for his problem, denial is sometimes reduced or eliminated altogether. This is not always necessary, however, for the intervention to be successful in having the person accept help.

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