Denial, And Wishful Thinking

The death of actress Carrie Fisher, in December, got me thinking again about the concepts of denial and wishful thinking as they apply to addiction. In her 2006 one-woman show, called “Wishful Drinking,” she spoke about her history of addiction and her bipolar disorder.  “Wishful Drinking” referred to the way alcoholics can, over and over, erroneously believe they can control their drinking.

Her death reminded me of her show, which I found powerful but very disturbing. And I’ve been thinking about the dueling concepts of denial and wishful thinking as they are used to characterize active addicts. I’ve been troubled for many years by the central position occupied by “denial” in the psychological understanding of addiction. Borrowed from psychoanalytic thinking, it’s considered a “primitive” or “pathological” defense, a refusal to acknowledge reality.  I think of it as a protective mechanism that, for example, allows one to buy time to absorb the unexpected news of a significant loss. The person will often exclaim, “Oh no! You must be mistaken” but over time gradually accepts the bad news as true.

Being “in denial” is commonly applied to a person who appears unaware of a substance use or gambling problem that seems obvious to most other people in his or her environment. Although there’s a superficial resemblance to the response of a person overwhelmed by sudden bad news, I believe the lack of insight in the thinking of the addict is quite different.  

“Wishful thinking” strikes me as a preferable way to describe what is interfering with my patients’ attempts to recover from their addictions. The result is indeed a distortion of thinking, a misperception of reality, but not one that can be resolved by a clinical interpretation of unconscious material.  Fisher’s phrase, “wishful drinking,” suggests that substances can be used to entirely avoid thinking or feeling.

One way in which wishful thinking can be altered is when a person first attends a meeting of Alcoholics Anonymous and hears a speaker describe experiences that are almost identical to those of the newcomer (“He’s telling my story!”).  Until this moment, the addict believes his or her experiences are unique. This revelation occurs in a non-confrontational setting, which I believe is conducive to changing how a person regards his or her own substance use.

Similarly, adversarial style confrontation in clinical settings has given way to gentler, more collaborative approaches such as motivational interviewing. While those who ignore reality do so at their peril, my patients who are willing to endure the pain of difficult truths find that their distress is time limited and they become able to reap the benefits of recovery.