The
Experience of the “Urge”
Leonard Lipson, M.A.,
Psychology
At
the end of my last article, I promised to give examples of what
others had reported as their experience of “Urge”.
Before doing that, let’s take a moment to review, so that
we don’t get lost in the examples and lose track of what this is
about.
The
point here is to increase the quantity and quality of patient adherence.
There are tons of reasons to focus on this, which are often
expressed in statistical terms.
Elevated blood sugar damages many areas of the body 10-15
years before the onset of symptoms. For every 5-8 pounds of extra weight there is a 6% increased
chance of developing diabetes.
Moderate changes in diet and exercise lowers the chance of
developing diabetes by 58% if you are pre-diabetic.
Etc. etc., etc. Then
there are the reasons expressed in human terms - the struggles of
the people that come into your offices, the impact of their disability
or death on their family and friends and the loss of quality of
life.
My last
article described some reasons for examining your own “Urges” as
a means to facilitate patient compliance.
This examination could lead to better communication based
on increased respect, empathy and caring.
It could illuminate your own personal experience, which could
then be shared with your patients.
It could show you how the investigation of the “Urge” experience
could, of itself, begin to combat habitual but destructive life
style choices. The
more you have attempted to examine your
“Urge”, the more meaningful the material below is likely to be.
Those of you who haven’t read the first two articles of this
series might find it useful to do so before continuing here.
The
Mind and Diabetes: Their Many Connections
Why
Examine Your Urge?
The
experience of the “Urge” has three phases we will focus upon in
this article:
1)
Emergence – the coming to consciousness of that which drives
you towards a particular behavior.
2)
Resistance – Responses that work against acting on the particular
behavior.
3)
Resolution – what you actually do in regard to the particular
behavior.
Having
“Urges” is normal behavior and one that adds quality to life.
What is done with them and how often, is what sometimes causes
difficulty. I have
wandered into the convention of referring to the “Urge.”
Others might prefer “Yearning”, “Craving”, “Longing”, “Need”,
“Want”, “Drawn to”, “Compelled towards”, “Impulse”, “Desire”, “Temptation”,
“Lured”, the ever-popular “It called my name” or other similar verbs.
Sometimes the “Urge” experience has the true obsessive-compulsive
quality of being driven to act, though you know that the behavior
is excessive or unreasonable.
The degree of anxiety, sometimes franticness, which accompanies
the “Urge”, varies from person to person.
One purpose of the detailed responses provided below is to
help you recognize the “Urge” experience that occurs in your patients
with blazing speed. Once
you’ve slowed down the experience sufficiently, you can help your
patients investigate the aspects that are obstructing their desire
for health.
“Experience”,
at least as I am using the term here, is divided into three dimensions:
1)
Thought – the cognitive, intellectual, idea/concept/judgement
dimension.
2)
Feeling – the affective, sensation, often non-verbal, inner
dimension.
3)
Action – That which can be seen or measured.
This includes bodily changes, such
as blood pressure.
We’re
going to use these dimensions of experience to examine three Phases
of the “Urge.” To begin,
we’ll look at examples of what is sometimes thought, felt and done
during the first Phase of the “Urge”, Emergence.
Emergence
– Thoughts
“I
have an urge for….”,
“I wish I didn’t have the urge.”
“Am
I hungry?”
“I
must be hungry.”
“Here
comes trouble.”
“How can I do this without being seen?”
“How
soon can I get X?”
“Where can I get X?”
A
shift in thinking wherein the Urge diminishes attention to other
objectives.
Emergence
– Feelings
Pull
to get/do the object of the Urge
Surprise/startled
Memory/anticipation
of pleasure
A momentary numbing of awareness
Helplessness
Hopelessness
The
strength of the Urge
Taken over by aliens
Fear
loss of control
Ashamed
Worry
about diabetes
Resigned
Emergence
– Action
Lesser
functioning at present task
Agitation
Lesser
connection to others
Becoming quieter
Can
you recognize yourself? Your experience of Emergence may be different.
The above are only examples.
The next Phase of the “Urge” experience is Resistance.
Once you recognize that the emerging impulse may have aspects
that aren’t good for you, what do you think, feel or do to fight
it?
Resistance
– Thoughts
“It’s
bad for me.”
“I’ll have to monitor/adjust blood sugar.”
“I
have to fight this.”
“I don’t need this.”
“I’ll
hate myself tomorrow.”
“This is off my diet.”
“I’m
diabetic. I can’t have
that.”
“I want to be strong.”
“I’m
going to ignore it.”
“Maybe it will go away.”
Resistance
– Feelings
Feel
the self-loathing of the next morning
Images of incapacity
A
stiffening
Determination
Fear
of loss of control
Pride
Avoiding
failure
The desire to be attractive
Fear
of displeasing others
Fear of losing others
An
unacceptable body image
Being
one down to a rival
Resistance
– Action
Increased
stress level/blood pressure
Attempts at distraction
Moving
away from the gratifying object/situation
Talking/writing
to oneself
Agitation
The
third Phase of the “Urge”, Resolution, will have to be left for
the next article. There are already too many items-on-a-list.
They generally have a numbing effect, which is being studied
for use as an anaesthetic.
Hopefully, you’re still with me.
Resolution
contains two parts. One resolution occurs when you successfully
resist the emerging Urge and the other resolution occurs when the
Urge controls what you do.
Listen to your patients using the framework above. Listen
to yourself. See if
you can identify the thoughts, the feelings and the behaviors that
emerge as you resolve the struggle between the Urge and the resistance
to it. Familiarity
facilitates control.
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