Five Stages of Grief: Denial

We recently published an introduction to our multi-part series on addiction and the five stages of grief. The first stage of grief is denial, and it can be one of the most difficult stages to contend with due to the fact that most people who are immersed in it cannot recognize it for what it is. In fact, as we will discover with each stage we examine in the coming weeks, denial can take a number of forms. Each of these can affect a person quite differently, and there is no perfect way to deal with them.

Below, we will take a look at some of the most common forms of denial. We will then examine how denial affects addicts and alcoholics, both active and recovering. Then, since addiction is a family disease, we will look at how denial goes hand-in-hand with codependency. Finally, we will talk about how both addicts and codependents can learn to deal with denial as they move toward the next stage in the grieving process.

Defining Forms of Denial

The most common form of denial with which we are familiar is what Sigmund Freud referred to as Verneinung, or abnegation. This is the outright denial of a difficult truth, such as addiction, mortality, or the loss of a loved one. In his best-selling book, A Species in Denial, author Jeremy Griffith compares abnegation to the cave allegory used in Plato’s The Republic. In this allegory, a large group of people are chained to the inside of a cave and cannot see the light of day. With the outside world unknown to them, they accept the darkness as their only truth. To see the real world, they must first “struggle free of their bonds.” In a similar fashion, abnegation traps us within a world of delusion, with no easy means of escape.

Freud identified a second form of denial, Verleugnung, or disavowal. In this form, we are not completely in the dark. We recognize the truth of our situation. We know that we need rehab, that we are dying, or that we have just lost a loved one; however, we refuse to acknowledge the deep impact that this has had on us. Freud believed that disavowal could give way to psychosis later on in life if not dealt with early on.

One particularly troubling form of denial proposed by Freud was Verdrängung, also known as repression. This is essentially abnegation wrapped up in neuroses, a state from which the sufferer cannot break free without major therapeutic intervention. This is very often the case with traumatic experiences, such as parental violence or sexual abuse. Note that these do not always result in repression, nor does the recovery of repressed memories necessarily end our denial. The ability to remember these experiences might just move the victim into a state of disavowal. They might minimize the effects of the abuse on their psyche, or else they might rationalize or justify that they somehow deserved this behavior.

Sometimes trauma can also cause memories to become more intensified. If this is the case, then the victim of the trauma might find themselves in a state of cognitive dissonance. This is essentially the state of holding two conflicting ideas at the same time. It is not denial at its purest, nor is it acceptance by a long shot. Cognitive dissonance is similar to disavowal in the sense that it presents no immediate threat of psychosis but can wear down the sufferer’s mind immensely over time.

Denial in Active Addiction

The form of denial most commonly seen in active addiction is something of a mixture between abnegation and disavowal. It can’t be pure abnegation, because no addict is in such deep denial that they can convince themselves they are not engaging in regular substance abuse. They will, however, convince themselves that the way in which they use drugs and alcohol should not be considered a problem. An article on About.com indicates that this form of denial will not end until the addict has finally hit bottom.

Unfortunately, the concept of “rock bottom” is extremely flexible. The best way to define rock bottom for the addict in denial is the point at which they have lost more (or are about to lose more) than they are willing to let go. For some addicts, this will happen the first time they see how their addiction has hurt their family. Others might reach this point as a result of multiple run-ins with the law. There are also many unfortunates who will not reach the bottom until they are lowered into the grave. These are the addicts who will never cease to disavow themselves of all responsibilities for their actions. They are ultimately destroyed by a problem to which they never admitted, perhaps never even knew they had.

Not only do many addicts struggle with denial in terms of their addiction and the consequences it has wrought, but many addicts also use substance abuse as a means of prolonging their denial of other life circumstances. For instance, many addicts are former victims of child abuse. By dulling their senses through the use of drugs and alcohol, addicts do not have to accept the horrific maltreatment that they have suffered. We’ve talked about dual diagnosis and co-occurring disorders in the past, but there are those who feel as if dual diagnosis treatment should be refocused to account for the shame experienced by abuse victims.

