The Other Side of Change: Who We Become When Life Makes Other Plans

Denial can take different forms. If a person is experiencing first-order denial, they will deny the basic facts of their situation, like the diagnosis they've received or the death of a loved one. If, like Olivia, they're experiencing second-order denial, they will accept the basic facts of their situation but deny the implications of those facts. They might minimize the seriousness of what is happening or project an overly optimistic view of the path ahead. They might also engage in avoidance and steer clear of anything that contradicts their narrative, as Olivia did when she shut out recovery stories that weren't like Kate's. You can think of denial as a kind of psychological immune response: the moment our minds detect a threat to our internal state, protective measures are deployed. 

Olivia's denial was a response to a threat to her self-identity. In the months following her stroke, she held on to the belief that she would quickly recapture her old self, not just because she was in pain and wanted it to end, or because she wanted to walk, talk, and eat on her own, spend time with her friends and hug her boyfriend, and do the activities she loved—though, of course, all of this was true. On a deeper level, she experienced denial because her stroke had destroyed the version of her who was just starting to feel like she belonged. For any of us, our attachment to a specific identity can stand in the way of accepting our new reality. If you anchor your worth to your reputation as a parent, you might initially dismiss reports that your child is having behavioral problems in school. If you pride yourself on excelling at work, you might refuse to accept a poor performance review. If you've long valued your steadiness during stressful times, you might struggle to accept the onset of an anxiety disorder. 

A threat to our sense of self is of course only one potential cause of denial. Denial can also stem from a fear that you, or those you love, lack the skills or resources to handle the consequences of a change. For example, a parent who receives a scary medical diagnosis might fool themselves into believing they're not actually sick so that they can avoid burdening their young children with the news. Denial can also emerge if your change carries a social stigma and you're afraid of how others might now treat you. As another example, when you're responsible for causing the change—perhaps your excess spending has led you into debt—you might engage in denial because it's easier to ignore your situation than to acknowledge the decisions you've made. 

In certain contexts, denial can be beneficial. It can offer us a powerful feeling of control, motivation, and hope. "There is a grace in denial," write the grief researchers Elisabeth Kubler-Ross and David Kessler. "It is nature's way of letting in only as much as we can handle." One study explored the recovery trajectories of patients who had been hospitalized for heart problems. Those with high levels of denial had better short-term outcomes than those with low levels; high-denial patients spent less time in intensive care and had fewer heart-related symptoms during their hospital stays. For Olivia, her belief that her recovery would mirror Kate's not only boosted her optimism but provided a jolt of motivation to push her through a grueling physical-rehabilitation regimen. 

But denial has its downsides. The same study on patients with heart problems showed that those with high levels of denial had worse outcomes in the year after their discharge from the hospital: compared with low-denial patients, they were less consistent in following their medical recommendations and ended up requiring more rehospitalization. For Olivia, the downside of her specific denial was that it set her up for potential devastation in the likely event that she never recovered as fully as Kate had. 

As Olivia lay in her hospital bed, she decided that if she really wanted to get back to who she'd been at a rate that was acceptable, she would need a change of scenery. Her days had fallen into a rhythm, with her friends visiting her between their classes in the afternoon and Shawn occasionally spending the night on a pullout cot. She appreciated their support but also felt stuck. As she saw it, she was wasting her mental energy feeling anxious about her appearance and trying to make her interactions less awkward, when what she really needed to focus on was learning to walk again. 

And so, when her family told her about an opportunity for treatment at one of the top rehab centers in the country—Spaulding Rehabilitation Hospital in Boston, more than five hundred miles away from her family's home in Virginia—Olivia didn't hesitate. Because she wouldn't have the ability to press an emergency call button or yell out if an issue arose, she would require round-the-clock care at Spaulding. Fortunately, her aunt and uncle already lived in Boston, and her grandfather offered to move there to spend his days with her. Olivia was thrilled. The change would spare her friends, and especially Shawn, the messiness of it all—her expressionless face, her physical pain, her hyena shrieks. She would work hard, away from their gaze, and when they came to visit she would be ready. I will be back to my old self, she thought.