The Way We Get By
Over the past several weeks, I’ve been working with a woman in her 80’s who – until a recent cascade of medical events – has enjoyed phenomenal health. Having taught aerobics for years, and being admittedly much more active than the majority of us (OK, I’ll just speak for myself), Jill is now understandably a bit stunned by her increased dependence on others and loss of confidence; she reveals a newly-acquired timidity in relation to her physical self. As Jill and I discussed her recent medical course and began to outline the new landscape she must now learn to navigate, she shook her head and said: “So, I guess I’m not invincible?”
As a courageous, independent woman whose relationship with her body and surroundings has been one of ability and grace, how could Jill have been expected to understand how this time would feel until she experienced it firsthand? And yet I’ve overheard conversations in which professionals wonder in bewilderment how those in their 80’s or older have not expected to decline, or how those faced with a serious illness don’t act quite as expected, and are quick to ascribe it broadly to denial.
A quick review of the roots of “denial.” Sigmund Freud first identified the concept (later elaborated upon by his daughter, Anna) as an unconscious defense mechanism, or a way to protect oneself without any intention or awareness. In order to regulate the environment around us, we simply do not recognize stimuli or data that we cannot afford to integrate at a particular time. Without consciously recognizing it, we filter the world into messages that can be absorbed and those that cannot.
In other words, denial is an integral, behind-the-scenes part of our everyday lives. Denial provides us all with the ability to move forward, to get out of bed each day. Within the medical setting, it feels to me as though the label of denial is most typically employed as a device to shame or ostracize. When I hear a physician or other clinician lament over a patient’s denial, I translate this to mean, “I’m frustrated that this person hasn’t accepted what I’ve told them so we can move in the direction I believe to be appropriate.” This undermines the process by which a person, with the proper psychological and concrete support, may eventually come to recognize the gravity of a situation. It happens on no predefined timeline, and necessarily looks different for each person.
So, has Jill lived in denial by not anticipating the various ways in which she might become seriously ill? I would argue that the question should be instead: what internal and external tools does one have to piece the world back together once denial is no longer utilized? Jill has managed to transform the recent recognition of her invincibility into meaningful action and planning in regards to her healthcare wishes, and that – to me – is the most one can ask for.
Leave a Reply
Want to join the discussion?Feel free to contribute!