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November 1958

Interpersonal Factors in Denial of Illness

Author Affiliations

New York

From the Department of Neurology, the Mount Sinai Hospital. Research Assistants in Neurology (Drs. Jaffe and Slote).

AMA Arch NeurPsych. 1958;80(5):653-656. doi:10.1001/archneurpsyc.1958.02340110123019

An accumulating body of evidence suggests that anosognosia has been artificially separated from the general concepts of psychological adaptation to illness.1-5 Psychodynamic approaches to denial of illness view it as a particularly dramatic instance of a premorbid defense mechanism. Its promotion to a distinct clinical entity can be attributed to the delusional, confabulatory severity of the phenomenon in the presence of altered cerebral function.1 The present report is an attempt to amplify this concept by assessing the role of interpersonal factors in the denial mechanism.

The study was stimulated by the observations of several investigators which point to the interpersonal, defensive quality of anosognosia. Legault,5 working in a psychotherapeutic setting, has noted the importance of denial for the relatives of the patient. Apparently, then, denial may be a group-adaptive phenomenon. Weinstein and Kahn1 have observed variation in the degree of denial in different interpersonal situations. They

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