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July 9, 1982

Denial: Are Sharper Definitions Needed?

Author Affiliations

From the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.

JAMA. 1982;248(2):210-212. doi:10.1001/jama.1982.03330020054029

THE TERM denial, when used clinically, is applied to patients who, consciously or unconsciously, try to relieve their anxiety by pretending that the serious situation described to them by their physicians is either exaggerated or nonexistent. I write here about three cases in which the term was used. The basic facts in each case, however, indicate that the term may have been misapplied. It should be pointed out that the patients, while understandably anxious and apprehensive, were not considered to be neurotic or psychotic. My knowledge of the cases was based on information from the patients.

Patient 1 was a 43-year-old woman who was an ambulance driver and paramedic. A mammogram and a biopsy specimen of a small lump in her breast led to the recommendation of a radical mastectomy. The patient declined to accept surgery. The physician, disturbed by her apparent denial of her condition, suggested she see a