In the case of abuse, the shame that spurs denial is often ingrained by the abuser themselves. This victim-shaming follows what is known as the DARVO model (Deny, Attack, Reverse Victim and Offender). The offender will deny any wrongdoing, attacking the victim through shame. The victim will eventually come to believe through either regression, justification, or sheer confusion that they are the one who has committed the offense. On some level, they might know that this is not the truth. Ashamed and unable to face this stark and troubling reality, they will seek chemical comfort.

There are all sorts of traumatic experiences that the addict might be trying to escape through the use of drugs and alcohol. These may include war, illness, or the loss of a family member. Any reality that the addict cannot easily stomach will be clouded from the mind with drugs and liquor until they are able to easily maintain their denial. And as we will discuss below, this denial does not always go away when the addict or alcoholic enters rehabilitation.

Denial in Addiction Recovery

The good news is that anyone who has entered addiction recovery has taken one step toward breaking through their denial. In most cases, anyway. There are certainly those who will enter treatment at the behest of a loved one while silently believing that they do not belong with the real addicts and alcoholics in treatment. They think that the other patients are lowlifes, reprobates. Whether a person’s denial is this strong or not, the initial steps into recovery will not be easy. As noted in the “Step One” chapter of AA’s Twelve Steps and Twelve Traditions: “Every natural instinct cries out against the idea of personal powerlessness. It is truly awful to admit that, glass in hand, we have warped our minds into such an obsession for destructive drinking that only an act of Providence can remove it from us.”

In other words, breaking through denial isn’t easy. But it’s a major component of Step One. Even at recovery centers that do not utilize a 12-step model, patients will generally need to accept the severity of their addiction if they are to become susceptible to treatment. The Clean Slate, a website that is vehemently opposed to what they call “recovery culture,” refers to denial as an Ayn Randian buzzword used to control patients. However, many of their points do not take into account the difference between abnegation and disavowal, nor do they account for the manner in which these two forms of denial may occasionally intersect.

It should be noted that treatment specialists do not use the word “denial” as willy-nilly as The Clean Slate seems to think. For instance, they believe that the word is commonly used in reference to outright lies. This, however, is not the case. Literature published by the Center for Substance Abuse Treatment in 2004 makes this very distinction, defining denial not as “a deliberate, willful act” but rather “a set of defenses and distortions in thinking caused by the use of substances.”

This distortion has been created over a long period of time. Chapter 3 of Alcoholics Anonymous uses the analogy of a jaywalker who has been crippled by numerous traffic accidents, yet continues jaywalking. No matter how many times an addict or alcoholic is beaten down by their own addiction, they will often return to it. They understand that they are hurting themselves, but they are so accustomed to the euphoric side effects of substance abuse that they have trouble seeing their behavior as anything but normal. This is going to be a roadblock in their addiction treatment, and it is imperative that this roadblock be put aside if they are to recover.

Facing denial in recovery can be difficult. The deeper the addict’s denial, the more stubbornly they will reject the severity of their addiction, the consequences it has wrought, and the impact that various life circumstances have had on their desire to numb their emotions through substance abuse. But with enough work, they can overcome this stage of their recovery. Of course, their family will have to undergo a similar process while they do so.

Denial and Codependency

First of all, we should note that addicts and alcoholics can be codependents as well. The University of Rochester Medical Center notes that while codependency is often associated with addiction, codependent behavior might also be exhibited by those with a history of abuse. As we have already mentioned, there are many addicts who began as codependents. In such cases, their denial was developed at an early age and nurtured well into their own addiction. But whether or not the codependent in question is dealing with their own substance problems, the threat of denial is very real.

Co-Anon, the support group for friends and family of cocaine addicts, publishes an “Anthology of Denial” in which many family members talk about their struggles with denial. Some exhibit their denial through abnegation, which causes them to enable their loved one’s addiction. One of our amazing and insightful contributors, Laurie Kesaris, has had her own history with enabling. One father in Co-Anon dealt with denial by disavowing his daughter of responsibility and assuming that it was his paternal duty to guide her into recovery. Both denial and codependency are complex emotional and behavioral systems, and they rarely present themselves in the exact same way for every codependent.

