I ranted and raged for a while, tears coursing down my face. Damn it--why couldn't I go without these medications? It was then that I realized that my general malaise was just one small symptom of generalized denial about the reality of what I had just been through surgically.
I took the two oxycodone tablets that I should have taken four hours earlier--before I went to bed.
Amazingly, I slept through the rest of the night and woke this morning somewhat refreshed and in a lot less pain.
Since the downside of taking the medications is that I find it hard to be at all creative while on them (tending to abruptly fall asleep even as I am composing something), I decided to reprint another of the posts in the series on Strategies for Dealing with Denial.
My hidden agenda with refusing to acknowledge the pain and pretending I didn't need the pain medicine is pretty straightforward. I have a certain need to be in control--that's partly why I am a physician to begin with. By admitting to myself that I am definitely NOT in control of this situation, it means that I am only human, with the same unrealistic expectations, wishful thinking, and innumerable imperfections that everyone else in the human species is prone to.
In this final essay, I will discuss strategies for dealing with denial in one's self and in others. I apologize in advance for the length; but bear with me because I think this is an important topic.
Part I is here.
and Part II is here.
At the center of all psychological denial is a hidden agenda. That agenda is usually not completely conscious--meaning that the denier has not thought through the issues surrounding his denial; and may not even be aware of what his motivation is in asserting something is true when it isn't; or false when it isn't.
Denial need not be absolute and completely cut off from reality. Even among alcoholics and drug users there is a varying level of awareness of their problem. Some accept that they are in jail or sick because of their substance use, but yet are still not willing to do anything about it. Some may recognize some facts about their drinking (like that they get put in jail), but completely deny the impact of those facts on themselves or their families; or the future implications of continued drinking or drug use (e.g., that they are killing themselves and will die).
The hidden agenda or underlying motivation behind the denial is very frequently related to the potential adverse consequences that could ensue if the denial were eliminated and reality acknowledged. That is where the unnacceptable feelings, needs, and thoughts come in. The denier (or part of him) has made an unconscious decision that awareness of certain feelings, needs, or thoughts is more threatening to his sense of self than the act of denial.
As an example, consider a person who develops a chronic cough. He might rationalize to themselves that his cough is because of a lack of humidity in the air; or because he has a slight infection; and most certainly is not a result of his smoking habits. He could go see a doctor, but doesn't, telling himself he is fine. As the cough gets worse, he become even more creative in his thinking about it (or not thinking about it) and is "too busy" to see a doctor; or tend to minimize the symptom even as it worsens.
This strategy of ignoring the problem goes on for some time--maybe months. The person may next fail to notice that he is losing weight and looking a bit drawn-out. The rationalizations now even include benign explanations for the specks of blood that can be seen in the cough. Finally, after much resistance, a loved one firmly intervenes--or the person faces the truth, confronts the issue-- and schedules an appointment. After a few tests, lung cancer is diagnosed. The prognosis is very poor because the cancer has already progessed to advanced stages during the months of denial.
Why would such a person deny the symptom to begin with? Because by denying the symptom, the person can pretend that everything is normal. Early on, when the symptom is new or minor, this possiblity may even be true. But as the evidence accumulates that something is very wrong; the person has now entered a phase of magical thinking and/or fantasy where he effortlessly pretends to himself that everything is as he wishes it to be. Eventually, the individual may become totally psychologically invested in believing that nothing is wrong ("lalalalala I can't heaaaar you"), and reacts (or overreacts) with anger and rage toward anyone who questions his view of things.
The entire act of denial was initiated to begin with by the psyche for a good psychological reason-- to temporarilly supress awareness that something was wrong--while the person struggled with the effort to face that possibility.
That awareness was so frightening, that a temporary psychological bargain evolved into a binding contract that allows the person to suspend cognition and reason so that he is able to ignore any knowledge or evidence that alters his fantasy reality.
Unfortunately, if the person really does have a cancerous process going on within them, it is completely unaffected by the psychological bargain made by the psyche. There are certain rules that govern the progression of cancers and they will be in force, whether or not the person is aware of them or not. Hence, the denier has made a short-term pact to feel better at the expense of his long-term health. In the case of this type of cancer, he has chosen to enjoy a period of relative complacency and blissful ignorance at the cost of catching the cancer earlier when it might be more treatable. In the long-run his unconscious choice is a very bad one.
