Déni, négation et dénégation : aspects psychopathologiques et cas cliniques

Abstract

The word “denial” has several meanings; in psychoanalytically inspired psychopathology, it signifies a refusal to recognize sensory evidence, and it has a defensive function. Denial makes the perception of certain realities disappear from mental and unconscious life, whereas repression, while performing a similar task, integrates the intolerable reality into the unconscious. The term “negation” points to the negating of a psychic reality; it is the refusal to recognize a thought, a desire, or a feeling that is a source of intrapsychic conflict as one's own. Psychotic denial is multifactorial; it includes the existence of psychic troubles, but also the medico-legal behaviors that result from these. Neurotic denial is partial; it plays the role of a defense mechanism in that, it rejects the reality of a perception perceived as dangerous or painful for the ego. Perverse denial is characterized by the coexistence – within the same personality – of two contradictory judgments, unrelated to external reality. In order to maintain emotional stability in the face of anxieties concerning his physical or psychological soundness, the subject resorts to banalization and minimization. These mechanisms are not limited to the unconscious. The denial of an act and/or its consequences characterizes psychopathic denial; this also includes law and authority. Anosognosia is not a defense mechanism, but rather a pathological symptom, demonstrating a neuropsychological deficit or a cerebral dysfunction. “Insight” is an Anglo-Saxon term related to denial, anosognosia, and introspection, depending on the context. Two clinical examples illustrate different types of denial in different psychiatric pathologies.