Self-Deception in Terminal Patients: Belief System at Stake

Abstract

A substantial minority of patients with terminal illness hold unrealistically hopeful beliefs about the severity of their disease or the nature of its treatment, considering therapy as curative rather than palliative. We propose that this attitude may be understood as self-deception, following the current psychological theories about this topic. In this article we suggest that the reason these patients deceive themselves is to preserve their belief systems. According to some philosophical accounts, the human belief system (HBS) is constituted as a web with a few stable central nodes – deep-seated beliefs – intimately related with the self. We hypothesize that the mind may possess defensive mechanisms, mostly non-conscious, that reject certain sensory inputs (e.g., a fatal diagnosis) that may undermine deep-seated beliefs. This interpretation is in line with the theory of cognitive dissonance. Following this reasoning, we also propose that HBS-related self-deception would entail a lower cognitive load than that associated with confronting the truth: whereas the latter would engage a myriad of high cognitive functions to re-configure crucial aspects of the self, including the setting of plans, goals, or even a behavioral output, the former would be mostly non-conscious. Overall, we believe that our research supports the hypothesis that in cases of terminal illness, (self-)deceiving requires less effort than accepting the truth.

“I Just Feel Like I Always Did”: Inotropic Dependency at End of Life

“…The ability to deny the terminality of one's condition is protective in nature and is rooted in deeply held belief systems. 16 Although the inevitability of death is a matter of fact for physicians, not surprisingly, it can be difficult for patients to accept this reality. Existing literature on prognostic discordance between oncologists and patients with cancer suggests patients' opinions of survival are usually more optimistic than their physicians'.…”

What Does Emotion Teach Us About Self-Deception? Affective Neuroscience in Support of Non-Intentionalism

“…are typically matters that most would not appraise as being under their full control. Likewise, the populations especially prone to self-deception (e.g., addicts, terminal patients) concern conditions over which control is critically missing or believed to be absent (Martínez-González et al, 2016;Echarte et al, 2016). Finally, empirical studies suggest that people are less inclined to gather more information about a given disease when they consider the disease untreatable (Dawson et al, 2006); the best predictor of information gathering is the treatability (and not the severity) of the disease, as predicted by the third condition.…”

Candid to the Bitter End: Indiscriminate Disclosures

“…At the same time, however, he had some hope, and even if self-deception was involved, it served a purpose and had a positive role, helping to maintain a fragile balance essential to the quality of his remaining lifespan. 1 The price of instantaneously extinguishing hope by following protocol without heeding the patient's feelings may be heavy, although the evidence is mostly anecdotal. 2 Here we had an unusually striking example of a mind-body response that seems intimately and pathophysiologically linked-an emotionally triggered hypertensive emergency and a devastating cerebrovascular accident.…”

“…Thus, physicians should be cognizant of the fact that too much information of ominous or uncertain prognostic significance may be a double-edged sword for quite a few patients. Rather than unwavering "total" disclosure, probing patients' preferences first 1,6 will allow for true patientcentered sensitive disclosures of diagnostic and prognostic information. More information may translate into lesserquality care for some patients.…”