Ruthless Compassion Institute

When I was a medical student, the professors liked to show us slides of people who were suffering from advanced diseases. I imagine that this was their way of toughening us up for our future careers as physicians. It was also an opportunity for them to demonstrate what a serious illness such as cancer or a major infection would look like if left unattended.

We viewed pictures of a man who’d had a slow-growing, locally-invasive basal-cell carcinoma that he’d ignored, and which had eventually eaten away his entire nose. We got to see that this unfortunate gentleman didn’t look measurably better with, as opposed to without his plastic prosthetic nose.

We were also treated to the image of an elderly woman who hadn’t dealt with a slow-growing, locally-spreading breast cancer. The tumor had attacked the flesh covering most of her chest, leaving a flimsy layer of tissue covering her vital internal organs. We also got to see her before and after pictures, with and without the silicone plate that had been stitched in place to protect her heart and lungs.

Both of these people would have been long-dead, had their tumors been more aggressive. As it was, they were doomed to spend the rest of their days severely disfigured. And all this because they couldn’t, or wouldn’t face the fact that something bad had been happening to their bodies.

During my last year of medical school, in the clinical clerkship phase of my studies, I assisted at the surgery of a woman who’d allowed a benign ovarian tumor to grow to the size of a large watermelon. Prior to her surgery, the woman, who was post-menopausal, looked like she was nine months pregnant.
When we removed the tumor it weighed more than15 lbs.

The only reason the woman had finally relented and gone to a doctor was that, due to pressure from the tumor against her spine, the woman had been losing the ability to walk. Again, she would have been dead many months prior to the surgery if this tumor had been malignant, and it was just good luck that had allowed this woman to carry on with a (physically, if not psychologically) normal life, afterwards.

The surgeons I worked with were a pretty jaded lot who’d seen just about everything, but this “watermelon” evoked quite a reaction from them. There was a lot of shaking of heads and tut-tutting, as they commented upon how many months the patient had endured an enormously expanding abdomen before she finally sought medical treatment.

These are only a few examples of the way people deny their illnesses. I also encountered a 19 year-old young man who was constantly in and out of the hospital because he refused to take the insulin prescribed for the juvenile diabetes he’d developed at 14. I remember a pleasant 27-year old diabetic woman who was quickly going blind because she never checked her blood sugars, even though they tended to fluctuate greatly.

The doctors had warned both of these individuals that they would suffer serious consequences if they didn’t begin dealing with their illness, but both of them continued as they had. The woman was in the dialysis unit when I met her because she had gone into kidney failure, and the young man was spending more time in hospital than out of it, but they held on tightly to their denial.

During my training I encountered people who had allowed their cancers to progress past the point where they were curable, and those who’d ignored infections or heart disease until they had permanent damage to vital organs, and as a result, permanent disability. Denial of illness was demonstrated to me very early in my career as a terribly unfortunate way of handling one’s medical condition.

At the time, I couldn’t understand why people would deny their illnesses. This always brought them to the point where things were far worse than they would have been if the person had only dealt with the problem when it first arose. Today, as a psychiatrist, I understand that denial is a primitive defense mechanism aimed at reducing anxiety. “If I ignore it, it’ll go away,” is how they think, but of course, 99% of problems not only don’t go away, but get worse when ignored.

Aside from all these serious situations, there are myriad examples of denial on a minor scale that happen every day, with regard to our health. Every time we choose to go to work when we have the flu, we’re denying that we’re really ill. Not only are we likely to infect others at our workplace, but we risk having our own condition drag on or turn into something more serious, like bronchitis or pneumonia.

We sit in the sun and tan or worse yet, go to tanning salons, after the media has thoroughly blitzed us with information about the current epidemic of skin cancer. We desire that “healthy glow” and so we deny the fact that we risk lethal illness in the pursuit of that perfect shade of bronze.

Smoking is a perfect case of health denial. Everyone by now knows full well the risks of this particular habit, and yet millions upon millions of people still choose to smoke. If this is not denial, I don’t know what is. So whether it’s on a major scale or a minor one, we put our heads in the sand and tell ourselves what we want to hear about our health, and consequences, be damned!

Sadly, we don’t only engage in denial around our health. We also go into denial around issues of relationships and money. For the same reason that we might ignore a big lump somewhere on our body, we’ll also tell themselves that our partner isn’t really being abusive, or that they’ll change.

Fear plays a major part in denial. We’re afraid to face the truth about our medical conditions, or about our relationships because this truth might be very upsetting to us. The impulse to deny is strong but illogical, as not dealing with a medical problem or an abusive relationship will, of course, ultimately make things worse. However upset we might have been initially; we’ll be that much more so in the end.

