The Pitfalls of Denial

When I was a medical student, the professors would show us slides of people who were suffering from advanced diseases. This was their way of toughening us up for our future careers as physicians. It was also an opportunity for them to demonstrate what a serious illness such as cancer, diabetes or major infections would look like if left unattended.

These were not the tragic cases of people who’d been feeling well and were unaware of some insidious process occurring within their body. All of the gruesome images we were shown were cases of denial of illness, where people had allowed things to get way out of hand.

It was shocking to see that people could ignore a skin cancer to the point that it ate away most of their nose, or that they’d let an ovarian tumor grow so large that it mimicked a full-term pregnancy. The only reason these people weren’t dead was that their tumors were benign or very slow-growing.

During my clinical clerkship, I attended a 19 year-old young man who was constantly in and out of the hospital because he refused to take the insulin prescribed for his juvenile diabetes. I also remember a 27-year old diabetic woman who was partially blind and in kidney failure because she, too, wouldn’t deal with her condition in spite of all these consequences.

During my training I encountered people who’d ignored infections or heart disease until they had permanent damage to vital organs with resulting disability. Denial of illness was demonstrated to me very early in my career as definitely the wrong way of handling a medical problem.

At the time, I couldn’t understand why people would deny their illnesses. Today, as a psychiatrist, I understand that denial is a primitive defense mechanism aimed at reducing anxiety. “If I ignore it, it’ll go away,” is the unconscious process going on. Sadly, the great majority of problems actually get worse when they’re ignored.

Aside from all these serious situations, people deny illness on a minor scale every day. Each time we go to work when we have the flu, we’re denying that we’re ill. Not only are we likely to infect others at our workplace, but we risk having our own condition drag on or turn into something more serious, like bronchitis or pneumonia.

We sit in the sun and tan or go to tanning salons long after the media has thoroughly informed us that these things are causing an epidemic of fatal skin cancer. We deny the fact that we risk dying in the pursuit of that perfect shade of bronze.

Smoking is another case of health denial. Everyone by now knows full well the risks of this habit, and yet millions of people still choose to smoke. When they become ill they’re shocked and horrified, having been convinced that they were somehow immune to the effects of smoking

Sadly, we don’t only engage in denial around our health. We also go into denial around issues of relationships and money. For the same reason that we might ignore a big lump somewhere on our body, we’ll also tell themselves that our partner isn’t really being abusive, or that they’ll change.

Fear plays a major part in denial. We’re afraid to face the truth about our medical conditions or about our relationships, because this truth might upset us. The impulse to deny is strong but illogical, as not dealing with a medical problem or an abusive relationship will only allow things to progress until they’re far worse. However upset we might have been initially, we’ll be that much more so in the end.

People don’t always want to acknowledge that their romantic partner is being hurtful, because then something would have to be done about it. Many individuals don’t feel empowered in their lives and the possibility of a confrontation is overwhelming. Facing the truth about a partner could mean having to sit down and discuss their behavior, which brings up fears of a bad reaction to this confrontation.

Sadly, many people don’t seem to understand that if they are truly frightened or intimidated by an unreasonable or bullying partner, they shouldn’t be with this person. On the other hand, if all they fear is that the other person might become defensive, it’s actually important to try and communicate with them in order to discover whether or not their partner is capable of respecting their needs and feelings. Staying with someone without knowing if they truly care is not the basis of a good relationship.

Many people are afraid to be alone, believing that they can’t be happy or fulfilled without romantic love. These individuals can’t accept that their partner is hurtful because the idea of breaking up terrifies them. It’s easier to deny the truth than to contemplate the prospects of aloneness. These people don’t realize that a relationship where there’s disrespect is not superior to being alone with self-respect.

Denial keeps people in bad relationships and sadly, the longer someone remains in such a relationship, the worse it affects their self-esteem. Remaining in an unhappy relationship makes a person believe that they can’t do any better, and if there’s abuse in the relationship, eventually the person comes to believe that they deserve this abuse. Denial of a bad relationship perpetuates unhappiness and low self-esteem.

In relationships, making a conscious, realistic choice provides a sense of empowerment. When someone faces reality and acts on it, they’ll feel that much more confident the next time they have a painful truth to deal with. Denial, on the other hand, leaves people feeling disempowered and helpless. The more they deny, the more powerless they feel until they become hopelessly trapped in an abusive situation.

There are other ways in which people are in relationship denial. Many unhappily married people are too afraid to admit that their marriage isn’t working. These individuals deny their frustration because they don’t want to deal with their problems any more than those in abusive relationships do.

