Denial: Implications of Its Internal, Relational, Social, and Political Functions
Nancy McWilliams, PhD, ABPP
SIPP: Italian Society of Psychoanalytic Psychotherapy
Milan, Italy: November 29, 2019
Thank you for inviting me to think with you about this critically important matter of the clinical, interpersonal, social, and political functions of denial, and to contemplate together how psychoanalytic thinkers can conceptualize denial and contribute to addressing its consequences. I understand denial as a dissociative phenomenon whose evolutionarily adaptive function is to initiate and facilitate the human capacity for mourning, a capacity central to both emotional maturation and life satisfaction. I will first give a short overview of the psychoanalytic concept of denial, from Freud’s thinking through contemporary contributions of attachment research and neuroscience. Then I will describe its relationship to mourning on both individual and societal levels. Finally, I will discuss, respectively, some clinical, social, and political manifestations of denial and, where possible, will suggest some ways of addressing them.
Overview of the concept of denial The word “denial” has been used in many different ways: as part of a descriptive psychiatric account (“the patient denies hearing voices”), to note the effects of brain damage (“the patient denies sensation in her left leg”), in popular speech (“You’re in denial!”), and among psychoanalytic writers, as a defensive process or mechanism (“the patient reacted to his diagnosis with denial”). I will restrict my comments to the psychodynamic meaning and will summarize what I believe to be the current consensus among psychoanalytic clinicians, researchers, and theorists about the origins, functions, and challenges of this defense.
Denial runs the gamut from individual defensiveness about areas of vulnerability and limitation to wholesale disavowal of dire threats to human survival, as in those who insist that global warming is either not happening or will have no negative effects. As you know, Freud was originally more interested in repression – unconsciously motivated forgetting – than in denial. He understood repression topographically, imagining it as if there are vertically arranged layers of knowledge, from conscious to deeply unconscious, that can be slowly exposed from the top as repression is overcome in psychoanalysis. This is a markedly different image from conceptualizing
deliberate not-knowing in terms of the coexistence of two separate but mutually exclusive states of mind that are firmly dissociated from each other.
There was a notable controversy in the late 1890s, culminating in a public disagreement between Sigmund Freud and Pierre Janet, about whether the more accurate explanation for conditions that were then called hysterical involves repression or dissociation. For several interacting reasons, contemporary psychoanalysts have moved toward Janet’s position favoring a dissociative model. But at the time, Freud’s conceptualization was generally preferred, probably because he was more skilled in the persuasive arts than his French colleague.
Freud wrote very little
explicitly about “denial,” a defense that his daughter Anna (1936) later theorized at length. When he did, it was relatively late in his career. For example, he wrote a short paper (Freud, 1925a) about verbal “negation,” which (in English) denotes a
subtype of denial [slide]. In negation, a person volunteers what he or she is
not thinking or feeling. Freud argued that the spontaneous, unprovoked announcement of what is
not true of the self indicates that the negated material is in fact true but energetically kept out of consciousness. He construed this as repression, not dissociation or denial. But in his 1927 paper on fetishism [slide], when describing the young child’s shock at learning about genital differences, he contrasted repression with denial, maintaining that “repression” relates to affect, while “denial” relates to cognition; that is, to ideas about, and perceptions of, reality. To my knowledge, he did not elaborate in later writing on this interesting discrimination, which is much closer to contemporary understandings.
Implicit Freudian musings about denial can be found, however, in at least three other areas: in Freud’s (1900) description in Chapter 7 of
The Interpretation of Dreams of the phenomenon of “hallucinatory wish fulfillment,” in his depiction of human maturation as involving the gradual abandonment of the pleasure principle for the reality principle (e.g., Freud, 1925b), and in his writing about mourning and melancholia (Freud, 1917). I will explore the implications of these ideas shortly.
Melanie Klein (1946) attempted to conceptualize psychological processes that are more characteristic of psychosis than neurosis, processes that are consequently perhaps more germane to the defense of denial, universally regarded as a primitive defense. Her formulation of the “paranoid-schizoid” position assumes a normal period of early development that precedes the capacity for repression, in which infants’ experiences are still dissociated and unintegrated. Her focus on “splitting” anticipated – by several decades – current ideas about dissociative processes. When we are in the paranoid-schizoid position, we dichotomize good and bad, attributing inner pain to external persecutory forces. This tendency is normal in infancy and is never entirely absent from the experience of even the most mentally healthy adults, especially when they are deeply frightened or hurt.
