FREE ESSAY ON PSYCHOLOGY: DENIAL

PSYCHOLOGY: DENIAL

Introduction
So you don't think that you are an alcoholic. Chances are that you are not, but this is
the thought that many who are unknowingly addicted to alcohol or other mind-altering
agents. This denial barrier is the first of many hurdles to overcome when they are
identified as having an addiction disorder. Although all denial isn't bad most of the
time, addicts are often the last to recognize their disease, pursuing their addictions
into mental illness, the degeneration of health, and ultimately death. This paper will
explain the concept of denial, its consequences, and the implications it has for nursing
care.
Review of Literature and Knowledge Base
What is denial? Dr. Hilary Knatz, the author of Getting On, states that "Denial, is a way
of coping with unpleasant realities" (Knatz, 1999). She then goes on to explain that:
Denial, in the psychological/psychiatric vernacular, is a defensive strategy to minimize
anxiety. It is defined and conceptualized in a number of ways, which differ according to
theory. In classical Freudian terms, denial is a defense mechanism invoked by a person
when there is a danger that he or she will become aware of or act on unconscious
primitive impulses that are unacceptable. We defend against such impulses, it is said, by
unconsciously limiting our awareness of them, or perhaps attributing them to others. A
murderous rage, for example, may be repressed or obscured from our awareness, or it may
be attributed to others (p. 2).
The Oxford English Dictionary defines denial to be "the asserting (of anything) to be
untrue or invalid; also, the denying of the existence or reality of a thing" (Simpson &
Weiner, 1989).
Sometimes denial can be constructive and adaptive, according to R. Davidhizar, V. Poole,
J. N. Giger, and M. Henderson the authors of When your patient uses denial. For example,
there have been studies of people with terminal illness that have suggested that denying
the seriousness of the condition may help postpone death. It is true that overwhelming
anxiety can hamper coping, and that screening out anxiety-provoking stimuli can help
prevent this kind of paralysis. In general, it must be observed, the world is full of
terrifying possibilities that we could never completely comprehend (1998).
Denial is the refusal to believe or accept the reality that certain events have happened,
are happening, or will happen. To accept the reality would bring emotional pain, so the
events are denied. Related to denial is the defense called minimizing. Events are
accepted, but only in a watered down version. "Sure I drink once in a while. Everybody
does. It's no big deal. Once in a while I might get carried away, but it really isn't a
problem" (USDHHS, 1994).
Denial is the primary psychological symptom of addiction. It is an automatic and
unconscious component of addictions. Addicts are often the last to recognize their
disease, pursuing their addictions into mental illness, the degeneration of health, and
ultimately death. Sadly, many addicts continue to act out on their addictions while their
world collapses around them blaming everything but the addiction for their problems
(USDHHS, 1994)
Denial is one of the reasons that recovery from addictions is seldom effective if the
chemically dependent person is forced into treatment. You cannot work on a problem unless
you accept that it exists (USDHHS, 1994). 
Active alcoholism and addiction are characterized by a struggle to control use. Addicts
resent the suggestion they are powerless until things get so bad they are forced to face
their addiction. Sadly, some alcoholics never break through their denial, and continue
use to the point of insanity and death (USDHHS, 1994).
The concept of denial plays a key role in the twelve-step addiction treatment model,
where denial of addiction is seen to be the chief hindrance to any kind of realistic
treatment of the problem. This is no easy task because addicts have developed an
"elaborate network of denial" (McCracken, 1998). Not only of addictive events, but also
of the meanings and consequences of those events, whose seriousness they try to minimize
with rationalizations (McCracken, 1998). 
The twelve step programs also recognize that any one person's denial can expand into a
group denial, most immediately, perhaps, to the family system. Family members play along
with the addict's behavior, assume the addict's guilt, and maintain a secretive united
front with the outside world (McCracken, 1998).
