Denial can be deadly. This is particularly true when it comes to health issues. Many of us can envision friends, family, or spouses who, for no good reason, kick and scream at the thought of seeing the doctor, even for a physical.
Wait a minute. No good reason? "Deniers" have plenty of "good" reasons for ignoring health problems: "I don't have time." "I'm perfectly fine (minus that daily headache and high cholesterol)." "What are they going to tell me that I don't know anyway?" "I don't like being around sick people."
For Atlanta management consultant Steffanie Edwards' mother, who is battling several health issues including obesity, it was, "'I tried. I stopped eating sweets but nothing's happened,' which I know isn't true because I see evidence that there were sweets around; the cookie bags, the potato chips, so I know she's not doing as well as she could," Edwards says.
Edwards tells WebMD she has expressed concerns to her 60-year-old mother about the health issues and their long-term toll. "She has hypertension and diabetes, and she's obese, and she had to have both knees replaced. It was told to her that if she lost the weight, a lot of her ailments would go away, and she hasn't been able to do it," she says. "Specifically, there's denial around her diabetes in that she doesn't think she has it anymore although she has not cut sweets or sugar out of her diet."
She says the obesity issue has always been a sensitive one. "She didn't want to talk about it and she didn't want to exercise. So that's all there was to it. It just wasn't talked about."
Warning Signs Are There for a Reason
It is common for people to get the cold shoulder when they express concern about their loved one's health problems. But if you're the one doing the denying, shrugging off red flags from your body now can limit your options for treatment later.
"I think that sometimes we don't want to face the reality that our health has changed to the negative," Jeanette Newton-Keith, MD, assistant professor of medicine in the department of gastroenterology at University of Chicago, tells WebMD. "Many conditions can be prevented or reversed if treated early, but [over time] some progress to the point where they require medication, surgery, or other interventions. So it's important to not ignore the warning signs for health in general."
Some general warning signs that should not be ignored include:
- Uncontrolled risk factors for heart disease, such as high blood pressure, high cholesterol, diabetes, and obesity
- Wounds that don't heal
- Shortness of breath
- Blood in the stool, or inability to pass stool
- Pain or fatigue that prevents you from doing normal activities
- Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
- Lasting numbness and weakness
- Unexplained changes in weight
- Changes in appetite
- Loss of vision
Family members, particularly spouses, are usually the sources of intervention but it's usually well- intended. But keep in mind, while they are often the ones scolded or ignored for trying to help, Newton-Keith notes their support is vital to a person's success at getting to the doctor and complying with any prescribed treatment.
So why is denial so common? Fear is often an underlying current behind the excuses people give about their health issues, says cardiologist Amit Khera, MD, director of the program in preventive cardiology at the University of Texas Southwestern Medical Center in Dallas.
"A lot of it is fear that people think that if they don't know [what is wrong with them], then they're OK and once they know, then they're not OK. ... Obviously, that couldn't be true."
Mark Ketterer, PhD, clinical professor of psychiatry and psychology at Wayne State University in Detroit, says he also sees the fear factor in his work with cardiac patients.
"I think there are some patients who have a family history of people having a given illness and when they begin to have symptoms, they're so fearful of it that the thought of going in and seeing the doctor is too frightening. There are other people who feel that illness is a distraction or a weakness and that they shouldn't yield to it. There are still other people who feel so distressed in their lives that their health is just a low, low priority compared with other things," he tells WebMD.
In the case of a severe event, such as heart attack, stroke, or bleeding stomach ulcer, it is the same fear factor that can have an opposite affect on people who are in denial about their health. Khera calls this the "aha" moment -- when he sees a heart attack patient who finally "wakes up." Initially, he says many patients will do anything the doc says, but then, with time, some begin to fall off the health care wagon.
"After time, just like anything else in life, people forget. They forget how sick they were; they forget how scared they were; they forget all of the deals they made with themselves, and they go on. And I think that it's unfortunate that it often takes a scare to make people care about their health," he says. I think part of what people think is that, 'If I have a heart attack, they'll open my artery and I'm "cured."' And I can tell you that there's nothing further from the truth. Now I'll tell you heart disease, coronary artery disease, is a lifelong chronic illness and there is no cure. There are plenty of therapies -- that's the good news -- and ways to reduce risk, but there is no cure."
The key, truthfully, is to prevent these nasty health problems from surfacing in the first place, and there are plenty of new treatments to help. But the picture of health becomes more complex with silent illnesses -- including high cholesterol, high blood pressure, and diabetes -- that put people at risk for much bigger problems down the road. All three conditions are tied to stroke and heart disease, leading killers in the U.S. Their slick nature makes getting regular checkups -- whether we like it or not -- essential.
"These are [illnesses] that you can't see and you can't feel but you just kind of know in your head that they may be bad for you. And psychologically, I guess people are less inclined to act on those things. Which in society we look a lot for immediate gratification, and with a lot of these prevention things, like blood pressure and cholesterol, there is no immediate benefit, such as if your knee hurts and fixing that," Khera says.
People should take an active role in prevention, Khera adds. "Everybody should know their cholesterol, and I don't think it's just enough to say that your doctor said it was just 'OK'. You should actually know your numbers. … Because I think that a lot of doctors are great doctors out there, but you know people are busy and not everyone looks as closely." He says the same is true for diabetes screening and blood pressure levels.
People who ignore their health problems aren't bad people. Outside of fear, required lifestyle changes that are drilled in our brains over and over again -- lose weight, exercise regularly, quit smoking, eat right -- are painfully difficult for most. But at some point we all must own responsibility for our own health and our decisions.
With that said, is there any way to help if you are the one on the outside looking in? Denial is a delicate and frustrating equation, a balance between a person not wanting to seek treatment and someone else wanting him or her to just do something!
"Rather than pointing out the faults, I encourage people to just have them get a healthy checkup. Focus on the positive of optimal health and improving their health," Newton-Keith, who is an expert in morbid obesity, tells WebMD. "Find a reason for them to come. For example, so that they can walk better, so they're not short of breath, so that they don't have so much fatigue, so that they sleep better."
Edwards, who has encouraged counseling for her mother's overeating and avoided unhealthy foods in her presence, says her mother finally made one lifestyle change when her mother felt it was important.
"She started getting embarrassed about the fact that she can't walk standing straight up [after the knee surgery]; she bends over a little bit. The doctor has always told her that she needs to exercise, which she found that when she did the stationary bicycle, her condition got better," Edwards says.
Ketterer says there is no magic pill that will shake people's denial. He notes however, that trust is part of the solution. "You need to trust your spouse and trust your family member as sort of a monitor. ... All of us tend to believe that we know ourselves better than those around us, but actually the evidence says that that may not be true."
In the end, you can lead a horse to water but you can't make him drink. "The real question is what's motivating them to seek medical care," says Newton-Keith. "And it's usually pain or an ache or a change that's different. If they're not motivated, they have to reach a point where they're sick and tired of being sick and tired to get to that point. ... You have to love yourself enough to want to be healthy."