Understanding Denial by Chris Johnstone

UNDERSTANDING DENIAL

Understanding denial Can insights from addictions treatment help us tackle ecological crisis? Chris Johnstone Author, trainer and coach in the psychology of change

My interest in behavioural medicine led me to the addictions field, where I worked for nearly 20 years as a doctor and group therapist. I will always remember a client who began the consultation by telling me, ‘I think the problem’s overblown; I don’t think my drinking’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 they were. I also count among my teachers the many clients I worked with who lived the story of recovery. I see that story as relevant to us all.

A word with a problem

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.

Denial is a difficult term. When you describe someone as being in denial, you’re accusing them of ignoring something you regard as obvious. Even if you do know the truth of things better than they do, the term is often experienced as insulting. That doesn’t encourage people to come round to your view. Yet denial, as a psychological defence mechanism, is well recognised and needs to be taken account of. Psychiatrist Elizabeth Kubler-Ross named it as a stage in the process of grieving. When we’re given a piece of shocking news, there is often a period of time before the reality fully sinks in. It is possible to get stuck in that adjustment phase, where we act as if the disturbing event hasn’t happened. When that occurs with bad news about the world, it blocks an effective response. To address this, we need to look at what gets in the way of accepting, and responding to, difficult realities.

Five pathways of denial Not all denial is the same. There are several different mechanisms by which unwelcome information gets blanked out, discounted or devalued. Here are five common ways this happens, each

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accompanied by possible response strategies.

High fear messages can lead to overwhelm and shut down Research on smoking and dental hygiene found that health messages generating high levels of fear were less effective it was at promoting behaviour change.1 While disturbing material helped a message get noticed, those already anxious were especially likely to switch off to high fear messages. At a certain level of distress, denial may kick in as a defence mechanism. These studies suggest that when someone is closing off to information because they find it frightening, showering them with more terrifying facts can deepen the denial. What’s needed here is a way of helping them work through their fears and come to terms with difficult information. Professor Steve Rollnick, a leading researcher on health behaviour change, has this advice: ‘Don’t just dump disturbing facts on people, but have a two-way flow of communication where after delivering facts you find out how they feel about this and what the information means to them’. The process of becoming aware has a number of stages, and blocks can occur at any of them. First we’re presented with information. Then we

UNDERSTANDING DENIAL Can insights from addictions treatment help us tackle ecological crisis?

make choices about what we give our attention to. One way of maintaining peace of mind, in the short term at least, is to avoid focusing on anything too disturbing; if we avoid looking at bad news, we don’t take it in. Even when we’re aware of an issue, if we fear the uncomfortable feelings it arouses, we may stop ourselves thinking about it. This can happen through voluntary choice or as a result of unconscious defence mechanisms. By talking about an issue, we counteract this avoidance tendency. This allows for the information to be digested, so that its full meaning can sink in. Our emotional reactions are part of this digestion process. By allowing ourselves to be disturbed, we feel the impact of shocking news in a way that makes it more real. There is a paradox here: anxiety can motivate change as well as block it. What makes the difference is what we do with our fear. If we listen to it, then like an alarm bell, it can rouse us to action. In my addictions work, I describe this as ‘good fear’; it can be life-saving.

It’s too disturbing to talk about How do people respond when you share your concerns about the world? Do they look intensely interested and ask you to say more? Or do their eyes glaze over before they change the subject? Many people are reluctant to discuss their worries about the world because they don’t want to bring others down, or be thought of as depressing. Yet if talking about our concerns is an important step in digesting difficult information, then this type of conversation can play a vital role. In the addictions field, the approach of motivational interviewing developed as a way of working with resistance to change. Research shows that resistance can be driven up or down by what the counsellor does. Blaming, shaming, negative judgements and harsh confrontations all 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 to share their concerns at depth. The more the client speaks about issues important to them, the more they talk themselves into addressing these. Rather than seeking to persuade or lecture people, a motivational approach emphasises interested listening that draws out deeper motivations for change. The US author/activist Joanna Macy has developed a similar 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 listen to themselves and hear their own deep, inner responses to what is happening to our world’. Opinion polls show that most people believe the condition of our world is deteriorating.3 When they talk about concerns they already have, they talk themselves into responding to them. At Macy’s workshops, paired listening exercises (see box 1) give people an opportunity to express their concerns 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 study looking at what effect these type of workshops had. Many of those responding described their experiences as life changing, and over 90% reported a strengthening of their belief that they could make a difference in the world.4