If you doubt the persistence of the paranoid-schizoid position into maturity, think of a time when you were shockingly betrayed by a loved person. Did you immediately enter the depressive position, noting how hard it must have been for that person to make a decision that caused you to suffer? I suspect that your reaction was more like “He is an evil snake!” When our pain is severe enough, we go into a paranoid-schizoid state; it offers the comfort of defining external enemies whose ultimate destruction we can then imagine with pleasure. Unlike Freud’s model, Klein’s posits the coexistence of separate self-states (the all-good self and the all-bad self, which can be projected into the all-good versus all-bad other), each of which exists in potential consciousness, unintegrated with its counterpart.
Whether or not Klein’s theory is satisfactory in its entirety, I think she was accurate in framing denial as intrinsic to normal human development. Denial facilitates a child’s adaptation to an overly stimulating, confusing, often frustrating and painful world. The fact that infants can withdraw into sleep even in loud, chaotic circumstances has been seen by many as an early instance of denial, and a very adaptive one. Even in adulthood, denial can be adaptive: The capacity to dissociate psychologically from a threatening situation, denying, for example, that one’s continued existence is in danger, can be life-saving.
Scholars in neuroscience [e.g., Porges, 2011] support the observation that when confronted with extreme stress, our response options are not simply fight or flight; we also have the capacity to
freeze psychologically – that is, we can go into a kind of dissociated paralysis in which we can believe that “this is not happening.” A threatened animal may “play dead.” A little girl being raped may find herself looking down from the ceiling at another little girl undergoing that terror and pain. A combatant in war may fight on without emotionally processing the gruesome death of his beloved comrade. In less dramatic ways, denial remains in adulthood a normal first response to painful truths: When we are told about a death or disaster befalling someone we care about, the first word we utter is typically “No!”
The sociologist of science Bruno Latour (1987, p. 93) remarked, “Reality is what resists.” In psychoanalytic thinking, reality is what
we resist. Adapting to reality is painful, and we are not always up to the task. Denial becomes a problem when we insist for any length of time that what is true is simply not true; living in unreality is never adaptive in the long term. Clinically, those whose psychopathology is most characterized by denial include people in psychotic states, those driven by manic and hypomanic conditions, those with severe eating disorders and addictions, those arrested in pathological grief, those invested in their sense of personal omnipotence, those who cannot bear limitation and aging, and those who attempt suicide because they don’t really believe they will die if they kill themselves. Much of our clinical work is taken up with such problems, often the hardest ones we face as therapists. Even those of us who are able to work with “healthier,” “neurotic-level” individuals run into regions of their psychologies in which denial dominates. In my own experience those are the areas that are most resistant to change.
In terms of what is denied, by definition, people with different personality disorders disavow different aspects of themselves. For example, the psychopathic person denies vulnerability, the narcissistic person denies dependency, the schizoid person denies the need for closeness, the paranoid person denies the need to trust, the depressive person denies anger and hostility, the obsessive-compulsive person denies painful affect, the histrionic person denies personal power and agency. Individuals with borderline personality organization deny whole parts of self, the body, or the continuity of time, depending on which self-state is active at any point. Psychotherapy technique can differ substantially based on these differences: for example, working with antisocial individuals, who feel omnipotent, requires different skills and interpretive emphases from working with more hysterical individuals, who feel they have no power and that life is always “happening to” them. I will mention shortly some clinical approaches that address specific versions of denial.
I want to note in passing that although research is badly needed on psychopathologies that involve significant denial, such conditions do not easily lend themselves to study by randomized controlled investigations of manualized treatments. In clinical trials of “evidence-based” therapies, participants with “comorbidities” are typically excluded. This legitimate research requirement has the unfortunate side-effect of rejecting patients who rely centrally on denial, as they are more likely to have “comorbid” conditions such as diagnosable addiction and personality disorders. Research participants who contribute to the evidence base for specific treatments thus tend to be restricted to the healthiest individuals on any continuum of psychopathology. Clinicians must consult other sources than RCTs to understand these patients and to develop therapeutic approaches that take into account the underlying meaning and complexity of their psychologies.
