Getting Around to Accepting Diabetes

June 7, 2004

GREETINGS --

The following piece looks at the stages of diabetes that need to be

overcome to get on with your life. It is an excerpt from a Diabetes

Self Management arrticle and offers some good insights whether you

are a newbie or a long-timer who is still having proglems coming to

grips with this chronic disease.

Remember to BE PROACTIVE,

wambo1941

Dealing With the Diagnosis

Where Do You Go From Here?

by Ruge, D.Min.

I began to wonder how two people of similar age and with essentially

the same health concerns could react so differently. I began to see

that either approach—viewing diabetes as a wake-up call or a curse—is

a choice that each person decided to make. And it is a choice you can

make, too. Armed with the right information and attitude, you can

still make the most of your life despite diabetes, and you can even

change your life for the better.

Shock and reorganization

Whether you've known for a while that you have diabetes or were

recently diagnosed, you already know that this challenging condition

requires you to rethink a lot of your life. How you engage in that

process might be the key to whether you become a or a as

you restructure your life and move on. To explain this kind of

learning experience, Virginia Satir, one of the pioneers of family

therapy, created the Shock and Reorganization Model.

Shock occurs when you suddenly get new information, such as finding

out you have diabetes, that conflicts with your sense of who you are.

Life as you know it is suddenly disrupted by profound new issues that

you have no choice but to deal with, whether or not you understand

them at the time.

Reorganization follows, in response to the initial shock. You find a

new way to put the pieces of your life back together, reorganizing

your self-image, activities, and relationships.

I see these steps at work in the life of a friend who recently

learned he has diabetes. It was indeed a shock. The news ushered in a

period of profound personal adjustment, which was made more difficult

by the fact that his life seemed to be in perfect order before the

diagnosis. Steve is a successful stockbroker who is happily married

and has two wonderful young children. Suddenly, he feels his health

has been taken away from him. Steve acts like someone grieving the

loss of a loved one. He is sometimes difficult to live with at home.

He says he feels exhausted—not so much because of his diabetes, but

because of the stress of adjusting to change. Yet even in these tough

days, he's beginning to put his life back together in a thoughtful,

constructive way. As Steve learns to deal with changes in his

physical health, his attitude is turning back toward more positive

thoughts. His wife and friends know that he's going to adjust and

that he'll be all right.

But will Steve merely cope with diabetes, or will he reach some

better, transformed life, as my friend did? Perhaps the answer

to that question lies in the writings of Dr. Elisabeth Kübler-Ross, a

psychiatrist and authority and counselor on issues related to death.

Stages of change

According to Dr. Kübler-Ross, when people confront a significant loss

or major life change such as the onset of a chronic illness, the loss

of a loved one, the loss of a job, or a divorce, they adjust to the

change in a series of predictable stages. Regardless of the source of

distress, most people go through the stages of denial, anger,

bargaining, and depression before reaching the final stage of

acceptance.

Denial. This is the first, ostrich-like response. When someone first

learns that he has diabetes, for example, he is likely to react by

sticking his head in the sand and saying, " This is not happening!

This can't be happening to me! This is not who I am! " When confronted

with any life-altering news that doesn't fit a person's sense of who

he is, this is a natural first response.

Anger. In this second stage, the person begins to wonder, " Why me?

This is unfair! What did I do to deserve this? Why is my health being

affected? " He may even become angry at God (who serves as a handy

scapegoat for unwanted life changes), or he may blame his spouse,

friends, or family members for his new problems.

Bargaining. In this stage, people begin to consider making changes.

The newly diagnosed person with diabetes may have thoughts such

as, " If I don't eat Snickers bars for the next six months, then

everything will be fine and I'll be back to normal. And I'll walk

every day, too. OK, is that a deal? " Of course, watching your diet

and maintaining an exercise program will help blood sugar control,

but you know that diabetes will not go away. Even though such

thoughts usually do not result in changes that improve the situation,

bargaining allows people to grapple with how they are going to change

their lives. Yet it isn't the ultimate answer, since people cannot

erase changes in their lives.

Depression. As people start to accept the permanence of these

changes, they usually get the blues. They lose hope, lack energy,

experience trouble sleeping, or see a drop in libido. At this point,

many people also report that they're just going through the motions

of daily life. " The horizon seemed a kind of bleak gray, " one woman

recalls, " and I thought it would stay that way forever. " Such

depression saps their sense of hope and sense of the future. But

after they have gone to this dark place, the gloom lifts and they can

move on.

Acceptance. A new day dawns somewhat gradually. People begin to

accept the new changes and they envision a future—a new life that

takes diabetes into consideration. They can see new possibilities and

new options for themselves. With the support of family and friends,

advice and guidance from health-care professionals, and some healthy

reevaluation, they can move ahead with a restored sense of hope.