But the reality is that some people in denial prefer the lethal consequences of their denial as long as they don't have to question their own motivations, beliefs, and ideologies.
Those individuals, groups, or nations who live in the world of deep denial are practically untouchable by reality or rational argument. They go through their daily lives secure in the knowledge that their self-image is protected against any information, feelings, or awareness that might make them have to change their view of the world. Nothing--not facts, not observable behavior; not the use of reason, logic, or the evidence of their own senses will make them reevaluate that world view.
All events will simply be reinterpreted to fit into the belief system of that world--no matter how ridiculous, how distorted, hysterical or how psychotic that reinterpretation appears to others. Consistency, common sense, reality, and objective truth are unimportant and are easily discarded--as long as the world view remains intact. As discussed in Part II, there are countless strategies --rhetorical ploys and logical fallacies--that can be used to keep the truth at bay.
Identifying the underlying motivational factors are important to understand the phenomenon of denial; the reasons why denial is used; and the overally psychology of deniers--whether they are individuals, groups, or even entire nations. There are limitations to this kind of analysis, however; and it is that exposing a motivation or even a hidden agenda in denial is not the same thing as a rational argument or analysis of what the denier is saying or arguing.
In a therapeutic relationship (i.e. therapist /patient) theoretically, a person in denial and the therapist collaborate and work together to discover the underlying problem. Even when very motivated to change, it is often the case that the denier exhibits a great deal of resistance to the idea that he or she is in denial.
In real life (not a therapeutic or professional relationship) we all have to deal with people in denial, and getting a person to accept that he or she is in denial is even more problematic. Unless there is a serious crisis in the person's life, there is little or no incentive for a person to emerge from the comforting cocoon of denial and rationalization--particularly when the consequences of doing so are more threatening to the sense of self than remaining ignorant or oblivious to one's true motivations.
What the psychiatrist does when a patient uses any psychological defense to interfere with treatment is to interpret the defense.
In psychiatry, particularly in psychoanalysis, the psychological defenses --especially the immature ones such as denial and projection --often stand in the way of a person being able to understand the source of their dysfunction and to deal with reality. These unconscious mechanisms act to protect the individual from reality by distorting that reality.
That is why I sound like a broken record and talk about DENIAL, PROJECTION and PARANOIA (see here and here for example) over and over again. Each time I observe such defenses, I work to get those who are using them to be conscious of what they are doing. Only then can they change their behavior.
Ultimately, an individual must CHOOSE to deal with reality. Noone can make anyone face a terrible truth they wish to avoid. One of the purposes of this blog is to "shine a psychological spotlight" on the maladaptive responses to the realities of our world.
A crisis may stimulate self-analysis and make the person more open to reflection and insight; but waiting for a crisis to happen, especially when someone's denial threatens your own well-being, is frustrating and irritating, to say the least. Also, those who have to deal with people outside of a therapeutic alliance, have neither the patience or desire to wait for the hoped-for epiphany in the denier.
Sometimes a crisis occurs (e.g. the events of 9/11) that should shake everyone out of their complacency for all time--but sadly, even that horrible day was not enough to open the eyes of some.
We have discussed the many faces of denial; i.e., the different psychological mechanisms used to facilitate and maintain an avoidance of a painful truth or reality; and we have discussed some of the cognitive tricks that are used to pretend to the rest of the world that one's fantasy is reality. What are the consequences of denial--both the positive (and there must be positive ones) and the negative?
THE CONSEQUENCES OF DENIAL
Positive consequences of denial include:
• In the short-term, psychological denial can help a person maintain their sanity--which would be threatened by awareness of a painful truth or reality
• In the short-term, denial can help a person function day to day
• In the short-term, denial can prevent a person from having to acknowledge painful thoughts, feelings or behavior and help them maintain their worldview from unacceptable reality
In the short-term, defenses--even denial-- may be creative, healthy, comforting, and coping. While they may strike observers as downright peculiar, in the short-term, they may be adaptative. Denial is a way to integrate one's experience by providing a variety of filters for pain and mechanisms for self-deception. It creatively rearranges the sources of conflict so that it becomes manageable.
