Ness D E, Ende J
Department of Psychiatry, Medical College of Pennsylvania, Philadelphia.
JAMA. 1994 Dec 14;272(22):1777-81.
Denial is a psychological defense in which the individual repudiates some or all of the meanings of an illness, thereby warding off an awareness of painful thoughts and feelings such as fear, grief, depression, and anger. Although it is often viewed as a problem, denial may at times be a healthy and adaptive response to illness. In the medical interview, denial may be exhibited by the patient, the physician, or both. Not all instances of denial can or should be addressed within the interview. The decision to address denial can be made based on how adaptive the denial is, what kind of psychosocial support is available to the patient, and how well prepared the patient is to deal with the fears that underlie denial. In those instances when denial should be addressed, the interviewer can use techniques of clarification, confrontation, and interpretation.
否认是一种心理防御机制，个体借此否定疾病的部分或全部意义，从而避免意识到诸如恐惧、悲伤、抑郁和愤怒等痛苦的想法和感受。尽管否认常常被视为一个问题，但有时它可能是对疾病的一种健康且适应性的反应。在医学问诊中，患者、医生或双方都可能表现出否认。并非所有的否认情况都能或都应该在问诊中得到处理。是否处理否认可基于否认的适应性如何、患者可获得何种社会心理支持以及患者应对否认背后恐惧的准备程度来决定。在那些应该处理否认的情况下，问诊者可以运用澄清、对质和解释等技巧。
