ABSTRACT
This chapter derives from experiences, both successful and unsuccessful, while working with hospice patients facing impending death. The presence of hope in a dying patient is thought by some to be an expression of denial. When responding to dying patients who maintain hope it is helpful to support them by continuing to be hopeful while at the same time trying to help them face the reality of impending death. Sigmund Freud was the first to identify the psychological mechanism of denial. He referred to it as “disavowal of reality”. He elaborated on this in his analysis of fetishism where an inanimate object is transformed into a sexualized object through a process of substitution. Psychoanalytic thinkers generally view denial as a defense mechanism in a fixed intrapsychic structure that is relatively unchanging; a primitive defense reverted to when reality becomes too painful or harsh.
