In this form, every person connected with the dying person realizes that he/she is dying, but the person does not realize it. Many people think this is the best way to help a terminally ill person - do not convey the extent of his/her condition so that he/she can maintain hope. However, this information probably cannot be suppressed for very long - bodily changes associated with the illness with changes in others’ behaviors and actions and in the person’s physical appearance soon make it obvious that something is happening. A perturbation of closed awareness can also exist when the dying person and certain involved individuals know what is happening, and others do not. An example is when a person knows he/she has a terminal disease and, with other family members, does not divulge it to another family member. This happens often with a dying parent trying to keep his/her condition from a child. However, usually, the child can observe that something is wrong.
If no one tells the dying person about his/her condition, but he/she begins to suspect something is seriously wrong, the result can be that trust is undermined and future communications are complicated.
This level of awareness is like performing a difficult dance. Everyone involved, including the dying person, knows the person’s condition, but no one will talk about it. It is another example of the “elephant in the room” - everyone knows it’s there, but no one will say anything about it. This “dancing around” the situation is fragile - one slip causes the whole scheme to fall apart and everything is out in the open.
In this context, everyone knows the full extent of the dying person’s condition and it is openly discussed. This does not mean that death is talked about constantly, rather, it is not a subject to be shunned.