Stepping Over the Line

I spent some time talking to a friend today. Because she knows I’m “into this kind of thing,” she wanted to know how to convince her family (and herself) to really take the plunge and change their lifestyle to a more active one. We talked a little about strategies associated with making changes – like modeling the change you want to see, establishing a ‘team’ through use of fitness tracker data sharing and the like. Ultimately, though, change is not going to happen until a person is motivated to put substantial energy into that change, and that line may not be where another person thinks it should be.

People can tolerate a lot of the devil they know instead of dealing with a new situation, in order to stay mentally comfortable. Cognitive dissonance – or the stress people feel when they are forced to hold two competing ideas at the same time due to the introduction of new information – is perceived as so noxious sometimes that people may avoid it at all costs, even if that means distorting perceptions and creating wild justifications. Cognitive dissonance can also give rise to denial of the validity of new information and a failure to incorporate that information into one’s worldview as a solid defense against stress.

If a person has an illness and the illness’s effects are enhanced due to one’s lifestyle factors, logically…you would want to mitigate that illness’s effects by any means that you could control. Like taking medication, losing weight, seeing a specialist, exercising, or testing blood sugar, for instance.

But the fact is that people do not do things that are in their best interest for all kinds of reasons. In health psychology and in the general medical universe, adherence to regimens and medications prescribed is called “compliance.” Compliance is a negative word and removes patient autonomy and values from the equation, so I prefer to use ‘adherence’ instead. But many things keep people from adhering their doctors’ recommendations, and a lot of those are psychological. Of course, socioeconomic status, religious values and language/health literacy are huge factors in agreeing to a treatment regimen. But sometimes non-adherence is as basic as a teen with Type I diabetes not wanting to be different from his or her peers, so they do not test and they do not keep to their diet in an effort to be like everyone else. So they smile and nod at the doctor’s appointment and then leave their testing supplies behind when they go to school.

Non-adherence often leads to serious medical complications and/or a worsening of the condition. I know someone with Parkinson’s who refuses to do any kind of physical therapy. All this person’s doctors recommend PT. This person has major imbalances that could result in hip fractures after a fall, leaning, and pain — all that could improve with PT. And yet, no PT is happening. Why?

Because in this person’s mind, PT=”I am weak, and I refuse to see myself as needing help.” The irony is that without PT, a wheelchair is on the horizon, if not already overdue.  Rather than re-examine the assumption that PT makes him or her weak, actual physical pain is preferable to the psychological uncertainty.

So people’s timelines for acceptance and change action are uniquely personal things, and the discrepancy between others’ timelines and the individual’s is why families and supporters of the person frequently get so angry and frustrated, saying, “WHAT NEEDS TO HAPPEN FOR YOU TO WAKE UP?”

If you are the family member or supporter in this scenario, all you can do is be the kind of change or model you would like to see, and maybe at one point you will be asked, “how did you do it?” And the real dialogue can start.

My friend told me (because I am into this kind of thing), “You probably don’t understand, you think this is logical and easy, that we should just do it.” I see why she might think that, but I do understand. I had my own line for change, and at that point I had a LOT of cognitive dissonance and shame. But the real challenge is feeling that stress, not denying its importance or existence, and then transmogrifying it into something motivational and healing.

This kind of disconnect between people is why I started writing here, because my line in the sand is not and was not anyone else’s line, but that line can move closer if people feel that change is possible and are not overwhelmed with the idea of the process. Change, while hard, is definitely possible and cognitive dissonance does definitely not kill you. Instead, it is a puzzle to be solved, a motivator.

There is nothing easy about any of that.  Nothing at all.