understanding denial

© Journal of holistic healthcare ! Volume 8 Issue 2 Aug 2011 27

Understanding denialCan insights from addictions treatment help ustackle ecological crisis?

Chris JohnstoneAuthor, trainer and coach in the psychology of change

My interest in behavioural medicine led me to the addictions field, where I worked fornearly 20 years as a doctor and group therapist. I will always remember a client whobegan the consultation by telling me, ‘I think the problem’s overblown; I don’t think mydrinking’s too bad’. He was yellow with jaundice from severe alcoholic liver disease.I saw many clients who, like him, found it hard to acknowledge how out of control theywere. I also count among my teachers the many clients I worked with who lived thestory of recovery. I see that story as relevant to us all.

A word with a problemDenial is a difficult term. When youdescribe someone as being in denial,you’re accusing them of ignoringsomething you regard as obvious.Even if you do know the truth ofthings better than they do, the term isoften experienced as insulting. Thatdoesn’t encourage people to comeround to your view.

Yet denial, as a psychologicaldefence mechanism, is well recognisedand needs to be taken account of.Psychiatrist Elizabeth Kubler-Rossnamed it as a stage in the process ofgrieving. When we’re given a piece ofshocking news, there is often a periodof time before the reality fully sinks in.It is possible to get stuck in thatadjustment phase, where we act as ifthe disturbing event hasn’t happened.When that occurs with bad news aboutthe world, it blocks an effectiveresponse. To address this, we need to look at what gets in the way ofaccepting, and responding to, difficultrealities.

Five pathways of denialNot all denial is the same. There areseveral different mechanisms by whichunwelcome information gets blankedout, discounted or devalued. Here arefive common ways this happens, each

accompanied by possible responsestrategies.

High fear messages can leadto overwhelm and shut downResearch on smoking and dentalhygiene found that health messagesgenerating high levels of fear were lesseffective it was at promoting behaviourchange.1 While disturbing materialhelped a message get noticed, thosealready anxious were especially likelyto switch off to high fear messages. Ata certain level of distress, denial maykick in as a defence mechanism.

These studies suggest that whensomeone is closing off to informationbecause they find it frightening, showering them with more terrifyingfacts can deepen the denial. What’sneeded here is a way of helping themwork through their fears and come toterms with difficult information.Professor Steve Rollnick, a leadingresearcher on health behaviourchange, has this advice: ‘Don’t justdump disturbing facts on people, buthave a two-way flow of communicationwhere after delivering facts you findout how they feel about this and whatthe information means to them’.

The process of becoming awarehas a number of stages, and blocks can occur at any of them. First we’represented with information. Then we

Summary

The process of denial,

where someone blanks out

bits of reality they find

disturbing, is an accepted

feature of addictive

behaviour. Could an

understanding of denial

help us work with, and

through, resistance to

tackling ecological issues?

Drawing on insights from

the addictions field, this

article explores how denial

develops and introduces

practical strategies for

countering it.

UNDERSTANDING DENIAL


© Journal of holistic healthcare ! Volume 8 Issue 2 Aug 201128

make choices about what we give our attention to. Oneway of maintaining peace of mind, in the short term atleast, is to avoid focusing on anything too disturbing; if weavoid looking at bad news, we don’t take it in. Even whenwe’re aware of an issue, if we fear the uncomfortable feelings it arouses, we may stop ourselves thinking aboutit. This can happen through voluntary choice or as a resultof unconscious defence mechanisms. By talking about anissue, we counteract this avoidance tendency. This allowsfor the information to be digested, so that its full meaningcan sink in.

Our emotional reactions are part of this digestionprocess. By allowing ourselves to be disturbed, we feelthe impact of shocking news in a way that makes it morereal. There is a paradox here: anxiety can motivate changeas well as block it. What makes the difference is what wedo with our fear. If we listen to it, then like an alarm bell, itcan rouse us to action. In my addictions work, I describethis as ‘good fear’; it can be life-saving.