Some negative consequences of denial include:
• In the longer-term, denial requires continued compromises with reality to maintain the pretense that "Everything is fine!" or "If only X would happen, everything would be fine!" Eventually, delusional thinking, along with paranoia and the inevitable conspiracy theories begin to take the place of rational thought in those who deny reality for long periods of time.
• The denier must then place the blame for the unacceptable reality on someone else and that leads to increased conflict between deniers and non-deniers. Efforts to maintain their denial consumes them and will lead them to escalate their anger and rage as their denial becomes untenable and ever more obvious.
• The denier will begin distort language and logic to rationalize and justify their behavior. Eventually, cognitive strategies and rational argument will be abandoned altogether by the denier, because those strategies are not sustainable and are unable to convince others; at which point the person in denial will simply refer to his feelings or emotions as the sole justification.
• The denier will feel justified in acting out against those who threaten the peacefulness of their fantasy.
• Problem solving and decision making will deteriorate as the entire focus of energy becomes the maintenance of the denial. In place of rational alternatives, excessive emotionality in general; and specifically anger and rage escalate toward those who are "blamed" for the reality that does not conform to the denier's worldview.
• In the end, interactions with those in denial are characterized by the denier's frequent smugness; sense of superiority; arrogance; belittlement of alternative views; and undiluted hatred toward anyone or any idea that questions their worldview.
In order to deal with someone who refuses to acknowledge reality or truth, there several basic approaches.
GET YOUR OWN HOUSE IN ORDER!
First, when confronting denial in others, your own house must be in order. In other words, if you are to have any hope of convincing someone else that they have a problem, you must be able to honestly and objectively assess any personal issues you yourself are carrying around that could cause you to distort reality.
In psychiatry, we call this process insight and self-awareness.
What do you look for?
• Hidden motives for your own behavior or beliefs
• Hidden agendas or ideologies that underlie your own thinking; or any thing in your own life that might facilitate distortion of reality or truth.
• Know yourself! Everyone has vulnerabilities, sensitivities, biases etc. These are not contraindicators for confronting denial in others--you don't have to be perfect; just honest with yourself.
Considering all the different vulnerabilities, sensitivities, and biases all human beings have, it actually requires a considerable effort of will to remain in touch with reality.; as well as a continual and conscious effort at a committment to truth. This is fundamental to personal honesty and integrity. Obviously this is not easy, and we are all prone to those self-deceptions that spare us from unpleasant truths about ourselves.
One of my frequent commenters, "Oh Bloody Hell" left a quote from Isaac Asimov on the Part II thread which is particularly relevant here:
"What I'm doing, really, is to look at things as they are. It's what you must do. Forget your ideals, your theories, your notions as to what people OUGHT to do. Consider what they ARE doing. Once a person is oriented to face facts rather than delusions, problems tend to disappear. At the very least, they fall into their true perspective and become soluble."So many people look at the world through glasses that filter unacceptable thoughts, feelings and reality; and hence they are only able to see what they want to see, instead of what is (and no, that does not depend on the meaning of the word "is").
Again, this does not require perfection--you don't even have to have "pure" motives--just conscious ones that help you to understand why you think and/or feel a certain way. Then you will be open to recognizing the truth and what is. Then you will have a choice in your actions.
If you are lucky, your scrutinized motives, beliefs, wishes, and desires will not seriously conflict with reality. But, if they do, then you must face the music.
Reality is completely indifferent to your feelings, wishes, or your unresolved issues.
DEALING WITH OTHERS IN DENIAL
Once you have applied some self-awareness and know your own limitations--or, as the philosoher Eastwood has said, "A man's gotta know his limitations."-- then you can begin to appreciate the magnitude of the task that lies ahead for someone who is chronically in denial about reality.
The second step in the process is to accept the fact that there are positive rewards for the person in denial (at least in the short-term), and that the psychological defense that you would like them to abandon is actually a creative strategy designed to help them keep their sanity and their sense of self and worldview intact.
