It is very common for people to experience denial of diagnosis shortly after first receiving the news. Whether the illness is mental or physical, the mind may need some to adjust. You go through some shock, which includes denial, until you can settle in to the idea of what it all means.
However, denial can grow to become a big problem. People who continue to deny their illness are at risk of insufficient treatment and suffer many symptoms. Unfortunately, denial can be a common, recurring issue for some people with mental health struggles.
Their caregivers can become frustrated and overwhelmed. Understanding what the denial is all about is a good first step in figuring out how to cope with it.
What is Denial of Diagnosis
As the name suggests, denial of diagnosis basically means that an individual has received a credible diagnosis from one or more licensed health professionals but refuses to accept that diagnosis.
However, it’s important to understand that denial isn’t a willful act. It’s not as though the person is adamantly refusing to “face the facts” although it can feel that way to care providers. There are many factors that can come into play.
Anosognosia
Anosonosia is a medical term for a person who lacks the insight or awareness to understand their own condition. They’re in denial of illness because their brain isn’t currently or fully capable of understanding the illness. In many cases, the individual will see the truth of their own diagnosis at times while at other times experience denial.
Anosognosia is a particularly common form of denial for certain mental health diagnoses. NAMI reports that 50% of people with schizophrenia and 40% of people with a bipolar diagnosis experience this form of denial.
For people struggling with this, it’s as if they are looking in a mirror and they simply don’t see what others around them see. They have an entirely different perception of themselves. It is not a perception that includes illness.
Memory Problems
Anyone who struggles with memory problems may have problems understanding their own illness. Unfortunately, memory problems are a feature of many mental health issues. People with depression, for example, often face memory challenges.
In some cases, memory problems may get exacerbated by substance use issues. Prescribed meds can also impact memory. Whatever the cause, limited memory can make it hard to remember all that you need to in order to accept your illness.
Fear of Stigma and/ or Treatment
People have very legitimate reasons for not wanting to be labeled with a specific diagnosis. Stigma still runs thick in our society. Once you have the diagnosis, you may have to face the stigma.
Likewise, some patients have fears about treatment. Their fears may be based on misconceptions and assumptions or on their own experiences. Regardless, the fears feel real and valid.
If a person is unable to articulate a deep-seated fear of stigma and/or of treatment options then they may present as in denial of diagnosis.
A similar problem occurs when someone tries treatment for their diagnosis and it doesn’t work. They’re tempted to assume that the diagnosis itself was incorrect.
Can Denial of Diagnosis Be Harmful?
It’s really challenging when you love someone who is denial of their illness. You may even sometimes have coherent, clear conversations with them about their need for treatment only to find later that they’ve done a 180 and no longer agree.
When you see your loved one spiraling down into their harshest symptoms because of denial of diagnosis, you desperately want to help.
In most cases, a person’s denial of their issues can lead to a lower quality of life but doesn’t rise to the level of harm. However, in some cases, the denial can be truly harmful.
For example, if someone you love is suicidal or dangerously reckless when off of their medications, then denial can present a very real threat to life.
How You Can Help Your Loved One
First of all, remember that they aren’t trying to be difficult. The fact that they can’t accept their illness is itself a symptom of the illness. With that in mind, here are some things you can do to help:
- Let them know that you are on their side. They probably feel very alone right now.
- Listen. They don’t want to be told what to do right now. However, they do want to be heard. Be present.
- Accept that you are powerlessness to convince them that they are ill. Focus on what must be done in the moment.
- Encourage them to do things that help reduce symptoms. Do those things with them. Medication refusal is common but you can try meditation, exercise, enjoyable events, grounding activities, etc.
- Get help if you believe that they are an immediate threat to themselves or others.
How a Therapist Can Help in Moving Beyond Denial
You might wonder how someone who doesn’t believe in their diagnosis even ends up in therapy. However, it happens all of the time.
First of all, a person might recognize that they are in distress even if they don’t agree that a mental health issue is the cause. For example, someone might come to therapy complaining about their spouse only to realize eventually that they’re dealing primarily with underlying depression.
Alternatively, people may end up in therapy due to court order or family intervention. Perhaps they don’t believe in the diagnosis, but they have shown up anyway. As long as they’re showing up, a therapist can help.
Therapy Can Be a Long Process
The most important thing that the therapist can do is to build up a positive, trusting relationship. This takes time, but it is critical. Once someone has trust in their therapist, they are much more likely to accept the truth of a diagnosis.
That said, there are some mental health conditions that may inhibit someone from accepting a diagnosis despite building a therapeutic relationship. Paranoid schizophrenia and borderline personality disorder are both conditions that cause frequent breaks in relationship trust. Therapy can take a long time.
However, therapists can do many things in the meantime to help their patients. For example, they can help:
- Address issues bothering the individual
- Develop coping skills
- Feel heard and understood
- Gain insight and self-awareness
- Improve communication
- Work on relationships
Therapists can help people move past denial of diagnosis. More importantly, though, they can help the patient improve their quality of life with or without diagnosis acceptance.
