Tamara McClintock Greenberg Psy.D.

21st Century Aging

Self-care and the Devil You Know

The commonality of poor self-care

Posted Mar 12, 2010

While preparing for a recent talk on the topic of what I loosely refer to as "self-destructive" dynamics and health behaviors, I had a chance to think about the juxtaposition between what most of us know we should do to take care of our health and what many of us actually do related to forging a healthy lifestyle.

The talk I was preparing is related to a chapter in my latest book, Psychodynamic Perspectives on Aging and Illness. The chapter describes self-destructive behaviors and how common it is to not take care of one's body. Since medical research has repeatedly shown that as much as half of the U.S. population fail to follow medical advice, it seems important that we try to understand what the barriers are that disrupt optimal self-care.

Taking care of one's body is complicated in a number of ways, as reasons for poor self-care involve many pathways. For example, we know from an important study by Felitti and others in 1998 that people who have histories of child abuse tend to not take care of themselves: they are more likely to drink excessively, smoke, are physically inactive and have unprotected sex. We also know that depression is related to difficulties in attending to one's health, but this is often mediated by a lack of trust in physicians. This is especially true for members of racial and ethic minorities, whom, as some have suggested, because of the Tuskegee experiment, have good reason to be wary of medical doctors and those in positions of authority.

Beyond these factors, putting energy in to health requires a lot of work--as well as time and money. The guidelines for self-care have expanded exponentially in recent years. They include moderate alcohol use (or relatively little if you are trying to avoid certain cancers), adequate sleep, managing weight, not smoking, consumption of plenty of fruits and vegetables (preferably organic), daily exercise, frequent visits to the dentist, as well as flossing everyday, and a diet low in saturated fats, to name the most common guidelines we are charged with. A recent Huffington Post article by Pooja R. Mottl addresses how wellness has become a luxury good. Not only is it hard to stay abreast of current healthcare advice, actually implementing recommendations requires money that many people don't have. To mention just two of the guidelines, healthy foods are more expensive than junk food and dental work and treatment require a full wallet, since many dental insurance plans have limited coverage.

I guess it is not a surprise that the privileged are more likely to stay well. Lifespan statistics have long illustrated differences across socioeconomic class lines. And though there are aspects of this sad problem we cannot control, I think that being realistic and honest regarding the difficulties of self-care may help people feel less ashamed regarding what they know they should do for their health and what they are actually able to do.

Advice related to self-care often comes from a middle-class perspective. When we pause to think about this, it should help us all be more sensitive to the struggles that people with relatively fewer resources face. This includes those in the middle classes who are trying to stay afloat in a barely functioning economy. By and large, people who engage in behaviors that are not healthy are aware of the risks. But when money and time are scarce, people stick with what they know. In this way, negative health behaviors are the known "devil" that does not require as much effort. Though I am all for encouraging people to adopt better lifestyles, advice needs to be dispensed in a nonjudgmental and non-elitist way. Reducing the shame that is inherent in lifestyle counseling and acknowledging the realistic barriers for those we try to help is a first step in changing our problematic healthcare system.

Additional references for this article can be obtained by e-mailing the author at Greenberg@medsch.ucsf.edu.