'You're in denial.' What exactly does this mean and how does it apply to depression? Unfortunately, the term denial is frequently used as weapon to bash people over the head with. It seems to suggest the person isn't thinking straight, that they are deliberately avoiding issues staring them in the face. But do we choose to be in denial, is it something that affects us at an unconscious level, or do we use it knowingly?
Denial is one of several psychological mechanisms we use to protect ourselves against unwanted, painful, or threatening issues. As we become more anxious about a situation or event a number of emotions such as guilt, embarrassment, shame or fear, begin to stir. By denying something too uncomfortable to manage we protect ourselves from its potential impact.
Denial isn't just about refusing to accept something - although it may be. It's not uncommon for someone to have a degree of awareness but to minimize or rationalize the situation. One of my own relatives used this form of denial in the lead up to his death. He knew his heart and kidneys were failing but he refused to talk about them. When the specialist arrived he would use humor and appear to trivialize the situation, brushing aside what could be worried about tomorrow.
In such a situation it seems that denial had its place. There was nothing my relative could do about his situation beyond what he was already doing (taking medication), so any accusation that he wasn't being realistic or facing up to the inevitable would be cruel and unhelpful. This tells us that defense mechanisms can have their place, but we also know there is a point where denial becomes unhelpful and possibly harmful.
So, why would anyone deny depression? There may be several reasons, the most obvious of which relate to work, self-esteem and self-image. Denying that your emotional state isn't all it might be is a good way of pressing ahead. You may not be firing on all cylinders, but you're hoping it's just a virus or a bit of pressure that will pass. This is extremely common. It's the psychological equivalent of running a car on reserve fuel and hoping it won't shudder to a halt. Denying depression is caught up with all sorts of things. Men, stand as a good example because depression doesn't fit with their sense of self. They may view depression as something that affects women, or they may struggle with admitting their symptoms to themselves.
This is where the issue of denial gets blurry. On the one hand people with symptoms of depression are less objective about their own situation than they may be in assessing others. Equally, denial of depression is a major hurdle in seeking treatment.
Denial is a powerful mechanism and one that, if confronted, can lead to angry and upsetting scenes. There is no time frame for denial. Some issues run deep enough to last a lifetime. In a secure and loving relationship it is sometimes possible to appeal to the intellect or better nature of the partner to seek help for their depression. Sometimes a compromise can be reached where the person agrees to be seen by a specialist - in order to prove or disprove once and for all - they have a problem. This at least moves the situation forward a little.
For the person in denial the situation is more complex. If the denial is deep enough they simply won't have the insights to see their situation for what it is. In the case of depression symptoms may progressively worsen the longer the person puts off seeking treatment. If there is acceptance at the level of minimizing or trivializing the problem then it may be easier for the person to be persuaded that their situation is more serious than they acknowledge.
Davidson, R. J. (2000). Anxiety, depression, and emotion. Wisconsin: Oxford University Press.