How these stages help

Knowing about these stages of change is helpful because it provides a

framework for people to understand their feelings and lets them know

that others have had similar experiences.

Knowing about these stages also lessens the chances of getting

stalled in one stage and not moving on. It's easy and seductive, for

instance, to get stuck denying one's diabetes by not taking

medicines, not exercising, and not monitoring your blood sugar. It's

equally tempting to get stuck in depression and self-pity, casting

yourself as a victim of a capricious God, your genetic makeup, or

your past habits. Denying your feelings of anger or depression is

another way you can get stuck moving through the stages. But if you

realize where you are in the process, you stand a better chance of

breaking out, moving on, and finding new meaning and rewards.

If you're going through such a process (or if you're supporting

someone who is), it may help to know that people usually work through

the five stages several times over and not always one after the

other. In fact, most people spiral back and forth through the stages,

gravitating slowly toward acceptance. One day they're working on

acceptance issues, then the next day they're bargaining, angry, or

depressed. It takes time and patience and inner courage to accept

your feelings as you move this process along.

From acceptance to mastery

Once a person with diabetes reaches acceptance, he can view diabetes

not as a loss, but as an opportunity to reorient his life and

priorities. That's clearly what did. He incorporated all his

changes and restructured his life magnificently.

When people reach acceptance, they often say they now occupy a new

kind of landscape—a place that's different from where they lived

before all the changes took place. Often, they start to review the

past.

When you have reached this stage of the change process, you too may

find yourself considering how you've lived your life up to this time.

What's been important to you? What would you have done differently?

You're really starting a new chapter! Another characteristic of this

stage is that time may become more precious to you. We're not

immortal. And our choices may be limited. But these thoughts aren't

necessarily limiting or morose. In fact, they may be an invitation to

take risks and redirect our lives to where we really want to be.

As that new horizon becomes brighter and better defined, many of us

can focus on what is truly important to us. An exercise developed by

Covey (author of several books, including Seven Habits of

Highly Effective People) can help you achieve that level of insight.

In this exercise, imagine yourself sitting in the back pew at your

own funeral service. No one can see you as you listen to eulogies

about you delivered by four different people. The first eulogy is

given by a colleague, who talks about what you were like at work. The

second speaker is a friend, who talks about you as a member of your

social circle. The third is a relative, who describes your home and

family life. The fourth is a member of your religious community, who

recalls you in that context. Listen closely as you sit in your

imaginary pew. What would those four people say, honestly, about you?

Is that the kind of eulogy you would like to hear? If not, what are

you going to do about it?

Certain questions will arise in your mind as you go through this

exercise. What qualities would you like to be remembered for? What is

most important in your life? What are your values? What do you stand

for? Are you living your life according to those values and beliefs?

These questions offer an opportunity to orient yourself toward a more

authentic you.

Creating a spiritual tie

As you set your life back on center and start moving ahead, you might

also want to bring another level of self-discovery into the process.

You might say, " OK, I'm in a new place. My health is back in my

control. I'm sorting out my values. But are these new life changes

also a spiritual opportunity for me? "

They probably are. In the words of author a D'Arcy, " God is in

the detours. " She means that any cataclysmic life change offers an

opportunity to ask the spiritual questions, " What am I supposed to be

doing with my life? " and " What does God intend for me? "

I recall my own father working out those issues. Dad faced hurdles

and losses like the rest of us, but he still somehow managed to

reorient his life toward a more spiritual plane. For one thing, he

had diabetes back in the days before many of the medical advances

that are available today. For another, he lost his wife at a

relatively early age. I recall that he went through stages of loss

similar to those I describe above—certainly through anger and

depression. Yet through it all, he defined a new role for himself as

a teacher and spokesperson in a 12-step recovery program. Helping

other people became a very meaningful opportunity for him to put his

diabetes in perspective and to get his life back in order after my

mother's death. Despite the difficult challenges, he used them to

open doors to new ways of thinking that were both meaningful and

personally authentic.

Finding your path

So, where are you supposed to go as you begin this new chapter in

your life? It may mean drawing closer to family and friends. It may

mean discovering and following your passion—whether it's a long-

deferred dream or some new interest. It may mean taking a new role as

you encourage acts of healing and reconciliation among your family

members and friends. Or it may mean an increased devotion to

spirituality or health or nature. Life is an open book. You can write

your own story.

As you navigate your unique journey, try to remember that your path

may not be exactly what it at first seems—a hard road, blocked by

high obstacles and tough challenges. It is really an opportunity for

you to redesign your life in a fuller and more authentic way. As you

walk this new walk, I wish you good luck, good friends, and Godspeed.

June 7, 2004

Thank you---Rolf

[alldiabeticinternational] Getting Around to Accepting Diabetes