When it comes to relationships I’ve found that people often don’t want to acknowledge that their partner is being hurtful because then they’d have to do something about it. Many people don’t feel empowered in their lives, and the possibility of a confrontation is overwhelming to them. Facing the fact that one’s partner is being cruel, unfaithful or disrespectful could mean having to sit down and discuss this behavior, and some people are terrified of how the partner might react.

Sadly, many people don’t seem to understand that if they are truly frightened or intimidated by their partner, then they simply shouldn’t be with this person. On the other hand, if all they fear is that their partner might be unreasonable, it would be worth at least trying to communicate with them, in order to find out whether or not their partner is responsive to their needs and feelings. Staying with someone and not knowing whether the person truly cares is not the basis for a healthy relationship.

Many people are afraid to be alone; believing that love is only available to them through a romantic relationship. These individuals fear facing the truth about a hurtful partner because the idea of breaking up is terrifying to them. It can feel a lot easier to just pretend to oneself that one’s partner is not being hurtful, than to contemplate the possibility of a break-up. These people don’t realize that it’s never better to be in a bad relationship than it is to be alone and working on developing one’s self-confidence and self-esteem.

Denial, therefore, keeps people in bad relationships and sadly, the longer someone remains in such a relationship, the worse it affects their self-esteem. Remaining in an unhappy relationship makes a person believe that they can’t do any better, while spending time in an abusive relationship sooner or later convinces a person that they actually deserve the abuse. In this way, denial of a bad relationship actually makes it so that the person keeps on receiving the mistreatment that they’ve been trying to deny in the first place!

People need to see that it isn’t better to deny their bad relationship than to see the truth and deal with it. Facing reality always gives one a choice about how to cope. At best, a person could open up communication with their partner and see whether it was merely a problem of not understanding each-other’s needs.

Alternatively, recognizing that a relationship isn’t going well could involve trying couples’ therapy, to see whether the problems could be resolved with the help of a neutral, trained professional. The worst thing that could come of facing the truth would be the decision to end the relationship, and if it’s a truly bad one, this would be a positive outcome.

When it comes to our relationships, the act of making a conscious choice based in reality will give us a sense of empowerment in our lives. The more we face reality and act on it, the more confident we’ll feel, the next time we have a painful truth to deal with. Denial, on the other hand, has us avoiding making choices and therefore leaves us feeling disempowered and helpless in our relationships. The more we deny, the more powerless we feel, until we end up completely unable to act on our own behalf and trapped in an abusive situation. Not an optimal outcome, by any means!

Again, there are more minor ways in which we go into denial around our relationships. I’ve worked with many a woman who was unhappily married, who wouldn’t admit to herself that she’s not fulfilled in her marriage, or that her intimate life with her partner is less than satisfactory, or that her husband’s refusal to help out around the house is making her angry. These women deny how frustrated they are because they don’t want to deal with their problems any more than the women in abusive relationships do.

The denial they are in only perpetuates their unhappiness, and unfortunately for everyone, it makes being in a mediocre marriage seem to be the “acceptable” norm. If most of their women friends are chronically suffering from low-grade malaise like they are, then “Who are we to make a fuss?” these women think. Rather than being able to improve their relationships – many of which could be helped with just a little effort – these women remain unhappily in denial.

Money is another area where people seem to have just as many problems with denial. One of the biggest surprises I’ve encountered since becoming a psychotherapist was the number of people in my practice who’d gotten themselves into huge credit card debt. These weren’t wealthy individuals by any means, but rather, people who were making between 30 and 50 thousand dollars a year. Even so, they had each accrued 40, 60 or even 80 thousand dollars worth of credit card debt.

In exploring the psychology underlying this problem, I realized that denial played a major part in it. These people didn’t want to acknowledge to themselves how much money they actually had, and instead, were pretending that they could afford the purchases they’re making. They were living caviar lifestyles on macaroni budgets, and denying where this spending was heading. I’ve had patients who were making less than thirty thousand dollars a year who’d go shopping for six pairs of pants at a time, or out for fancy dinners five nights a week.

I’ve had patients making $600 each week who were running up $1000 or more on their credit cards, and this was aside from their basic necessities. The credit card companies collude with the denial of these individuals by constantly increasing their credit limits and offering them multiple new cards; some of my most troubled patients having a dozen or more different cards, all close to their their limit, with 19% or higher interest to be paid monthly.

Each month, when the successively higher bill would come, their growing anxiety would cause them to deny that they were getting into trouble and they simply kept on spending money they didn’t have. This went on until they could no longer meet the minimum monthly payments on their cards, or when they couldn’t pay their bills or buy groceries because all their money was going to manage their debt.

Most of these people have had to declare bankruptcy because of their denial around money. They didn’t want to accept that what they were earning wasn’t sufficient for their extravagant tastes, and they refused to believe that their spending would get them into trouble. Rather than coming to terms with how much money they actually had to spend, or making the decision to get a better-paying job, they created terrible financial crises for themselves which would take years to finally resolve.

