In conversations with the terminally ill, it is always noticeable how much these patients hold on to images, wishes, and future perspectives that embody something unreal, utopian, and illusionary for outsiders. It seems like an illusionary misjudgment of reality. This adherence to apparent illusions has a high significance for patients, and an external assessment, from the point of view of an alleged certain reality and so-called common sense, does not do justice to this phenomenon. Whether denial of the incurability of a disease is useful or harmful to the patient is a controversial issue. From a psychoanalytical point of view, the fantasies of inviolability and immortality are regarded as necessities of life. The physician should recognize denial as a protective illusion and avoid forced confrontation with reality. Patients often oscillate between the illusion of immortality and acceptance of the reality of cancer leading to death. The doctor should make the patient feel supported by an empathic relationship to him/her, so he/she is able to at some point let go and find peace.
KeywordsDying Palliative medicine Denial Misjudgment of reality Feelings related to dying Empathic conversation
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