Response to Open Peer Commentaries on 'In Defense of 'Denial': Difficulty Knowing When Beliefs Are Unrealistic and Whether Unrealistic Beliefs Are Bad'

摘要

In our article, we argued that philosophical and practical challenges regarding "belief" and "accuracy of belief" make it difficult to determine when a patient is in denial, unrealistically optimistic, or self-deceived, as opposed to merely hopeful. Furthermore, we argued that even if we could make these determinations, doing so does not provide an answer about the normative status of denial, because beliefs that are unrealistic are not always as harmful as critics contend. We concluded with a recommendation for a more permissive approach to patients who are perceived to be unrealistically optimistic, in denial, or self-deceived. Unless they significantly misunderstand their situation and thus make decisions that are clearly bad for them, we should not intervene by trying to change their mental states, persuade them to behave differently, or by paternalistically denying them certain options. We received many thoughtful commentaries in response. Here, we respond to key points.