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Balancing Hope and Realism

By Arlene F. Harder, MA, MFT

One of the most difficult aspects of adjusting to a serious illness is the seesaw ride of emotions—hoping desperately that things will turn out okay and greatly fearing they will not. Unfortunately, this problem can be compounded when the patient is feeling "up" while you are "down," and vice versa. And if the doctor says there is no cure and your loved one believes a cure is possible, is he or she in "denial" and "out of touch with reality?"

To better understand the role that hope, optimism and denial play in a life-challenging disease like cancer or multiple sclerosis, let's look for a moment at different types of denial. First is the denial of the diagnosis itself. The second kind of denial admits the diagnosis is correct but refuses to acknowledge the implications of the diagnosis. In the third kind of denial a person recognizes the disease is incurable but still views illness as indefinitely prolonged, denying the possibility of death.

Before you rush to consider how you can get the person to see things "realistically," you might consider the benefits of denial. Denial helps people adjust to illness. There is a great deal of information to process and manage when we are given such a diagnosis. Whom we tell and how we share that information may affect not only promotions at work, but relationships with fellow employees. So it's not unusual to emphasize the most optimistic scenarios or even to use evasion and deception. The person may be quite aware that death is possible and acknowledge to selected individuals the seriousness of the situation, but at other times, with other people, seem to ignore such issues. What we hear a person say does not tell us what is going on within his or her mind.

In examining what we consider "denial" in someone else, it helps to realize that in early stages of the disease it makes little sense to submit to painful treatment if the person feels there is no possibility of ultimate success. Expending psychic energy (i.e., fear and anxiety) dealing with the "reality" that an individual may die means less energy is available to get through the rigors of treatment. It is better to put faith into the possibility of a "cure" or long-term control.

Besides, there are two other reasons you should not mess with denial. One is the fact that there is evidence suggesting denial can play a role in survival for a person who is in treatment but not willing to admit death is possible. The other is the observation that if you take away someone's denial, there is usually nothing to replace it and the person plunges into despair and hopelessness.

In the case, however, that your loved one refuses treatment by insisting nothing is wrong, you may need to do something. Tackling his or her resistance head-on, as much as you may want to take this route, is not likely to be successful. Then you will probably need to talk with a professional to explore what can be done.

© Copyright 1999, Revised 2002, Arlene F. Harder, MA, MFT