Le déni comme angle d'approche psychosomatique en cardiologie et en oncologie

For patients suffering from organic disorders, denial is one of the available coping styles to face the stress of the disease. In case of coronary disease or of cancer, denial diminishes the risk of anxiety disorders and of depression, at least at short term. On condition that it does not prevent fast access to care, it also seems to be beneficial for the short term somatic evolution of the coronary patients. However, at long term, the coronary patients who deny are less compliant to medical recommendations, and their somatic prognosis worsens. Denial may also damage the compliance of cancer patients, and for instance extend the delay in medical presentation for care. Most of research works in psycho-oncology have failed to confirm results of studies pleading for a favourable effect of denial on the somatic evolution of cancer patients. The effects of the stress on the cardiovascular system are well known, and its deleterious somatic impact in case of coronary disease is well established. These scientific data are in agreement with the fact that coping mechanisms as denial, which allows the subject to avoid the confrontation with the stress, may protect him against somatic complications of the latter, at least at short term. On the contrary, there is no consensus about a possible favouring role of the stress on the cancer progression. So, the contradictory results concerning the effects of denial on the cancer evolution are in accordance with the current knowledge about the impact of the stress: just as we can not clearly support this one, we must be very careful when hypothesizing that some coping styles can be beneficial for the somatic outcome of the cancer patients. So, the coronary psychosomatic model, which among others attempts to explain the harmful effects of the stress and the protecting effects of denial, cannot be applied in oncology as it is. A psychosomatic model which is relevant in a particular field of the health can not be blindly transposed in other fields, and we must display a critical thinking to denounce the abusive generalizations sometimes at stake in psychosomatic medicine. (c) 2005 Publie par Elsevier SAS.