Denial

“Refusal to admit the truth or reality

(as of a statement or charge)” (per Merriam-Webster).

A more clinical description from AlcoholMD.com:

Psychological defense mechanism … includ[ing] a range of psychological maneuvers that decrease awareness of the fact that alcohol use is the cause of a person’s problems… Denial becomes an integral part of the disease and is nearly always a major obstacle to recovery. Denial in alcoholism is a complex phenomenon determined by multiple psychological and physiologic mechanisms… Denial is the reluctance or failure to attribute problems to alcohol consumption; it is often a psychological defense against acknowledging the pain caused by the problem.

The NIAAA offers a Denial Rating Scale Decision Tree. It defines a scale of denial from Level 1 (an alcohol-dependent person saying that drinking is not a problem) to Level 8 (a person connecting with his self-image as an alcoholic, knowing how easy it would be to fall back to drinking without being threatened by it).

It’s certainly possible for us to gloss over tangible negative effects that drinking may have had on us or our loved ones. (I’ve dabbled in it at times.) It’s critical for us, as responsible, self-sufficient adults, to use all of the resources at our disposal to do personal reality checks and adjust our distorted perceptions whenever possible.

The challenge in identifying denial, though, is that the word has sometimes been used to describe:

• Any resistance to a recommended treatment approach.
• Academic disagreement about the necessity of adopting powerlessness and a higher power to achieve recovery.
• Resisting 12-step approaches, or refusing to identify one’s drinking problems as a disease, even mixed with willingness to pursue long-term abstinence.
• Believing that drinking problems don’t all progress to dependence and death (which they don’t).

There is no doubt that denial can be real — it’s possible for us to short-circuit our own logic, and even for long-term alcohol abuse to contribute to that — but slinging denial allegations can also be done sloppily. Once they’ve slung it, folks often feel vindicated by the inevitable resistance expressed by their target. “You’re questioning me? You just proved my point!”

Even when some form of denial is in play, the circumstances are often more complex than a simplistic lack of consciousness or smarts. If we’re not willing or ready to face the ways in which our actions are affecting others, we may still be cognizant that our behavior patterns aren’t smart. We may not be embracing the gut-level assessment by friends or family members, yet entirely willing to admit that things are breaking and/or broken in some fashion. And, the issues on which we disagree may be founded on rational, realistic perceptions.

Presuming that denial is always a player when we’re in a pattern of less-than-optimal choices can raise the spectre of shame. “Damn it, I made another choice that I promised I wouldn’t, so there still be a huge well of denial lurking within me. How could I be that stupid?” In truth, human behavior is often complex. It is not easily understood, and our actions are based on more than simply what we know or what we don’t, what we accept or refute. Taking on shame — thinking “since I did the not-so-smart thing again, I must not be smart enough to admit the reality of the situation” — does a disservice to the complexity of our honest, sincere, yet humanly flawed lives.

Denial isn’t even a universal component of alcohol abuse. On page 33 of his 1995 book, The Natural History of Alcohol Alcoholism, Revisited, George Vaillant notes that problem drinkers have reported their drinking accurately in non-threatening circumstances.

Other researchers have found that alcoholics describe their own excessive drinking practices more accurately than their relatives describe them (Guze et al. 1963; Haberman 1966). Sobell and Sobell (1975) have also documented that the symptomatic diagnosis of alcoholism can in fact be reliably made from the patient if certain rules are followed. Subjects should be without a clouded sensorium and relatively sober at the time of interview. They should be questioned by a sophisticated interviewer who asks the “right” questions, who is not in a position to threaten the alcoholic’s right to drink, who obtains reasonable rapport, and who has time to conduct an adequate interview.

Stanton Peele and Archie Brodsky, in a 1991 article in Reason Magazine, talk about the emphasis on denial in Alcoholics Anonymous:

This proselytizing tendency, originating in the religious roots of the movement, was legitimized by the association with medicine. If alcoholism is a disease, then it must be treated — like pneumonia. Unlike people with pneumonia, however, many people identified as alcoholics don’t see themselves as sick and don’t want to be treated. According to the treatment industry, a person with a drinking or drug problem who does not recognize its nature as a disease is practicing “denial.”

In fact, denial of a drinking problem — or of the disease diagnosis and A.A. remedy — has come to be a defining characteristic of the disease. But indiscriminate use of the denial label obscures important distinctions among drinkers. While people sometimes do fail to recognize and acknowledge the severity of their problems, a drinking problem does not automatically prove a person is a lifelong alcoholic. Indeed most people “mature out” of excessive, irresponsible drinking.

The disease approach uses the concept of denial not only to force people into treatment, but to justify emotional abuse within treatment.

Peele and Brodsky don’t point to denial as something that never happens or doesn’t need to be considered, but to the dangers of indiscriminate use of denial.

Emphasizing the potential, and looking intently, for signs of denial has been found to be counterproductive by some researchers. Instead, they have found it more helpful to consider the natural role of ambivalence as folks progress through the stages of change, and look for ways to increase personal motivation.