Many psychoanalysts of a previous generation, following Anna Freud (1936), conceptualized almost all defenses as manifesting elements of denial; only the highly mature coping mechanisms, such as sublimation and humor (Cramer, Perry, Vaillant), are not built upon it. Instead of disavowing unattractive aspects of mental life, mature strategies embrace them and find constructive outlets for them. Contemporarily, analytic theorists are more likely, as I am, to construe
dissociation as an overarching defense, of which other potentially problematic defenses, including denial, are subtypes (Bromberg, Howell, others). (I think Clara Mucci, whom you will hear tomorrow, takes a similar position.) For example, denial involves dissociation from overwhelming reality, repression involves dissociation of knowledge, intellectualization involves dissociation of affect, self-mutilation involves dissociation from the body, and acting out represents dissociation from judgment (cf. Braun, 1988). What we have called denial can apply to any of these areas.
Denial and the process of mourning Analytic therapists know from clinical experience that mourning is necessary for psychological, relational, and cultural adaptation to painful realities. When a man who has been holding a bitter grudge moves slowly from anger and hatred to sadness and a sense of vulnerability, his frozen emotional development thaws, and he can move toward acceptance, even forgiveness, or at least an emotional understanding of the complexities. When a woman who has been clinging to a sense of indignant victimhood becomes able to feel compassionate sorrow for herself, and even for those who have mistreated her, she similarly gets back on track developmentally and can live her life with more sense of agency. Correspondingly, many have argued that when a nation confronts its traumatic past with shared grief and reminders of its surviving values, it is less likely to repeat what it has already suffered and/or perpetrated (ref.).
Mourning, which begins with denial, seems to be nature’s way of enabling us to bear what is initially unbearable. It permits us to assimilate catastrophic events bit by bit, as Freud movingly described in “Mourning and Melancholia” (1917). The grieving process helps us move on through life’s challenges with increased wisdom and acceptance; without it, we can remain stuck in resentment, envy, rage, humiliation, and other consuming negative states. In Kleinian terms, if we cannot move from the paranoid-schizoid to the depressive position, we cannot acknowledge the complex realities that caused us to suffer, and by grieving them, avoid further damage to whatever extent we can. In Freudian terms, we cannot complete the oedipal task of developing an integrated superego. In Fonagy’s conceptualization (e.g., Fonagy, Gergeley, Jurist & Target, 2004), we cannot attain capacities for reflective function and mentalization. Some psychoanalytic writers (e.g., Stark, 1999) have conceptualized psychoanalytic treatment itself as essentially a systematic, safe facilitation of mourning.
We need denial. It allows us to mourn in bearable doses. Following conversations with Michael Garrett (my husband and an expert on psychotic denial - e.g., Garrett, 2019), I suggest that the underlying mechanism denial’s role in the mourning process is as follows: When reality is unbearable, we are flooded with painful affects. Denial is our first line of defense against being incapacitated by them. It allows us to be temporarily in a different reality in which those affects are given a chance to ebb. When our emotional overload begins to subside, as we assimilate the pain bit by bit, more mature responses become possible. The denial does not ever entirely go away, however; its mature expressions in adult life include wishful thinking and day dreaming, processes that, in normal development, slowly replace Freud’s hallucinatory wish-fulfillment.
As Klein (1940) observed, the infant’s most profound terror is that the mother will not come back. Recent research supports the conclusion that the most traumatic – and, in fact, life-threatening – experience the young human being can suffer is absence or loss of the caregiving other. Investigations of trauma have established that neglect is even more powerfully damaging than engaged abuse (ref.). Attachment researchers tell us that the only markedly pathological attachment style, disorganized-disoriented or “Type D” attachment, is highly associated with early abandonment and negligence (ref.). In this insecure attachment style, a child in the Strange Situation behaves in chaotic, contradictory, and confusing ways; for example, clinging to the mother and biting her at the same time, much as our patients who have suffered early trauma may insist simultaneously that they hate us and that they cannot bear our absence.