Another surprise in my practice was how several of my patients confessed to me during the course of their therapy that they hadn’t filed their taxes for 5, 10 or more years. Most of them had their taxes deducted at source, and so the worst that would happen was that they’d be missing out on years of refunds. A few of these individuals, however, were self-employed, and these people were creating a more serious problem for themselves as they gradually accrued a significant tax debt.

Again, it was denial that was keeping all of these people from dealing with their taxes. For whatever psychological reason, they were anxious about filing or paying their taxes and they simply preferred not to deal with the whole matter. They chose to ignore the entire area of taxes in the futile hope that it would all just go away, or they pretended to themselves that somehow, they would be magically exempt from having to deal with this issue. Clearly, they had forgotten the familiar saying that the two things in life that are unavoidable are “death and taxes.”

One of my tax-denial patients had boxes and boxes of receipts amounting to more than 10 years worth of taxes, and yet they couldn’t bring themselves to file. They knew that they had to do this – their reason for collecting the receipts- and yet every time they contemplated sitting down with the boxes, they became overwhelmed by the magnitude of the task they’d created for themselves. Each year, they had that many more receipts and that much more paper to deal with. For this person, their denial led to the creation of much more difficult situation.

Many people are in lesser degrees of denial around money. Evey time we make an impulse purchase that we can’t really afford, we’re denying that we don’t have the money to cover it. Every time we let our credit card bill accumulate, we’re in denial about how we’ve been spending more than we can pay off, each month. I even had a patient, years ago, who worked as a secretary, but who went and bought a dress at Chanel. I’m a doctor and I don’t shop at Chanel, and yet this young woman saw fit to spend probably her entire monthly salary on one article of clothing. And she had no-where to wear it. One brief moment of extreme denial of her income, expenses and lifestyle!

So, whether it results in serious illness or deformity, relationship strife, financial catastrophe or even serious legal problems, denial is the kind of psychological mechanism that always makes things worse. The more we deny, the worse things become, until we can no longer keep the denial going. Eventually, reality slaps us in the face and demonstrates that we must face the consequences of our denial and the fact that whatever situation we were dealing with originally, we’ve allowed things to go from bad to worse. Even minor denial eventually catches up with us.

One example of this would be someone ending up taking more days off work rather than fewer, because denying that they feel sick and going in with the flu has only made their illness drag on. This person risks making their boss more angry than he or she would have been in the first place, and possibly jeopardizes their job. In another example, a woman could end up in an extra-marital affair because if she’s denying how unhappy she is in her marriage, she’ll find an unconscious outlet for her unmet needs, and risk destroying a marriage that could be worked on. In both cases, denial will backfire on these people.

Overcoming denial isn’t easy, but it’s necessary. Otherwise, our lives will be far more complicated, painful or difficult than they have to be. Denial is a childish attitude; one of fearful avoidance of a possibly painful or frightening reality. The sad irony is that, as adults, our varied life experience has equipped us to handle whatever new challenge is thrown at us. It’s just that some of us, sometimes, believe that we’re not. We employ the defense of denial because we feel overwhelmed by what’s happening to us, even though we’d be fully capable of handling our health, relationship and money issues, if we’d only just try.

The best way to overcome denial is to begin by acknowledging our own adult abilities to cope with the various challenges in our lives. It’s easy for some of us to believe that we’re still the scared, helpless child we once were and ironically, being in denial supports this: The more we avoid dealing head-on with challenging situations, the less experience we’ll gain by mastering them. This makes it very hard for us to develop the confidence which would make these same challenges seem less frightening.

Denial always backfires on us, and always makes the thing we’re denying worse. Yes, it can be unsettling to have a medical symptom we don’t understand; and yes, it can be unpleasant to face the fact that our salary doesn’t afford us the lifestyle we’d prefer; and yes, it’s devastating to discover that the person we love isn’t who we thought they were. Still, we can choose to deal with these situations from now on, rather than pretending that they don’t exist.

The more we engage in denial, the less we feel confident about handling difficult or upsetting situations in our lives. The more we face these situations and do our best to handle them; whether it’s seeing the doctor, finding a better-paying job or dealing with our relationship issues, the more confident we’ll become and the easier these challenges will be for us to resolve.

The sense of empowerment we’ll feel after having made a conscious choice about how to handle a challenging situation will result in our having greater trust in our ability to cope with what might come along. The sense of relief we’ll feel once we’ve resolved the challenge will go a long way toward reinforcing to us that painful and frightening though they may be, it’s always far better to deal with the difficult situations in our life than to pretend to ourselves that they don’t exist.

© Marcia Sirota MD
2009