When it's helpful to tune out the truth

(Roy Scott For The Washington Post)
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By Ibby Caputo
Special to The Washington Post
Tuesday, April 27, 2010

A mother finds a lump in her breast while in the shower. It doesn't hurt, and she has to get breakfast on the table and go to work, so she ignores it.

A husband goes to the hospital to have a total knee replacement. While there, he shows signs of alcohol withdrawal, but when the doctor asks his wife if he has a drinking problem, she says he hardly drinks at all.

These are examples of denial, a common defense mechanism that is often misunderstood, according to psychiatrists. In extreme cases, such as when a woman denies signs of breast cancer, the results can be deadly. But more often, a healthy dose of denial helps people endure and process a disturbing reality they or one of their loved ones are facing.

"From a psychiatric perspective, denial is the mind's way of protecting the body and, actually, the mind, from some noxious truth," said Terry Rabinowitz, medical director of the psychiatric consultation service at Fletcher Allen Health Care in Burlington, Vt. "Think of the whole brain as comprising a bunch of different loudspeakers: Denial is the way for the brain or mind to turn down the volume on a certain set of speakers."

The concept of denial as a defense mechanism was introduced by Sigmund Freud, according to Hanoch Livneh, a psychologist who specializes in rehabilitation at Portland State University in Oregon.

"Freud literally thought about it as very pathological," Livneh said, "something that a normal person should not engage in."

In some cases, denial can indeed be pathological.

Lillie Shockney, administrative director of the Johns Hopkins Avon Foundation Breast Center and a two-time breast cancer survivor, said she sees such cases at least once a month. "A patient will come into the emergency room complaining of severe pain," she said, "not in the breast but in the spine or lungs, because the disease is everywhere."

Shockney said that in these cases, as soon as the patient's clothes come off, she can see the tumor eating through the breast tissue. She said such women will typically admit their breast has been in this condition for years, but when she asks if they thought it was cancer, they often remain silent.

"It doesn't matter how much I see it, I'm always stunned that someone can endure this," Shockney said.

It is a minority of patients who suffer in such a severe state of denial. Still, the majority of those with a life-threatening illness experience some form of denial, Shockney said. She can understand why.

"Breast cancer remains the most feared disease of all women, no matter what age, ethnicity or race," said Shockney. "From the time that a girl gets fitted for her first bra, she's taught the value of having breasts. Society places a lot of importance on sexiness and womanhood."

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