Whether it’s recommendations from a caring friend, caregiver, doctor or other medical professional, why do people, including ourselves, do the complete opposite or ignore it? In short, why do we, and those we care for, sabotage our health? However, is it always self-sabotage?
There are probably as many variations as there are people and there isn’t one common cause that covers the water front when it comes to behavior. While fear is a leading factor noted for “self-sabotaging behavior,” low self-worth, stress and past trauma are other psychological factors noted. Yet, there are unique aspects when dealing with chronic and life threatening conditions. It’s helpful to have a better sense of what’s going on and not just assume that you or they aren’t implementing recommendations because of stubbornness or being inconsiderate.
The steps that are often listed as ways to deal with self-sabotaging behavior-recognize how you do it; analyze or understand why; create a plan (find healthy alternative behaviors and develop a plan); and take action- begin with understanding the problem. To that aim, below are some factors to consider.
• People are comfortable with what they know and a change, even it improves how one feels, may not be trusted. They know how to deal with being sick but not necessarily feeling well. Then there is the fear that symptoms could come roaring back. It can also be a version of “the devil you know may be better than the one you don’t.” In short, change is hard and can be a lot more complex than “just do it.”
• Family and friends adjust to how someone is and when that starts to change, no matter how positive it is, they can unknowingly reinforce sabotaging behaviors. My mother described my father’s family as being fully vested in keeping someone in the family sick as it gave some family members a purpose. I worked with an individual that had a wife with chronic health problems. He’d miss meetings, deadlines, show up late and his excuse was always his wife’s health. HIs enabling behavior wasn’t good for him or his wife but it provided him with an excuse that was hard to fault him for.
• Not sure they can make changes and sustain it.
• Exhaustion/frustration. After trying regiment after regiment, and not getting desired results, compliance fatigue is very real. It’s easy to feel defeated and just not willing to try something new after one or two major failed attempts.
• Fear of success and expectations that could come with it. What do you lose if you become successful? Does this require a level of accountability that is concerning? When the meds came out that increased life expectancy for people with HIV/AIDS, while many embraced it, there were those that just weren't ready to do so. Could they really go back to work? Who would hire them? Could they make rent?
• Sense of shame about being in the situation, particularly if they engaged in a behavior, such as driving while under the influence, smoking, ignoring symptoms, and ending up with major health issues.
• Lack of funds: A nurse practitioner friend told me of her frustration with a couple where she’d get one person’s conditions under control, only to have the other person’s health spiral out of control. It was looking like couple sabotaging until she delved into how they were managing their meds. The woman explained that they didn’t have enough money so they’d alternate, one month she’d take her meds and the following month it was her husband’s turn. Variations on this theme happen all the time. Mothers are particularly prone to put the needs of the kids and family before their own.
• Needing to feel in control of something. Having no sense of control over being sick in the first place, people grab for control wherever they can find it.
• Have an underlying condition that isn’t being recognized. An elderly neighbor wasn’t adhering to medical advice skipping pills, not getting out of bed etc. etc. This was a source of frustration to the visiting nurses and their adult children. Viewed as being self-sabotaging, it was actually advancing cancer that had gone undiagnosed.
• Depression. A number of conditions, and even treatments, can cause depression
• Are overwhelmed by their situation and just can’t seem to figure out how to implement changes.
• Don’t trust the person giving them advice. If a person is vested in complementary and alternative medical practices, they may be weary of a western style practitioner and therefore not ready to heed their advice. Check out Whose health advice do you take seriously?
• Fear of doctors. A very common fear, this can result in not keeping medical appointments, going for tests etc.. Latrophobia (Fear of doctors)
• Did they hear the recommendations in the first place? Having an extra set of ears at medical appointments, as well as keeping a health notebook makes a major difference in reminding people what their provider is recommending. I keep a health notebook on my phone (using Reminders feature) for my husband. Every office visit, lab, and even comments he makes about his health between medical appointments, I jot down. The number of times this has made a difference in compliance, to say nothing of his health in general, is significant. Various studies show that people just don’t remember what they’re being told in office visits. In short, patients’ memory, including our own, for medical information isn't the best.
• They’re just done. In the last year of my mother’s life, she died at 99, she no longer did the things her doctor recommended. It became clear to me that she was simply done and was “ready to move on.” Easier to accept this when they’re old and have lived a full life versus someone who is younger and can have a future.
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