We all live with some degree of denial. It’s one of the many psychological defense mechanisms we use to protect ourselves from painful emotions. Some of these mechanisms you may be more aware of than others: Sophisticated mechanisms like humor help people cope with stress by finding something funny to laugh about (hospital food jokes), while other defense mechanisms are less helpful, like acting out (throwing pill bottles across the room) when you are stressed.
People living with cancer often lean heavily on denial to cope with the extraordinary levels of stress and uncertainty that come with cancer diagnosis. But just how helpful, or harmful, this defense mechanism may be when you are dealing with cancer really depends on the degree of your denial. So it’s important to look honestly at the role that denial is playing in your thinking.
Basic denial (low degree) – We all live with a low degree of denial. This form of denial may be called suppression by some therapists, or compartmentalization by others. It is the tendency of our minds to suppress (or put away, block out) thoughts that are uncomfortable or stressful for a short period of time. Ben is a 78-year-old who was treated for a brain tumor last year and struggled to return to independent living because of difficulty walking. Though Ben had accepted the prognosis from this doctor that his recovery would be limited given the location of his tumor, during his physical therapy (PT) sessions, he would talk as if he could make a full recovery; focusing on recovery helped him stay motivated. He was determined only to think and talk about sports, athletes and outdoor games during PT. “I just can’t think about the problems all day, I need to put them away some times. I know I may not walk like I used to, but I can make small improvements every day!”
Difficult denial (medium degree) – This form of denial is one that gets in the way of people completing tasks related to cancer, but doesn’t stop them from actually getting the cancer treated. Dan is a 60-year-old living with stage IV melanoma, who had responded well to immune therapy, and his current scans are stable. Because his cancer was stable, he did not think he needed to have advance directives or a will written up: “I am fine now. No way am I to that point yet!” After talking with his oncology team and family, Dan was able to recognize his denial about his potentially life-limiting cancer diagnosis and gather the psychological energy to write up his papers (an energy consuming task for many because you have to think about your own death, for some people for the first time). Completing the papers was actually a bigger relief to Dan than he expected: “At least I know that is taken care of, so when I think about the what-ifs down the road, at least I know those papers are there to help my family.”
Pathological denial (highest degree) – People with pathological denial are the ones that have their head in the sand about the seriousness of cancer or the need for medical treatment. When they try to think or talk about cancer, they are not able to take in information or think through what treatment path they want to go down (if there is a choice). Betsy is a 52-year-old with breast cancer who did not want any conventional treatment (no surgery, chemo, or radiation) because she really loved her body (especially her breasts) and did not want to “torture” herself. For months, she suffered with pathological denial: She refused scans, surgery, and medications because she thought the cancer would melt away with special juices and vitamins she had researched. Not until the cancer broke the skin, and became painful, would Betsy let the doctors help her. She actually did well through treatment, which she was able to do because she addressed her pathological denial in therapy.
Understanding your degree of denial may help you see how your defense mechanisms may be helping you or holding you back as you journey through your cancer experience. Figuring out your level of denial may tricky, though – you may not even be aware you are using denial as a defense mechanism! Talk openly with your oncology team, support group, family, friends or a therapist to help you identify where and how you are using denial to cope and whether you need to do anything to change it.