Is There Such a Thing as Positive Denial?

Positive denial

Denial is considered one of the most primitive of the defense mechanisms.  It is usually thought of as a distortion of reality, and therefore as being very unhealthy.  To put it bluntly, denial sometimes involves a person lying to themselves.

But I am now wondering if there is a healthy form of denial.  Or another way of putting it is, maybe there is a role for extreme optimism which is not fully justified by the evidence.

The issue came up with a patient of mine with Parkinsons.  (I have permission to share this.)  This patient is aware of all of the statistics about the disease's progression.  He is seeing all the appropriate doctors and taking all of the appropriate treatments.  Therefore, the denial in question is not the same as ignoring the warning signs of a disease; this is quite different.

An article came out in JAMA Neurology which suggested that some persons with Parkinson's remain stable, or even get better, over a six month period of time when they have sufficient vigorous exercise.  My patient has seized on this as a touchstone, figuring that he, too, will remain stable, or even get better, as long as he exercises enough.  This may be denial because Parkinson's is always a progressive disease; it's just that sometimes it progresses very slowly.  This person's "denial" is helping him to exercise 75 minutes a day, which will almost undoubtedly help the Parkinson's.  Without this optimism, he might crater, go into depression, and hence might give in to the disease.

Is there a down side to the denial in this situation?  Or is it even denial?  Maybe it's just taking optimism to its ultimate lengths, extrapolating in a very hopeful way on some of the research available.

Now, it could be argued that a slightly toned down optimism might be just as useful.  That is, believing that vigorous exercise will slow the disease rather than keeping it totally stable, might be more realistic and still motivate the required level of exercise.  However, for this particular person I'm not so sure that a toned down level of optimism would be nearly as effective in motivating him.

Moreover, we can't overlook the role of the placebo effect.  If you believe a medicine is extremely powerful, then it is more likely to be.  Placebo effects have been demonstrated even in the treatment of cancer.

So, it is still true that some forms of denial are destructive and prevent growth.  However, I am now seeing that extreme optimism (even up to involving some denial) may be just what the doctor ordered in some situations.

States of Mind: Active versus Passive, and Doing Versus Being

Many of us like to be doing things.  America was built on doing things.  Getting things done and accomplished is usually a good thing.  But there are other useful--and pleasant--states of mind as well.

Primarily I want to talk about "doing" versus "being."  Another way of thinking about this would be active versus passive mental activity.

First, let's start with what is positive about "doing."  The "doing mind" is active.  I sometimes refer to it as "active ego" (as opposed to passive ego).  Passive ego occurs when we are aware of thoughts and feelings, but they just wash over us.  We may be overwhelmed with good feelings (as on the beach) or worry (as when a family member is sick).  We just worry and worry and worry.  I sometimes see passive ego manifested as a neutral emotional state in the state of hypnosis (which I used to do, but hardly do anymore).  In hypnosis, the patient is not actively directing their own thinking, and the mind is in a receptive state to suggestion.   The opposite then is what I refer to as "active ego."  In active ego state, the mind is ready to solve problems and is actively considering options.  In this state, it appears to be less susceptible to worry and rumination.  That can be very helpful when there is anxiety.  The thoughts associated with this mental state may be, "What can I do about this situation?  I can do something to fix it!"

There is also an in between state--neither clear passive or clearly active.  When we appreciate what is around us (nature, people, even the feel of the air in the room), there is a kind of activity, but it is not visible to  others.  We are making a choice to focus our minds.  While we do not appear on the outside to others to be doing anything, we are actually expending mental energy.

Is there anything negative or self defeating about the active/doing mind?  On the negative side, the "doing" frame of mind can become overly habitual, and maybe even addictive.  We "do" out of habit, or because we are afraid to be alone with ourselves and our feelings.

Mindfulness therapy generally points out the value of the opposite of doing, which is learning to simply "be" or to appreciate what is around us.  Mindfulness tends to play down the role of actively achieving goals.  To the degree that it promotes doing, mindfulness therapy creates an awareness of the thoughts and feelings associated with it, so that the person is not "doing" purely out of habit.