Denial of marital unhappiness makes being in a mediocre marriage appear to be the “acceptable” norm. If friends of a couple in relationship denial are also suffering from marital malaise, they could learn from this example not to “make a fuss.” Rather than being able to improve their relationships – many of which could be helped with just a little effort – all of these couples remain unhappily in denial.

Money is another area where people engage in denial. This is evidenced by the epidemic of credit card debt. In my practice, I’ve encountered people earning 30 or 40 thousand dollars a year who’d accumulated credit card debt of 60 and 80 thousand dollars.

In exploring the psychology underlying this problem, it’s clear that denial plays a major part in it. These people didn’t want to acknowledge how much money they actually had and instead, were pretending that they could afford their extravagant or excessive purchases. They were living caviar lifestyles on macaroni budgets, and ignoring where this spending was heading.

Most of these folks who are in denial around money have had to declare bankruptcy because of their compulsive spending. They couldn’t accept that they were spending far more than they had, and until the last possible minute, they ignored the fact that this over-spending would get them into serious trouble.

Some people engage in money-denial by not filing their taxes. I’ve had patients who hadn’t done so for 5, 10 or more years. Most of them had their taxes deducted at source so the worst consequence was that they missed out on years of refunds. A few of these individuals, however, were self-employed and were creating a major problem for themselves as their tax debt continued to accrue.

Out of a general anxiety around matters pertaining to money, or from a need to act out against authority, tax-avoiders are in denial. They ignore the area of taxes, hoping that no-one will notice, or they pretend to themselves that somehow, they are magically exempt from having to file and if necessary, pay. Clearly, they’ve forgotten the familiar saying that the two unavoidable things in life are “death and taxes.”

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Many people are in lesser degrees of denial around money. Evey time we make an impulse purchase that we can’t really afford, we’re in denial about our actual finances. Every time we let our credit card bill accumulate, we’re denying how we’ve been spending more than we can pay, each month.

So, whether it results in medical complications, relationship strife or financial troubles, denial always gives exactly the opposite result of what someone wants. The more we deny, the worse things become until we can no longer keep the denial going. Eventually, reality slaps us in the face and demonstrates that we must face the consequences. Even minor denial tends to backfire on us.

One example of this would be a man with the flu going in to work. He didn’t want to take time off, so he told himself that he’d be fine. Unfortunately, because he didn’t take care of himself, he developed bronchitis which then took him out for a whole week. While at work, he also infected three of his colleagues with the flu, so now the boss has lost four workers. This person was trying to avoid angering his boss by calling in sick, but because of his illness-denial, the boss is angrier than she would have been in the first place.

In another example, a woman is so intent on denying how incompatible she is with her husband that she finds an unconscious outlet for her unmet needs by entering into an affair. Rather than dealing with her feelings and having the chance to resolve the problem, if only through an amicable separation, she’s forcing a very unpleasant confrontation and creating bitter acrimony between the two of them.

Overcoming denial isn’t easy, but it’s necessary. Every instance of denial adds pain and trouble to our lives. Denial is a childlike attitude; one of fearful avoidance of a possibly upsetting reality. Sometimes, like with taxes, we deny out of childish spite. The irony is that we adults are equipped us to handle whatever new challenge is thrown at us. It’s just that some of us, sometimes, believe that we’re still helpless kids. We employ this defense mechanism because we feel overwhelmed by our own needs or feelings when in reality, it’s not that big a deal at all.

The best way to overcome this problem is to begin by acknowledging our own adult abilities to cope with the various challenges in our lives. Sadly, for those of us who are convinced that we’re still incapable of handling difficult situations, being in denial only reinforces this belief: The less we deal with our challenges, the less confident we become with regard to future difficulties.

On the other hand, the sense of empowerment we’ll feel after having mastered a challenging situation will result in our having greater trust in our ability to cope with the next challenge that comes along. The sense of relief we’ll feel once we’ve resolved the challenge will go a long way toward reinforcing to us that however unpleasant or frightening they may be, it’s always far better to deal with the difficult situations in our life than to pretend to ourselves that they don’t exist.

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About the Author

Marcia Sirota MD FRCP(C) is a board-certified psychiatrist, that does not ascribe to any one theoretical school. Rather, she has integrated her education and life experiences into a unique approach to the practice of psychotherapy. She considers herself a realist with a healthy measure of optimism. Sign up here for her free monthly wellness newsletter. Listen here to her latest podcast. mariasirotamd.com