[Paleopsych] NYT: Scare Yourself Silly, but the Real Terrors Are at Your Feet

Lynn D. Johnson, Ph.D. ljohnson at solution-consulting.com
Thu Oct 27 14:08:29 UTC 2005

It is well known that fear is not a reliable motivator for change, 
because we can habituate to fear so quickly. The best motivator seems to 
be hope for a better future. Medics have tried for years to scare people 
into health; it would work better to have pictures of Lance Armstrong 
and a 'you can do this too' message.

The Motivational Interviewing people have a good deal to say about 
motivating change, and they do not emphasize fear and threat. MI's 
original impetus came from Bill Miller being disenchanted with the 
confrontational method of helping problem drinkers.

Premise Checker wrote:

> Scare Yourself Silly, but the Real Terrors Are at Your Feet
> http://www.nytimes.com/2005/10/25/health/psychology/25essa.html
> [I have not read this article, since I'm trying to cut back on my 
> reading. It should be of interest to several people on my list, and it 
> takes only a few seconds to send it. If it's really good, let me know.]
>    Just in time for Halloween, the usual yearly ritual of terror by
>    headline is now playing itself out in medical offices everywhere. Last
>    year it revolved around flu shots; a few years ago it was anthrax and
>    smallpox; a few years before that it was the "flesh-eating bacteria";
>    and before that it was Ebola virus, and Lyme disease and so on back
>    into the distant past. This year it's the avian flu.
>    "I was crossing Third Avenue yesterday and I was coughing so hard I
>    had to stop and barely made it across," a patient told me last week.
>    "I'm really scared I'm getting the avian flu."
>    I just looked at him. What could I say? He has smoked two packs of
>    cigarettes a day for the last 50 years. He has coughed and wheezed and
>    gasped his way across Third Avenue now for the last 10 years. His
>    emphysema is not going to get any better, but it might stop getting
>    worse if he were to stop smoking.
>    He made it clear long ago that this is not going to happen. When it
>    comes to the whole cigarette/health question, his motto, apparently,
>    is "What, me worry?"
>    But the avian flu - now there's a health scare a person can sink his
>    teeth into. So scary and yet, somehow, so pleasantly distant. So
>    thrilling, so chilling, and yet, at the same time, so not here, not
>    now, not yet. All in all, a completely satisfying health care fear
>    experience. Unlike his actual illness.
>    Scary movies give children nightmares. Scary health news gives adults
>    the extraordinary ability to ignore the immediate in favor of the
>    distant, to escape from the real (and the really scary) into a far
>    easier kind of fear.
>    A few years ago, a young woman waited patiently to be seen in our
>    office after hours. She was a patient of one of my colleagues, but she
>    couldn't wait for their scheduled appointment; she needed to see
>    someone right away.
>    "I'm worried I have Lyme disease," she said. "I have all the symptoms.
>    I think I need to be treated."
>    "But you have AIDS," I said.
>    "I'm tired and weak and I have fevers and sweats. I've lost my
>    appetite. I can't think straight. I'm losing so much weight!"
>    She had seen a TV news report on Lyme disease, and then she had
>    checked the Internet. All her symptoms were right there.
>    "But you have AIDS," I said. "And you don't want to take meds. That's
>    why you're feeling so bad."
>    "I'm really scared about Lyme disease," she said. "I really need to
>    get treated."
>    "If you want to be scared, how about that untreated AIDS of yours?"
>    We looked at each other. It was an impasse. The fact that logic was on
>    my side mattered not at all: evidently the real was just a little too
>    real for her. How much better to find another illness to be scared of,
>    obsess over, get treated for, get rid of.
>    Eventually she coerced my colleague into testing her for Lyme disease
>    and treating her despite negative tests. Then she decided her symptoms
>    might actually be due to a brain tumor, instead. And so it went, until
>    she died of AIDS.
>    Of four patients I saw in a single hour last week, three announced how
>    scared they were of the avian flu. I reassured them, but there was
>    quite a bit I did not say, and here it is.
>    I did not say: If you want to be scared, then how about that drug
>    habit of yours you think I don't know about? How about the fact that
>    you are 100 pounds overweight and eat nothing but junk? How about the
>    fact that in a few short months Medicaid is going to stop paying for
>    your very expensive medications and no one knows how just high that
>    Medicare Part D deductible and co-payment are going to be? I did not
>    say: If you want something to be scared of, how about the
>    drug-resistant Klebsiella that is all over this very hospital, an
>    ordinary run-of-the-mill bacterial strain that has become so resistant
>    to so many antibiotics that we've had to resurrect a few we stopped
>    using 30 years ago because they were so toxic.
>    That Klebsiella is one scary germ. It's in hospitals all over the
>    country, and by now it's probably killed a thousandfold more people
>    than the avian flu.
>    But you don't hear much about our Klebsiella. Like our bad habits and
>    our dismally insoluble health insurance tangles, our
>    antibiotic-resistant bacteria are with us, right here, right now.
>    Apparently they all lack the drama, the suspense, the titillating
>    worst-case situations that energize our politicians and turn into a
>    really newsworthy health care scare.
>    They're all just too real.
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