Denial: A Clarification of Concepts and Research PDF
Preview Denial: A Clarification of Concepts and Research
Denial A Clarification of Concepts and Research Denial A Clarification of Concepts and Research Edited by E. L. Edelstein The Hebrew University Jerusalem, Israel Donald L. Nathanson The Institute of Pennsylvania Hospital and Hahnemann University Philadelphia, Pennsylvania and Andrew M. Stone University of Pennsylvania Philadelphia, Pennsylvania Plenum Press • N ew York and London Library of Congr~S! Cataloging in Publication Data Denial: a clarification of conc~pt' and research. Based on th~ International Symposium on Denial, held Jan. 26-31, 1985, in Jerusalem. IncJud~s bib!iographi~s and ind~x. I. Denial (Psychology)-Congrels~l. I. Edelstein, E. L. (E1i~ser Ludwig), 1922- . II. Nathanson. Donald L, [JJ, SlOne, Andrew M. IV, International Symposium on Denial (1985: Jerusalem) [DNLM: L o.,nial (Psychology)-congrc:s5Cs. WM 193.5.03039391985] RC455A,D45D46 1989 616.89 88-35671 ISBN-13:978-1-4612-8057-6 ,,-ISBN-13: 978-1-4613-0737-2 001: 10.10071978-1-4613-0737-2 © 1989 Plenum Press, New York Softcover reprint of the hardcover I st edition 1989 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All right. re.erved No part of this book may be reproduced, .lOred in a retrieval system. or transmitted in any form or by any means, electronic. mechanical, photocopying, microlilming, r~cording, Or otherwise, without written JH'rmission from the Publisher To The Israel Psychoanalytic Society Contributors LEA BAlDER, Department of Clinical Oncology and Radiology, Hadas sah University Hospital, Ein Karen, jerusalem, Israel RAMI A. BAR GIORA, ILAN Child Guidance Clinic, P.O. Box 8125, jerusalem, Israel MICHAEL FREDERIC CHA YES, Private Practice, Burmanstraat 9 hs., Amsterdam, The Netherlands SHAMAI DAVIDSON, Late of the Shalvata Mental Health Center, 'Hod HaSharon, Israel THEODORE L. DORPA T, Departments of Psychiatry and Behavioral Med icine, University of Washington School of Medicine, Seattle, Washington E. L. EDELSTEIN, Department of Psychiatry, Hadassah University Hospi tal, Ein Karen, jerusalem, Israel RIVKA R. EIFERMANN, Department of Psychology, The Hebrew Univer sity of jerusalem, jerusalem, Israel H. SHMUEL ERLICH, Department of Psychology, The Hebrew University of jerusalem, jerusalem, Israel RICHARD C. FRIEDMAN, Private Practice, 225 Central Park West, New York, New York GEMMA j APPE, Private Practice, Riesstrasse 21, Bonn, Germany HILLEL KLEIN, Private Practice, 14 Tchernichovsky Street, jerusalem, Israel ILANY KOGAN, Private Practice, 2 Mohaliver Street, Rehovot, Israel RAFAEL MOSES, Sigmund Freud Center for Study and Research in Psy choanalysis, The Hebrew University of jerusalem, jerusalem, Isra el, and Austen Riggs Center, Stockbridge, Massachusetts HERMAN MUSAPH, Private Practice, C. van Renesstraat 30, Amsterdam, The Netherlands vii viii CONTRIBUTORS DONALD L. NATHANSON, The Institute of Pennsylvania Hospital and Hahnemann University, Philadelphia, Pennsylvania DIETER OHLMEIER, Sigmund Freud Institute, Myliusstraase 20, Frank furt, Federal Republic of Germany GIORGIO SACERDOTI, Private Practice, Rio de la Crose 149, Giudecca, Venice, Italy ANTONIO SEMI, Private Practice, Rio de la Crose 149, Giudecca, Venice, Italy RUTH S. SHALEV, Neuropediatric Diagnostic Unit, Bikur Cholim Hospi tal, Jerusalem, Israel JOEL SHANAN, Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel ANDREW M. STONE, Department of Psychiatry, Philadelphia Veterans Administration Medical Center ,and University of Pennsylvania, Philadelphia, Pennsylvania MICHAEL H. STONE, Beth Israel Medical Center/Mt. Sinai Medical School, New York, New York MARTIN W ANGH, Private Practice, 20 Neve Sha'anan, Jerusalem, Israel AVERY DANTO WEISMAN, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts LEON WURMSER, Private Practice, 904 Crestwick Road, Towson, Maryland Preface We do not think about everything at once all the time. Various mecha nisms allow us to choose from among the themes, issues, topics, feelings, ideas, and memories that might occupy consciousness. One can focus selectively on anything deemed important; yet the methods by which this is accomplished vary greatly. We clinicians assign to these various mech anisms names that fit whatever theoretical system is central to our work-the healthy suppression of "background noise" allows us to pay attention to certain matters; the repression of unconscious conflict may assist our functioning in one moment despite its later cost; whereas denial and disavowal are used as general and fairly nonspecific terms for matters that are left out of awareness in order to avoid the noxious emotions specific to the personal significance of such awareness. Despite the attitude of scientific objectivity characterizing Freud's introduction of psychoanalysis, an aura of morality clings to certain of these mecha nisms, for we tend to judge people by their use of them. We are a society of doers, people of action and accomplishment who look