The Danger of Denial

Anger, anxiety, and depression can hasten the progress of heart
disease, as scientists have known for some time. The problem, according
to one study, is that people with heart problems often deny that they're
feeling bad—with serious consequences for their health.

Mark Ketterer, Ph.D., of Henry Ford Health Systems in Michigan,
asked 144 men who had undergone heart surgery to report how often they
experienced negative emotions; the impressions of each man's wife or
close friend were also collected. The results, published in the Journal
of Psychosomatic Research, suggested that 40 percent of the men were
underreporting the distress they felt. Such denial, the researchers
found, was the most powerful predictor of heart attacks, surgery, and
death—stronger even than familiar risk factors like smoking, alcohol
use, and obesity.

Though men who use denial as a coping strategy may not even admit
to themselves that they're troubled, signs of distress are often obvious
to wives and friends—and their perceptions match up well with those of
expert interviewers. "Clearly, the results argue that you can't rely only
on the patient," says Ketterer, who would like to see all treatment for
heart disease include input from significant others. Once people at high
risk for denial are identified, they can be helped with stress management
therapy. Although some of Ketter's patients continue to deny that they
need help, about three-quarters comply. "They may never 'fess up' to the
snit fits they throw at home," he says, "but they do listen attentively,
read the material we give them, and make some adjustments."