Denial: Psychologically Healthy or Harmful?

I am at an Acute Care floor for my fieldwork. As the nature of the care setting, patients are admitted to the hospital with life threatening conditions that may or may not get better. As the patients are faced with life changing health events, the patients may go through a grieving process to deal with the reality of the health problems. The first stage of grieving is denial. According to the Mayo Clinic website, denial is a psychological coping mechanism that allows a person time to come to terms with the traumatic changes happening to the person. This stage is beneficial to allow the person to absorb and process the changes happening. However, if the patient refuses to accept the changes and move on to the next stages of grieving, denial can become a negative psychological behavior impacting the patient's mental health and support network. This is the case with two patients I met.

The first patient, age 66, has lung cancer that has spread to his brain and bones. He is in denial and believes he is going to be fine as soon as he can get out of bed and go home. He refuses to talk with anyone about his prognosis or hospice even though the medical staff has explained the medical situation. After a week, the patient realized his health was not going to improve without some medical treatment and agreed to seek support for his family through hospice. By accepting his prognosis, the patient was able to acknowledge the grieving process improving his mental health and receive support from his family and friends as his life comes to the end.

The second patient, age 56, has a severe foot infection and the doctor has recommended a BKA. The patient refused to have the BKA after the medical staff explained the complications of not having the BKA. He has chosen to receive an IV line of antibiotics for 6 weeks at the SNF in hopes the infection will clear up. The course of medical action might work, but there is a strong indication the infection will return and the patient will eventually lose his leg or pass away from the infection. By denying the severity of the infection and situation, he is compromising his physical and mental health. The psycho-social effects of his decision include lack of medical care and family support as he is not doing everything he can to improve his overall health.

In the end, each person needs to decide his/her course of action when some type of traumatic event changes everything in life. Some denial can help the person adjust to the changes or even help the person change his/her life to prevent more problems. An example would be with heart attack patients. Many patients make changes in eating and exercise habits to prevent more health problems. In situations that life decisions can make a difference, denial can be a great motivator for change to a better lifestyle and mental health status.

However, in terminal situations or situation with permanent physical changes such as a brain injury or amputation, denial of the situation can cause significant problems with the person's mental and physical health and family support system. Dealing with any type of loss or grief affects a person's mental health and the person's needs for support and understanding from family members and friends to return to a healthy mental status and accept the new reality of life.

Denial can be a useful psychological coping mechanism to help a person adjust to undesirable news. Denial becomes a negative coping mechanism when the person will not or can not accept the news.

The Mayo Clinic has some great tips on dealing with denial at:

www.mayoclinic.com/health/denial/SR00043