with disrespect at the avoidance of any responsibility or task. Thus denial has taken on a negative connotation, and those who use this avoidance system are seen as the lesser among us. Yet, in the clinical practice of psychotherapy, we see denial in so many ways that suggest its relationship to courage, bravery, and creativity that it seems almost irrational and perhaps unfair to use so negative a label for the underlying process. In a single day, a therapist might work with a patient riddled with metastatic carcinoma, able to accept the dehumanization and disfigurement of antineoplastic treat ment only by disavowal of the ominous progression of the illness; a barely functioning patient reeking of alcohol, who claims "I can stop any time I want"; a physician drenched with sweat and shivering with chills, IX x PREFACE ignoring fever as she continues to work in the hospital; and a war vet eran discussing a moment when, in a fine disregard of what appeared to others as certain death, he pulled a companion to safety. It may well be that in some of these instances what has been disavowed might usefully be recognized and discussed, whereas in others, what is denied cannot be solved and is best left unanswered. This is a book as much about the skill of denial as it is about denial as a defense. The problem for us is one of language, not of action. A map is not the territory it depicts but rather a description of a territory. The words used to describe entities and events are not the things themselves but complex forms by which we attempt to structure those portions of reality amenable to such manipulation. Nowhere is this expressed more poi gnantly and simply than by Wittgenstein, who described his monu mental Tractatus Logico-Philosophicus as consisting of two parts, the one resting in the hands of the reader and called a book, and another, to him even more important but inexpressible. "Wovon man nicht sprechen kann, daruber muss man schweigen." (Whereof one cannot speak, thereof one must remain silent.) Yet here the not-saying is not denial but rather a recognition of the limitations of language. As psychoanalysis approaches its second century, some of its lan guage requires refinement. The symposium "Denial: A Clarification of Theoretical Issues and Research" was organized by Eli Edelstein for precisely this purpose. A word with too many meanings ceases to be useful; a concept limited too narrowly loses significance. Intended was a broad-based, comprehensive review in which each participant would be encouraged to discuss the idea of denial from a personal vantage point. From the start, it was understood that some scholars would discuss the oretical issues, others a wide range of practical applications of the con cept. We were unprepared for the intensity of interest created by this request or for the excitement generated at the meeting itself. So com plex was the resulting gestalt, so intriguing the data presented that week in Jerusalem, that the task of turning this group of papers into a co herent book proved correspondingly complex. As a participant in the symposium, Donald Nathanson has joined its organizer to complete the conversion of the original symposium into the current volume; toward this end we have enlisted as co-editor Andrew Stone, whose assistance has been invaluable. All of us know the experience of first recognizing, then learning a new word that becomes part of our vocabulary. Not infrequently, just as we come to recognize this word, it begins to appear everywhere we turn. For Nathanson, this visit to Jerusalem was an introduction to the Middle East-rather than return directly to Philadelphia, he and his wife lin- PREFACE Xl gered as tourists in Israel for a few days, visiting Egypt as well. Clamber ing wide-eyed through the tomb of Rameses VI, they were asked by their Egyptian guide to pause before a wall painting depicting pharaoh in the act of being interrogated. The guide explained that this was The Hall of Negative Confession, an intriguing if perplexing description. "It is important that the wrong man not become Ra," continued the guide. "There are many things a real pharaoh would not have done. If the man who has died and has traveled the great river to get to this point is successful in his journey, he will become Ra, the sun god. It cannot be allowed for the wrong man to be made Ra. So he is asked a great many questions: 'Did you do this?' or 'Did you do that.' And to each question he must answer, 'I did not do it.' Only after he has made negative confession to all of the questions is he allowed to pass on to the final portion of his journey." Travelers from the International Symposium on Denial had journeyed from Mount Scopus to the Hall of Denial. It is our hope that, in breaking through the limits of tradition, we have collected new material useful both within the professional disci plines of the healing arts and well beyond into other areas. E.L.E. D.L.N. A.M.S.
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