There is considerable research, however, suggesting that children can survive traumatic loss, and even develop significant resilience, if there is someone close by who warmly helps them to formulate in words what has happened and how they feel about it (refs.) Children with Type D attachment tend to have suffered, at a critical developmental phase, both traumatic neglect and the absence of any help symbolizing it.
In young mammals, each creature has a distinctive separation cry. When the baby cries, an fMRI identifies a brain area and associated neural activity that Panksepp (1998, 2012) has called the PANIC system. In immediate response to the infant’s expression of separation distress, those same areas of the parent’s brain light up on a brain scan, indicating that the distinct pain of separation is shared by both parties. And interestingly, at least according to state-of-the-art ways of measuring brain activity, this emotional anguish is not neuroscientifically distinguishable from physical pain (ref.).
Because of the evident degree of suffering of infants whose caregiver is physically present but emotionally absent, Tronick’s (1989) famous videos of mothers’ “still face” are almost impossible for sensitive witnesses to watch. In these experiments, designed to simulate the wooden countenance of a woman with severe postpartum depression, healing happens with the quick return of the mother’s responsiveness. It is interesting to note that the infant seems initially to react to the mother’s still face by denying that she has withdrawn emotionally; the baby works and works to elicit her normal responsiveness, and only as time elapses does the child move from denial to extreme anxiety to depressive affect. For children who face such a loss in real life, without the possibility of the return of the primary love object, the presence of someone who can name the disaster and facilitate the child’s grief is critical to the child’s ongoing development (ref.).
For occasions when life devastates us, it stands to reason that during human evolution, we would have developed a means of handling the initial shock of such extreme pain. Denial helps us to remain standing when life threatens to crush us. Students of human reactions to the deaths of beloved others and to the prospect of their own deaths (e.g., Kübler-Ross, 1969; Parkes, 19XX; Shabad), have noted that denial is the first phase in the normal mourning process. But if reality is to be faced squarely, leading to effective ways to face the situation, denial must yield to other ways of coping. In clinical work, that is often the central adaptive process we try to facilitate.
Denial in the clinical situation I have been strongly influenced by Otto Kernberg’s arguments (e.g., 1984) that people with severe personality pathology do not have, as many analysts had hypothesized, defenses that are too fragile and must be shored up; rather, they have
powerful but primitive defenses that must be gently but insistently deconstructed. Denial may in fact be the
most primitive defense. In my experience, patients who depend on denial are not responsive to the kinds of exploratory and interpretive interventions that reduce defensiveness in patients less centrally reliant on denial. In order for a person to move from a state in which critical aspects of self are disowned to a state of mourning, denial must be effectively undermined, but patients in the grip of denial typically cling to their disavowals despite a therapist’s best efforts to weaken them even slightly.
Instances of the problems involved in challenging denial are common in the practices of almost all therapists. Consider the man with evident bipolar illness who refuses to try any medicine that will reduce his mania. Wondering with him if there is perhaps something driven about his hypersexuality or agitation or sleeplessness generally elicits only disconfirmation. Or consider the addicted man whose family and friends have tried for years to challenge his conviction that he is in control of his substance use. Raising a question such as “Do you ever wonder if you have a problem?” will rarely elicit thoughtful self-examination or behavioral change. The anorexic teenager who insists on starving herself despite being on the brink of death will not begin to consider eating in response to a clinician’s tentative suggestion that she may be denying her normal need to for nutrients. Perhaps denial is so hard to influence because its functions include avoiding shame, a particularly toxic feeling, and supporting a sense of control, a particularly attractive one.
People who have had early relational trauma may be especially defended against acknowledging their normal human attachment and prefer to deny that they need others at all. Helplessness and vulnerability seem to be so terrifying to human beings, so activating of the cellular-level infantile knowledge that without a caregiver we cannot survive, that we often prefer to lie to ourselves. In all these situations, we therapists tend to feel at a loss: If we confront our patients’ denial too aggressively, we may lose them; if we are too empathically supportive, we may reinforce the denial and enable the continuation of self-destructive behavior.
