一位剛被診斷出癌症末期的病人對護理師說：「我知道檢驗報告一定是錯的，我感覺很好，這輩子沒這麼健康過。」該病人正在使用哪種防衛機轉？
A client newly diagnosed with terminal cancer tells the nurse, 'I know the lab results are wrong. I feel fine and I've never been healthier.' Which defense mechanism is the client utilizing?
- AProjection投射
- BRationalization合理化
- CDenial否認正確答案
- DDisplacement轉移
- C否認
此案例展現了典型的「否認（Denial）」防衛機轉。否認是一種心理策略，個人透過拒絕承認痛苦的現實或事實，來保護自我免受過度焦慮的威脅。在面對末期疾病的早期階段，這也是庫伯羅絲（Kübler-Ross）悲傷五階段的第一階段。病人雖然客觀上收到了檢驗報告，但心理上無法負荷如此巨大的打擊，因此直接否定事實。護理師此時的重點不應是強迫病人接受事實，而是提供支持性的環境，等待病人準備好後再進一步討論。其他選項：轉移作用（Displacement）是把情緒發洩到較安全的替代對象身上；投射（Projection）是將自己的負面念頭歸咎於他人；合理化（Rationalization）則是為行為找藉口。
- A投射
投射是將自己內心無法接受的情緒或衝動說成是別人的（例如：明明是自己討厭某人，卻說成是某人討厭自己）。
- B合理化
合理化是為失敗或無法接受的情況尋找冠冕堂皇的藉口（例如：沒考好是因為題目出太爛），而不是直接否定事實的存在。
- C · 正確答案否認
否認是拒絕承認現實，將痛苦的真相排除在意識之外，是面對重大打擊（如癌症）時最常見的初步心理反應。
- D轉移
轉移（Displacement）是指將不滿或憤怒對準一個較不具威脅性的目標（例如：病人對醫師生氣卻對護理師發火），與否定事實無關。
美國醫護溝通強調『誠實告知（Full disclosure）』，並尊重病人的心理進程；台灣臨床上，家屬常要求醫護人員對病人隱瞞末期診斷，這使得護理師在處理病人的否認機轉時，面臨更複雜的倫理困境。
English explanation
This case illustrates the classic defense mechanism of denial. Denial is a psychological strategy in which an individual refuses to acknowledge a painful reality or fact in order to protect the self from overwhelming anxiety. In the early stages of facing a terminal illness, this is also the first stage of Kübler-Ross's five stages of grief. Even though the patient has objectively received the laboratory results, the psychological impact is too great to bear, and they therefore directly deny the facts. The nurse's focus at this stage should not be to force the patient to accept reality but to provide a supportive environment and wait until the patient is ready for further discussion. Other options include displacement, which involves shifting feelings from a threatening target to a less threatening one; projection, attributing one's own unacceptable thoughts to others; and rationalization, providing logical-sounding excuses for one's behavior.
最近修訂：2026-05-17