Mass denial in modern society

Abstract

Denial in society is discussed with reference to the media's use of language, and application is made of Breznitz's (1983) model of denial. Particular reference is made to the media reporting of crime and the public reactions to BSE and the ensuing beef crisis. Denial is seen as serving as a protection against anxiety over external threats, and against fears of one's own natural impulse to wish death on others. Denial might serve a useful purpose to protect the individual from unnecessary stress, but can possibly lead to a kind of madness in society.     

Perceived health following myocardial infarction: cross-validation of the Health Complaints Scale in Danish patients

With an ageing population and a decline in cardiac mortality rates, the number of patients with cardiac disease is increasing, which in turn poses a major challenge for secondary prevention. For this end, appropriate, sensitive, and validated instruments to assess health complaints and quality of life are required. The objectives of the current study were: (1) to cross-validate the Health Complaints Scale (HCS) in a Danish sample of patients with a first myocardial infarction (MI); and (2) to investigate whether perceived health, as measured by the HCS is related to cardiac disease severity. The HCS was originally developed in Belgian patients with coronary artery disease. One-hundred-and-twelve consecutive patients with a first myocardial infarction were assessed by means of a questionnaire four to six weeks post infarction. Clinical measures were sampled from medical records. The factor structure of the HCS and the internal consistency of the Somatic Complaints (alpha = 0.91) and Cognitive Complaints subscales (alpha = 0.94) were confirmed. The construct validity of the scale was confirmed against measures of psychopathology and personality. Patients scored significantly higher on the HCS Somatic and Cognitive scales as compared with self-reports of depression and anxiety (p < 0.0001). Health complaints were unrelated to severity of cardiac disease and rather reflected subjective perception of quality of life. These findings show that the HCS is a valid instrument that is equally applicable in Danish cardiac patients to monitor perceived health as a major component of quality of life.     

Does the Illness Behavior Questionnaire measure abnormal illness behavior?

Abnormal illness behavior (AIB) has been proposed as a construct measuring the inappropriate or maladaptive modes of responding to one's state of health, and the Illness Behavior Questionnaire (BQ; Pilowsky, 1975) was designed to measure this construct. Previous studies using small samples have failed to agree on the factor structure of this questionnaire. The present paper examines the factor structure of the Illness Behavior Questionnaire and critically evaluates the interpretation of its dimensions as well as the construct of AIB. A factor analysis of responses from 1,061 health care and nonhealth care seeking subjects yielded six interpretable factors which substantially replicated Pilowsky's previous results. Six scales were calculated and correlated with several personality measures. The results indicated that the Illness Behavior Questionnaire is saturated with neuroticism, a dimension known to be related to excessive medical complaints. But excessive medical complaints cannot be equated with hypochondriasis or AIB in the absence of objective medical information. In the absence of evidence for the discriminant validity of the IBQ, its use as a diagnostic device is unwarranted. Treating elevated IBQ scores as indicators of abnormal illness behavior without corroborating medical information may be more misleading than accepting patients' symptom reports at face value.     

Differences between employed and unemployed alcoholic inpatients in trouble for drinking and denial

The Trouble-Due-to-Drinking scale and the Denial scale of the MMPI were administered to two groups of inpatients of low socioeconomic status, an employed group (27 men, 3 women) and an unemployed one (44 men, 12 women), at a state alcoholism facility in an inner city catchment area. The former were significantly older than the latter; Ms = 40.4 and 35.5 yr., respectively. The Trouble scale correctly identified 98% of the unemployed group but only 83% of the employed group. The unemployed scored significantly higher on MMPI Denial and significantly lower on the Trouble scale than the unemployed. The Pearson r between scores on the two measures was negative and significant for the combined sample and for the unemployed as well, whereas r for the unemployed was negative but nonsignificant. It was concluded that the unemployed group was less given to the use of denial and had encountered more alcohol-related problems than the employed group.     

Useful lies: The twisted rationality of denial

He who increases knowledge increases sorrow.

Ecclesiastes 1:18

The truth will set you free.