Clinical approaches to problems of denial I have developed a few ideas for approaching patients who cling to denial at a significant cost to their own authenticity and growth. These come from my own experience, from the shared experience of analytic colleagues, and from the empirical literature. First, patients who are highly reliant upon denial do not respond well to the usual psychoanalytic practice of “moving from surface to depth” (Fenichel, 1945); that is, the exploratory treatment that enables other patients to tolerate learning about painful aspects of their psychologies. Instead, the therapist may need to be quite confronting, to “take on” the defense directly. Such confrontation should be honest, warm, and respectful, in spite of the negative countertransferences that patients in denial often provoke.
Here are some examples from my own work. Please keep in mind that the kinds of interventions I offer here express my particular personal integration of the principles I am illustrating. A style that is authentic to another therapist’s personality may be quite different from mine, but I think the underlying principles can still apply.
- Frontal assaults on denial: “You’ve got a problem!”
Sometimes, denial must be taken on directly. When I am asked for therapy by patients with substance use disorders, for example, I have sometimes been able to engage them therapeutically by stating, rather bluntly:
I think you are addicted and are in a state of denial about that. I know you disagree. I am willing to work with you, but you should know that this is what I think. If you decide to go into therapy with me, my first goal will be to get you to see that you need treatment for your addiction – probably detoxification, rehabilitation, and a follow-up program like Alcoholics Anonymous in addition to ongoing therapy. If you are willing to tolerate my continuing to raise this issue, we can try working together and see how it goes.
There is nothing tentative or exploratory about this. The tone is quite different from the attitude of “not-knowing” that characterizes most psychoanalytic exploration, especially the open-minded stance valued by relational psychoanalysts. A comparable confrontation of the addict’s denial would apply to people with mania, anorexia, pathological grief reactions, and other manifestations of the defense.
With patients who are hypomanic, for example, I might state as an obvious fact that while they think they are enjoying one entertaining idea after another, they are distracting themselves from a profound underlying sadness, and that they are not likely to find mental peace until they can feel that sorrow and go through the grief process that will eventually mitigate it. Or when mania manifests itself as rage, I might say:
I know you feel constantly irritated. But I think that underneath that irritation is a deep sense of loss and vulnerability that you are desperate not to feel. It is my job to help you feel it and realize that feeling it won’t kill you, and that feeling it is better for your mind and body than being in a low-grade rage all the time.
With patients who are anorexic, I insist that as a condition of having a therapeutic relationship with me, they must work with a nutritionist and maintain a baseline level of weight. With patients immersed in any version of denial, I might say, “It seems that you and I have very different understandings of reality. Do you think you can tolerate working with someone who is in basic disagreement with you about the facts?”
- Normalizing mental states that give rise to denial: “We’re all selfish and needy.”
A second thing a therapist can do with a patient who relies on denial is to try to normalize the feelings or fantasies that are being denied. This approach contrasts with, and can be complementary to, the previous strategy of a frontal assault on the denial. I think of it as “going under” or “going around” the defense. I find this style particularly useful with paranoid patients. Analytic theorists have emphasized the role of
projection in paranoia, but we should note that what is particular to paranoid reactions is not simply projection but the fact that
what is projected has been completely denied. Thus, a crucial part of a therapist’s job is to help paranoid patients integrate disowned and projected parts of their selves.
Normal hostility, greed, envy, vanity, longing, and other uncomfortable states of mind need not only to be named but also to be explicitly
accepted as an inevitable part of being human. If they are only “uncovered,” a person in a paranoid state tends to feel exposed, to react with shame, and to resort again to denial and projection. The clinical challenge is how to help these suffering individuals to embrace their inner experience so that they no longer hate it and need to project it. I submit that this process, rather than the analysis of defense, is the most critical means of mitigating the denial at the center of the subjective world of paranoid patients.
With some paranoid clients, especially those who defer comfortably to the therapist’s expertise, one can take a didactic tone and comment supportively about the ordinariness of hated aspects of self, a process similar to the “cognitive reframing” or “normalizing” emphasized by cognitive-behavioral therapists. But this strategy risks humiliating patients who are hyperalert to being patronized. Such clients require creative ways of being educative without talking down to them. My own solution to the quandary of how to normalize feelings without condescension involves frank exposure of my own feelings and the circumstances that give rise to them. This self-disclosure goes beyond countertransference acknowledgment and may be a better fit with my personality than that of other therapists, who may work out different strategies. I have learned that paranoid clients may not easily take in the implicit normalization of a quiet, accepting attitude, but if I give them the clear evidence that I have gone through what they are describing, and that I do not hate myself for my feelings, or see them as shameful, they are more likely to be able to rethink their self-loathing and the dissociation of self-experience it sets off.
