Self Caring

Does Denial Have an Up Side?

Last updated: Jan 18, 2011

Posterised Vector of Ronald Reagan by Iain Forbes

In last week's celebrity Alzheimer's headline, Ron Reagan, Jr., asserted in a new book that his father, President Ronald Reagan, already had Alzheimer's Disease while in office. President Reagan served in office from 1981 to 1989, and was diagnosed with Alzheimer's in 1994.

If he's right -- and there's considerable debate about this, within the Reagan family and beyond --then someone was in denial: Reagan, his aides, his wife Nancy, his doctors, perhaps all of the above.

Denial is classic in early dementia, for many reasons. First, we have a natural human inclination not to believe bad news. Second, Alzheimer's is so huge and awful, there's a tendency to postpone facing it. What's more, early memory loss is hard to reconcile with the end-stage symptoms -"“ same disease, but quite different pictures of everyday life, so it's easy to brush off. Thinking problems are easily mistaken for stress or lack of sleep. Finally, there's the inconvenient truth that Alzheimer's still carries a huge stigma -"“ and who wants to be instantly shunned and pitied, as often happens?

Unfortunately, denial means that treatment and advance planning are delayed.

But I also wonder this: Does denial about memory loss also have a bit of a positive, protective benefit? Refusing to see the signs lets everyone live a few more days in the happy fiction that everything is still as it once was. And it's not entirely fiction. Before severe-stage Alzheimer's, most people do continue to be productive, interesting members of society for awhile, sometimes for years. Stick a disease label on them and they're suddenly perceived as little more than the label, rather than who they really are and what they can still contribute.

The hallmark definition of dementia is cognitive impairment that's bad enough to interfere with daily life, not something reported at the time in Reagan's behavior. Nor did any of his many doctors record dementia symptoms. Of course, dementia may be preceded by what some researchers now call mild cognitive impairment or, sometimes, "pre-dementia."

Reagan, Jr., says his dad would have resigned had the Alzheimer's diagnosis been made while he was in office. What about a diagnosis of mild cognitive impairment? What about a strong genetic inclination?

Where exactly is the point at which denial should end and the long goodbye begin?