“Is denial a regressive defense, indicative of a fragile ego? Or is it a tactical defense?” Thanks to Johannes for this important question!
In his seminal work, Denial and Defense, Theodore Dorpat pointed out that denial is the basis of ALL defenses. Think about that for a minute! I might deny that I have a feeling. Or I might deny that I have a feeling and do one more thing: e.g., relocate it in someone else (projection), cover it with words (intellectualization), or make someone else feel it (projective identification). What do we deny? Two things: 1) the stimulus (otherwise known as reality); or 2) our feelings and internal responses to that stimulus. If I can deny the reality of a stimulus, I don’t have any feelings about it. “He said he wanted to break up, but I had been thinking of leaving anyway, so I don’t think that’s what my depression is about.” Here, the patient denies the significance of reality to avoid having feelings about it.
Since all defenses are based on denial, all of us use this defense. Thus, we can’t say that it is always a regressive defense or a tactical defense. Instead, new questions arise for us. In a given moment, what impact does the denial have on the patient’s reality testing and what function does the denial serve?
Denial can obviously be a regressive defense in a fragile patient if the other defenses are regressive, the patient’s anxiety is in cognitive/perceptual disruption, and the denial impairs the patient’s reality testing. For instance, a suicidal patient denies the lethality of her suicidal attempt through omnipotent denial. “My suicide will not lead to death but to rebirth in a new life.” Notice in omnipotent denial that the patient not only denies reality but offers the complete opposite of reality as a substitute.
Denial can also function as a tactical defense in a highly resistant patient if he uses tactical, repressive, and character defenses, if his anxiety is discharged into the striated muscles, and if his reality testing is good. For instance, he might say, “I don’t have a problem. You should ask my wife, since she’s the one who thinks there is a problem.” Here we see first the defense of denial. Then we see projection of his awareness (which he denies) onto his wife. This is not a loss of reality testing because, most likely, his wife really does think he has a problem. Here, the defense of denial wards off his awareness of his problem, but it also functions as a tactical defense to keep the therapist at a distance from his inner life.
Of course, the denial of any part of reality or of our feelings in response to it will falsify our picture of reality and ourselves. Thus, denial always impairs our reality testing. But the degree to which our reality testing is impaired occurs on a spectrum from neurotic denial (“I don’t have a problem”) to psychotic denial (“My suicide will lead to my rebirth as a savior of the world”).
In my forthcoming Youtube videos on denial, you’ll learn about the four types of denial: denial per se, denial through fantasy, denial through words, and denial through deeds. And in my book, Co-Creating Change, you’ll find an entire section on denial since it is such an important defense to understand and address if you are to gain access to the patient’s feelings.