For example, a 40-year-old paranoid woman whom I had been seeing for several months came into my office one day in an uncharacteristically anxious, self-attacking state, saying she was a terrible mother who did not deserve to live. After her adolescent daughter had been particularly provocative, she had had a fantasy of strangling the girl. She had never harmed a child (or anyone else), but now she feared she was dangerously homicidal. I knew I would sound patronizing to this sensitive woman if I said something like, “It’s pretty normal for parents to have hostile fantasies toward teenage kids,” so instead I sighed and said something like, “Tell me about it! When my daughters were your daughter’s age, I wanted to strangle them about three times a day.” This calmed her in a way that felt more deeply healing than “psychoeducation.”
- Addressing the denial in narcissism: “Did you make your needs explicit?”
Narcissistic patients deny their own normal dependency (Bursten, 1973, Gabbard & Crisp, 2018; Kernberg, 1975, Mucci, 2018). They also deny limitation and personal shortcomings and try to preserve a sense of themselves as flawless. Instead of asking for what they need, they criticize others for not divining their wishes and offering care without their having to ask for it. The therapeutic challenges with such patients can be particularly daunting. Often, they can hardly bear the shame of being in therapy in the first place, and they deal with the reality of their having sought psychological help either by idealization (“You are so wonderful that everyone should be seeing you”) or devaluation (“What am I doing with this idiot?”), and they are chronically at risk of fleeing the therapy relationship. They assiduously avoid mourning, because they cannot bear how grief exposes their own vulnerability and inability to transcend life’s limitations and disappointments.
Narcissistically driven people prefer to complain about others rather than to solve problems. When they go on about the failings of their family members, employers, employees, friends, and colleagues, I ask them, “Did you make your needs explicit?” They tend to react with horror, contempt, and protest, saying things like “What do you mean, ‘needs’?” Such responses open the door to the therapist’s commenting on their contempt for their normal attachment needs and their pathologizing of people who do not meet them rather than simply asking for what they want. Once they do take the risk of asking explicitly for care, often they learn that the world is responsive, and that the relational cost of their prior denial has been unnecessarily high.
Another part of breaking through the narcissistic person’s denial of dependency and limitation is the therapist’s matter-of-fact acknowledgment of ordinary needs, mistakes, and failings. People in states of narcissistic self-protection are incapable of genuine remorse because they deny all shortcomings in an effort to prop up a grandiose self-image. In my view, one of Kohut’s (1977) greatest contributions to psychoanalytic technique was to recommend that the analyst apologize when he or she had misunderstood or had unwittingly committed a narcissistic injury. Not only does sincere remorse allow for the process of rupture and repair that relational analysts have found so central to therapeutic process (ref.), this behavior also models the reality that a human being can feel adequate self-esteem without having to be perfect. The narcissistic person pays a heavy price for denial of imperfection and needs examples of more realistic ways of managing a sense of good-enough-ness.
- Addressing our own denial.
In an account of clinical examples of denial, I would be remiss not to note instances of denial in therapists. For example, for many decades, most psychoanalysts ignored evidence of the extent of childhood sexual abuse. Perhaps it was too painful to face, or too much of a reminder of the limits of what we can do for someone who has been traumatized, or too different from what Freud came to emphasize. I recall taking a course on borderline psychology from James Masterson in the 1970s when his developmental formulation of borderline dynamics was attracting attention. After he elaborated on his theory of the origin of borderline states, one of my classmates asked, “But wouldn’t you get similar dynamics in a child who had suffered early sexual abuse?” Masterson paused to think, and then commented, “Interesting. That’s the first time anyone has ever raised that question.” Such a response would be unthinkable today, now that the clinical community has moved past its denial about the frequency of incest and molestation and the impact of early relational trauma (e.g., Meares, 2012).
