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.