Why Anger Plays A Critical Role In Diabetes Self-Care

This post appears on my personal d-blog, which can be found at http://sstrumello.blogspot.com/, which you may wish to check out if you can.

The other day, a friend of mine, Chris Bishop (Type 1 Tidbits) wrote a very compelling blog post called "Diabetic Superheroes" (see here) which I think was really well said. The simple reality is that anyone who deals with a chronic condition is a superhero, and deserves to be recognized as such, especially since it's such a thank-less job.

A number of people (including many medical professionals) make bold claims that anger should have no role to play in managing a chronic disease like diabetes. Some of these individuals suggest that acceptance is or should be a key component to effective, ongoing self-care. I can't tell you how many diabetes educators who cling to this belief, because over the years, I've met simply too many to even try to recount here.

David Mendosa, whose great work I admire tremendously, recently posted about this very subject, with a story featuring a provocative title "Are You A Noncompliant Diabetic?" (see here). While I agree 100% with David's well-written article about "Incorrect Diabetes Terms" (see here), I still take issue with the contention that getting angry is as unproductive as calling patients noncompliant or diabetic.

David cites a new study in the medical journal Hormones and Behavior, that shows that when people get angry, their heart rates and arterial tension increases along with other psychobiological changes. Those may very well be accurate facts, but I still believe that healthy anger can lead to some very productive outcomes, and for some people, may actually play a vital role in effective self-care.

In fact, healthy anger can mean we have a whole lot more personal power and energy to help solve problems (which is needed on a daily basis to effectively manage a rapidly-morphing disease like type 1 diabetes, where insulin dosages defy the rules at almost every turn). The key is to acknowledge that anger is a healthy and natural emotion, and then learn to channel that emotion and use it in healthy and productive ways.

Personally, I think the minute I "accepted" diabetes into my life was also the same moment that my diabetes management went into the toilet because I viewed it as so permanent. To me, diabetes acceptance = defeat. By accepting diabetes as a permanent part of life, I had little energy or even willingness to stay on top of it, and my health was impacted. When I accepted and welcomed diabetes as a part of who I was, my self-care (and my HbA1c) was much, much worse than it is today. I would argue that anger about the diabetes was a far more effective self-care motivator, and continues to be many years later. In fact, my care did not improve until I completely rejected the idea of accepting and welcoming diabetes into my life. It was only after I channeled my anger and rejection of diabetes into self-care, as well as into fundraising and advocacy, that I achieved better significantly better results. So for those of you who claim that we need to "accept" diabetes, I have always said NO WAY.

Fight against it, diabetes should always be treated as an unwelcome guest in your body and in your family, and it does not belong there! Use that anger for a worthy purpose, instead.

Sure, some CDEs and doctors will point to yet another study of the obvious and ask what evidence I have that anger plays a role in effective self-care. I think my HbA1c's speak for themselves, both before and after my outright rejection of the idea of diabetes acceptance. But for those pin-heads that ask for clinical data to back my assertions up, let me refer you to one of my earliest blog postings, nearly 5 years ago (September 29, 2005) in which I cited a then recent study that showed medical research spending had doubled, yet all of this research had yielded mostly disappointing results. My personal experience proves that anger can indeed play a critical role in diabetes self-management (as it should), so I don't need more validation than that. In fact, we can and should argue that acceptance might actually have the opposite effect on good self-care behavior -- when that anger is channeled properly.

I think one way that "anger" can effectively help deal with diabetes is best demonstrated by the birth of a not-so-little nonprofit organization now known as The Juvenile Diabetes Research Foundation (JDRF), whose very roots were born in anger, not acceptance. That emotion has helped turn millions of frustrated parents and family members into a fundraising and lobbying dynamo (see here and here for 2 interesting presentations on the role of advocacy for JDRF), and that organization has arguably done far more to alter the course of diabetes research prioritization than a much longer-established diabetes organization like the American Diabetes Association has. In effect, parents' and patients' anger has been effectively channeled into an organization whose goal is not to maintain the status quo of treating diabetes in perpetuity, but to eradicate this disease completely, and put themselves out of business.

In the words of Lee Ducat, one of JDRF's founders in 1970 and the first President of the organization: "When you have children with an incurable disease, you have an insatiable appetite to do anything and everything you possibly can to help them, and that's why I started this Foundation. I'm optimistic that a cure is going to be found and the Juvenile Diabetes Foundation can go out of business."

Of course, that promise has yet to be fulfilled, but if it weren't for the JDRF, we would be much further away than we are today, and I think the evidence speaks for itself as far as advances are concerned. And anger, I think, played a key role in that. In fact, one could argue that MORE anger about type 2 diabetes could actually go a long way towards changing the research priorities for that form of the disease, possibly advancing cure-related efforts there at a faster pace than we have seen to date. We need look no further than looking at how AIDS activists like Act Up which was the very definition of a patient political advocacy, turned the paradigm on it's head. In 2004, The Wall Street Journal wrote "Not since AIDS advocates stormed scientific meetings in the 80's has a patient group done more to set the agenda of medical research" (in reference to JDRF). That same anger also needs to be unleashed against type 2 diabetes, or I fear we're likely to see just more of the same (which frankly, isn't working very well) for a long time to come.

For me, anger with diabetes is what motivates me to fight so hard against it, and therefore manage this disease as well as humanly possible given the relatively rudimentary tools we have to do the job. But that anger is also what keeps me motivated to continue fighting against it, by fundraising and sharing these views with others. Above all else, I think it's time to finally recognize the tremendous value that anger actually does bring to the equation.

