Hope was the first thing I noticed when, in college, I volunteered
at a camp that served adolescents and young adults who were diagnosed with
cancer. I walked in expecting to see, at best, moderated sadness, or at worst, utter
despair. To me, these seemed like normal responses to a diagnosis of cancer at
such a young age. Instead, I was surprised by hope. The campers I met were, on
the whole, optimistic about their futures and wore bright smiles most of the
day. At times, I was inspired by their joy. In other moments, I felt their hope
looked a lot like denial. As I have continued my career working with children
and adolescents who have life-threatening or life-limiting conditions, I have become better acquainted with hope and denial and come
to realize that there is, indeed, a fine balance of both that is needed to survive
the uncertainty associated with serious illness.
this blog post, I will call reality the objective sense of what actually is the
diagnosis, prognosis, and treatment of a disease. (My social construction
leanings are well aware that even that reality is subjective, but let’s just
leave it at this meaning for now.) Hope is beautifully simple and complex all
at the same time. While hope is grounded in an array of values and beliefs and comes
in many forms, it is mainly a sense of optimism. This optimism helps a patient
or family member cope with the seriousness of their reality. Hope is an
adaptive behavior to have in the face of a challenge.
|The relationship between |
hope and denial is a delicate one.
on the other hand, has a pathological connotation and is understood as hope
gone dangerously awry. An individual or family are "in denial” when they are
defensive to hearing new information, become increasingly defensive upon
hearing bad news, and begin to block out all new information, which then
interferes with proper decision-making and coping with the reality of the
situation. Whereas most people would typically agree that hope should be
supported when coping with a medical illness, I find that once a patient is
labeled as "in denial” their concerns are more often dismissed and we begin to
shut out our understanding of and appreciation for the reasons why a patient or
family member is not accepting their painful reality. When we consider a person
in denial we may very well stop being curious about their situation which
severely impacts our capacity to help.
and denial are both normal reactions to a stressful and terrifying diagnosis,
and both states of being may actually be necessary and helpful for patients and
family members as they face a chronic or critical illness through its various
stages and developments. While hope can go too far and lead to unrealistic optimism
(which we label denial), this perspective can also lend itself to reducing the
terror and excruciating pain associated with the potential loss that is at
stake with a serious illness. It is normal to resist bad news, to not want to
integrate the new information.
all have experienced moments of denial when we encounter situations that we
want to desperately escape from in our own lives. While I am not espousing that
we allow denial to run rampant, I do suggest that we reconsider the role denial
plays in a patient and family’s coping process and ask ourselves a few
questions. Are we witnessing a family that is still holding on to hope as a
positive coping strategy? Does the patient or family have the same understanding
of the medical information or experience we are privileged to hold? Have we
considered what could result if the family did fully accept their condition and
understand the role denial is playing for them? Do we respect that different
people need different amounts of time to integrate difficult news? Have we
considered how our communication with the family could be influencing their
I have learned that the relationship between hope and denial is a delicate one.
When I am tempted to say someone is "in denial” it now triggers me to further
ponder the impact that acceptance of their reality would have on themselves and
their loved ones which allows me to see more clearly why they are holding onto
hope for dear life.
Jackie Williams Reade, PhD is a Postdoctoral Fellow at Johns Hopkins University in Baltimore, MD. She received her Master’s in MFT from Seattle Pacific University and her PhD in Medical Family Therapy at East Carolina University. She is also the administrator of the Medical Family Therapy Group on Facebook.