Saturday, September 4, 2010

Why we wait

The last few days I've been thinking about the question of why we wait to get treatment.  This question surfaced when a client e-mailed telling us she would not be in class this past week.  Her e-mail had said she had a family emergency where her "bad" dog almost tried to kill her "sweet" dog. From other details of the e-mail, this assessment would be about right since the injured dog wound up in a neuro ICU at an emergency vet clinic for four days and now needs constant care.

A., my boss, and I had discussed this client before.  She had not asked about private consultations, but we knew it sounded like she could benefit from them.  She lives with 5 or 6 German Shepherds, at least 1 or 2 of them have to remain separate from the rest, and the most recent GSD, her son's dog, has dog reactivity issues.  The latter had gotten in a dog fight several weeks prior to class, and her husband got bit.  Our assessment was that either something awful and traumatic would happen before immediate action would take place, she was in denial there was a real problem, or possibly her husband did not want to do private training due to time, cost, or only wanting to use a heavy hand so to speak (we run into this frequently)

Now, I'm not just pointing out this specific client, because we run into problem all the time.  In fact, ask any dog trainer, and most will say that a good 75% of their cases are related to fear and aggression.  Many times, people wait until there is a real problem where major damage has been done, instead of looking at all the warning signs that have been shown.  Sometimes, people do not even know what the potential signs are, so it is vital to continue education.

I think this entire thinking is very similar to eating disorders and other illnesses.  We often wait until we have a major break down before getting help.  Whether it is denial, validation purposes, or whatever, we wait.  We wait until it's almost too late, until the problem is acutely, visibly seen, until our bodies and mind begin shutting down from starvation, purging, compulsive exercise, etc.

In other instances, people still have the notion that this is just a phase for the ED sufferer, that the person will just snap out of it, that all they need to do is eat, and all will be better.  Other times, people fear the stigma of having a mental illness or that they don't deserve help.  Meanwhile, no treatment is done at all, therefore, the problem which might have been caught early has now escalated and snowballed into months and years of an eating disorder.  

This is certainly not to say that sometimes efforts are made by both the sufferer and other family members/friends and either treatment is denied/unaffordable or the sufferer refuses, but here, I'm focusing on the whole concept of waiting until things go from just awry to bad to worse to traumatic.

In some ways, it almost seems like human nature. Whether it is a dog's behavior, an ED or another illness, 
having some major trauma, break down episode forces us to see and realize things are not hunky dory.  It's sad that most times this is what it takes to get our attention. Imagine if we all took more of a proactive stance?  With dogs, there would be less dog behavior problems.  With those with EDs, more would get help earlier on and not fall into years and years of misery.

I have to say that with recovery, I've gotten to a point where it is easier for me to be more proactive than I used to be.  Therefore, I have less chance of falling into a deep, dark pit of despair.  It's not easy to change this type of thinking, but in the end, your life may be worth it.


ola said...

I think in my rotations (in adult medicine - parents tend to act much faster when their kids are ill or when they think so) 60% or even more of patients are decompensated because they didn't act rationally - waiting and postponing is one of the problems.

And it is interesting that even very anxious/perfectionistic or high educated patients (including medical proffesionals) are coming very late.

ED-wise- I am one of those who get help early. I was losing weight very quickly and practically in 3 or 4 months after I developed anorexia, I was in hospital. But later when my weight was low but not life threatening, I just waited. I waited until SOMETHING (miracle recovery or "treatment-sufficient" weight loss etc.) HAPPENS. Exactly how you write. It is bad cycle:( It costs time, health, money, energy... and sometimes lives. Let's not wait.

Sarah said...

Great post. As you may or may not know, public health has three levels:
-primary prevention: preventing a health problem before it happens (i.e. not driving while drunk, vaccinations)
-secondary prevention: finding a health problem before it becomes a bigger problem (i.e. cancer screenings)
-tertiary prevention: mediating the disease process in some way so that a health outcome is better than it would be without interference (i.e. antibiotics don't take the illness away right away, but they shorten the length of time you're incapaciated.)

Since we don't know that much about ED primary prevention, secondary prevention is really important. We need to screen and pay attention to problems with body image, eating behaviors, exercise behaviors, eating attitudes, etc. This post provides a great reminder of why this is so important...

I Hate to Weight said...

thought-provoking post. i tend to wait and wait and things i can fix things on my own. that never really works very well.

i need to learn to be pro-active. my old habits die hard.

you make interesting analogies. thanks

Lisa said...

your analogies are interesting and

the healthcare system in the US is...screwed up, especially when it comes to mental health and...a lot of times, just like I hate to Weight said

i tend to wait wait and wait until i've hit rock bottom and have no choice....

thanks for this interesting post
take care of yourself

Kim said...

Great post. I think denial can be very strong. What was hard for me is that I had no idea what was going on when I first got sick...and, of course, my loved ones didn't want to believe, and the doctors were no better (as related to Carrie's recent post, I think doctors don't catch on unless the patient herself is stressing that it's a problem). I've gotten better at being proactive, but there are days when I recognize red flags and try to look past them. I catch myself early though ;)

Nicole said...

Another great post!

I agree with the other comments.

For me, personally, it was because when I did reah other my hand was slapped away.
The people around me didn't believe I had a problem even though it was right there in front of them. I was right there in front of them.
Then when people, my sister, finally got it and she did take me to get help there was the money issue. So, my help was limited. Very very limited.

Finally I just gave up until recently.

Angela said...

I think that I waited until I thought I was "sick enough" to "deserve" to be helped if that makes any sense. The weeks before when I was waiting to get into residential were the worst. I wanted to prove that I needed to be there. I think now I reach out for help much sooner because I don't really want to go down that road. It wasn't pretty.

Tiptoe said...

Thank you all for sharing your thoughts. I agree with each and every one of you. There are so many powerful factors (denial, lack of money, our health care system, never feeling like we deserve help, uneducated professionals, etc.) in why we wait. I hope as we all recover we can take more proactive approaches, so that we do not fall deep(er) into EDs. And at the same time, we all look out for those warning signs as it doesn't take much to be in the throes of an ED.