The role of denial in clinical practice

Denial is typically viewed as maladaptive in clinical practice, despite ample evidence of its adaptive role in personal and health crises. The failure of health professionals to embrace the positive aspects of denial lies deeply rooted in cultural beliefs, which have been reinforced in more recent times by misapplication of clinical theory. Denial is a form of self-deception that protects the individual from threats to the self and involves exaggerated perceptions of control and self-efficacy. Social-psychological research suggests that such biases in cognitive appraisal are the norm and not exclusive reactions to crises. It is proposed that denial has the following functions during crises: denial protects the integrity of the self-concept by distorting reality in a self-enhancing way, promoting a sense of mastery and control; this in turn leads to lower levels of anxiety, which may enhance decision-making under conditions of stress. Psychological health appears to be contingent, at least in part, on an ability to see the world through 'rose-tinted glasses'. Health professionals should be aware, therefore, that whilst trying to promote psychological well-being we do not ask patients to be unrealistically realistic.