For many years, most therapists also attempted to deny the extent of our counter-transference responses to patients, fearing that such reactions indicated our lack of psychoanalytic maturity. One of the most welcome contributions of the relational movement has been the greater honesty and openness of analysts when describing their work with patients. Once we all witnessed case presentations in which a self-revealing therapist was candid about subjective feelings and fantasies, and noted that doom did not fall, the psychoanalytic space became safer, and the wisdom of acknowledging countertransference became obvious.
In a more trivial example of professional denial, we have tended to deny the complications of many clinical challenges by seeking unbreakable “rules” of technique. Psychoanalysis has had a tendency, like all wisdom traditions, to tilt toward a paranoid-schizoid fundamentalism. Insisting on a rigid “rule,” for example, that the patient should pay for every session, whether or not it is attended, spares us the necessity of thinking through what makes sense in a particular instance, with a particular patient, and also allows us to deny the role of our own greed in setting up our policies. We may rationalize such unbreakable “rules” in terms of what is good of the
patient, and often we are not wrong about that, but they also allow us to keep a professional self-image that emphasizes our unselfishness while maximizing our income.
Denial at the social, cultural, and political level What we assume to be “reality” is both socially constructed and constrained by the limitations of our nervous systems. One way of thinking about contemporary manifestations of denial at the social, cultural, and political level involves appreciating the fact that our species has evolved to adapt to relatively stable tribal communities in which there are a limited number of available roles. In small, preliterate societies, individuals presumably know what is expected of them and feel known and valued; community survival depends on everyone’s participation. In such societies, there is a consensus about the nature of reality. Tribal knowledge is preserved by elders and communicated to the young via stories and rituals. When individuals reach biological maturity at puberty, they undergo a rite of passage and assume one of the available adult roles in the community.
In contrast to the groups in which human beings have lived for millennia, contemporary civilization is vast, overstimulating, mobile, confusing, and changing at a more rapid pace than our nervous systems can easily handle. Because so many jobs in such a culture require years and years of training, adolescence, for which we did not even have a word until the late 19th century, now stretches into the thirties. Mass communications assault us with images of wealth and celebrity, stimulating our feelings of inadequacy and our primitive envy. Political conflicts raise the specter of mass destruction, not simply the deaths of some soldiers at the periphery of our communal turf.
In such circumstances, we cannot function without using denial. We crave simplification in the form of ideologies, which inevitably involve spitting and othering. The speed of change puts severe stress on our capacity to mourn losses and disappointments, as we often have to move on before we are emotionally ready. In a mass culture with a dizzying rate of change, relationships can be fleeting: when facing new life demands, people change residences, schools, nationalities, even identities. Under such conditions, mourning, which requires a community – or at least one person who can bear witness to loss and devastation – is challenging.
On one hand, it is a blessing to be able to say to children that they can grow up in any direction that appeals to them, but on the other, it can be overwhelming to face unlimited choices (cf. Schwartz, xxxx). I have wondered if the immensity and pace of contemporary Western cultures has something to do with the striking increase in youthful suicide that we have seen over recent decades. Adolescents and young adults may be distracted with amusements, which they can find in abundance in the Internet age, but they also need some sense that they
matter. In a global context, when they are so far from the centers of power, and where employment opportunities in their region may be severely limited, how can they find that feeling?
Starting in the twentieth century, scholars in the social sciences and humanities began talking about an “age of anxiety” (ref.). Anxiety has never been avoidable for human beings – we need an emotional awareness that at any time we could become a meal for a predator, or a neighboring tribe could attack, or a drought could cause starvation. But our collective going-on-being is currently under threat as perhaps it has never been, by the proliferation of nuclear weapons and other means of mass destruction, and by the consequences of global warming in the form of droughts, fires, floods, and irreversible pollution of the natural world. When human beings are frightened enough, they revert to the paranoid-schizoid position, in which the self is pristine and innocent, and all badness is a threat from “out there.”
I watched that happen on September 11, 2001. In the terror and confusion that accompanied the news that planes were being flown into buildings, Americans craved simple explanations and objects for their outrage. President Bush was happy to respond to such wishes, with his split between an innocent United States and the “Evil Empire” of Iraq, Iran, and North Korea. Thus began the damage to the entire Middle East, and to our own democratic institutions. It has been painful to witness this regression toward denial of any responsibility and projection of all destructiveness to outside elements. It has made constructive problem-solving impossible, just as denial does in the clinical situation.
