Why Am I in Denial After a Cancer Diagnosis?

As we have discussed in one of the previous articles, people can react in numerous different ways when they first find out they are suffering from cancer, depending on a series of individual factors such as their coping style and perception of the illness. Denial, the refusal to acknowledge a painful event, is a common psychological response among recently diagnosed cancer patients. It is a defense mechanism which allows the individual to cope with the shock and the overwhelming feelings a cancer diagnosis often brings about and to eventually accept their diagnosis.

While denial is usually helpful, providing people with the time they need to adjust to their illness and become fully aware of its implications, this psychological reaction might have serious consequences for the patient’s health if it lasts for too long. Similarly, when a person is in total denial, convincing themselves that their diagnosis is not real, their prognosis might suffer tremendously, as they will most likely refuse to seek treatment. However, complete denial is rare.

The Four Phases of Denial

Denial is experienced by each cancer patient differently, to a greater or lesser extent and over the course of various periods of time. It might concern the illness per se or it might pertain only to certain aspects of the diagnosis, such as the implications or the consequences. The duration of denial also ranges. In the majority of cases, denial tends to wear off within the first few weeks after the patient receives the news, whereas some individuals will be in denial for the rest of their lives. Denial can also reappear throughout a person’s battle with cancer – for instance, if their disease does not respond to a certain treatment or the tumor has spread to other organs, denial might ensue again due to the negative connotations such news bear.

Although denial manifests itself in a unique way for every cancer patient, a general pattern has been observed by psychological studies. The course of denial can be described as follows:

• complete denial: the patient refuses to acknowledge their diagnosis, unable to accept that they are really suffering from cancer
• denial of diagnostic implications: while the patient accepts their cancer diagnosis, they minimize the implications of the disease and avoid thinking about its life-threatening nature
• denial of effect: the patient has accepted their diagnosis for what it is and no longer denies the seriousness of the disease, but refuses to show how much distress and anxiety the news causes them
• acceptance: finally, both the implications of the diagnosis and the negative emotions concerning it are accepted by the patient, who is now able to deal with their illness more easily

In a 1976 study aimed at observing the psychological and emotional response of recently diagnosed cancer patients, 53% of the 163 participants did not experience denial at all, while a mixed reaction was noted in 47% of them, who oscillated between denial and acceptance over the course of 6 months. Only 3 patients, two of whom were struggling with lung cancer, were in total denial.

What Are the Most Common Signs of Denial?

Avoidance, refusal, and minimization are the core traits of denial, which will shape the reactions, thoughts, and behavior of the affected individual. Some of the most frequently encountered signs of denial among newly diagnosed cancer patients are:

• refusing to talk about anything related to cancer
• denying that you have ever been told about your diagnosis
• refusing to go to appointments, failing to return for follow-up visits and not seeking appropriate treatment for cancer
• avoiding the word “cancer” and using euphemisms instead (“inflammation”, “lump” etc.)
• refusing to find out anything about your disease and your treatment options
• pretending that you are perfectly healthy despite having been informed about your cancer diagnosis
• trying to convince yourself that you do not have negative emotions concerning your illness

Several studies suggest that people with schizoid (aloofness, avoidance, suspiciousness) and obsessive (rigidity) personality traits are more prone to experiencing denial after a cancer diagnosis, as well as those who have a history of alcohol or drug abuse. Denial is also more prevalent among individuals who had one or multiple unpleasant, anxiety-provoking or traumatizing experiences with the health care system.

The Positive and Negative Consequences of Denial

Short-term denial is generally beneficial for cancer patients. When confronted with a very stressful or painful event, most people’s reaction will be to retreat, to remove themselves mentally from the situation. Denial is a natural response to a cancer diagnosis. For most people, it represents a very effective way of coping with the devastating news, which will eventually lead them towards acceptance. During this stage, cancer patients deal with their overwhelming feelings, anxiety, and fear, gradually taking in the existence of their illness. Being comfortable with the idea that you have a serious disease, which is often terminal, is incredibly difficult and understandably, you will need time to fully accept it.

However, when denial does not wear off within a reasonable period of time – two or three weeks, at most – it could have severe effects on mental and emotional health, as well as on prognosis. The consequences of long-term denial for cancer patients include:

• uninformed health-related decisions
• refusal of cancer treatment, since the individual has convinced themselves that they are healthy and do not need it
• delayed treatment, which might have a negative impact on prognosis and survival
• noncompliance with the medical team
• withdrawal from family and friends, as they are not willing to talk openly about their illness or even acknowledge it, which might, in turn, lead to depression

If you or a loved one who has recently been diagnosed with cancer is struggling with denial and cannot overcome it, we strongly encourage you to seek help from a social worker, counselor or therapist. Persistent denial could have very serious implications for both your physical and emotional health. It is crucial to get through this otherwise normal psychological stage in order to find more useful coping strategies and ultimately be able to accept your diagnosis.