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The defence mechanism of denial is directed against external reality. With this in mind it follows that perception must play an important rôle in this defence mechanism. The undeveloped perceptual apparatus in childhood facilitates denial, since what is inaccurately perceived is more easily moulded in accordance with the predominant wishes. If the capacity for denial weakens as the perceptual apparatus develops, then, conversely anything which interferes with perception facilitates denial. Clinical illustrations are presented to support this hypothesis. Patients who develop defects of perception and memory do not all indulge in denial to the same extent. The readiness to employ denial depends upon certain features in the character structure of the patient. Striking disturbances of brain function may occur without the patient developing any of the characteristics of denial of illness. Many patients utilize denial freely in chronic elated states without there being any organic impairment of perception or memory. However some observations reported on four patients with a marked tendency to employ denial suggest that in such elated states there is a disturbance of perception. This tendency is termed 'inexact perception'. A need for denial arises in those cases where there is this disturbance of perception. In such cases with an intect perceptual apparatus the 'inexact perception' originates in the wish to avoid the anatomical reality of the female genitalia. It then spreads to a generalized tendency towards making inexact observations. In patients suffering from organic brain diseases a caricatured exaggeration of 'inexact perception' can be observed, namely a functional disturbance of perception based on the patient's need for denial.
Denial and repression may be closely related. An example is given which shows that although repression was the final defence the preliminary denial of an external reality made a more effective repression possible. The assoc