I had an interesting exchange with fellow twitterite and blogger Medical Skeptic today. The topic was denial on the part of the terminally ill. Is it something you can decide to stop? Does that mean it’s a choice? It is a normative response, but was it conditioned by a “death-denying society”?
With a view to furthering that conversation, I am going to look back at my most recent bout of denial, earlier this year. I wrote a little about it back in July.
For the first few days after I learned about the new lesions in my skull I was doing the Denial Dance with great energy. It’s a clerical error; they sent me someone else’s results. Well, okay these are my results but the radiologist read the pictures wrong. Okay, the radiologist saw what she saw, but it’s artifactual; nothing wrong with me at all. Okay, there really are skull lesions, but they are from a childhood injury. (Source.)
What is denial? What function does it serve? One way of understanding this defense mechanism is that it is one of the ways our psyche protects itself from unbearable pain or anxiety. It is a sort of reflex, like jerking your hand away from the hot oven or covering your ears when there is an enormously loud noise. It isn’t voluntary and it isn’t logical.
I already knew I had cancer; I already knew I had mets, that I was in the “incurable” category. Years before, long before I had my first cancer diagnosis, I had given thought to my end of life plans. Seeing people in ICU and reading case reports convinced me long ago that I do not want any extraordinary measures. On the other side of things, I am a spiritual and religious woman. In one sense, every day of my life helps me prepare for my death. I am not afraid of it.
So what gives? Why would I, of all people, go into radical denial at the news of a further progression of my disease?
Any soldiers out there? It’s one thing to practice on the range, to participate in military exercises, even live fire exercises. It is an entirely different thing to be on the field of battle with people out there doing their level best to kill you.
Any doctors or nurses? It’s one thing to pound the daylights out of a sophisticated plastic doll (“Annie, can you breathe?”) and an entirely different matter to try to bring a dead person back to life while incidentally breaking their ribs.
The metaphors are many. The point is that there is a real difference between head knowledge and gut knowledge. I believe that denial as a defense mechanism exists as a cushion to protect us while the knowledge moves down from head to gut. While I was in denial I was frightened and I felt a little frantic. The various alternative scenarios that I was proposing seemed like real possibilities to me at the time. In the natural course of things my own psychic integrity brought me gently along to the place where I could accept the new reality: there are lesions in my skull now. Denial protected me until I was ready to take the next step toward acceptance and action.