Jan 27, 2021
David H. Rosmarin, PhD, joins Lorenzo Norris, MD, to discuss how
to think about the concept of denial and its role in the
sociopolitical challenges of our society.
Dr.
Rosmarin is a clinical psychologist and director of the
spirituality and mental health program at McLean Hospital in
Belmont, Mass. He also is an assistant professor of psychiatry at
Harvard Medical School, Boston.
Dr. Rosmarin has no disclosures. Dr.
Norris has no disclosures.
Take-home points
- Denial is defined as a cognitive and emotional process by which
a person avoids facing aspects of reality, especially when it is
difficult to assimilate the details of reality into one’s current
thinking.
- Arguably, denial is a coping or defense mechanism meant to
address the tension that arises from trying to change an
individual’s current way of thinking and understanding of
reality.
- Another form of denial is choosing to focus only on one’s
perception of reality and struggling to see the other side of an
argument. We can see this form of denial play out in COVID-19
pandemic denial and in certain political narratives.
- Denial in its most potent form causes individuals to disconnect
from any conversation around the salient topic, which can make
denial even worse.
Summary
- Denial can be adaptive in its role of protecting a person's
psyche. When the midbrain and limbic system are activated, the
frontal lobe needs time to process and integrate the information.
For example, people will deny the presence of an event they regret
or fear until they have enough emotional capacity to integrate new
facts into their current model of reality.
- Yet, denial can be harmful when there are “side effects.” The
classic example of pathologic denial is an individual who has
experienced trauma, and through continued denial of its impact and
poor integration of the event, starts to experience somatic
symptoms. Dr. Rosmarin says the problem with denial is that people
who are experiencing denial are often the last to recognize their
need for treatment or an intervention.
- Dr. Rosmarin discusses how, with certain topics, we must value
and preserve relationships over persuading certain social contacts,
such as family and friends, to overcome their denial. Validating
emotions and finding the validity in a person's beliefs and
grievances can go a long way toward preserving relationships that
are challenged by denial of certain facts.
References
Rosmarin DH et al.
Lancet Psychiatry. 2021 Feb;8(2):92-3.
Hall C and Pick D. Hist
Workshop J. 2017 Oct;84(1):1-23.
Miller BL. JAMA. 2020 Dec
8;324(22):2255-6.
Rosmarin DH.
Spirituality, Religion and Cognitive-Behavioral Therapy: A Guide
for Clinicians. New York: Guilford Press, 2018.
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Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast; assistant clinical professor in the department of
psychiatry and behavioral sciences at George Washington University,
Washington; and staff physician at George Washington Medical
Faculty Associates, also in Washington. Dr. Posada has no conflicts
of interest.
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