The aforementioned father hints at a common reason for denial in codependency. We love our friends and family, and it is difficult for us to cope with the idea that they have such a baffling and powerful defect. Many family members are familiar with the negative personality myths and stereotypes that govern the common image of the addict or alcoholic, and they do not want to view their spouse, parent, or child through that same lens. This can result in a level of cognitive dissonance. Faced with a problem and uncertain how they should feel about it, codependents will often resort to denial, disavowal, repression, or simple avoidance.

Confusion and fear are often at the root of this reaction to a loved one’s addiction. In Everyday Health’s eight signs of codependency, three are about confusion and difficulty communicating while the rest are about fear and low self-esteem. As with the Co-Anon father mentioned above, some are afraid that it is their duty to make their loved ones better. This may not sound like denial, since the problem is still being addressed. However, this reaction entails denying the nature of addiction itself by assuming that one family member’s influence is enough to overcome the addict’s cravings. Furthermore, control and enabling are both tools used by codependents who fear that their beloved friend or family member may exit their lives if left to their own devices.

While the tendency of some codependents to enable the addicts in their lives is unhealthy, the cause of their denial is certainly understandable. It is important for the families of addicts to recognize the signs of denial and codependency in their lives, but they should not be ashamed. Their denial was, for better or worse, born of love for someone close to them.

Living and Coping with Denial

Since denial affects everybody differently, there is no singular course of action that might be recommended for dealing with it. Trying to fight a person’s denial will not necessarily help them break through it, so the best guideline for the families of addicts and alcoholics is simply not to reward their behavior. University of Utah Health Sciences even trains their students to expect that substance-abusing patients are much more likely to exhibit signs of denial and resistance to treatment when they have been enabled by those closest to them.

For addicts to break through their denial, it helps them to develop a strong and sober support network. This will not only help them cope with their denial but will also help prevent them from slipping back into it. Codependents may benefit from such support as well. Al-Anon, Nar-Anon, and the previously mentioned Co-Anon are all wonderful support groups for those who have struggled with codependency. Here at Amethyst, we also offer support in the forms of our Amethyst Recovery Moms’ Corner and parent alumni program.

It should be noted that denial can play a healthy role in certain circumstances. Oncologist Daniel Rayson encountered such instances when working with cancer patients, noting that it helped patients and their families to cope when their loss was impending. In the case of addiction treatment, there are addicts who will only walk through the doors of a treatment center because it is important to their loved ones. Such addicts might realize on a subconscious level that they truly need help, but the notion that they are performing a noble deed for those they love is enough to get them past their fear of treatment.

Bear in mind that such cases, in which denial can be a boon rather than a burden, are quite limited. The Mayo Clinic says it best: “When faced with an overwhelming turn of events, it’s OK to say, ‘I just can’t think about all of this right now.’ You might need time to work through what’s happened and adapt to new circumstances. But it’s important to realize that denial should only be a temporary measure—it won’t change the reality of the situation.” Eventually, true healing will need to begin. If an addict or alcoholic is having trouble coming to terms with this, then the family might have to take the first step by staging an intervention.

In a Hazelden pamphlet by best-selling author Melody Beattie (which can be purchased on Amazon for less than $2), Beattie states that “you don’t always have to do something. People “get it together” by falling apart—and the process often begins with denial.” There is much truth to this, although it can be difficult to sit idly by and watch a loved one’s descent into rock bottom. This is why those who suffer from codependency are in need of support. Beattie also notes that, as we have said many times: “There are no absolute rules for dealing with denial or for dealing with people. Each situation and person is unique.”

This is why our programs here at Amethyst Recovery are personalized to ensure that every addict who walks through our doors is given the best possible treatment for their specific situation. For deep cases of denial brought on by abuse, trauma therapy might be necessary in order for denial to be broken. Some addicts might need little in the way of personalized treatment with the exception of the style of counseling they receive. Either way, we will be here to ease them through the process as they grieve the loss of their old self.