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Since denial is a defense against external stimuli, perception and preconscious memory must play important roles in this mechanism. Sensory stimuli have a twofold function: they alert the ego, raising the level of consciousness or awareness of stimuli in general; and they serve the specific function of orienting
the ego with respect to reality. The author cites clinical evidence for the appearance of denial when perception and external stimuli are diminished or absent. Preconscious memory is important, for it liberates the individual from the need of a continuous stream of orienting data from without.
The employment of denial as a defense is associated with special features in the character structure of the patient. Interferences with perception and preconscious memory may facilitate denial, but do so primarily when a tendency to denial already exists. When this tendency is strong, one may encounter in patients what the author terms 'inexact perception'. He states, 'Just as disturbances of perception facilitate denial, so does a need for denial result in disturbances of perception'. The tendency to denial is the product of a central wish; if this central wish can be achieved, numerous secondary wish fulfilments may occur as products of the associated generalized tendency to denial.
The relationship of denial to repression, regression, and other defense mechanisms is considered with reference to impairment or restoration of hearing or sight. In Lewin's 'neurotic hypomanic personality' idealization of the parent—denial of his actual shortcomings—is facilitated by the parent's death or absence. Orality is also related to denial; food or pharmacological agents may induce a state of clouded consciousness in which perception and memory are impaired and denial facilitated.