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Recognition and Management

David E. Ness, MD; Jack Ende, MD

JAMA. 1994;272(22):1777-1781.

Abstract
Denial is a psychological defense in which the individual repudiates some or all of the meanings of an illness, thereby warding off an awareness of painful thoughts and feelings such as fear, grief, depression, and anger. Although it is often viewed as a problem, denial may at times be a healthy and adaptive response to illness. In the medical interview, denial may be exhibited by the patient, the physician, or both. Not all instances of denial can or should be addressed within the interview. The decision to address denial can be made based on how adaptive the denial is, what kind of psychosocial support is available to the patient, and how well prepared the patient is to deal with the fears that underlie denial. In those instances when denial should be addressed, the interviewer can use techniques of clarification, confrontation, and interpretation.

(JAMA. 1994;272:1777-1781)

Author Affiliations
From the Department of Psychiatry, Medical College of Pennsylvania and Hahnemann University, Allegheny Campus, Allegheny General Hospital, Pittsburgh (Dr Ness), and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (Dr Ende).

Footnotes
Reprint requests to Department of Psychiatry, Medical College of Pennsylvania and Hahnemann University, Allegheny Campus, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212-4772 (Dr Ness).

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