You have two choices at this point. You can engage the denier in rational argument in the hopes of breaking through their denial; or you can work around them and let them suffer the consequences of their denial. The second strategy may be the best in some cases, but is obviously more difficult if your own fate is tied to theirs. Let's discuss engagement first.
Just because you wish to engage the denier in argument does not mean that you have to allow them to abuse you or threaten you (this has been an issue several times on this blog--while I want to engage people, I don't have to put up with their abuse). That means that the first principle of engagement is
• Limit Setting - you must make sure that the rules of engagement are followed and that what you are seeking is a rational discussion of issues; not a name-calling session where the person who screams the loudest or speaks with the most swear words considers himself the "winner".
Once the limits are set; be prepared for the person in denial to ignore them.
If you still want to engage, then the second principle is:
• Redirection - where you point out what the rules are again and only respond to the rational argument thatmight be buried in all the emotion. Gently (or at least as respectfully as you can--remember, it is your choice to engage them) point out to the person that they are avoiding the point by using such and such a rhetorical ploy or logical fallacy, etc. You can then challenge them to use a rational argument or present their premises and any evidence to support them. This is as close as you might get to "interpreting the defense". Either they will come back more appropriately and logically, or they'll ignore you; or they'll simply abandon the argument. Limit set and redirect as often as necessary.
If you can get the person back on the topic, and expressing his perspective honestly:
• Give constructive feedback (but not in a condescending tone). You can say something like, "that's a good point; let me see if I can counter it."
• Be ready then, to present your own rational perspective, with whatever evidence or facts you have available that might help them begin to question their own irrational beliefs; or even their own honesty.
• Be ready to point out the specific errors in logic; or fallacies and/or rhetorical ploys in their own arguments. Call them on it and ask for objective evidence from that that you would consider. Make sure you know what these fallacies and ploys are!
• Be willing to acknowledge when they have a point..
• Try as much as possible to engage them with what really exists--not what either of you would like to exist.
• Ask them for specific suggestions on how to deal with the problems you can both agree on. Be ready to give your own specific suggestions.
• When applicable, don't solve their problems for them; or shelter, protect or help them avoid the consequences of their denial --unless those consequences also impact you. If that is the case, understand that by letting them off the hook, you have encouraged them to think that their worldview is correct and yours is not.
• Have some standby information to direct them to that they can read on their own time that may help them to face the problem.
• Don't give into the temptation to call them names or to do unto them what they might be doing unto you…unless, of course, you are human; then in that case once in a while it might help your own mental health.
As you can see from the above list, it is quite difficult and time-consuming; as well as frustrating and endlessly repetitive to engage a person in denial.
Sometimes you may think you have put an issue to rest and successfully argued your point; only to discover that later the denier will bring up exactly the same slogans or mantras that you had previously and painstakingly countered!
That is why the level of denial is important to ascertain. Some people simply need to be nudged or reminded of certain facts--e.g., seeing a movie like United 93, which can bring back the reality of the events of 9/11 which may have slipped from conscious awareness simply from the everyday vissictitudes of living one's own life.
At the other end of the spectrum are those people, groups, and nations committed to the denial of reality the way others are committed to truth. Their entire sense of identity is dependent on a certain view of the world and they would rather die than relinquish that view.
If you want to continue with the challenge of engaging someone in denial, you must recognize that moments of epiphany and breakthroughs in insight are few and far between. In therapy, you can wait for months and even years for people to confront their own denial and understand the motivations that underlie their own unhappiness--but that is in therapy, where they presumably come to see you to get well and/or happier.
Unless the person you want to engage is a loved one, engaging a person in denial can be a thankless task. As I said in Part II, "You can lead a denier to reality, but you can't make him/her
As I said earlier, ultimately, an individual must CHOOSE to deal with reality. Neo-neocon has written about her own journey in her excellent series, "A Mind is a Difficult Thing To Change" which I highly recommend (click on the link and go down her right sidebar to access those posts).
Finally, what do you do if you conclude that you must find a way to ignore or work-around people in denial because you are at risk due to their behavior?
