Dr. John Leach is one of the world’s leading experts on survival psychology. He likes to tell a story about London’s tragic King’s Cross underground station fire in 1987.(1) As the fire spread, trains kept on arriving in the station, and hurried commuters headed right into the disaster. Officials unwittingly directed passengers onto escalators that carried them straight into the flames. Many commuters followed their routines despite the smoke and fire, almost oblivious to the crush of people trying to escape – some actually in flames! Thirty-one people perished in the King’s Cross fire, and incredibly, the Underground staff never sprayed a single fire extinguisher or spilled a drop of water on the fire.
Dr. Leach, who teaches at Lancaster University, has a name for this phenomenon. It’s called the incredulity response. He explains that people simply don’t believe what they’re seeing. So they go about their business, engaging in what’s known as normalcy bias which is incredibly powerful and sometimes even hazardous. People can act as if everything is okay, and they underestimate the seriousness of danger. Some experts call this analysis paralysis.
What he’s describing is precisely how I felt while undergoing two weeks of increasingly debilitating cardiac symptoms before being finally hospitalized. Although all signs clearly pointed to a heart attack – crushing chest pain, nausea, sweating and pain radiating down my left arm – I seemed fatalistically determined to go about my life acting as if everything was fine, just fine until – when symptoms became truly unbearable – I finally returned to the Emergency Department that had sent me home two weeks earlier with an acid reflux misdiagnosis.
Dr. Leach explains how my treatment-seeking delay came about:
“During a crisis, most of us will quite simply be stunned and bewildered. We’ll find that our reasoning is significantly impaired and that thinking is difficult. We’ll behave in a reflexive, almost automatic or mechanical manner. We’ll feel sick, lethargic, numb. Our hearts may race.
“And we’ll experience perceptual narrowing or tunnel vision. We’ll barely hear people around us. The brain has limited storage, so when we face sudden threats, it pushes other things out in order to process them. If we’re anxious or worried, our decision-making skills temporarily disappear.’”
Apparently, I am not alone in being too “stunned and bewildered” to comprehend what’s actually happening in mid-heart attack.
Denial that something bad is happening to us is almost universal, even among individuals with excellent training, according to Laurence Gonzales, writing in National Geographic’s How To Survive (Almost) Anything: 14 Survival Skills. He writes:
“It is in our nature to believe that the weather will improve, that we’ll find our way again, that the fire alarm doesn’t really mean ‘fire!’, or that night won’t fall on schedule.”
He cites this story from a retired Los Angeles police officer named David Klinger, from his book called Into the Kill Zone. One night, while moonlighting as a bank guard, Klinger saw three masked figures with assault rifles run through the foyer of the bank.
His first reactions:
- 1. the local SWAT team is practising
- 2. they are dressed up for Halloween
Klinger later said, “It was just disbelief!” (Mind you, he did recover from his denial in time to shoot at the crooks).
Denial plays a large role in many wilderness accidents, Gonzales adds. A lost hiker in denial will continue walking even after losing the trail, assuming he’ll regain it eventually. He’ll press on – and become increasingly lost – even as doubt slowly creeps in. Gonzales offers this advice:
“Learn to recognize your tendency to see things not as they are, but how you wish them to be – and you’ll be better able to avoid such crises.”
For those whose physical symptoms indicate they might be having a heart attack, denial can be a fatal condition.
The five most dangerous words associated with chest pain are: “Maybe it will go away!”
We know that, particularly for women, treatment-seeking delay can result in demonstrably deadly outcomes. If you believe that there is even the slightest chance your symptoms mean a cardiac event is imminent, call 911 and take one full-strength aspirin immediately. See also: Downplaying Symptoms: Just Pretend It’s NOT a Heart Attack
According to the Alberta Health Services, denial after a heart attack has happened is a common defense mechanism used to reduce anxiety by reducing the threat. It is normal, necessary and healthy. But when it’s prolonged, it becomes a problem.
Early on, you may be in denial while still in the hospital recovering from a cardiac event if you say things like:
- “Well, doctors do make mistakes.”
- “It’s not possible.”
- “This couldn’t be happening to me.”
Here are some other behaviours that suggest denial after your discharge from hospital:
- You start to smoke again.
- You stop taking your cardiac medications.
- You over-exercise to prove something to yourself.
- You maintain the same pace of activity as pre-heart attack.
- You continue to indulge yourself in a diet that is not heart-healthy.
- You become over-involved in other people’s problems to avoid your own.
This denial is not at all surprising. Heart patients are booted out of hospital surprisingly quickly post-op with little or no discharge planning, scheduled home nursing follow up, mental health counselling, or medical support other than the ‘make an appointment with your doctor in three weeks” advice.
A report in the Archives of Internal Medicine showed that hospital length of stay after a heart attack plummeted from an average of 12 days in the mid-1980s to less than half by the year 2000.
I have observed nurses and doctors who treat cardiac patients as if they’ve just had an appendectomy or other acute care procedure that has now “fixed” the problem forever.
Everything went fine. You’re fine. Now go home and have a nice life. We need to free up your bed for the next patient.
So what can you do if you’re a patient in denial?
- Research! Research! Research! Find out as much as you can from credible sources about your diagnosis. Mayo Clinic is a great place to start.
- Listen to all medical advice. Really listen.
- Listen to your body (pay attention to any distressing signs and symptoms).
- EVEN THOUGH THE MEDICAL STAFF WILL REPEAT THE FACTS TO YOU, IT IS UP TO YOU TO BELIEVE THEM!
Dr. Leach reminds us that some people prefer not to think about unpleasant possibilities in case we somehow make them happen.
For example, do you check under your seat for a life jacket when you board a flight? Or does part of you worry that thinking about something going wrong with the aircraft could tempt fate by somehow jinxing the flight?
“You don’t need to speculate about everything that could go wrong at any time. But it does help to pay attention!”
He claims that we all experience brain freeze to some degree when we encounter a serious threat. What’s important is the speed at which we recover from it.
And here’s an oddly practical coping tip: after a severe shock, someone may offer to make you a cup of tea. It’s actually far better to make it yourself, advises Dr. Leach. Going through the motions actually prompts your brain to function to co-ordinate movements. Once one area of the brain gets going, it helps to kickstart the others, helping you to shake off this incredulity response.
And what if there’s no time to make tea? Dr. Leach suggests:
“Running through the alphabet in your head should help!”
- Can denial ever be a good thing for heart patients?
- Knowing & Going: act fast when heart attack symptoms hit
- Downplaying symptoms: just pretend it’s NOT a heart attack
- The myth of the “Hollywood Heart Attack” for women
- Am I having a heart attack?
- Why hearing the diagnosis hurts worse than the heart attack
- How we adapt after a heart attack may depend on what we believe this diagnosis means
- Which one’s right? Eight ways that patients and families can view heart disease
- Six personality coping patterns that influence how you handle heart disease
- Surviving the crisis: the first stage of heart attack recovery
- The new country called heart disease
(1). Read this Newsweek report on Dr. Leach and crisis survival.
NOTE FROM CAROLYN: I wrote much more about denial in heart patients in my book for Johns Hopkins University Press (“A Woman’s Guide to Living With Heart Disease“).