I think that Americans sometimes get into "doing" mind so much that they miss out on some of the other aspects of reality. Back in the sixties and seventies there was a clash of cultures in America, between the "establishment" and the "hippies."  One aspect of this clash was the disagreement about the value of turning inward and meditating.  This was disparagingly called by some "navel gazing."  This pejorative term implied that people would focus too much on themselves and their feelings, to the exclusion of taking positive action in their lives or helping others around them.  Fortunately, we have progressed beyond that dichotomy.  We no longer see life as either/or in that regard.  We can be energized by our times of quiet and reflection to go out of our own personal sphere and accomplish goals.

So, let's summarize.  Here are some different states of mind that we have available as human beings:

Doing mind--planning and getting ready to cope or to execute a plan of action

Active (but not doing) mind--focusing intentionally on what is around oneself, or maybe focusing intentionally on clearing the mind.  An example would be some forms of meditation or prayer.

Passive mind--Letting ideas wash over  you.  This can be good, such as on vacation and in creative states of mind; but it can also be negative as when we succumb to runaway rumination and uncontrolled worry.

You may want to reflect on which of these three states occurs the most with you.  Do you need to ruminate less and be more actively in problem solving?  Do you need some calm down times when you are more focused (meditating and/or praying)?  Or is it even possible that you need some more time for thoughts just to wash over you, when you can be open to creative states of mind?

States of Mind: Gratitude and Thankfulness

In the past, psychology has been very focused on what was wrong with people.  It was not unusual to hear terms such as "overly dependent," or even more negative terms such as "orally fixated," "anal," and so on.

Fortunately, now, clinical psychology can talk about people's strengths as well.  Being educated in my Ph.D. program in the seventies, I can throw around negative terms with the best of them.  But I usually don't find that to be useful (except sometimes in psychological testing, but that is a different matter).

Many times issues bring with them to therapy can be normalized to a great degree.  For example, instead of saying to a person in therapy that they have a dependent personality, I might say that they simply are not in a good balance between depending on themselves and depending on others.  It is in fact somewhat normal to have difficulty finding just the right balance in life.

But that is off the point.

Focusing on the positive can mean focusing on growth.  Many situations that bring people into counseling are crisis situations.  Crisis doesn't feel good; but it does one positive thing: it breaks up  old, ensconced behavior patterns and potentially allows for new growth.  It is like breaking up hard, parched ground and letting new seedlings come through.

Early counseling sessions often focus on putting out fires; but often there is often eventually an opportunity in therapy to start looking for new directions in life.  One new direction can be bringing new positives into our lives--looking for what is good, looking for where we have been fortunate.  Gratitude is easier when we have a lot to be thankful for.  But that doesn't always have to be the case.  Even in bad situations, there may be persons who have given us a helping hand, or fortunate turns of events.  When we look for the positives we are likely to find them.

There is a school of therapy that focuses a great deal on reframing.  For example, in losing a job where one was subjected to a tyrannical boss, a reframing interpretation might focus on the possibility that the client has been unconsciously wanting an impetus to move on to something better.  A child who is being "bad" in their behavior may actually be wanting attention to deal with grief or anxiety.  And so on.  There are almost a limitless number of different counseling situations and possible reframes.  The interesting thing to me is that when I work out a reframe with a patient, even if it doesn't seem too plausible at first, I often eventually see it as very plausible.  Reality is a very slippery thing.  We think we have it well in hand until we begin to look at situations from different angles; and then we may begin to realize that we were overly committed to one particular view (e.g., the "bad" kid) and closed off to wider views of reality.

So even in tough situations, they may not be the pure calamity that we think they are.  They may offer the opportunity for growth, and that is something to be thankful for.

With other clients, there is no particular calamity they are facing.  They suffer from depression, anxiety, or perhaps some other emotional state.  But their lives are just normal otherwise.  With these types of clients, there is no struggle to find something for which to be grateful.  But there may be a lack of gratitude simply because that faculty of the mind has not been used  much.

Think it over.  How would it feel to be thankful today?  Are there negative thoughts and emotions that you could set aside for a little while and replace with gratitude?  And if so, why not?  What do you have to lose?