Let me return to my own major motivation for blogging: my observations of the psychological denial --particularly after 9/11--and increasingly psychopathological responses of the left (including many in the Democratic Party) to the war on terror. My hope when I started blogging was that I could offer a unique perspective on the problem and by "shining a psychological spotlight" on the dysfunctional behavior, I could help those with an open mind to to come to grips with the critical issues of our time--Radical Islam and the threat to western civilization.
I remain hopeful that there are many people out who can be motivated to do exactly that. I don't expect them to all think exactly the same as I do about the current situation in the world; nor do I expect them to agree with me on what to do. Surely, reasonable people can differ on these points and amicably work together to come up with optimal solutions.
But what I do expect is some fundamental agreement on what the reality is.
The left's current concensus view on terrorism, Iraq, Afghanistan, the war on terror and Freedom is flatly wrong and cannot be justified by the facts that are out there. Their rhetoric is designed to obfuscate and deny objective reality --which they don't even believe in to begin with (or, they believe in it until it become threatening then they seek refuge behind postmodern political rhetoric). The motivation for their continual Bush/Republican bashing is simple: Bush is the current symbol of their demise--the fly in their utopian ointment; the light shining in their darkness; or, to be more precise, the symbol of the end of their ideology.
How do I know this? Since Bush's election at the millennium, things have been going very badly for the left. As the real world presses in on them, their voices have become more shrill and hysterical; their rage is escalating out of control. No longer do most of them even bother to argue their points logically; they simply loudly denounce any idea or person who threatens their worldview; or deliberately and with the ruthless finesse of all tyrants and thugs, simply attempt to supress all dissenting opinions.
9/11 did not wake them up; rather it forced them to openly move toward what they have supported surreptitiously all along--the elimination of free speech in the name of political correctness and multiculturalism; a dictatorship where the pseudo-intellectual, politically correct priesthood rule; and complete control over the lives of others (for their own good, of course). Since their objectives dovetail nicely with those of the Islamic terrorists, they have made common cause with them and have not lost many opportunities to enable and encourage them, even as they denounce America and the principles of freedom and democracy.
They pretend their actions are motivated from love and peace and patriotism; but this is only how they rationalize it to themselves. Their self-deception and denial is simply stunning in its sweeping grandiosity and self-righteousness betrayal of the good.
Gerard Vanderleun has a post up about the eerie appropriateness of the recently discovered "Judas gospel". The money quote:
Treason, done with the kiss of "my personal freedom," proves that you do not really hate your country, you love it. You are, in the final analysis, your country's best friend. In these "new" old tales about Jesus we read that Judas betrayed the Son of God because Jesus told him to do it. Really? Or did his betrayal come, not from any request that may or may not have been made, but from humanity's persistant lust to sin freely and without even the thin penalty of remorse? Was this final treason done because this sin had been secretly blessed by God, or for the sheer dark thrill of asserting the self at the expense of life in the light?Careful observation and analysis of behavior is what I do for a living. I am very good at it. My patients tend to get well for the most part. I am not always correct and I have a great tolerance for ambiguity and doubt. I can be convinced that I am incorrect because I accept my own humanity and its limitations. But if you want to convince me, you will have to give me some compelling argument that is rational and which conforms to what I observe in the real world. Calling me names and threatening me (try reading my email for a week) just will not do it; and, quite frankly, only confirms my premises.
"I betrayed my friend, because he gave me the freedom to do so. Feel my love for him."
"I betrayed my country because it gave me the freedom to do so. Feel my love for it."
Black is white. Hate is Love. Slavery is Freedom. Treason is Loyalty. That last phrase fits right in to the secular catechism, doesn't it? All it needs to become holy writ is an avatar, a solid historical personage with the power to turn darkness into light, lies into truth, and betrayal into something that was, in the final analysis, "all good."
Saint Judas, step right up to the Gates, ring that bell, and don your halo -- you the man.
If you can look in the mirror and truly know yourself, including all those hidden motives and agendas and unresolved issues in life which we all must grapple with; you can gain some control over your own life; make choices and attack problems based on a clear view of reality. Yes, people may still make the wrong choices, or screw up in dealing with the problems even when they are aware of their own unconscious conflicts. Human beings are not perfect.
But when denial distorts or obscures reality, we are far more likely to make the wrong choices and ignore the serious problems. Our energy becomes solely focused on maintaining and nurturing the denial as we get angrier and more out of touch with reality all the time.