John 8:32

Denial, or the habit of treating a real problem as if it were a nonissue, has both rational and irrational features. The interplay between these is best captured by a utilitarian-rationalist framework stretched to its limits. When in denial, people follow what they feel to be in their best interest by minimizing the psychosocial cost of acknowledging their problems. At its core, denial is thus based on a self-interested rationale of pain avoidance and harm minimization. Depending on the characteristics of the issue at hand, some of the effects are deeply ironic. I demonstrate this by starting from the simplest and most beneficial form of denial, before moving on to cases that are more complex and harmful. I also show how people can be liberated from denial when the practice has become counterproductive. Most of the mystery surrounding denial disappears when we accept that it is premised on a twisted kind of rationality.     

Control, denial, and heightened sensitivity reactions to personal threat: testing the generalizability of the threat orientation approach

The threat orientation model proposes three dispositional responses to threats: control, heightened sensitivity, and denial. Two studies explored the psychometric properties of the previously developed threat orientation scales and the relationship between the orientations and the responses to a variety of threats. Study 1 found that the control-based and heightened sensitivity-based scales are reliable and were related to perceptions of health, financial, and terrorist threats with a nationally representative sample. Findings held across gender, age, and ethnic groups. Furthermore, Study 1 suggested two types of denial processes: optimistic denial and avoidance denial. Study 2 used a diverse sample to gain additional evidence for two processes of denial and developed measures of each type.     

Bearing bad news: Dealing with the mimics of denial

Denial is a common label for certain reactions to bad news. However, true denial is rare, and most cases actually represent a variety of responses with very different causes and needs. Three of these, disbelief, deferral, and dismissal, are characterized according to origins and needs. Failure to differentiate between these seemingly similar behaviors can result in inappropriate counseling, and interfere with attempts to convey information and provide support during a time of crisis.     

Ideology and climate change denial

Examining the relation between ideological variables and climate change denial, we found social dominance orientation (SDO) to outperform right-wing authoritarianism and left–right political orientation in predicting denial (Study 1 and 2). In Study 2, where we experimentally altered the level of denial by a newscast communicating supporting evidence for climate change, we demonstrated that the relation between the ideology variables and denial remains stable across conditions (newscast vs. control). Thus, the results showed that denial can be altered by communicating climate change evidence regardless of peoples’ position on ideology variables, in particular social dominance. We discuss the outcome in terms of core elements of SDO – dominance and system-justification motives – and encourage researchers on climate change denial to focus on these elements.     

The effect of low social support on short-term prognosis in patients following a first myocardial infarction

The objectives of the current study were (1) to assess adjustment in patients following a first myocardial infarction (MI) at 9 months compared with 4-6 weeks post-MI, (2) to examine the availability of and satisfaction with social support over time, and (3) to determine separate baseline psychosocial predictors of recurrent cardiac events. A questionnaire assessing post-traumatic stress disorder, anxiety, depression, health complaints, and social support, was distributed to consecutive patients 4-6 weeks and 9 months post-MI. Prior to assessment at follow-up, 8 (7%) of 112 patients had dropped out, and two had died due to cardiac causes. Objective clinical measures were obtained from medical records. There was an improvement in somatic and cognitive symptoms at follow-up, but no change in symptoms of arousal, depression, and anxiety. Half of the patients were afraid of a recurrent MI. There was a significant decrease in social support between baseline and follow-up, and lower social support at baseline was associated with a 10% increased risk of recurrent cardiac events at follow-up (OR: 0.90; 95% CI: 0.84 to 0.97) adjusting for all other variables. Some patients still experienced difficulties with psychosocial adjustment 9 months post-MI despite a reduction in somatic and cognitive symptoms. Social support decreased over time, which may have serious prognostic implications; lower social support at baseline was an independent predictor of recurrent events at 9 months. An important step for future research will be to investigate how social support can be enhanced in patients at risk.     

Perspective taking combats the denial of intergroup discrimination

Despite the continuing, adverse impact of discrimination on the lives of racial and ethnic minorities, the denial of discrimination is commonplace. Four experiments investigated the efficacy of perspective taking as a strategy for combating discrimination denial. Participants who adopted a Black or Latino target's perspective in an initial context were subsequently more likely to explicitly acknowledge the persistence of intergroup discrimination than were non-perspective takers (Experiments 1–3) or participants who adopted a White target's perspective (Experiment 1). Perspective taking also engendered more positive attitudes toward a social policy designed to redress intergroup inequalities (i.e., affirmative action), and this relationship was mediated by increased recognition of discrimination (Experiments 2a and 2b). Increased identification with the targeted outgroup, as reflected in automatic associations between the self and African Americans, was found to underlie the effect of perspective taking on sensitivity to discrimination (Experiment 3). The collective findings indicate that perspective taking can effectively combat discrimination denial.     

