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Confronting Your Intimate FOE – Fear of Evaluation


by Mark Gorkin, LICSW

Ten Personal-Psychological Factors that May Impede Early Cardio/Health Prevention, Detection, and Intervention

Why are we often reluctant to know the state of our medical health, let alone whether we have a medical condition? For example, why don't we more frequently avail ourselves of the advances in cardiovascular health testing to foster disease prevention or early disease detection? The evidence is compelling: did you know that as many as 90,000 lives could be saved each year if cardio health screenings were conducted on all asymptomatic men between the ages of 45-75 and women between the ages of 55-75 (American Journal of Cardiology, July 2006)? (And while these questions are of universal import, I suspect they have particular relevance for men, a species known for ignoring health issues.)


However, the intention of this essay is neither to rag on men nor to provide all the compelling reasons for considering the "For the Young at Heart" program. (Though such compelling reasons include it being simple, quick, non-invasive, and painless, performed in-office, and yet provides crucial information about the health of your cardiovascular system.) No, my intention has less to do with the logical benefits of early screening and more with the psycho-logical fears and factors that keep us from making that evaluation appointment. Why do we keep procrastinating or tuning out the encouragement from family and friends to see the doctor...or delay implementing a doctor's recommendation? Why can't we respect the early warning whisperings of our own inner voice?

Please consider these "Ten Personal-Psychological Factors that May Impede Early Cardio/Health Prevention, Detection, and Intervention." I also call this essay "Confronting Your Intimate FOE: Fear of Evaluation":

1. Personal/Family History with Illness. Certainly one's prior history or the experiences of significant others with the health care system and/or with a challenging illness may affect our readiness to take on this "Intimate FOE." However, holding on to problematic experiences in the past may limit your awareness of advances in health care evaluation and treatment. A grandmother's, a parent's, or even a sibling's story may no longer be a valid sounding board for present medical assessment and intervention possibilities. If such a medical family story creates evaluation static, try discussing the facts and feelings with a concerned and objective friend or counselor/health professional.

2. Don't Trust Doctors/Don't Look for Trouble. Some people fear that if they see a doctor (or go into the hospital) for one thing, suddenly other problems will be discovered. For example, you go in for an anemia assessment and then suddenly you are being evaluated for hypertension, arrhythmia and the functioning of your carotid artery...when you basically just feel a little fatigued. (And are all these tests really necessary?) A personal analogy comes to mind: not being a car maven, I'm often antsy bringing my car to a new mechanic. Will the problem morph beyond the engine into trouble with the transmission, the electrical system, and even the brakes? Of course, the problem-solving keys here are getting a solid professional recommendation and especially developing trust between the patient-customer and the medical-service expert.

3. What Does Illness Mean to You? For most people illness is more than a medical malady involving disease, disability and/or dysfunction. When your health is questioned, tested, or compromised an existential challenge can quickly ensue. Issues related to self-control, self-esteem, trust in one's body, as well as fears of dependency, both short- and long-term, can become a source of worry or even shame. Your state of health can also send a message or be perceived by others as a reflection on one's lifestyle or self-risk choices – e.g., smoking, drinking alcohol and sugar-laced sodas, or eating high fat foods. Medical conditions may also intersect on larger societal issues, e.g., eating red meat and not going vegan. And whether warranted or not, illness is increasingly being attributed to an inability to handle stress as well as to "bad genes." With all this speculation, judging and moralizing going around, no wonder so many stay in the FOE closet.

4. Macho Mentality. Of course, some folks see themselves as invulnerable to significant illness; not surprisingly younger adults can fall into this category. However, for other adults, especially for some men, acknowledging pain or a medical problem is synonymous with being whiny or a wimp, that is, you should just "tough it out!" Asking for help means admitting your mind-body is not as strong, reliable or trustworthy as you believe or want to project. Or, perhaps you don't want to be a bother. I've seen some of this mentality in my father's battle with cancer and chemo. His oncologist recently chastised my father for his stoic attitude toward pain. By not complaining, the doctor is hampered in being able to identify and address issues that might enhance my father's treatment and alleviate some of the neuropathic pain.

