A Question About Denial

Question: Is there anything a person can do to help family members break through denial? Boy, is it unpleasant to be the truth-teller to a person who isn’t ready to hear it! Should we just allow others to drift in denial? Should we leave it up to “professionals” to deliver the hard, unpleasant truths?

There are several questions here and I will start with the last one. Yes, professionals, and by that I mean physicians, need to be the first to explain to a patient/ family that a person cannot be fixed or that a point has been reached where the likelihood of a cure and a return to normal life is probably not going to happen. A patient/family needs to hear from their doctor that the dying process has begun.

Physicians are the front runners because they order and oversee the tests, the procedures, and the treatments. A non-physician does not have the credibility of a physician to say that a condition can’t be fixed.

Once that information has been given and understood, the door is open to discussion by others.

My approach has been that once a person has been told that they can’t be fixed if they choose to be in denial then so be it. It is not up to me, as a non-physician professional or lay person, to insist they talk about their feelings. They will face this final challenge in the same way they have faced any other challenge in their life. If they chose not to deal with it, I will not force the issue. However, that said, I won’t “play the denial game” with anyone by lying about their prognosis if the subject comes up. I believe it is important to always be gentle and truthful. Generally a person will ask questions when they are ready to hear the answers. At that time they deserve the truth as we know it.

I don’t like to leave families in denial about approaching death. As a non-physician end of life professional, I will try to gently guide significant others into understanding where a person is in the dying process, what they can expect to happen, and what they can do to support the people they care about. Because knowledge reduces fear, and family and significant others are frightened about what the future now holds for them, most are open to guidance and information. For those who are not open I will still gently tell them the information I feel I need to impart. They don’t have to believe me. I can only hope that at some point in this process the information I have given them will surface.

Tensions often develop when family dynamics are such that some members are understanding that death is approaching and others are in denial. It is sad to see the family balance disrupted during a time when they need each other so much.

As friends, neighbors, members of shared religious affiliations, even Hospice volunteers, I feel it is not our responsibility to address a family or a patient’s denial. This is their life experience. They will meet the challenge as best they can. Be a presence, a support person, a listener. Don’t lie if asked what you think, but remember, it is not our place to offer an unsolicited opinion about what is happening.

Denial occurs because we just can’t face the reality of a situation. It hurts too much. It is too frightening. It is not productive to insist someone believe what they are not ready to process. It is not productive because there is no way you can make a person believe something, even with rational proof. The proof will be in however the situation unfolds. Time will hold the proof and then the consequences of our denial will be lived. And isn’t that what life is about--choices, consequences, and lessons learned?

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