In a Quagmire of Denial: Assessing Consequences and Solutions
In a stressful situation our brain gets burdened and opts for defense mechanisms and denial is one of them. Denial is the non-acceptance of the truth to reduce unease (Shah, 2013). There are three types of denial. Simple denial in which a person denies unpleasant reality, minimization in which a person accepts an unpleasant truth but refutes its importance and projection is blaming others (“Denial”, 2013).
A study was conducted at Anadolu University, Turkey. Researcher asked students to write defense mechanisms used by them. Denial was second most commonly used defense mechanism (GOKDAG, 2015). On my psychiatric clinical rotation, I encountered a 32 year old client suffering from schizophrenia. Her presenting symptoms were sadness, anger and fear. She got divorced five years back.
The history given in her file was that after divorce she moved from one sibling’s place to another,having bad relations with all. The client was living in her brother’s friend house a few days before the hospitalization. He reported that the client at night, tried to escape outside, claiming to meet her husband.
In the interview, she kept saying that she wasn’t divorced. She also went to every student asking for a mobile phone and remained frustrated. She became restless and anxious whenever someone refused to give her a mobile phone. People around her used to become agitated. She did not do exercise or participate in activities. She stood at counter with bags, claiming that her husband will come. Whenever the staff explained to her that she was divorced, she would get aggressive.
People think that denial is a coping mechanism but in the long term, it can worsen problems, hence my purpose is to create awareness about the effects of denial, to shed light on dealing with patients who are in denial and to see it as a serious issue. A psychological trauma can be caused by a one time event, for example an accident, an ongoing stress such as disease and commonly overlooked causes such as separation from a loved one (Lawrence Robinson, 2016).
The cause of a client’s psychological trauma may be a commonly overlooked cause i.e. divorce that made her to go in denial. According to Shah (2013) there are basic feelings fear, guilt, pain and anger that impel denial mechanism. We replace these feelings with denial. These feelings come back frequently and denial becomes our habit. Fear and anger were the presenting symptoms of the patient. These were compelling her to use denial to overcome these feelings and to use it repeatedly. As a result, denial became her habit.
The major disadvantage of denial is that it prevents us from seeing the reality and what is not right. It hampers us from taking the right action and it makes problems worse. As a result, we become sufferers of our own actions (Shah, 2013). Denial prevented the client to accept the reality of her divorce. . It also hampered her from taking the right action.
She used to become restless and anxious when someone refused to give her mobile phone which further worsened the problem. She became sufferer of her own actions as other people used to remain agitated and started moving away from her. After divorce she had bad relations with her siblings.
In Sigmund Freud’s model, ego is a part of personality that is based on the principle of reality. Anxiety signals ego that things are not going right and to cope with it, ego uses defense mechanisms. Denial is one of them. Long term denial leads to maladaptive behavior as the person refuses to admit the things that have already taken place (Cherry, 2016).
Trust building is the first step towards increased understanding (Kleinsinger, 2010). On an individual level, a nurse builds a trusting relationship with the patient and works towards understanding and solving the problem. The patients suffering from denial take time to open up. So a nurse should establish her presence, talk when a patient wishes to, encourage expression of feelings, should not insist the client to feel the acceptance of divorce and should not be afraid to ask the outcome of denial.
Once a patient notices that someone is there to help her, a relationship begins. Eliminate distraction as in this case mobile phone was a triggering factor so a nurse should not carry mobile phone. According to Kleinsinger (2010) denial should be challenged in a tactful and nonjudgmental manner because the patient can get anxious.
This can be done by asking what the patient understands about the problem, why does he need treatment, what alternative approaches are there, what I can do to solve this problem, what are the barriers which are preventing this problem to be solved and what can be done in the future.
All these techniques come in cognitive behavioral therapy under cognitive restructuring in which patients learn to identify and alter the dysfunctional beliefs (Stuart, 2013). CBT includes a technique of progressive muscle relaxation. A client tenses the muscles of the body and then slowly relaxes which are helpful to reduce anxiety (“Progressive Muscle Relaxation”, n.d.).
By encouraging the patient to do exercises will lessen the chances of denial as the patient did not do exercise. A nurse can use all these techniques to help a patient realize and overcome denial. There should be more mind diversion activities arranged by a nurse so that client don’t think about her husband and ask for mobile phone.
On community level nurses can talk with community heads to build more library, parks and arrange functions. This can distract the client from thinking about her husband. Nurse can take help from other nurses, psychotherapist and psychiatrist. Their motivation and training can be very helpful for client (Kleinsinger, 2010).
On institutional level nurses with institution managers can arrange awareness sessions regarding denial, its effects and its treatment for public and more specifically for patient’s family members and staff. A special focus should be on informing that not to move away from client and help her understand the reality. In the aforementioned case, people used to move away from her so people should be given awareness about how to deal with her.
Many people are going into anxiety and are ending up in denial. Work load and problems won’t decrease but our way of dealing will alter the outcome. If the energy utilized in maintaining the denial is rather used in a productive way, a person can do wonders. So it is a nurse’s duty to help patients understand, that by refuting, problems won’t go away, instead they will remain unresolved and that we can learn a lot if we are not denying the problem.