Personality and Dissonance Among Mormon Missionaries

The distinguishing characteristics of dissonant missionaries were identified by examining the responses of 58 current and former Mormon missionaries to a questionnaire about missionary service, a Minnesota Multiphasic Personality Inventory (MMPI) Denial scale, and Millon Clinical Multiaxial Inventory (MCMI) Compulsive and Submissive/Aggressive special scales. The participants, 12 women and 46 men, were mailed the materials after being identified by their friends or acquaintances as current or former missionaries. Women had less satisfying missionary experiences than men and were more likely to report a loss of self-esteem due to missionary service, but were not more dissonant missionaries than men. Missionaries with lower scores on the Denial, Compulsive, and Submissive/Aggressive scales were more likely to question mission policies than subjects with higher scores. Thus, it appears that Denial, Compulsive, and Submissive/Aggressive scale scores can identify potentially dissonant missionaries.     

Gender disparities in common sense models of illness among myocardial infarction victims.

Symptom attributions were contrasted between male and female myocardial infarction victims (N = 157) who were comparable on age, cardiac risk status, medical history, symptom presentation, and other variables. Women were less likely than men to attribute their prehospital symptoms to cardiac causes. In the context of hearing symptom attributions or advice from support persons, women were less likely than men to report receiving a cardiac attribution or advice to seek medical attention. Results have implications for how victim gender influences the lay interpretation of cardiac symptoms.     

An examination of the MMPI-2 Wiener-Harmon Subtle subscales for D and Hy: implications for parent scale and neurotic triad interpretation

This research explores the scale development process for the MMPI-2 Wiener and Harmon (1946) Subtle subscales for Depression (D) and Hysteria (Hy) to provide insight into why certain items were included on these scales and were subsequently but inappropriately assumed to be subtle indicators of the same pathology that the Obvious items measure. In this research, I also explore what the Subtle scales on D and Hy measure and their potential utility for the interpretation of their parent scales and the "neurotic triad." It was hypothesized that the D and Hy Subtle subscales are related to denial, repression, or both and this hypothesis was supported. In a sample of 1,240 inpatient and outpatient psychiatric patients at a large Army medical center, it was found that these subscales had strong positive correlations with othe scales on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom. Graham, Tellegen, & Kaemmer, 1989) related to denial, repression, or both. It was also found that they had strong negative correlations with scales on the MMPI-2 and Millon Clinical Multiaxial Inventory (MCMI-II; Millon, 1987) that are related to symptom endorsement, which can be considered the opposite of denial or repression. In addition, ratings of the Subtle items on D and Hy by clinical psychology residents were consistent with the hypothesis that these items reflect a denial of psychological or physical dysfunction.     

Social dominance orientation and climate change denial: The role of dominance and system justification

Extending previous research, we examined whether the relation between social dominance orientation (SDO) and climate change denial reflects group-based dominance (SDO and nature dominance) or general system justification. Moreover, we examined whether the relation between personality (domineering and empathy) and denial is mediated by group-based dominance variables. The results showed that the group-based dominance variables reduce the effect of system justification on denial to nonsignificant. Also, social dominance and nature dominance explain unique parts of the variance in denial. Moreover, path analyses showed that the relations between empathy and system justification with denial are mediated by both of the group-based dominance variables, while the relation between domineering and denial is mediated only by SDO. Together, these results suggest that denial is driven partly by dominant personality and low empathy, and partly by motivation to justify and promote existing social and human-nature hierarchies. We conclude by suggesting that climate change mitigation efforts could be more successful if framed as being clearly beneficial for everybody and nonthreatening to existing social order.     