Views: 329

Tags: 2010, Chris Bishop, David Mendosa, JDRF, Lee Ducat, anger

Comment by The Diabetic Welfare Queen on June 3, 2010 at 6:20am
Accepting one's Diabetes isn't tantamount to being a doormat about Diabetes; it's tantamount to taking it by the horns, and wrestling it into the ground. The anger most people talk about is not the sort of anger that drives someone into motivation, to do something about their condition; it's the anger that makes people throw themselves against the wind, and never do anything because they are so angry they got this disease, that now they're just going to let their lives go...

We can either be rationally angry, or productively angry... And anger is a healthy part of life. If we did not get angry at the various injustices of the world, there would be no laws, and no justice system. If we did not get angry at little children having to stick their fingers every day, and have to think about things no children should, there would be no JDRF.

One of them is an effective motivator, and a driver of goals, ideals, and motivation; the other destroys lives. If you have moved into the type of anger where you actually do something about the Diabetes, then you have accepted your diabetes... And you, my friend, are no doormat.
Comment by foodiemcbody on June 3, 2010 at 6:50am
Wow, this is a great and provocative post. I never thought of it in these terms. I was diagnosed with Type 2 D a little more than a year ago. Prior to that, I was overweight, inactive and unhealthy in pretty much every way. When I was diagnosed, it blasted me into action and motivated me to change my life. I lost 35 lbs, became a runner for the first time, and made many other changes. So I am actually immensely GRATEFUL to diabetes for bringing these changes on. I do feel determined, fiercely determined, to keep my diabetes under control, and I don't feel that I *accept* it. But at the same time I do feel weirdly grateful. Because it woke me up.
Comment by Bradford on June 3, 2010 at 8:10am
I think your post is really interesting. To me, anger doesn't seem to be the best term. The only time I was "angry" was during my teenage years, and my A1cs showed it (in a bad way). I was p***ed to be dealing with this disease when others were not. Then I think I came to my senses and used more positive emotions to come to much more positive diabetes management results. Also when I read items like Ducat's quote above, I didn't read "anger" at all. I read "drive," "passion," and even "motivation," among others. I feel like we might operate similarly with our diabetes management (testing often, counting carbs, delivering insulin to keep our BGs in check) but our motivators seem different, at least on the surface of the terms we use. Despite the emotional terms we use being different, I'm glad that each of us is able to control our diabetes so effectively. Nice post.
Comment by YogaO on June 3, 2010 at 2:51pm
Interesting post. I agree with others that the crux of disagreement lies with your statement, "To me, diabetes acceptance = defeat." I have to reject that approach, but if it works for you - YDMV!

To me, diabetes acceptance = get engaged in treating this chronic condition. Reduce the times where it consumes my every thought and action. Increase the times where it lives in the background. Again, for me anger is just not sustainable enough to let me commit to managing my D 24/7/365/4LIFE!

Now as to your second thesis around the "anger" that started JDRF and the need to get "angry" over the explosion of T2, that's more thought-provoking.

Fair Winds,
Comment by DC Reporter on June 4, 2010 at 2:31pm
i'm probably a lucky exception, but i've never bothered with this exercise in all my years with D. i was dx'd at 8 months and have been T1 for 50 years. i have no complications; never had a seizure; never been to the hospital; never had a nasty moment. i am happy and productive. and ... i have never regretted D for a second. i've never resented it and never pouted about the things i couldn't eat. life is too short. d is what it is. you deal with it and lead a happy, productive life.
d is like the dull roar of an interstate in the distance. you know it's there -- always -- and you have to know when you get close, but it doesn't change the way you live your life. i'm convinced i'm healthier and, yes, happier because i have d. i know i'm stronger and more resourceful. it has nothing to do with accepting it or not. there's no choice so you deal with it and move on.
Comment by Annie on June 5, 2010 at 8:04am
shout out to the JDRF!!!! In hopes that my 4 yr old son (dx at 2) will one day not have to pause what he is doing to make sure his numbers are good, where he can be a "normal" kid and go to sleep overers with out his mom tagging along. JDRF is our life line of hope!!!!
Comment by Kathyann on June 5, 2010 at 9:30am
Anger is also part of depression and I don't want to be depressed about the betes
Comment by Kathy on June 5, 2010 at 8:09pm
Scott, I have a very strong flippin' freakin' crazy woman side to me and have been mad at the world for most of my life. I don't think any of that would have changed if I didn't have db. However, anger does provide me with an excuse to compromise on self-care, so for me, it is of little use.
Comment by Scott Strumello on June 6, 2010 at 9:09am
To Lots of Shots,
I've lived with type 1 for 34 years as of next month, and while the five stages of grief might sound applicable if grief had anything to do with it, I still believe that anger plays a vital role. Acceptance during my teen years meant ignoring diabetes because it was viewed as a moot point. Some of this is an exercise in semantics; you say tomato, I say tomahto, the reality is that what motivates each person's self-care does not follow a text-book definition for all, and if anger works, then who is anyone to argue with that?
Comment by Ronnie Gregory M on June 7, 2010 at 4:56pm
I say to each his own, whatever gets you off that couch and do something about taking the bull by the horn and taking care of your health, to you it is most certainly anger but I personally, I am a happy go lucky kinda guy and I must admit that fear has been my biggest motivator when it comes to diabetes. When I see those highs and feel those symptoms I am motivated to do something about it.


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