Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating …
This item is available in full to subscribers.
Please log in to continue |
Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating effective health and wellness programs.
The Department of Health and Human Services (HHS) classifies the total or partial disregard of personal health as self-neglect. A key distinction is capacity versus choice. Researchers do not agree on whether it stems from an underlying medical or psychiatric disorder or the simple unwillingness or inability to seek help for a variety of personal reasons.
• Diminished capacity reflects physical or mental impairment, dementia, depression or simply an inability to care for oneself.
• Personal autonomy covers individuals who make a conscious, voluntary lifestyle choice or who hold personal or religious preferences not to seek certain medical care, provided they understand the consequences of their decision.
According to the National Institutes of Health (NIH), a self-neglector is a person who exhibits one or more of the following traits:
1. Persistent inattention to personal hygiene and/or environment.
2. Repeated refusal of some or all indicated services that are expected to improve quality of life.
3. Self-endangerment through the manifestation of unsafe behaviors or unhealthy living conditions, i.e., persistent refusal to care for a wound, creating health hazards in the home through hoarding, drug or alcohol abuse, personal safety issues of self or others, unsanitary conditions or severe nutritional deficiencies.
Individuals may recognize health symptoms, understand their risks and even fear the consequences, yet continue behaviors that threaten their health. Psychology offers the following explanations for this contradiction:
Fear and avoidance
Fear is one of the strongest drivers of health avoidance. For example, someone may notice a lump, persistent fatigue, chest discomfort or unexplained weight fluctuation. Instead of seeking medical attention, they convince themselves it is nothing serious because seeking care might confirm something frightening.
Denial and psychological self-protection
Denial is not always a conscious refusal to accept reality. Sometimes it is an automatic psychological defense against overwhelming information. The consequences of unhealthy behavior are often delayed, while the rewards are immediate.
Learned helplessness and low self-efficacy
Some individuals attempt to improve their health without success. They may have struggled with weight loss only to regain the weight or tried to lower their blood sugar without success. This can create a pattern in which repeated experiences of lacking control led to passivity.
Trauma, chronic stress and emotional exhaustion
Individuals who have experienced prolonged adversity may develop patterns of disengagement from their physical needs. Chronic stress can cause feelings of overwhelm or disconnection. They may normalize symptoms others find alarming. For others, healthcare environments may trigger feelings of vulnerability or loss of control.
Fear of judgment or lack of respect
Individuals may avoid seeing a healthcare provider because of past negative experiences, such as a condescending attitude, being told that whatever they are doing isn’t enough, spending more time in the waiting room than in the doctor’s office or not receiving a timely appointment if they do reach out.
A person may believe they are strong and do not need medical care, that family members should handle it, that they don’t want to become dependent on medication, that tests may reveal something else, that they fear medical bills or that they put everyone else in the family first. These beliefs may be embedded in culture or familial beliefs.
Not everyone who delays healthcare is avoiding it psychologically. Some lack health insurance, cannot pay out of pocket, have too many caregiving responsibilities, lack transportation or are confused about how to navigate the healthcare system.
Are we teaching health or simply warning people about disease?
The focus has been on why patients do what they do and, to a certain extent, why they are not doing what is needed to live a healthier lifestyle. More focus is needed on individuals who face significant barriers to accessing appropriate healthcare services.
When symptoms are ignored or chronic conditions remain untreated, a later diagnosis can result in a potentially once-treatable disease now becoming acute, preventable hospitalizations, greater disability and loss of independence, increased family caregiver demands and higher healthcare expenditures and strain on community resources.
This is where the faith community can offer guidance, health education and support to help remove barriers to healthcare.
Dr. Cheryl Christy is a Baldwin County resident and registered nurse with nearly 30 years of experience. She holds master's degrees in nursing education and nursing practice and a doctorate in nursing practice. She is a member of Sigma Theta Tau, Phi Pi Chapter, a certified lay counselor and the author of "Voices for Healthcare," a healthcare blog.
Read her previous column titled "Chronic cortisol effects on the body" on www.GulfCoastMedia.com. Her blog can be found at https://substack.com/@dnprn.
