When Emotions Drive Health Behaviors

From a rational perspective, being healthy isn’t complicated. You need to move often, eat lots of vegetables, and sleep regularly. Put into practice, health is a challenge for most people. Whether it’s an unhealthy attachment to your couch, an inability to say no to potato chips, or a tv addiction that keeps you up late, most of us have something that prevents us from living a fully “healthy” lifestyle.

One factor that also disrupts the rationally correct health behavior is emotions.

A recent New England Journal of Medicine article explored some of the feelings-based reasons why people decline to take their heart medications as prescribed. The reasons included a distrust of chemicals, an over-estimation of risk coupled with an under-estimation of benefit, and a belief that if you feel healthy, there’s no need to take any medication.

One of the emotional issues identified in the article is one I’ve written about before, feeling a disconnect between who you think you are and who you think the medicine is made for. People who identify as youthful resist taking drugs they think are for the old; people who think they are strong or manly avoid medications that are for the weak and helpless.

Given my background, I see a need for a cultural shift around how we talk about illness and health to help disrupt these sorts of identity misalignments. There’s a role for how we market products and talk about illness in the media; the NEJM article points out, for example, that pharmaceutical ads tend to give more coverage to potential side effects than potential benefits. Meanwhile, it remains rare to see a television or movie character with a chronic illness who is not old or infirm.

The way our culture talks about illness may also spark negative feelings even when people do the “right” things to take care of themselves.

I recently saw Kerri Sparling, who’s managed Type 1 diabetes since childhood, speak. She talked about a recent diabetes complication she’d experienced, and the irrational shame she felt as a result. Kerri pointed out that after decades of having diabetes, no matter how well you manage it, it’s likely to experience some complications. Yet she felt like a “bad” person for not being able to avoid them.

Kerri mentioned a cultural trope around diabetes jokes that she thinks contributes to these feelings of shame and self-blame; the tendency to talk about getting diabetes from eating certain foods. A quick search on Twitter for the word “diabetes” yielded me a photo of candy with the caption “Gonna wake up with diabetes,” among other similar jokes. It’s true that certain diets can contribute to the development of diabetes, but Kerri’s point is that these jokes also reinforce an understanding that diabetes is caused by the patient, and, on the flip side, could be controlled or cured by the patient if only they had the willpower. Similarly, a recent New York Times article pointed out how we say a patient “failed” therapy when a drug doesn’t work–when the drug failed the patient. We talk about illness in a way that implies blame for the patient.

Just 48 hours after I heard Kerri speak, this came up in my Twitter feed:

Kerri has a point.