As long as the left continues to live in the world of denial and play their rhetorical games and use their non-logic to justify the unjustifiable; to tolerate the intolerable; and support the unsupportable; then I will continue to blog and expose their motives and hidden agendas; and do everything I can to prevent them from regaining political power.
This means that no matter how badly I think of the current crop of Republicans--and I do think very badly of them--when the alternative is the Party of Denial, better known as the Democrats and the loud lunatic fringe that they cater to; then the Republicans are going to get my vote every time. Where once I had the luxury of voting for third party candidates (e.g. libertarian), the stakes are far too crucial now to waste my votes.
POST-ELECTION UPDATE: We shall see how far the Democrat's denial is likely to take them now that they have control of the House and Senate. I expect that two things in the media will change quite abruptly:
1. Now that the Democrats are in a position to take credit for it, the economy will suddenly be reported as being robust and "on the rebound". The American public will abruptly be subjected to stories of how intrepid Dems have been working behind the scenes to change the economic picture during Bush's first six years of morally degenerate economic policies.
2. As a corollary to the above, we will stop hearing about the budget deficit created by Bush and the Iraq war --not because it is quietly being taken care of by the booming economy generated by the Bush economic policies--and will instead hear how America must increase spending astronomically on the usual Democrat social programs that haven't worked in the last 50 years and aren't expected to work in the next 50 either, but so what? It makes the Dems feel good about themselves and appeases their various victim groups.
3. Another interesting and immediate shift we should see is that the terror threat will suddenly NOT BE OVERBLOWN by BushHitler anymore! The politics of FEAR are gone! No, it will now be the NEW REALITY, sanctioned by the Democrats. The Anchoress already notes some of this spin:
CBS news is telling us that Al Qaeda is planning a holiday blitz:Do you want to know why the NEW REALITY will now be sanctioned? By winning, the Democrats intuitively believe that they can blame Bush for any attacks that occur in the next 2 years. Thus, they can maintain that terrorism is not a significant threat, and at the same time insist that it is --all because of Bush! It's a beautiful strategy, really; sort of a "doubling down" of one's essential psychological denial.Intelligence agencies have been warned that al Qaeda may be planning to attack air and rail travel in Europe in actions that may occur during the busy holiday travel season, CBS News has learned exclusively.It’s an important story, you’ll want to read it all, especially now that the press is now deciding to report that there may actually be terrorists in the world, after all.
In separate interviews with Arab and other intelligence sources, CBS News has been told that the warnings come from interrogations of al Qaeda suspects who recently left Afghanistan and Pakistan.
And just think, now that the election is over, no one can say this is just Bush/Rove trying to “scare” us via the poodle Tony Blair.
Tigerhawk writes: before all our friendly lefty commenters go bananas, I am not suggesting that the Democrats agree with all the various dirtbags who are rejoicing their victory. I am, however, willing to say this: When you cite “world opinion” of George W. Bush as a reason to vote against him or his party, you cannot then object if others cite the opinions of enemies and adversaries who delight in your victory.
I’d say that is about right.
Like Kernberg/Kohut a commenter who thinks it is safe to make an ad hominem attack on both me and ShrinkWrapped since I am somewhat incapacitated at the moment (what a real man he must be), I also don't think denial is a good thing. But I wonder why anyone with any intelligence whatsoever--let alone any analytical skill-- would think that truth, or reality for that matter, is something that can be decided by a vote?
Far from denying what happened on election day, I --as always--wait for the logical consequences of the ideas behind what happened to play themselves out in the real world. Did the American public just acknowledge a painful reality and take corrective medicine (with its own attendant risks)? Or, are they still blithely ignoring the really painful reality that we are fighting a ruthless enemy who wants to destroy us; and swallowed the Democrats' happy pill that deadens the senses even further, and takes us even further from a reality that needs to be faced.
That's one of the hardest things to accept about reality. Reality doesn't care much whether you vote for it or not. It will just go its merry way, no matter whether anyone recognizes it or not. In the end, ideas matter. Choices matter. And every action has consequences that will have to be faced eventually.
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