What is it about a threat to health that is so disturbing that we put off regular health exams, ignore obvious signs of disease or refuse to seek treatment?

Simply put, it is a deep-seated fear of change. Not just change of routine or habits, but of the sense of self. In other words, the person you are today is not the same as the person you will be if you have a severe health issue.

And that can be very scary to people.

We sometimes couch this fear in terms of “fear of impending mortality.” Death is a final change, one we cannot control or escape. Those who have a hope of an afterlife, however it is framed, may find this fear less threatening.

Some find it difficult to face loss of control, whether over body functions (e.g., heart, lung or kidney function) or of daily living choices. Will we have to give up favored activities? Will we even be able to care for ourselves?

I submit that the deeper psychological aspects are the scariest.

You go through life with a sense of who you are that is based in several schema, the complex conceptualizations about yourself and the world that you build from experience, education (in many forms) and the conclusions you draw. Depending upon its nature and severity, the development of disease invalidates the schema to varying degrees. In a very real, but very deep way, you become a different person, one that even you do not really know.

In the process, you begin to question every aspect about yourself, to investigate how much different you are. Deep down, you wonder if you will ever return to “normal.” If “normality” does not return, you wonder if you can be happy with the person you have become.

Sometimes, the presence of disease makes very negative statements about your self-worth. If, deep inside, you see yourself better than those with disabilities or severe illness, or if you felt disgust and embarrassment over the social implications of another person's imperfections, I guarantee that your pride will take an immense hit the day you find yourself like them in some way. Many a senior citizen suicide stems from this “loss of dignity.”

So it is always good to hear a person say, “I may have this disease, but I can still do these other things.” Such a person has successfully incorporated the disease-related changes into his self-image. It is more than a statement that “I can live with this.” It is a statement of “I am okay, and I still like/love myself.”

What makes the adjustment process easier for some than for others is the degree to which they have been flexible and adaptive in other areas of their lives. Rigidity in approach to problem solving, no matter the problem, is always problematic. It is as if you always used a hammer for every repair job, because that is all your toolbox has in it. If flexibility is difficult for you, I encourage you to contact a clinical psychologist who can, over time, address that issue with you.

Next week: finding peace when disease wins the battle.

Grace MacDowell, M.A., of Auburn, is completing her

doctorate in clinical psychology.

She can be reached at drmac2be@yahoo.com