Denial and Objectivity in Hemodialysis Patients

Abstract

Patients with end-stage renal disease are treated with hemodialysis to extend their lives and maintain their physical status so they may function as effective and productive family and community members. Patients generally attempt to adjust to their illness and treatment as though they were in an improving state and often as though they were hardly ill at all. One of the mechanisms of defense they use is denial which makes it appear as though they see themselves as being only marginally ill and marginally handicapped while also appearing to negate the fact they have a serious and usually irreversible disease. The use of denial has been widely documented^1–5 and has been accepted as an almost universal defense in dialysis patients. This study revealed evidence which indicated that patients in addition to denial make equal use of the adaptive process of objectivity facing reality in an undistorted manner. By believing and yet denying they have a serious illness, dialysis patients use two diametrically opposite adjustment mechanisms. Furthermore, this study revealed one other significant phenomenon, specifically, that patients shift back and forth from denial to objectivity in a rapid and never-ending fashion. It is believed that this balanced shifting between these two divergent strategies is essential for harnessing the adaptive strengths of both defenses for use in surviving the prolonged ordeal of life on dialysis.