It’s too disturbing to talk aboutHow do people respond when you share your concernsabout the world? Do they look intensely interested andask you to say more? Or do their eyes glaze over beforethey change the subject? Many people are reluctant todiscuss their worries about the world because they don’twant to bring others down, or be thought of as depressing.Yet if talking about our concerns is an important step indigesting difficult information, then this type of conversation can play a vital role.

In the addictions field, the approach of motivationalinterviewing developed as a way of working with resistanceto change. Research shows that resistance can be drivenup or down by what the counsellor does. Blaming,shaming, negative judgements and harsh confrontationsall tend to close down engagement and increase resistance.2 To draw out enthusiasm for change, the counsellor needs to help the client feel safe enough toshare their concerns at depth. The more the client speaksabout issues important to them, the more they talk themselves into addressing these. Rather than seeking topersuade or lecture people, a motivational approachemphasises interested listening that draws out deepermotivations for change.

The US author/activist Joanna Macy has developed asimilar approach in her workshops on facing global issues.‘I don’t assault people with painful information’, she says,‘instead, I invite them, in simple structured ways, to listento themselves and hear their own deep, inner responsesto what is happening to our world’.

Opinion polls show that most people believe thecondition of our world is deteriorating.3 When they talkabout concerns they already have, they talk themselvesinto responding to them.

At Macy’s workshops, paired listening exercises (seebox 1) give people an opportunity to express theirconcerns and any feelings that may accompany them.There is often tremendous relief when participants find

they aren’t alone in recognising the global crisis we face.Over a decade ago, I carried out an outcome studylooking at what effect these type of workshops had. Manyof those responding described their experiences as lifechanging, and over 90% reported a strengthening of theirbelief that they could make a difference in the world.4

Box 1 Drawing out our motivationThis is a paired listening exercise used in workshops onfacing global issues.With the following half-sentences asstarting off points, one partner says whatever naturallyfollows for them.The other partner gives their full interested attention as a listener. After spending twominutes on each sentence, partners swap roles and repeat the process.

1 When I think about the condition of our world,I think things are getting…

2 The feelings I have about this include…

3 What I do with these feelings is to…

Social validation and group denialOne way we work out how to respond to a situation is bylooking at what others do. A response is more likely to bejudged as valid when we see others doing it too. This hassuch a powerful effect that people may deny their ownperceptions and go along with a majority view, even whenthey know this is wrong. This tendency to conform helpsexplain denial in groups: people are more likely to ignorean issue if they see that everyone else does too. The thinking may be, ‘If the problem was that bad, then surelysomeone would do something’. However, if everyonethinks this, a self-reinforcing loop is created (see figure 1)that keeps the denial in place.

In an experiment on a busy city street, a man stoppedwalking and gazed up at the sky for just 60 seconds. Mostpeople around him just carried on with their journeys. But4% of his fellow pedestrians also stopped to see what hewas looking at. When the experimenters had five peoplerather than one gaze upwards, the proportion ofpassersby who followed their example rose to 18%. With astarter group of 15, the local traffic was almost halted, aswithin a minute 40% of pedestrians had stopped to look atthe sky.5

By making our concerns visible, we add to the numberof people looking upwards at the bigger picture of our

Can insights from addictions treatment help us tackle ecological crisis?

Figure 1 A self-reinforcing loop of denial

Each person thinks ‘it can’t be that bad’ No-one does anything

© Journal of holistic healthcare ! Volume 8 Issue 2 Aug 2011 29

world. The more of us who do this, the more likely itbecomes that others will too. At a certain level, a tippingpoint can be reached where something that was marginalbecomes the new mainstream. In their book The culturalcreatives, social psychologists Paul Ray and Sherry RuthAnderson describe how such a shift is already well underway.6 The more we participate in the developmentof an ecologically conscious culture, the more we help itgrow. And the more it grows, the more likely people are toparticipate in it. It is through self-amplifying loops like this(see figure 2) that a culture can move out of denial.