Detection of faking on the MMPI-2: differentiation among faking-bad, denial, and claiming extreme virtue

The purpose of this study was (a) to evaluate the ability of the existing validity indices of the Minnesota Multiphasic Personality Inventory (MMPI-2) in detecting faking. bad and faking-good profiles, (b) to differentiate between two strategies for faking-good (denial and claiming extreme virtue), (c) to determine the effectiveness of the new MMPI-2 validity scale, the S scale, in detecting people's tendency to present themselves in a superlative manner, and (d) to explore the response strategy under conditions in which individuals we known to be distorting their responses to the MMPI-2 Participants were 167 undergraduate, college students who were administered the test under different conditions, and 50 hospitalized, psychiatric patients. Mean profile configurations and optimal cutoff scores obtained in this study were similar to those reported in previous studies. Accurate identification of faked profiles was achieved. The new S scale and its subscales, especially S2 (Serenity), S3 (Contentment With Life), and S5 (Denial of Moral Flaws), showed particular promise in detecting faking-good (denial and claiming extreme virtue) profiles, Participant's debriefing provided valuable information about the participants' understanding of the instructions and their deception strategies. The attempts to differentiate between two strategies for faking-good, denial and claiming extreme virtue, were not successful, However, these results should not be taken to indicate that the particular strategies assessed in this study cannot be differentiated. Methodological issues reviewed suggest that further research might yield more understanding of the nature of any deception efforts made by respondents. In addition, future, research is needed to discover if the findings from this study generalize to other clinical settings and populations.     

Denial of responsibility: a new mode of dissonance reduction

Denial of responsibility as a mode of dissonance reduction and the conditions under which it is likely to occur were explored in 3 experiments. Two experiments tested and supported the hypothesis that following a counterattitudinal behavior, participants prefer the mode of reduction made available to them first, regardless of whether it is attitude change, trivialization, or denial of responsibility. The 3rd experiment tested and supported the hypothesis that denial of responsibility reduces the negative affective state induced by dissonance. The mechanism of denial of responsibility in dissonance reduction is discussed.     

Anger and denial as predictors of cardiovascular reactivity in women

The relationship between behavioral and physiological reactivity and cardiovascular disease has been extensively researched in men, indicating that the expression of anger may be a contributory factor in the development of coronary heart disease. Few studies, however, have focused on women. Among these, women generally have been found to be less reactive to laboratory tasks than men. In the present study, 45 women aged 19–21 years were selected to represent three groups—(1) low anger/low denial, (2) high anger/low denial, and (3) low anger/high denial—based on their scores on the State-Trait Anger Expression Inventory and the Marlowe-Crowne Social Desirability Scale. Subjects received three conditions: (1) no feedback, (2) error feedback without observer present, and (3) error feedback with observer present. As hypothesized, women who reported a high level of denial and low anger exhibited elevated stress-related reactivity. The results are suggestive of a subgroup of highly reactive women not previously identified within the literature. The hypothesis that all groups would display greater reactivity in a condition providing error feedback with observation was not supported.This study was supported by a research grant to Carol S. Emerson from the Women's Research Institute of Virginia.     

New dimensions of abnormal illness behaviour derived from the Illness Behaviour Questionnaire

The primary aim was to explore the factor structure of the Illness Behaviour Questionnaire (IBQ) and the generalisability of the derived dimensions to both general community members and four chronic illness groups. A questionnaire was administered to 675 participants, comprising 344 from the community, 80 with asthma, 95 with diabetes, 79 with chronic pain and 77 with chronic fatigue syndrome (CFS). Illness severity was calculated for all chronic illness participants (self-rated health for community members). Three IBQ scales were derived following an exploratory factor analysis for the whole sample: Affirmation of Illness (α = 0.71 (CFS)–0.79 (asthma, diabetes)), Concern for Health (α = 0.71 (asthma)–0.78 (pain)) and General Affective State (α = 0.70 (CFS)–0.80 (asthma)). Patterns of response across the five samples, and intercorrelations among the new scales and the original seven scales, were largely in accord with expectation. Long-standing criticisms of the IBQ were addressed by using systematic statistical principles to identify meaningful and psychometrically sound IBQ dimensions. The derived structure offers a more parsimonious account of possible illness responses, with the availability of a more concise yet informative index of abnormal illness behaviour having practical utility for researchers and clinicians alike.     

Evidence of denial and item-intensity specificity in the state-trait anxiety inventory

The Dutch form of the State-Trait Anxiety Inventory (STAI) was administered to 188 surgical patients the day before their operations and 3 days later. Scores for the state anxiety-present (S-Anx+) items were consistently lower than for the state anxiety-absent (S-Anx-) items; scores on the S-Anx+ items before and after surgery were close to minimum for males. Tentative explanations for these findings and consequences for scoring the STAI State Anxiety scale are indicated. The effects of item-intensity specificity, social desirability, and denial as a mechanism for warding off the distressing emotion of anxiety are discussed.