Monday, March 17, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 5

In my last post [click here for the first of the series], I discussed the personalities, coping strategies, and health-related needs of the third type of individual, the "Inactives." I now conclude this series by examining the fourth and most resistant group: the "Ignorers/Deniers."

Simply put, Ignorers/Deniers just don't focus on their health. This is for a variety of reasons, which I'll be discussing. First, these people "close their eyes and ears" to information about healthy living. They refuse to acknowledge or accept they have health problems or risk factors, or they refuse to do anything about it. These maladaptive behaviors are a consequence of a mindset they adopt, which includes thoughts such as:
  • "I do not accept there's a problem with my health" – despite convincing evidence.
  • "I fine the way I am … It doesn't matter what others say" – even though their health is deteriorating, relationships are crumbling, and overall quality of life is suffering.
  • "I'm different … I'm special … I'm not like those other people … Nothing's going to happen to me!" – a false sense of security and invincibility.
  • "I don't trust doctors" – an attitude based on gross overgeneralization.
  • "Getting help is a sign of weakness ... A strong person handles one's own problems" – an irrational belief driven by pride and based on a distorted measure of self-worth.
Ignorers/Deniers, therefore, differ from the other personality types in essential ways; for example:
  • The three other types of individuals think about their health, and when confronted with a health problem, many question whether they can make good decisions and help improve things, which may make them anxious due to self-doubt. Nevertheless, despite their anxiety and doubt, they are willing to learn and act wisely. Many Ignorers/Deniers, on the other hand, are so terrified by the notion they may have (or get) a severe illness that they avoid thinking about their physical and emotional health—preferring, instead, to pretend everything is all right. As a result, Ignorers/Deniers may refuse to accept the reality of their situation, even when confronted with the threat that they will probably die from their health problems; to them, the thought of being or being ill is too great to consider. Although this self-deception may keep their fear in check for a while, their inaction and ignorance make them vulnerable to worsening health and personal problems.
  • If Ignorers/Deniers did think about their health, many would feel hopeless and helpless, believing they cannot deal with serious illnesses or personal problems. And those who portray an air of invincibility are likely covering up great self-doubt and fear, or they may be delusional.
  • While other types of individuals may have valid concerns about finding a competent healthcare practitioner, some Ignorers/Deniers are so distrustful of the healthcare profession that they won't even consider seeing a doctor, even if they are in pain or distress, often until it's too late.
  • While health problems may cause other types of people to become sad or even depressed, for a time, they can get themselves motivated and begin to take constructive action because they want to live and be happy. Ignorers/Deniers, on the other hand, may be so lonely and depressed that they believe they have nothing for which to live. For them, living longer in chronic emotional pain isn't motivating. And when confronted with the knowledge that their health risks can kill them, many Ignorers/Deniers deny the facts because the idea of dying is also too emotionally painful for them to acknowledge; the threat of death, therefore, isn't a motivator. In fact, the odds are great that such a person will fail to make substantial lifestyle changes, even if facing probable death. This prevents them from having the drive and focus needed for constructive action.
  • While other individuals are willing to get help when needed, Ignorers/Deniers may have been so influenced by their cultures that they believe seeking assistance for personal problems is a sign of weakness.
  • Unlike the other personality types, Ignorers/Deniers may have physical addictions or powerful psychological compulsions that prevent them from focusing on healthy living until they reach "rock bottom," which, unfortunately, may be too late.
What this means is that Ignorers/Deniers rely on some of the same "avoidance" coping strategies as the Wannabes and Inactives; that is, they may:
  • Try to feel better by doing enjoyable or interesting things rather than gaining knowledge and developing a plan of action
  • Act as if nothing has happened or trying not to think about their problems
  • Resign themselves that nothing can be done to improve the situation, even though they lack adequate understanding and fail to exert sufficient effort.
As I discussed in my previous posts, these coping strategies are maladaptive in the long term since the inertia (inaction) they promote allows their health risks to emerging as serious problems and their existing health problems to worsen.

Because these thoughts, feelings, and reactions are so deeply ingrained in their personalities, getting through to Ignorers/Deniers is very difficult. However, all is not lost! Consider the following:
  • There are compelling discoveries in cognitive science, linguistics, and neuroscience about how "reframing" serious health-related issues can help motivate resistant people to change. For example, instead of trying to break through the denial of Ignorers/Deniers through threats they will die, it may be much more helpful to reframe the issue in a way that focuses them on a vision of "joyful living" rather than a "fear of dying," since joy is a more powerful motivator than fear [reference]. This kind of reframing changes the mental structures that shape one's view of the world; it typically requires months of psychological counseling to break through the thoughts and feelings that block Ignorers/Deniers' awareness and motivation to change.
  • When cultural influences create a "machismo" attitude, in which Ignorers/Deniers perceive getting help as a sign of personal weakness or failure, cognitive-behavioral counseling can combat that belief. In addition, innovative self-help software that guides the person toward healthier behavior and thinking can be helpful. One focus would be reframing the situation from (a) getting help revealing weakness to (b) receiving help when needed and using it to improve one's life is a sign of wisdom and personal strength, whereas refusing help is childish and self-destructive.
  • Dealing with a person's lack of trust may require the intervention of a wellness coach who takes the time to establish a close, positive relationship with the Ignorer/Denier and has the knowledge and experience to gain the person's confidence.
  • As for Ignorers/Deniers with addictions or compulsions, lengthy counseling (and possible medications) may be needed before they acknowledge their problems and have the will to confront them.
Regarding wellness programs, the Ignorers/Deniers are the least likely to participate. Engaging them is critical, such as offering meaningful incentives to take a self-assessment and speak with a wellness coach. The initial goal of such wellness counseling should focus on understanding and helping reframe their beliefs and perceptions. This will enable them to be more open to gaining awareness about their health situation. Innovative technologies that help focus and entice people to break through their negative mindsets and resistance would be helpful. Once Ignorers/Deniers stop deceiving themselves, have a stronger desire to live and enjoy life, gain trust, are more aware and open to receiving help, and are no longer controlled by their addictions/compulsions, they can be treated as Inactives or Wannabes as appropriate.


Anonymous said...

Hi. I've really enjoyed this series! Just wanted to say that I know someone who fits this last category to a "T." Ironically, he is himself a medical doctor. In thinking about it, I doubt this is an unusual case. Quite interesting!

Dr. Steve Beller said...

Thanks, Elizabeth.

In fact, others have shared a similar observation about smart professionals--doctors, scientists, etc.--who fit into the Ignorer/Denier category. It's certainly not a matter of intelligence!

I'll be posting more on the topic, starting next week.