A number of years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn't be sure it wasn't a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn't get it done for seven days.
Two days into the seven, he called me in a panic over the possibility that the lesion in his liver was cancer, a fact, if true, he understood would change his prognosis from good to dismal. I offered him a prescription for Valium, which he accepted gratefully, and then suggested a strategy to help him manage his anxiety that took him by surprise: denial.
Denial gets a bad rap it doesn't entirely deserve. Refusing to face up to the truth is almost always considered a bad thing: it prevents you from taking appropriate, proactive action to mitigate disaster and manage its consequences. But a complete refusal to acknowledge a painful fact—what I consider to be willful ignorance—represents denial only at its most extreme. In a less severe form, denial can actually be quite adaptive.
What I recommended to my patient wasn't willful ignorance of the possibility the lesion in his liver could be cancer. I recommended a form of denial I call controlled distraction. He needed to cease ruminating over a possibility that he knew might be in store for him. Yes, the liver lesion could have been cancer, but in between the time the biopsy was scheduled and the time it was performed the only kind of waiting available to him was passive waiting. That is, no amount of thinking about his situation would provide him any course of action he could take to affect the outcome. All his thinking did was make him anxious.
He'd already wisely decided to have the biopsy so willful ignorance was clearly not preventing him from taking the action he needed to ensure he had the best chance for a good outcome. So I suggested he work to focus his attention on something else while he waited. By not thinking about the liver lesion, I told him, he'd be able to avoid feeling anxious.
This kind of denial does, in fact, work—if you can actually find a way to stop thinking about what's triggering your anxiety. My patient needed a little help to do this—the Valium—but he still found the suggestions I made about how to focus his attention elsewhere helpful:
After a difficult week, my patient had his biopsy. A day later the pathology came back. It was a benign liver adenoma. He had his lung cancer removed and three years later remains disease free.