In the Trump presidency, we see the “othering” spreading to include immigrant groups to whom we formerly extended at least a modicum of hospitality, minorities we previously treated with at least an effort to respect, and honorable people of different political leanings, with whom we once were able to find common cause. There is something about denial and the projection of what is denied that sets off a vicious cycle of multiplying primitive mental states, enacted at the sociopolitical level in profoundly destructive ways.
Especially in Western cultures, there is a shared illusion that social scientists call the “myth of progress.” This fantasy assumes that we consistently improve over time – not just scientifically and technologically, but also psychologically and morally. What is the evidence for inexorable human progress? The best I have seen was marshalled by Steven Pinker (2011) in
The Better Angels of Our Nature. But while reading his argument, just when I was starting to feel persuaded of our species’ advancement toward greater overall humanity, there was news of beheadings of journalists, kidnapping and sexual slavery of young girls, and in the United States, an increasing enthusiasm for torturing those we had cast as enemies.
Are there some ways in which the kinds of approaches to denial that I suggested for the clinical situation might be applicable at the sociopolitical level? Can we effect change by making a frontal assault on social denial, by “speaking truth to power”? Or by normalizing and embracing without shame the aspects of life that denial functions to disavow and project? Or by reminding ourselves of our dependency on each other and trying to articulate those needs? Or by examining ourselves with enough rigor that we expose and transcend our own areas of denial? I am looking forward to opportunities at this conference to examine questions like these.
In electoral politics, I do not see any way to avoid splitting and othering, two of the elaborations of denial and the paranoid-schizoid position supporting it. Political activity finds itself necessarily in the paranoid-schizoid position –politics works this way and always has: We choose a side, we have our enemies, and we work to get like-minded people in power and frustrate those whose vision differs from ours (cf. McWilliams, 2019). But in speaking for overall social and political values, psychoanalytic understanding suggests that if we wish to avoid the terrible consequences of collective denial, we need to continue to insist on welcoming diverse groups and viewpoints. This requires creative, inspiring political leadership. Petty tyrants quickly learn that framing issues in either-or ways, and naming clear enemies, gives citizens the delicious pleasure of feeling correct and morally righteous. It is harder to articulate a politics of inclusion and to stand for the reality principle. Where is Nelson Mandela when we need him?
Because affects that are hard to bear will always be with us, I see the problem of denial as an unending one, requiring constant self-monitoring. The project of owning our own darkness, tolerating the shame it causes, and trying not to project it never ends. A sober look at the history of our species suggests it is dangerous to assume we will soon get, or have gotten, ahead of the process of denying and projecting our badness. We have to keep working on improving things
as if we are headed toward increasingly just solutions – and we do make progress in some areas – but we cannot expect our gains to be permanent, and we cannot safely divert our gaze from the ongoing moral responsibility of thinking about what kinds of denial we are still engaged in. The unconscious is truly unconscious, and we need to stay open to noticing its derivatives.
Even as we ravage our planet, the belief that life is somehow going onward and upward persists. People who would not necessarily subscribe to the assumption that goodness will ultimately prevail can be heard making comments such as, “Who would have imagined that this could happen in the 21st century?!” As if a process of continuing moral improvement has some kind of historical inevitability. When Donald Trump won the 2016 US election, part of the devastation and incredulity that followed among those who had opposed him seems to have been the destruction of a not-entirely-conscious fantasy that Americans were moving consistently forward toward progressive ideals: We had elected our first African-American President, we were about to elect our first female President, the Supreme Court had endorsed gay marriage, and we saw our political life as embracing closer and closer approximations of social justice. Our confidence that we were marching toward utopia may have had a lot to do with our defeat.
In closing, let me recall Freud’s deep conviction (e.g., xxxx), for which I believe there is immense evidence, perhaps especially lately, that civilization is not an automatic or inevitable arrangement for human beings. Denial is ubiquitous. Civility is fragile. Resistance to the ongoing attractions of denying unattractive realities depends on collective habits of honesty, open-mindedness, and discipline, which are, after all, core values of the psychoanalytic tradition. The world is in a bad way, and I would like to believe that we can help somehow.
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