ABSTRACT
AMONG the over two hundred dying patients we have interviewed, most reacted to the awareness of a terminal illness at first with the statement, “No, not me, it cannot be true.” This initial denial was as true for those patients who were told outright at the beginning of their illness as it was true for those who were not told explicitly and who came to this conclusion on their own a bit later on. One of our patients described a long and expensive ritual, as she called it, to support her denial. She was convinced that the X-rays were “mixed up”; she asked for reassurance that her pathology report could not possibly be back so soon and that another patient’s report must have been marked with her name. When none of this could be confirmed, she quickly asked to leave the hospital, looking for another physician in the vain hope “to get a better explanation for my troubles.” This patient went “shopping around” for many doctors, some of whom gave her reassuring answers, others of whom confirmed the previous suspicion. Whether confirmed or not, she reacted in the same manner; she asked for examination and reexamination, partially knowing that the original diagnosis was correct, but also seeking further evaluations in the hope that the first conclusion was indeed an error, at the same time keeping in contact with a physician in order to have help available “at all times” as she said. This anxious denial following the presentation of a diagnosis is more typical of the patient who is informed prematurely or abruptly by someone who does not know the patient well or does it quickly “to get it over with” without taking the patient’s readiness into consideration. Denial, at least partial denial, is
used by almost all patients, not only during the first stages of illness or following confrontation, but also later on from time to time. Who was it who said, “We cannot look at the sun all the time, we cannot face death all the time”? These patients can consider the possibility of their own death for a while but then have to put this consideration away in order to pursue life.