Box 1 Drawing out our motivation This is a paired listening exercise used in workshops on facing global issues. With the following half-sentences as starting off points, one partner says whatever naturally follows for them.The other partner gives their full interested attention as a listener. After spending two minutes 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 denial One way we work out how to respond to a situation is by looking at what others do. A response is more likely to be judged as valid when we see others doing it too. This has such a powerful effect that people may deny their own perceptions and go along with a majority view, even when they know this is wrong. This tendency to conform helps explain denial in groups: people are more likely to ignore an issue if they see that everyone else does too. The thinking may be, ‘If the problem was that bad, then surely someone would do something’. However, if everyone thinks this, a self-reinforcing loop is created (see figure 1) that keeps the denial in place. Figure 1 A self-reinforcing loop of denial

Each person thinks ‘it can’t be that bad’

No-one does anything

In an experiment on a busy city street, a man stopped walking and gazed up at the sky for just 60 seconds. Most people around him just carried on with their journeys. But 4% of his fellow pedestrians also stopped to see what he was looking at. When the experimenters had five people rather than one gaze upwards, the proportion of passersby who followed their example rose to 18%. With a starter group of 15, the local traffic was almost halted, as within a minute 40% of pedestrians had stopped to look at the sky.5 By making our concerns visible, we add to the number of people looking upwards at the bigger picture of our

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UNDERSTANDING DENIAL Can insights from addictions treatment help us tackle ecological crisis?

world. The more of us who do this, the more likely it becomes that others will too. At a certain level, a tipping point can be reached where something that was marginal becomes the new mainstream. In their book The cultural creatives, social psychologists Paul Ray and Sherry Ruth Anderson describe how such a shift is already well underway.6 The more we participate in the development of an ecologically conscious culture, the more we help it grow. And the more it grows, the more likely people are to participate in it. It is through self-amplifying loops like this (see figure 2) that a culture can move out of denial. Figure 2 A self-amplifying loop of ecological recovery

People become more active

Ecological culture grows

Counter-motivation A study looked at reactions to a research paper claiming to show that heavy coffee consumption was bad for women’s health. Women coffee drinkers were less convinced by the research than women who didn’t drink coffee. They saw themselves as having something to lose if the research was right and so were more suspicious of it.7 In a similar way, if someone sees information about climate change as threatening to valued aspects of their lifestyle, they may be more dismissive of it. The term for this type of resistance is counter-motivation. Motivation is very rarely one way. Much more often there is a mixture of competing pushes and pulls inside ourselves. When someone continues doing something harmful, they may well know about the risks, but other motivations over-ride this. Professor Dick Eiser, an expert on risk perception, says, ‘what controls behaviour is the immediacy of effects. The over-riding concern tends to be short gain or avoidance of short-term costs’. Most smokers know tobacco kills, but find its temporary comfort or avoidance of withdrawal more compelling. Throughout the 1990s, Thailand’s chief meteorologist repeatedly warned about the risk of a massive tsunami triggered by an underwater earthquake. He recommended that beachside hotels shouldn’t be built too close to the sea and should be fitted with tsunami alarms. His recommendations, which were seen as a threat to the tourist trade, were ignored. He faced a difficulty shared by addictions counsellors and climate change scientists. It is hard to promote a change if people view it as more of a loss than a gain, especially if the cost is immediate and the benefits long-term or uncertain. Even so, every year large numbers of people succeed in giving up smoking or in moving on from other deeply ingrained habits. It is possible to break the grip of the short-term fix. Strategies that help people do this can also be usefully applied to ecological recovery.

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A core principle of motivational interviewing is ‘avoid arguments’. When people feel attacked they often become defensive and more deeply entrenched. Even if you win on logic points, behaviour tends to be driven more by wants than reason. The skill is to find out what someone really wants and then to explore whether the behaviour in 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 drinking because he was scared they’d try to get him to stop. He saw alcohol as the only thing that worked when he was panicking; he couldn’t imagine how he’d survive without it. What mattered to Tony was finding relief from disabling symptoms of anxiety. To him, alcohol was the solution, not the problem. I wouldn’t be able to work with Tony if I didn’t understand his concerns. Lecturing him about his liver would miss the point as far as he was concerned. So I asked him to describe the ways he found alcohol helpful. This helped build rapport; it also brought out how much he depended on alcohol. Then I asked him what the downside was, focusing particularly on ways alcohol might be adding to his anxieties. He knew it was only a shortterm fix, that in the long term it added to his concerns. But he couldn’t see how else to deal with his panic. He’d made a shift though: he was now interested in exploring possible alternative approaches. While Tony had taken that first important step of recognising the problem, this moved him straight away into facing the next obstacle – his lack of confidence that he could cope any other way. Feeling hopeless makes it tempting to shut out the problem again. This creates the next type of denial.

