In her classic of 1969, On Death and Dying, the psychiatrist Elisabeth Kübler-Ross introduced a model of bereavement that is commonly referred to as the Five Stages of Grief. This model describes, in five discrete stages, a process by which people react to grief and tragedy, especially terminal illness or catastrophic loss. The five stages are denial, anger, bargaining, depression (or grieving), and acceptance.

People might move back and forth between the stages, often several times and at great speed, or they might get stuck in one of the earlier stages, failing to come to terms with their loss or fate. The model has been criticized on a number of grounds, but Kübler-Ross did emphasize that not all five stages need occur, or occur in the given order, and that reactions to illness, death, and loss are as diverse as the people experiencing them.

Sigmund Freud first formulated the concept of denial. His daughter Anna thought of it as an immature ego defence, first, because it is especially used in childhood and adolescence and, second, because its continued use into adulthood leads to unhealthy and unhelpful behaviours and a complete failure to engage or come to terms with reality.

It is often difficult to verify the existence of an ego defence, but a person’s denial in the face of hard evidence to the contrary can easily be spotted by almost anyone else.

Problems arise in the absence of hard evidence, not only because the denial can no longer be spotted, but also because it can be imagined or invented by others. Indeed, the charge of denial can be levied at anything and everything that a person can say or do that runs contrary to some pet theory about her, such that the pet theory can only ever be supported but never refuted.

For example, if a patient undergoing psychoanalysis is regarded by her analyst as being in denial about her sexual orientation, then both disagreeing with the analyst and having a string of heterosexual relationships can be taken to confirm her supposed homosexuality: “You’re only saying this because you’re in denial … You only did that because you’re in denial.” As a result, the patient cannot possibly prove her heterosexuality to the analyst and might even come to believe that the analyst is correct.

An ego defence closely related to denial is negative hallucination, which is the unconscious failure to perceive uncomfortable sensory stimuli, for instance, the failure to see something that should clearly be seen, hear something that should clearly be heard, or feel something—such as crushing chest pain—that should clearly be felt. Thus, a common experience in conversation or in a social setting is for a person to ‘edit out’ a challenging or contradictory remark. The person momentarily goes blank, and then carries on as though nothing significant had been said.