House Call: When Diagnosis Meets Denial

From OncoLog, May 2008, Vol. 53, No. 5

House Call: When Diagnosis Meets Denial

Being diagnosed with a serious illness is a devastating experience for almost anyone. On hearing the news, some people become fearful, while others are angry, anxious, or sad. Still others deny that anything is wrong, telling themselves that the doctor must be mistaken, the diagnosis isn’t serious, and everything will be fine.

The basics of denial

Denial is a psychological defense mechanism that protects us from anxiety by allowing us to refuse to admit that a problem exists. Many people initially have trouble believing or accepting the fact that they have a serious illness. As a temporary response, denial can be a helpful buffer, allowing time to adjust to a new diagnosis. Usually, this early period of denial is followed by other, more realistic coping responses.

Denial of a serious medical problem can happen at different times:

Before the diagnosis. A person might ignore symptoms or think that there’s no reason to seek medical attention because “it’s probably nothing.”
After a diagnosis. A denying patient might insist he or she isn’t really ill or doesn’t need to return for follow-up care.
When a cured ailment returns. In this case, the patient may think, “I’ve completed my treatment and done everything I was supposed to do. This can’t be happening again.”

Persistent denial can lead to serious medical complications. Patients who won’t accept that they are ill will avoid or delay treatment, miss doctors’ appointments, and ignore symptoms or warning signs of problems. They often do not follow medical advice.

Tuning out the details

Whether denial is a temporary reaction or a persistent mindset depends on the way the patient has dealt with past crises, said Mary K. Hughes, C.N.S., a psychiatric advanced practice nurse in M. D. Anderson’s Psychiatry Service. “People aren’t going to change their coping mechanisms because they are ill,” she said. “They’re going to do what’s comfortable.” If denial is the way they’ve coped with past problems, they are likely to tune out what the doctor is telling them.

Deniers don’t hear the details of medical treatment or information about the severity of their disease. “They don’t pay attention to specifics,” Ms. Hughes said. They might tell themselves that the doctor will take care of the problem and everything will be fine.

It’s vitally important, Ms. Hughes said, to watch for signs of denial in a loved one who is ill. You can accompany the patient to medical appointments and pay attention to the details that he or she may ignore. In the doctor’s office, you can serve as an extra pair of ears, ask the physician questions, get treatment specifics, take notes, and generally offer the patient support. You can also ask the doctor about possible side effects from treatment and how those side effects can be managed, which may help the patient feel more comfortable.

Beyond denial: How to cope

Almost everyone diagnosed with a serious illness experiences a wide range of feelings afterward. These feelings can change often and unexpectedly. Having someone who will listen to the patient discuss these often confusing emotions can be a big help. The listener might be an empathetic friend or family member, other patients in a support group, or a member of the clergy. Professional counseling can also be beneficial.

Perhaps most important of all is making sure that patients realize that a wide variety of help is available—from health care professionals, friends, family, and volunteers—and they do not have to carry the burden of illness alone.

Deniers don’t hear the details of medical treatment or information about the severity of their disease.

For more information, talk to your physician, or

contact the Department of Neuro-Oncology’s Psychiatry Service
call askMDAnderson at 1-877-632-6789

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