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Defenses

Denial

Denial is refusing to acknowledge something painful that would be plain to anyone else: a fact about the world, or a feeling, wish, or action of your own. It isn’t lying. The person genuinely doesn’t let the knowledge in, and may become irritated when others point to it.

In the Defense Mechanism Rating Scales, the person deals with conflict or stress “by refusing to acknowledge some aspect of external reality or of his or her experience that would be apparent to others” (Di Giuseppe & Perry, 2021). The DMRS adds that the person is “blinded to both the ideational and emotional content of what is denied”: both the idea and the feeling stay out of view.

Denial protects against knowledge that would bring shame, grief, or other painful feelings. Raters can often see it most clearly when it gives way: the person suddenly feels the shame they were avoiding, and may even apologize. The cost is that a problem nobody will acknowledge can’t be solved, and the person can’t take responsibility for a part they don’t admit to.

Where It Sits

Denial belongs to Level 3, the Disavowal Defense Level, within the Immature Defensive Category. Disavowal defenses keep an unacceptable piece of inner or outer reality from being recognized. By refusing to acknowledge it, the person avoids owning a problem, and so also avoids looking for ways to handle it. The DSM-IV’s Defensive Functioning Scale places denial at the same disavowal level, alongside projection and rationalization.

Among the immature defenses, denial is grouped with the non-depressive defenses, which protect self-esteem by disavowing reality rather than turning distress against the self.

Compared with its neighbors:

How It Shows Up

Common signs, adapted from the items raters use to identify denial:

Examples

“No, not me”

In a 1970 teaching film, Dr. Elisabeth Kübler-Ross described how people face a terminal diagnosis: “When the patient is told that he has a serious illness, he first reacts with shock and denial. ‘No, not me.’” She called denial “the biggest and strongest defense” against the fear of death, and noted, “We have seen patients maintaining their denial for months and months to their family, and to their physicians.” She also described its cost: patient, family, and doctor each knowing the truth and each pretending to the others, when it would be much better to talk frankly “rather than to waste all the little remaining energy in playing a game.” When she and her colleagues asked patients plainly how sick they were, making clear that the pretense wasn’t needed, patients answered just as plainly. Kübler-Ross used “denial” for a stage of coping, which is broader than the DMRS definition, but her observations show both what denial spares people and what it costs them.

Elisabeth Kübler-Ross, Until I Die (1970), film transcript

Kai is mortal, but not me

In Tolstoy’s novella The Death of Ivan Ilyitch, a court official is seriously ill, and in the depths of his soul he knows he is dying, but he “simply did not comprehend it, could not comprehend it.” He had once studied a textbook syllogism: “Kai is a man, men are mortal, therefore Kai is mortal.” It “had seemed to him all his life true only in its application to Kai, but never to himself.” He tries to push the thought away and return to his old routine in court, but the pain in his side keeps breaking through. Tolstoy doesn’t name a defense, but this is a precise portrait of denial wearing thin: the facts are known, and their meaning for me is refused.

Leo Tolstoy, Iván Ilyitch and Other Stories (N. H. Dole, trans., 1887), pp. 54–56

How It Differs From Look-Alikes

Repression
In repression, a disturbing idea is out of awareness while the feeling attached to it may still be felt. Anna Freud described denial as the outward-facing counterpart of repression: a way of warding off pain that comes from outside rather than from within.
Suppression
Suppression is a deliberate, temporary choice to set something aside until the right time, and the person can call it back to mind readily. Denial isn’t chosen, and the unwelcome fact isn’t waiting on a shelf for later.
Rationalization
In rationalization, the person admits what they did but supplies a reassuring, incorrect reason for it. In denial, the person disputes that the act, feeling, or fact is there at all.
Psychotic denial
The DMRS explicitly excludes “psychotic denial,” in which a person refuses to acknowledge a physical object or event right in front of them. Ordinary denial leaves perception intact. It concerns feelings, intentions, responsibility, and painful facts.

In Personality Styles

These personality styles count denial among their characteristic defenses:

By contrast, the schizoid style page notes that people with that style rarely rely on it.

History

Anna Freud gave denial two chapters in The Ego and the Mechanisms of Defence (German 1936; English 1937): “Denial in Phantasy” and “Denial in Word and Act.” She saw it as a normal part of early childhood, when “the infantile ego is free to get rid of unwelcome facts by denying them, while retaining its faculty of reality-testing unimpaired.” In adults, she warned, leaning heavily on denial means that “the ego’s relations to reality will be profoundly shaken.”

Elisabeth Kübler-Ross made denial the first of five stages she described in dying patients, ending in acceptance, and presented the framework in teaching films such as Until I Die (1970).

Research suggests that denial can help in the short run and hurt in the long run. Levine and colleagues (1987) rated denial of illness in 45 men hospitalized for heart attack or bypass surgery. High deniers spent fewer days in intensive care and showed fewer signs of cardiac dysfunction in the hospital. But among the 30 men followed for a year after discharge, high deniers adapted more poorly: they followed medical advice less and needed more days of rehospitalization.

The DSM-IV’s Defensive Functioning Scale (1994) placed denial at the disavowal level and listed psychotic denial separately, among the most severe, psychotic defenses (Vaillant, 2011). J. Christopher Perry’s Defense Mechanism Rating Scales follows the same distinction: it defines neurotic denial at Level 3 and excludes the psychotic form.

Sources