Defining and Understanding the Concept of Denial, Addictions and Otherwise

In their sincere efforts to discredit twelve step programs for drug and alcohol addiction, there are some who are in denial about the psychological concept of "denial." It appears that the reason for this is that Alcoholic's Anonymous adopted the concept of denial very early on. While I have no problem with people criticizing and rejecting AA and other twelve step programs, I do feel compelled to explain psychological concepts and their validity quite apart from the fact that some program or other may have adopted and distorted its use.

First, let me direct the reader to the original article that provoked some comments about denial:

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=28976&w=5&cn=14

The comments can be found at the end of the article or by using this URL:

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=28976#dc15440

According to Webster's Medical Dictionary, Denial is defined as:

Main Entry: de·ni·al
Pronunciation: di-'nI(-&)l
Function: noun: A psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality.

The origins of the psychological concept of denial are found in psychoanalysis. Denial is one of many defense mechanisms used to reduce anxieties and overwhelming fears. Mostly, defense mechanisms are healthy because they allow us to function despite the fact that we face dangers in the outside world. However, denial is considered to be primitive and potentially damaging.

The reason why denial is thought to be potentially damaging is that is serves to reject reality. Here are some examples:

1. A College freshman returns home from school and is warmly greeted by her parents. The parents fail to notice that their daughter has lost an incredible amount of weight and has a skeletal appearance. It is only when the girl's uncle, a physician, sees her, that alarm bells are sounded and the family and girl begin to face the fact of her anorexia.

2. I have known and worked with dozens of anorectic young women who, when they look in the mirror, see themselves as disgustingly fat. Yet, the scale and their appearance clearly shows them to be very dangerously malnourished.

3. A mother is called to her son's High School to meet with him and the Principal of the school. The boy is covered in sores all over his arms and legs. He is unwashed and his face is also covered with acne. Mother, son and family are professional and the boy has a high I.Q. The school is for those who are high achieving and gifted.

When confronted with the fact that the school administration believes that the boy is abusing drugs, as evidenced by his overall appearance and the obvious puncture marks on his arms and legs. the mother sees nothing and insists that he is perfectly fine. She offers no explanation for her son's sores and appearance.

What is The Difference Between Lying and Denial?

Fundamentally and from a psychological point of view, lies are deliberate and fully conscious attempts to hide and distort the truth.

On the other hand, denial is a form of delusion and therefore, shares a lot in common with psychotic forms of thinking. There is no attempt at distortion, or conscious distortion or deliberate twisting of the facts. In denial, there is total and complete unawareness of reality.

AA claims that when an alcoholics denial of their drinking is proof of their alcoholism. However, the question is whether the individual is truly in denial or is lying. That is very difficult to distinguish.

It is unlikely that someone who drinks is in denial that they drink. Drinking is a deliberate activity done with full consciousness. It is the fact that the consumption of alcohol is causing them problems that they may be either in denial or lying about.

My guess is that the alcoholic's failure to admit to the harmful effect that drinking is having on their physical and mental health is closer to lying than to actual denial. This person may be lying to others and to themselves but there is usually an awareness of what they are doing. This can be seen when they are asked if they are aware of the way their drinking affects themselves and others and their immediate reaction is to become angry. Perhaps this is what AA is referring to when they talk about denial being proof of alcoholism.

However, the main point of this article is to clarify definitions and facts. The fact is that denial exists and can be observed in many types of people who suffer from any number of psychopathologies.

Here is another definition of denial from Kaplan and Saddock's Synopsis of Psychiatry, Eighth Edition, page 220:

"Denial is avoiding awareness of some painful aspect of reality by negating sensory data...Denial abolishes external reality."

Some of the accounts given by Holocaust survivors describe how they stopped seeing, smelling and hearing all the death that surrounded them. They no longer saw the bodies, of which there were endless numbers. It is not they became accustomed to it or inured against it but rather that all of it ceased to exist. Perhaps that is how some of them survived. Any defense mechanism can sometimes have adaptive functions.

Is someone you know in denial about something or are they lying? Are they lying about their substance abuse or are they in denial?

What are your opinions and experiences, with others and yourself?

Allan N. Schwartz, PhD