Dealing With Denial

his is for all of those frustrated spouses, parents, children, siblings and friends out there who can hardly bear to stand by and watch those they love make self-destructive choices. I see this dynamic all the time. The daughter who asks me with tears in her eyes to help her dad follow his diabetic diet as he stands outside my office and laughs at her, the customer who finds her overweight, hypertensive husband adding chocolate chips to his healthy breakfast cereal and the husband who can't convince his wife with heart disease to exercise with him are all experiencing the fear, anger and frustration that accompany the threat of illness in a loved one who does not take care of his or her health.

Denial is at the root of this situation. People deny that their weight, health, smoking or sedentary habits are serious and life threatening for many reasons. It is easier to continue to deny that there is a problem than to take on the burden of changing lifestyle habits or incorporating a treatment plan into their current lifestyle. Change is very difficult and it means giving up certain things, like French fries or cigarettes. People often have unconscious associations with foods that comfort them and they use those foods to transport themselves to a time or place when they felt emotionally fulfilled and safe. Giving up a comfort food means giving up the emotional comfort it provides.

Denial is a normal coping mechanism when a person is initially confronted with a health issue such as diabetes or high blood pressure, but it can become self-destructive when the denial persists rather than giving way to a desire to deal with the condition. Refusal to recognize or admit that there is a problem manifests itself in many different ways: simply denying that the situation exists, minimizing the severity of the illness, blaming someone or something else, rationalizing or making excuses for not complying with treatment, avoiding or changing the subject of illness when it comes up, and becoming angry or hostile when the behavior or illness is referenced. These are all red flags that a person is not caring for themselves properly in the face of illness. Excuses like "I'm too busy", or "I'll go to the doctor later", or "Just a couple of bites won't hurt me" are part of the denial, too.

Of course, we all know that person who, when diagnosed with prediabetes, will immediately call a dietitian, start working with a personal trainer, and completely revamp his or her lifestyle. What drives this person to embrace important changes immediately? Healthy doses of narcissism, stubbornness, and internal discipline all work together to motivate lifestyle changes. Some people inherently have more of those traits than others, but the others aren't doomed to swim in denial forever.

The others who lack such discipline need to start rationalizing healthful behaviors that are emotionally gratifying in ways that regression is not. They need to come to believe that they have the power to change. Repeated efforts are usually required in order for a change to stick-very few people can change instantly-and that needs to be understood and accepted.

If you are someone who wants to help someone make a change, there are some important things you can and can't do. You can't make someone change, no matter how badly you want them to; you can, however, help them want to change. This requires gentle encouragement without judgment, and empowerment without enabling. These are tricky balances to maintain, but the goal should be to make your loved one believe that they have the power to make changes successfully.

If someone you love is struggling to accept that their health is in danger, then it is important to understand their process and gently work to bolster their belief that they have the power to achieve their goals. Treat them lovingly and try to support, not sabotage, their efforts (for instance, don't smoke in front of them if they're trying to quit, and order fruit instead of chocolate cake for dessert if they're trying to eat better). Respect them and help them love themselves, and hopefully that will help motivate them to make some healthy improvements in their lives.