COPING WITH THE CRISIS
After the Diagnosis, Then What?
After learning that you or someone you love has diabetes, then what? How will you feel? How will you cope?
Describing the multitude of emotional reactions that may occur is about as easy as describing all the different kinds of animals in the world! Everyone responds in his own unique way. And yet, there are some fairly typical responses—certain stages of adjustment—which most people do go through.
These stages are quite similar to the stages of grief that a person experiences when a loved one dies. Not everyone goes through all of the stages. Some people may experience two or more of the stages at the same time. Within a family, each person may be at a different stage of adjustment to the diagnosis.
For some people, acceptance of the diagnosis of diabetes may be rather painless and quick. Take Larry, for example. At age 37, he was rapidly losing weight, “disappearing physically”, as he described it. Larry skipped the depression stage; he did not feel angry; he did not blame God or the doctor or anyone else. He did not go through a period of denial—“How could I argue with a glucose level of over 400? It was real. It was a problem.” Larry’s initial reaction was a feeling of gratitude and relief that the doctor had correctly diagnosed his problem.
For other people, accepting diabetes is far more painful and prolonged. Unfortunately, some never do make a full emotional and physical adjustment to being diabetes. Some become emotional invalids. Others spend their lives denying the fact that they have diabetes, or agonizing over “Why me?” or feeling guilty—as if they had done something wrong that caused the disease.
Many diabetics find that life simply goes on after the initial shock and adjustment period. The fortunate ones can even see a bright side to having diabetes. They are forced into a much healthier lifestyle than ever before. Often diabetics reach goals in sports or other aspects of life that they never would have dreamed of until diabetes demanded strict discipline.
However a person reacts in the beginning, he will still have good and bad days. Throughout life there will probably be periods of denial, anger, bargaining, depression—as well as more times of acceptance and adaptation. There are some rather predictable occasions when emotional crises may arise again.
The first experience with a severe insulin reaction, ketoacidosis or diabetic coma will most likely be followed by some strong emotional reactions. Pregnancy and childbirth, surgery, infections which keep returning—all are occasions in a diabetic’s life which may bring on an emotional crisis. So are the beginning of a long-term complication or disability, or the approach of death.
Let me offer a word of encouragement, however: Handling one crisis well is likely to give courage to face new challenges in the future.
Let us take a look now at some of the specific emotional responses which are typical of a newly-diagnosed diabetic or his family.
As we look at some of these responses, let’s go back to my 50-year-old friend Nancy. She finally went to the doctor because she thought she had malaria. For some time, she had been feeling extra thirsty. That made her slightly suspicious, since three of her closest family members were diabetics. Yet, she did not want to think that she might have it. Surely it could not affect her. In spite of her suspicions, when she did go to the doctor and he diagnosed her trouble as diabetes, it was a shock!
Most of Nancy’s denial came before the confirmed diagnosis. She knew the hereditary link; she knew the signs and symptoms; yet she denied her own risk and vulnerability to the disease. Nancy was basically a healthy person. She was successful; she was always on the go. How could she have a serious illness?
Even after the diagnosis has been confirmed, some people stubbornly refuse to admit that they have diabetes. When one doctor diagnoses diabetes, a person may go to a different doctor—and still another—in the hopes that someone, somewhere will say it isn’t true. Doctor-hopping is a common indication of denial.
As Nancy, and very many people like her, delayed going to the doctor for the initial signs and symptoms, many diagnosed diabetics also deny the possibility of complications. They believe that the complications can’t happen to them, and so they put off going to the doctor, even though they know all
the danger signals.
Denial comes in still another form. Some diabetics stubbornly refuse to take their insulin or other medication, or they never follow the prescribed diet. Roger Lee and his brother Steven do try to follow the rules of diabetic life. But one of Steven’s secondary school classmates recently died of diabetic complications. “All his life he fought it,” Steven says. He refused to take his insulin because he always felt, “I don’t want to be a diabetic!” He died a victim of denial.
Depression and Anger
After the diagnosis, Nancy went through a brief period of depression. “I was feeling like I would be an invalid for the rest of my life,” she said. As the supervisor of an international home and family services department, Nancy spent most of her time traveling throughout the Asia-Pacific. Being a diabetic would certainly cause some real confusion to her lifestyle.
Often a person who finds out that he has diabetes will experience fear. He may be afraid that he will lose control over his life. Like Nancy, he may fear that he will become helpless and dependent on others, and that he will lose his own freedom.
Many people see the diagnosis of diabetes as a proclamation of doom. They feel doomed to a life of disability, disfigurement, and even death due to the complications which may occur in the years to come.
After the depression had passed. Nancy felt angry. She was angry with herself for her lifestyle in the past. Nevertheless, she went out to eat and eat—and eat some more. She reacted with the attitude, “I’m going to have all I want!”
Some young people begin soon after diagnosis to drink too much alcohol, take drugs, or drive recklessly. Their behavior becomes very self-destructive as they think that life has given them a bad deal.
A child may be angry with the parents for letting him be born into this cruel world, or for passing on the genetic tendency toward diabetes. That’s how Robert felt. In the early days, he resented his parents for passing diabetes on to him.
The diabetic may also be angry with the doctor or nurse or whoever broke the news to him.
Although anger and depression normally follow the initial diagnosis of diabetes, it may return at any time of crisis. If a diabetic complication develops, these emotions may begin all over again.
When something goes wrong, most of us look for someone to blame. Sometimes we blame others, sometimes we blame ourselves. Diabetics are no different. When they hear the diagnosis of diabetes, a diabetic and his family members may immediately start looking for someone to blame.