Feeling powerless Someone can be highly informed about an issue, fully accepting of how serious it is, and yet still act as if the problem doesn’t exist. If they don’t believe they can do anything about it, awareness is doubly painful. Not only is there the distress of concern, but also the anguish of powerlessness. This leaves them stuck between the conflicting voices of ‘must respond’ and ‘can’t respond’. Shutting down awareness offers relief, but this often comes at a price. Closing down emotional engagement dampens vitality, as numbing out pain can block sensitivity to enjoyable feelings too. Drugs or alcohol may be relied upon for emotional anaesthesia, but they are never entirely effective. Problems denied get worse over time and if someone knows they’re avoiding something, they may feel guilty about this too. In his learned helplessness model, Martin Seligman names the experience of powerlessness as a cause of depression. The other side of this is that finding our power to address concerns can help improve mood. The research on happiness shows that people tend to be most satisfied when engaged in serving a purpose larger than

UNDERSTANDING DENIAL Can insights from addictions treatment help us tackle ecological crisis?

themselves.8 But to meaningfully engage, we need to believe our actions are worth the effort. A perspective I find helpful is to think of our lives as an adventure story. Epic tales often begin by introducing an overwhelming threat, and in the early chapters things often seem pretty hopeless. What makes these stories compelling is the way the central characters rise to the challenge. They often appear under-equipped for the job at first, but that doesn’t stop them. They begin a journey where searching out the tools, allies and insights needed becomes part of their quest. To find our power to respond to issues like climate change, it helps to think of ourselves as being on such a journey. There are tools that can help us grow in strength, become more inspired and find ways through blocks. I’ve gathered some of those I’ve found most useful in my book Find your power. Any task can seem too much until we’ve found a way of moving forward with it. When we begin the journey of looking for a way, we’re more likely to find one. This is how breakthroughs can occur.

Rising to the challenge When facing issues like climate change, it is easy to feel defeated 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 problem and the prospect of switching off our awareness has many attractions. Painful realities can be difficult to look at. But the fields of addictions and health psychology have developed approaches for working with resistance to change. The time has come to apply these insights to environmental issues. Dr Chris Johnstone is author of Find your power (Permanent Publications, 2nd ed, 2010). His next book, Active hope, co-authored Joanna Macy, and will be published by New World Library in early 2012. www.chrisjohnstone.info

Resources www.joannamacy.net information 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

EVENTS SEPTEMBER 20

Capita’s 2nd national GP commissioning conference, London. Call 0870 400 1020 for details. Beyond Dilnot – a new future for social care? The King’s Fund, London. See www.kingsfund.org.uk/events/beyond_ dilnot.html for details. 24 William Bloom talks about his new book The Power of Modern Spirituality, Isbourne Centre, Cheltenham. Details from info@Williambloom.com. 26–30 Sustainable health care. A Schumacher College course, Devon. See http://members.collegeofmedicine.eu /courses/sustainablehealthcare for details.

OCTOBER 20

References 1 Worchel S, Cooper J and Goethals G (1988).Understanding social psychology (4th ed), pp 237. Pacific Grove, California: Brooks/Cole Publishing Company. 2 Miller WR, Benefield RG, Tonigan JS (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology, 61(3), pp 455–461.

NOVEMBER 2

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 Chesner A, Hahn H (eds) Creative advances in groupwork. London: Jessica Kingsley. 5 Milgram S, Bickman L and Berkowitz L (1969) Note on the drawing power of crowds of different size. Journal of Personality and Social 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: Bantam Press. 8 Seligman M (2003) Authentic happiness. London: Nicholas Brealey Publishing.

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

Doctors, clergy and the troubled soul: Two professions, one vocation? A Royal Society of Medicine event. St Marylebone Parish Church, 17 Marylebone Rd, London. Details at www.rsm.ac.uk/academ/evc02.php. William Bloom talks about his new book The Power of Modern Spirituality on the Alternatives Programme at St James’s Church, Piccadilly. Details from info@Williambloom.com. Recognising spiritual pain, meeting spiritual need. A St Christopher’s Hospice course, London. Details at www.stchristophers.org.uk To publicise your event send details to Edwina Rowling at erowling@tiscali.co.uk.

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