Denial can be a normal, natural and even instinctive response to the stresses of life. It’s a way of refusing to deal with an uncomfortable or painful reality, or an aspect of our experience. Denial becomes problematic when its continued use as a way of coping interferes with our ability to deal with serious health or personal problems. Ultimately it can limit the satisfaction we’re able to gain from life or actually harm us in some way.

Sometimes denial can be a way of coping with feelings that seem overwhelming. When diagnosed with a potentially terminal illness, denying the seriousness of the illness can be adaptive if it allows one to maintain hope in a positive outcome and to fully engage in treatment. A MAP client described to me recently how everyone but him had been fully aware of how close he was to death from a serious illness. He had simply shut that possibility out of his mind, and focused on the positive steps he could take to get well. This same kind of denial can be harmful, however, if one decides that medical treatment isn’t actually necessary.

A little bit of denial goes into the decision not to buy health insurance. It’s a bet that you won’t be the one to develop tendonitis, appendicitis or some even more serious “-itis” that could result in a very large medical bill.

There’s a little more denial involved when the evening performance just isn’t up to snuff after the matinee break in the bar, but you tell yourself you were just tired and no one notices anyway.

A lot of denial is involved when the paycheck keeps disappearing to cocaine — but you keep telling yourself that next week is always going to be different.

Sometimes we deny the harmful aspects of a particular behavior so we won’t have to give up the only way we’ve found to deal with distressing feelings or thoughts. For some people drugs or alcohol gradually become a way of getting through the day. What started out as a way to unwind, or feel more relaxed when socializing, has become an all-purpose solution. The thought of giving up the only thing that seems to work can be terrifying. Relying on this one method of coping, however, shuts out the potential for discovering alternatives.

There are many ways in which denial can manifest itself. We may blame other people for the problem, or find excuses and justifications for our behavior. We may rationalize or minimize the risks and dangers of the problem. Denying there’s a problem can seem like a very attractive solution, because then nothing needs to be done, there’s no chance of failure and there’s no need to change.

Over time it can take more and more effort to maintain our denial. We have to hide behaviors from others so they won’t start to ask questions. If other people were more aware of the problem, they might expect us to change, make judgments and even cause us to feel ashamed.

When a serious problem is being denied in a family, children learn from their parents to deny their own feelings and perceptions. Children need to believe that their parents are right and so they come to think that what they’ve seen and heard with their own eyes must be wrong. Children grow up not trusting themselves, and they’re less able to recognize dangerous or unhealthy situations when they arise.

Coming out of denial can be very painful, but it can also be a great relief. All the energy that has gone into blocking reality out can be invested in other parts of life. There is the possibility of beginning to take some control over one’s life, to look at what needs to be done and to deal with the world as it actually is. There is the opportunity of beginning to make the changes necessary for a richer, more satisfying life.

In working with MAP clients who are coming to terms with their histories of drug or alcohol abuse, I’ve had the opportunity to see this painful but ultimately liberating process a number of times. It’s incredibly satisfying to watch as people begin to put the pieces of their life back together and each step of the way experience more and more pride and satisfaction in their achievements.

In taking ownership of the problem you also own the accomplishment of overcoming it. As always, if you’d like to discuss any of the issues raised by this article, please feel free to call the MAP office for a confidential appointment.

Leslie Cardell is a licensed clinical social worker, and the coordinator of the Musicians’ Assistance Program’s services. MAP office hours are Monday, Wednesday and Friday from 9:30 to 5. Call (212) 397-4802 for an appointment.