5. All or None Thinking. We've all heard the old saws: "No news is good news" or "What you don't know can't hurt you." And, of course, the objective validity of such sayings is often questionable, especially regarding one's health. I suspect people who limit their intake of health data may have a tendency to view life through a "black or white" or a "full or empty" lens. By definition, a person confronting a "Fear of Evaluation" opts for timely and accurate data regarding his or her state of health. That is, you open yourself to the possibility of short-term "bad news" in order to prevent and/or detect possible problems along with protecting your ongoing health. You are willing to forego short-term relief to avoid long-term regret! (And as you may well know, finally having a diagnosis for an uncertain medical condition itself brings real stress relief.) Remember, an ability to hold seemingly contradictory ideas in the mind at the same time when problem-solving is frequently seen as a sign of first-rate intelligence. Ironically, when confronting our "Intimate FOE" by viewing the proverbial health glass as half empty we are replenishing and adding to the "half-full" quantity and quality.

6. Can't Disrupt Our Tightly Scheduled Routine. Some folks just can't seem to fit that evaluation into their filled-to-the-max schedule. Or they say, "I'll make the appointment when I have more time"...and never do. Invariably, the only time they have more time is when they have waited too long and are starting to show sufficiently troubling or disruptive signs or symptoms. Now the body has grabbed their attention! And sadly, living everyday so tightly wound – with insufficient opportunity for reflection and reexamination, for relief and relaxation – itself may become a dicey variable in your health equation. In fact, sometimes ongoing stress/anxiety or unrecognized signs of depression contribute to both a burdensome schedule and/or an ongoing state of disorganization or denial.

7. You Have to Be Strong for Others. Another rationalization for overlooking or delaying one's own health assessment is that your first priority is the well-being of others. People are depending on you; you don't have the luxury of being ill. Or again, "when things calm down, then I'll see the doctor." Of course, there's another way of reframing this: By staying on top of your health, for example, through a regimen of heart healthy eating and regular exercise as well as timely evaluation, you become a proactive role model when it comes to health care and family wellness. Now you are really available and also an inspiration to others.

8. Fear of Dependency. The complement of being "strong for others" is the fear of being "dependent on others." Sometimes people avoid engaging with health issues because the possibility of needing others' help, of not being "in control" of one's body or life, is so frightening or ominous that you avoid any possibility (like health assessment information) that might shake your tightly fortified or constricted world-view.

9. The Nature of Your Lifestyle. Sometimes people don't consider having health evaluations because they are "leading a healthy lifestyle." For example, as an actor on a heart-related TV commercial says: "I was the last person thinking I would have a heart attack. I was doing everything right. I was invincible." Alas, this attitude reflects a common coping mechanism – the "illusion of control." You choose to assume all is fine rather than taking quick and safe steps to actually find out. As research increasingly indicates, despite all your best efforts, when it comes to health, sometimes nature trumps nurture; family history really does matter. Conversely, those who are obviously engaged in high-risk health activities, that is, people who smoke regularly, drink excessively, eat fried foods or pizza five days a week, etc. – often avoid a health assessment (despite the obvious need) because they don't want to be reminded (or lectured about) their behavior.

10. Financial Considerations. Of course, financial resources, including the range and quality of one's medical insurance coverage, can influence your health care activity, timeliness, type of procedures available, etc. However, a quick, safe and non-invasive evaluation, such as the one provided by the "For the Young at Heart" cardio care program is really an investment in self having both present and future benefits. And, along with a high ROI (Return on Investment) it's also quite affordable.

However, as this article has delineated, choices around health care are not simply a product of logical or rational considerations. Exploring health options is a complex psychological process as well. It often takes courage to engage personal angst and pursue optimal and timely health care evaluation. That "Fear of Evaluation" begins to feel like a Pandora's Box. Who wants to open the box and possibly have all those furies flying about? However, many forget that the last fury to escape was perhaps the most powerful dynamic of all – Hope! I can't think of a better incentive for "Confronting Your "Intimate FOE."

Mark Gorkin, MSW, LICSW, "The Stress Doc" , a Licensed Clinical Social Worker, is a one-of-a-kind "Motivational Humorist & Team Communication Catalyst." The "Doc" is an acclaimed keynote and kickoff speaker known for his interactive, inspiring and FUN speaking and workshop programs. The "Stress Doc" is also a team building and organizational development consultant for a variety of govt. agencies, corporations and non-profits. And he is AOL's "Online Psychohumorist" ™. A former Stress and Conflict Consultant for the US Postal Service, the Stress Doc is the author of Practice Safe Stress and of The Four Faces of Anger. See his award-winning, USA Today Online "HotSite" -- www.stressdoc.com -- called a "workplace resource" by National Public Radio (NPR). For more info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 01-875-2567.





Posted: 06/07/2010

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