Counter-motivationA study looked at reactions to a research paper claiming toshow that heavy coffee consumption was bad for women’shealth. Women coffee drinkers were less convinced by theresearch than women who didn’t drink coffee. They sawthemselves as having something to lose if the research wasright and so were more suspicious of it.7 In a similar way, if someone sees information about climate change asthreatening to valued aspects of their lifestyle, they may bemore dismissive of it. The term for this type of resistanceis counter-motivation.

Motivation is very rarely one way. Much more oftenthere is a mixture of competing pushes and pulls insideourselves. When someone continues doing somethingharmful, they may well know about the risks, but othermotivations over-ride this. Professor Dick Eiser, an experton risk perception, says, ‘what controls behaviour is theimmediacy of effects. The over-riding concern tends to beshort gain or avoidance of short-term costs’. Most smokersknow tobacco kills, but find its temporary comfort oravoidance of withdrawal more compelling.

Throughout the 1990s, Thailand’s chief meteorologistrepeatedly warned about the risk of a massive tsunamitriggered by an underwater earthquake. He recommendedthat beachside hotels shouldn’t be built too close to thesea and should be fitted with tsunami alarms. His recommendations, which were seen as a threat to thetourist trade, were ignored. He faced a difficulty shared byaddictions counsellors and climate change scientists. It ishard to promote a change if people view it as more of aloss than a gain, especially if the cost is immediate and thebenefits long-term or uncertain. Even so, every year largenumbers of people succeed in giving up smoking or inmoving on from other deeply ingrained habits. It is possible to break the grip of the short-term fix. Strategiesthat help people do this can also be usefully applied toecological recovery.

A core principle of motivational interviewing is ‘avoidarguments’. When people feel attacked they often becomedefensive and more deeply entrenched. Even if you winon logic points, behaviour tends to be driven more bywants than reason. The skill is to find out what someonereally wants and then to explore whether the behaviourin question threatens this. This is referred to as ‘developing discrepancy’. Here’s an example.

Tony told me he’d lied to the doctors about his drinkingbecause he was scared they’d try to get him to stop. Hesaw alcohol as the only thing that worked when he waspanicking; he couldn’t imagine how he’d survive withoutit. What mattered to Tony was finding relief from disablingsymptoms of anxiety. To him, alcohol was the solution, notthe problem.

I wouldn’t be able to work with Tony if I didn’t understand his concerns. Lecturing him about his liverwould miss the point as far as he was concerned. So Iasked him to describe the ways he found alcohol helpful.This helped build rapport; it also brought out how muchhe depended on alcohol. Then I asked him what thedownside was, focusing particularly on ways alcohol mightbe adding to his anxieties. He knew it was only a short-term fix, that in the long term it added to his concerns.But he couldn’t see how else to deal with his panic. He’dmade a shift though: he was now interested in exploringpossible alternative approaches.

While Tony had taken that first important step ofrecognising the problem, this moved him straight awayinto facing the next obstacle – his lack of confidence thathe could cope any other way. Feeling hopeless makes ittempting to shut out the problem again. This creates thenext type of denial.

Feeling powerlessSomeone can be highly informed about an issue, fullyaccepting of how serious it is, and yet still act as if theproblem doesn’t exist. If they don’t believe they can doanything about it, awareness is doubly painful. Not only isthere the distress of concern, but also the anguish ofpowerlessness. This leaves them stuck between theconflicting voices of ‘must respond’ and ‘can’t respond’.Shutting down awareness offers relief, but this oftencomes at a price.

Closing down emotional engagement dampens vitality,as numbing out pain can block sensitivity to enjoyablefeelings too. Drugs or alcohol may be relied upon foremotional anaesthesia, but they are never entirely effective.Problems denied get worse over time and if someoneknows they’re avoiding something, they may feel guiltyabout this too.

In his learned helplessness model, Martin Seligmannames the experience of powerlessness as a cause ofdepression. The other side of this is that finding ourpower to address concerns can help improve mood. Theresearch on happiness shows that people tend to be mostsatisfied when engaged in serving a purpose larger than



Figure 2 A self-amplifying loop of ecological recovery

People become more active Ecological culture grows

© Journal of holistic healthcare ! Volume 8 Issue 2 Aug 201130

themselves.8 But to meaningfully engage, we need tobelieve our actions are worth the effort.

