It may happen that when faced with the symptoms of breast cancer, one prefers to “not see”, to pretend nothing has happened. A well-known phenomenon in psychology, called “denial”. This is a completely normal defense mechanism, as he explains Maria Teresa Nasta, expert in clinical psychology and adjunct professor of Fundamental Human Sciences at the Nursing course of the State University of Milan, whom we interviewed for the newsletter of HealthBreast (here the link to register for free). And that tells us why it is important to recognize it and how to deal with it.
Professor Nasta, what causes some women to overlook breast cancer symptoms?
“It is important to start from a consideration: that the patient is a whole person and we cannot think of distinguishing the physical component from the psychological and relational one. Pathology attacks the body but also affects the psyche. According to psychodynamic theory, our ego protects us from anxiety and the internal dangers that cause it, by putting in place defense mechanisms. They are automatic and unconscious mechanisms that prevent contact with distressing and unacceptable mental contents. Among these mechanisms we find, for example, denial and denial, whereby the ego does not allow the recognition of a certain aspect of reality (denial) or rejects its emotional and affective aspect (denial). There is therefore the non-acceptance of thoughts, emotions, behaviors, as they are considered to be intolerable. Consequently, the person behaves as if that event or emotion did not belong to him or did not exist, even if they are evident “.
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And can this also happen in the medical field?
“Yes, it is not that uncommon for people to deny the disease. One can even go so far as to ignore the objectively manifest symptoms and signs of the pathology on one’s body. It has been reported to me by health workers how some women have presented themselves to the breast service with breasts now swollen and in a state of necrosis, that is, with a condition of more than evident disease. But why have these women waited so long? I think we can provide precisely this psychological explanation: the implementation, albeit in an unconscious way, of a defense mechanism such as denial ”.
How common are these cases?
“Difficult to answer. However, we know that they occur. However, we must not think that the defense mechanisms are always linked to an aspect, so to speak, of psychopathology. We use them all. On the contrary, they are a guarantee of balance and psychic well-being, and play an important role in outlining the personological characteristics of each of us. When then do they become pathological? When archaic, primitive, rigid defenses are used and when these continue to persist in an age in which they should no longer be used, except in exceptional cases and in a transitory way. It is a very complex concept. We must refer to psychoanalytic theory: the study of defense mechanisms originated from Sigmund Freud. Some authors speak of pre-conscious mechanisms, but mostly they are considered related to the unconscious and are formed in childhood. Reconnecting to denial, we can consider as less problematic the situation in which the person only initially takes an emotional distance from the painful event: for example, he may not recognize aspects related to the severity of the pathology and the uncertainty of the prognosis. This mode of implementation of the defense mechanism allows a gradual and more functional adaptation to the ‘disease situation’, as long as it does not interfere with early diagnosis and adherence to the therapeutic path. We can define it as a sub-type of denial: only at first I do not accept the condition that I am experiencing. This distortion of reality helps not to be overwhelmed by anguish and still serves to carry on the motivation to undertake medical treatment. Hope is maintained and continuing to hope can be associated with a better prognosis ”.
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Do doctors and health professionals have the tools to help those who deny the disease?
“I have been teaching these topics for many years in university courses for the training of health professionals, such as nurses and radiology technicians. It is important that they are aware that in front of a stressful event, a person can activate these mechanisms. The health worker must know how to conduct a helping relationship with his client and possibly report to the health team the perception of something wrong. Today, fortunately, the figure of the psychologist is present in health facilities and especially in oncology services. As I have emphasized, taking care involves taking charge of the ‘whole’ person ”.
So it’s all about communication?
“Communication is fundamental in the treatment process, especially in the aspect of listening and observing our client. The patient must not be put in a condition of passivity, he must be able to actively participate in treatment and must be educated to bring out his own potential in order to cope with the disease. Unfortunately, the health team does not always manage communication well, even if it would be a duty: not only the technique is needed, but also good humanistic / relational skills. The first rule is not to judge, but to accept the patient in a positive and unconditional way, as a person of equal value: avoid blaming and, with a good degree of empathy, inform and support emotionally. It is important to communicate effectively both on a verbal and non-verbal level, because it is not only what I say that counts, but how I say it. Whoever puts himself in the correct way greatly favors the patient’s adherence to the therapeutic path. Often what the patient complains about is precisely the lack of information, of support, of time dedicated to him. The technical error can also be forgiven, but the one on a human level, such as the lack of respect and the lack of listening, is hardly forgotten and all this undermines the climate of trust that should be the basis of any helping relationship . I am more motivated to do, for example, chemotherapy, if the staff recognize me as a person. It doesn’t take much: a greeting, being called by name, a smile, a hand on the shoulder: positive reinforcements that give the patient the strength to move forward, essential elements for not giving up. Healthcare professionals are expected to embrace the emotional aspect and the “there is not enough time”, although it is sometimes objectively true, other times it sounds like an excuse. The humanization of medicine provides for all this. “
Is there a “return” for health professionals?
“It is well known: if the team is able to carry on a good helping relationship, everyone benefits from it, the patients but also the operators themselves. After all, even the operator, first of all, is a person, with his human and emotional aspects. There is less risk of trespassing into a burnout situation. Doctors and health professionals are not only called upon to heal, because realistically this, unfortunately, will not always be possible. Medicine is a great science, but it’s not perfect. Instead, what you can always do is cure, or rather, take care of the other. And do it even when the only possibility will be to accompany the person towards the end of his life path, making him feel the sensation of never being alone. The death of a patient can also be experienced as a failure, but no one is omnipotent. Knowing that we have taken care of it, on the other hand, is the only thing that can save us from judging ourselves ”.
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