This post is written by John Zrebiec, L.I.C.S.W., Director of the Behavioral Health Section at Joslin Diabetes Center and Lecturer in Psychiatry at Harvard Medical School and Robert A. Gabbay, M.D., Ph.D., Chief Medical Officer and Senior Vice President at Joslin Diabetes Center and Associate Professor Medicine at Harvard Medical School. This post is in response to the New York Times article, “I have diabetes. Am I to blame?” by Rivers Solomon, which was published on October 12, 2016.
Based on years of treating people living with diabetes, we have seen their tireless efforts at self-management lead to the massive motivation roadblocks of blame and shame, driven by the great American myth that more self-discipline and willpower will reign. As Ms. Solomon eloquently notes, these are elusive qualities that sabotage motivation and engagement in treatment.
Unfortunately, medical professionals have often added to this torment by implying that patients can achieve idealized targets if they just try harder. We propose an alternative strategy, where the focus shifts from fortifying self-control to changing one’s environment and setting realistic goals in order to make it as easy as possible to manage the complex demands of diabetes.
As Ms. Solomon movingly expressed, she found it impossible not to internalize that she was to blame. We often see patients describe themselves as “bad, lazy or selfish” for not reaching therapeutic goals. This palpable level of shame is fertile ground for depression, destroys self-worth, and is one of the most common reasons for not discussing self-care with healthcare professionals. That is why we propose an individual, family and medical model based upon constructive problem-solving rather than blame and shame.
To those with diabetes, we suggest that persisting with the daily grind of taking care of diabetes stems from the inspiration of more important non-diabetes life goals, such as a promotion at work or walking down the aisle at your daughter’s wedding, rather than anything intrinsically rewarding about checking blood glucose levels several times every day. We need to empower those with diabetes to make these human connections to events, milestones and staying healthy so they can live the life they deserve, and enjoy it with their loved ones. Trying to motivate patients with guilt or shame is counterproductive and unsuccessful.