Step One of Alcoholics Anonymous deals with working through our denial, allowing us to
accept our powerlessness over addictions and the chaos and unmanageability they bring
into our lives. This is just one of the curious and beautiful things about recovery. The
acknowledging of the powerlessness the addict is empowered to lead a healthy life
(USDHHS, 1994). 
There are several defining characteristics that identify the possibility that a patient
may be in denial. Some examples include pretending something does not exist when in
reality it does. Being willing to admit there is a problem, but unwilling to see the
severity of it. Seeing the problem as being caused by something or someone else. The
behavior is not denied, but its cause is someone else's responsibility. Offering excuses,
alibis, justifications, and other explanations for behavior. Dealing with the problem on
a general level; avoiding personal and emotional awareness of the situations or
conditions. Changing the subject to avoid threatening topics. Becoming angry and
irritable when reference is made to the condition. These defining characteristics help to
avoid the issue at hand (Whitfield, 1994).
Synthesis
Denying disease is a well-recognized phenomenon in medicine. Every year thousands of
people with treatable illnesses die because they don't take prescribed medicines
properly, or at all (Davidhizar, Poole, Giger, & Henderson, 1998). Even the healthiest
among us are sometimes prone to denial, such as putting off annual checkups for fear of
finding some illness. Some people even contribute to illnesses by their denial, most
commonly by smoking. 
In some cases the denial impulse can have a positive effect. In order to be a normal
functional being, you must deny death. Healthy denial allows you to keep going. It's when
it interferes with survival that it seems to cause a problem. What we call denial is
often really suppression, which is "the conscious or semiconscious decision to avoid
attending to the conflict" (Davidhizar, Poole, Giger, & Henderson, 1998). We know that we
are ill but we choose not to do anything about it. The most common reason for that
behavior is fear, though not always fear of death. People make their life-and-death
decisions based on what makes their lives worth living, for them. It is the author's
belief that most likely almost every oncologist can tell stories of women that lost their
lives because they rejected recommended treatment. However, women who define their
self-esteem through their body image may have a difficult time following through when
treatment includes mastectomy. Doctors acknowledge that, for some, conventional medicine
simply does not fit in with their personal belief system. 
Implications for Nursing Care
The implications for nursing care are centered on the identification of a patient's
denial and to take steps to help the patient identify that they have a problem. It is
especially important to help the patient identify that there is a possibility that they
may have a problem to try to convince to them that they need help. 
The concept of identifying denial can be used in the author's nursing practice in such a
way that it helps to identify a nursing implementation. This implementation will be
necessary to be collaborative with other specialties, such as with a psychiatric
specialist, along with including the family. This collaborative effort will help insure
that the patient will receive proper help along with a supportive environment.
Summary
In conclusion, denial can be a serious and potentially lethal state of mind. Although
denial can prevent illness, for the most part it hinders it. Remember that denial is the
primary symptom of addiction. It is important to note that there are programs out there
that can help individuals overcome their denial and get the proper treatment they need
and deserve.
Bibliography
List of References
Whitfield, C. L. (1994). Denial of the truth: Individual and political dysfunction in the
Thomas-Hill hearings. Journal of Psychohistory, 19, 269-279.
Davidhizar, R., Poole, V., Giger, J. N., & Henderson, M. (1998). When your patient uses
denial. Journal of Practical Nursing, 48, 10-14.
McCracken, A. L. (1998). Healthy People 2000: Aging and alcohol. Journal of
Gerontological Nursing, 24, 37-43.
Simpson, J. A. & Weiner, E. S. C. (1989). Denial. In The Oxford English Dictionary (Vol.
4, p. 456). Taunton, MS: Clarendon Press.
Knatz, H. (1999). Getting On. [On-line]. Available:
http://www.awa.com/w2/getting_on/go-3.9.html.
U. S. Department of Health and Human Services. (1994). Signs of effectiveness 2:
Preventing alcohol, tobacco, and other drug use: A risk factor / resiliency-based
approach (DHHS Publication No. 94-2098, p 93-94). Washington, DC: U. S. Department of
Health and Human Services Publications.