A perspective I find helpful is to think of our lives as anadventure story. Epic tales often begin by introducing anoverwhelming threat, and in the early chapters thingsoften seem pretty hopeless. What makes these storiescompelling is the way the central characters rise to thechallenge. They often appear under-equipped for the jobat first, but that doesn’t stop them. They begin a journeywhere searching out the tools, allies and insights neededbecomes part of their quest.

To find our power to respond to issues like climatechange, it helps to think of ourselves as being on such ajourney. There are tools that can help us grow in strength,become more inspired and find ways through blocks. I’vegathered some of those I’ve found most useful in my bookFind your power. Any task can seem too much untilwe’ve found a way of moving forward with it. When webegin the journey of looking for a way, we’re more likelyto find one. This is how breakthroughs can occur.

Rising to the challengeWhen facing issues like climate change, it is easy to feeldefeated before we start. The information we face is frightening, it can be difficult to talk about our concerns,those around us may seem to be ignoring the problemand the prospect of switching off our awareness has manyattractions. Painful realities can be difficult to look at. Butthe fields of addictions and health psychology have developed approaches for working with resistance tochange. The time has come to apply these insights to environmental issues.

Dr Chris Johnstone is author of Find your power (PermanentPublications, 2nd ed, 2010). His next book, Active hope, co-authored Joanna Macy, and will be published by New WorldLibrary in early 2012. www.chrisjohnstone.info

References1 Worchel S, Cooper J and Goethals G (1988).Understanding social

psychology (4th ed), pp 237. Pacific Grove, California: Brooks/ColePublishing Company.

2 Miller WR, Benefield RG, Tonigan JS (1993). Enhancing motivationfor change in problem drinking: A controlled comparison of twotherapist styles. Journal of Consulting and Clinical Psychology,61(3), pp 455–461.

3 Netpulse Global Poll (2002) 67% of 25,164 people from 175 countries considered the global environment to be getting worse.

4 Chris Johnstone (2002) Reconnecting with our world. In ChesnerA, Hahn H (eds) Creative advances in groupwork. London: JessicaKingsley.

5 Milgram S, Bickman L and Berkowitz L (1969) Note on the drawingpower of crowds of different size. Journal of Personality andSocial Psychology 13, pp 79–82.

6 Ray P, Anderson SR (2000) The cultural creatives. New York:Harmony Books.

7 Persaud R (2005) The motivated mind, p 56. London: BantamPress.

8 Seligman M (2003) Authentic happiness. London: Nicholas BrealeyPublishing.

Resourceswww.joannamacy.netinformation about Joanna Macy’s books and workshops

www.GreatTurningTimes.org a free email newsletter on finding our power to address global issues

www.culturalcreatives.org website devoted to a culture of engaged response

www.motivationalinterviewing.org website about motivational interviewin



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24 William Bloom talks about his new book The Power of Modern Spirituality, Isbourne Centre, Cheltenham. Details [email protected].

26–30 Sustainable health care. A SchumacherCollege course, Devon. See http://members.collegeofmedicine.eu/courses/sustainablehealthcare for details.

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20 Commissioning for integrated care. The King’s Fund, London. See www.kingsfund.org.uk/events/commissioning_for.html for details.

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2 Doctors, clergy and the troubled soul:Two professions, one vocation? A RoyalSociety of Medicine event. St MaryleboneParish Church, 17 Marylebone Rd, London.Details at www.rsm.ac.uk/academ/evc02.php.

14 William Bloom talks about his new book The Power of Modern Spirituality on theAlternatives Programme at St James’s Church,Piccadilly. Details from [email protected].

17 Recognising spiritual pain, meeting spiritual need. A St Christopher’s Hospicecourse, London. Details at www.stchristophers.org.uk

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