A child may blame the doctor or the nurses or the hospital. Not understanding the causes of diabetes, the little child may feel that the doctor or the hospital gave him the disease. After all, it was only after hearing the diagnosis that he had to begin taking insulin injections. It was only after seeing the doctor that he could no longer eat some of his favorite foods.
Older children or even adults may blame parents or other family members who already have diabetes.
Some people blame themselves. Many diabetics and their family members experience feelings of guilt, even when there is often no real cause for such feelings.
Type I diabetes has little or nothing to do with anything that a person has done or not done in the past. Yet parents of the insulin-dependent child may blame themselves for not protecting their child from harm. They believe that they have failed as parents. Some parents feel certain that they have done something wrong—otherwise their child would surely not be sick.
In type II diabetes, a person’s lifestyle—overweight, improper eating habits, lack of exercise, et cetera.—may truly have contributed to the illness. Thus he may feel that he is being punished for his wrongdoing, and so he experiences strong feelings of guilt.
Once the reality of the diagnosis has struck, almost everyone asks, “Why me?” Or a parent will ask, “Why my child?”
Several years ago, my very dear friend Norene and I coauthored a vegetarian cookbook. Both of us had trained as nurses at the same school, and we were both excited about health education. We wanted the recipes in our book to be nutritious, tasty, and healthful.
In her home life, Norene was even more strict than I was about following every good health principle. She fed her family only the most healthful meals—they rarely had sugary desserts. Norene trained her children to get daily exercise from the time they were small; she ensured that they had adequate rest; most of all, she taught her children, Royce and Caroline, to trust God to help them through times of stress.
Norene’s children were almost always the healthiest in the neighborhood. Then, when he was 17, Royce became sick. After many tests, the doctor gave the diagnosis: insulin-dependent diabetes. It was not only a shock, It was also a struggle for Norene and her dentist husband not to feel betrayed, not to feel, “We’ve always done our part. We’ve always taken good care of the children. Why, now, has God allowed this?”
Often the family and the patient with recently diagnosed diabetes or cancer or other serious disease will begin trying to bargain with God or with fate.
“If I’m really good,” they reason, “God will help me get over this.” Or maybe, “If I’m a good patient and do everything the doctor tells me to, I won’t have to worry about any complications.”
Some may try to bargain with the doctor. They have the attitude, “If I do everything the doctor tells me to, maybe he will let me eat whatever food I want.”
Some diabetics, after hearing the diagnosis, may begin to isolate themselves socially. Failing to really accept their diabetes, they feel that others cannot accept them with it either. So they withdraw, avoiding activities which are normal for their age group. They may stop going to parties or other activities that they once enjoyed. Young diabetics often begin going home immediately after school instead of hanging around with friends as they had before.
Loneliness is a common problem. Some diabetics avoid making close friends—or begin avoiding friends who were previously close to them—because they feel that they cannot trust anyone with the knowledge of their illness. Others have a feeling of shame, as if having diabetes were the result of some terrible sin they had committed.
Others begin to associate only with other diabetics, feeling more secure about being accepted. Although they do have much in common, there is a real danger that their friendship may focus too much on their shared problem rather than on the positive aspects of life.
Teenagers June and Stephanie met at a camp for diabetic children. Soon they became close friends, discussing everything about diabetes, including their secret worries and frustrations. At the end of the camp, the two girls continued to see each other often. After a year or two, however, June stopped phoning and going places with Stephanie. And Stephanie questioned why.
June gently explained. When they first met, they were both just learning how to cope with life as diabetics, so that was naturally what they always talked about. “But life has to go on—there’s more to life than just being a diabetic. I’ve got to have friends who can talk about real life, friends who can talk about something other than their diabetes!” June continued, “Diabetes is still your life, Stephanie, but I can’t let diabetes control me. I’m going to control it!”
June was interested in music, school, sports…and she was not going to allow her diabetes to interfere. Fortunately, many—like June—do decide that they are not going to let life pass them by or control them.
Acceptance of diabetes indicates that the denial period is over and the reality of the diagnosis has sunk in. More than that, however, it means taking up the new responsibility of living with the disease and its inconveniences and problems.
The Oxford dictionary gives several definitions of “acceptance”: to take willingly; to treat as welcome; to take as true. It is difficult to believe that anyone would receive diabetes happily or welcome it into his life! No, most likely the idea of “to take as true” and another definition—“to undertake (a responsibility)”—are the most applicable to the diabetic.
After Nancy’s initial anger led her to eat anything and everything she wanted, she soon began to experience some pretty bad headaches. Then she came to the realization that it was “time to quit all this and live right.” She told herself, “I’ve got to get up and fight it.” She decided that she should be happy. She had been overweight for a long time. She had never before had the willpower to live the way she knew best, but now she would be forced to stick to a really healthful lifestyle.
Be happy about having an incurable disease that changes your whole life? Impossible, you say? Well, maybe being happy seems a bit too much to ask of a person. But at least a diabetic can learn to be content with his life. He may go on to become the best person he can be, do the greatest things he can do, and be the happiest he can be.
Many diabetics find that in trying to live with their diabetes they have actually become greater, more athletic or more talented people than they had ever hoped to become. What a diabetic accomplishes with his life depends on his own acceptance of his condition.
Perhaps a better word than “acceptance” might be “adaptation”, or simply “acknowledging diabetes as a fact of life”. The diabetic needs to decide, “This is for real, and now life must go on!” This is the time when diabetes stops becoming the biggest thought in the mind of the diabetic or his family members. This is when diabetes becomes part of the daily routine. This is the time when diabetes may give you the discipline to succeed in newer and greater endeavors.
Diabetes may become a handicap or a hurdle to jump over, a hindrance in life or a help. It may become a curse or a challenge. Attitude is what makes the difference.