Two patients each seem, on the surface, to be refusing to accept that something is badly wrong. One has had a stroke and insists their paralysed arm works fine; the other has just been told they have a serious illness and keeps making long-term plans as if nothing has changed. Before revealing the answer, decide: what single question would you ask to tell these two apart at the bedside, and why?

The fastest discriminator is whether there is a neurological event that could account for the unawareness. Anosognosia follows demonstrable brain injury (classically a right parietal stroke) and the person is often strikingly unable to register even direct, repeated evidence of the deficit. Denial, as a defence mechanism, occurs in people with no brain pathology at all, concerns the emotional weight of a threatening reality rather than a physical sign, and usually leaves the person capable of registering the facts on some level even while behaving as though they haven't. Note that this activity deliberately points at the defences/denial entry rather than the emotion-domain phenomenon also named "denial" — the same word names two distinct catalogued entries in this app, and this pairing is a live test of that.