Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
2 January 2002

REFRAMING

     Thousands of years ago a very famous Greek philosopher stated,  “There is nothing ever good or bad but thinking makes it so.”  This quote applies to medical considerations so frequently because both disabling belief’s (thinking) and reckless disregard abound in medical considerations.  A lady recently came to the clinic with a significant medical problem and was shown that she could gain highly beneficial comfort from simply reframing a belief system that was ill founded.

    To give an example of what reframing means, there is the story of a gentleman who was about to cross the street.  He had barely stepped off the curb into the street when a very expensive sports car came racing by and nearly hit him.  As the car came racing by, the man noticed that there was a young child driving the sports car and an elderly gentleman sitting in the passenger seat.  The man that had almost been hit by the sports car was highly indignant.

    Unfortunately, he did not see the license plate, but reported the description of the car to the police and registered a formal complaint.  He felt that he had almost been killed through the reckless allowance of  a young child to drive a very powerful fast sports car in busy traffic.

       The next morning he picked up the newspaper and read how a 12 year old child who had never driven a car was able to race his grandfather to the emergency room at a local hospital, saving the grandfather’s life.  Both child and grandfather apologized for any fright they might have caused from the ride, but the 12 year old child indicated that he loved his grandfather very dearly and did what he could do to save his grandfather’s life.  All acknowledged that there just wasn’t time to wait for an ambulance.

       How different the gentleman who had almost been hit by the sports car felt when he heard the actuality of the story.  It didn’t lessen the danger he had faced but it did explain in noble terms what the gentleman had previously viewed as a reckless, dangerous, irresponsible, and uncaring act by a child who was only out for thrills.  Now instead of the child being viewed as a reckless, uncaring thrill seeker, he was viewed as a hero.  The actual act when the gentleman crossing the street was almost hit was unchanged but the frame in which it was placed was entirely different.  The gentleman who had almost been hit could now withdraw his complaint and was at peace with what had happened.

       This is called reframing.  It means placing a context and a perception on an event that allows a person to have a different and hopefully, a more favorable experience with the things that happen.

       So now comes the story of an individual who did not like medicines.  To her, medicines symbolized weakness and her own mortality, which she (like all of us) was very uninterested in facing.  She was invincible.  She was a “normal” human being.  There was no reason to go to doctors or seek health advice because there was nothing wrong with her.

       I promise you that people with this attitude sooner or later come to a rude awakening. She developed chest pain and eventually had to have a procedure done to open a coronary artery that had been closed due to a number of factors that cause coronary artery disease in our population.  All of a sudden, her invincibility and immortality had to be reconsidered.  She was very resentful, even depressed, of the idea that medications were an important part of her care. She said that prior to having her heart treated she didn’t have to watch what she eats.   She didn’t have to stop smoking.  She didn’t have to stop drinking.    She didn’t have to go to bed at night. She didn’t have to do anything to watch her health.  Now thrust upon her were all of these restrictions.

       I pointed out to her that what she was asking for was rather like being able to drive down the road with your eyes closed, not having to pay attention to where the car was going, or what might be in the way.  Most people just don’t drive like that, they open their eyes, they watch for obstacles, they keep the car on the road, and they get to their destination.  Why would you think that your health and your life would be any different?

       So now it was time to reframe her thinking and point out what a gift she had received. First, she had been spared the heart attack that would have left her with a heart that was half as strong as it was prior to the heart attack.  Her heart was still intact, no damage had occurred because of the excellent cardiac care that she had received.  Second, where as her blood pressure had been high previously, she was now started on a medication to keep her blood pressure down. To her this symbolized weakness and vulnerability.  It was pointed out that simply taking a pill to keep your blood pressure down and avoid further heart attacks was a magnificent gift.  It wasn’t like she was being asked to go run three miles a day or lose thirty pounds or stop eating pickles or any one of a host of other things that might be much more odious than simply taking a pill to keep your blood pressure down.  What a marvelous gift that something so dangerous as high blood pressure can be effectively treated with something so simple as a pill and watching one’s blood pressure was rather like opening your eyes while your are driving down the road.

       When the second pill came along to keep her cholesterol down, she became even more distraught but the same philosophy and the same reframing were applied.  Isn’t it wonderful that you don’t have to change your diet so completely to get your cholesterol down to avoid another heart attack.  Instead a simple pill each day allows you to eat more or less what you want and still avoid the heart attack.

       Thus, reframing simply means placing into context the events that happen in your life. They all depend on how you interpret them.  One could interpret in a very destructive manner believing that health is a natural right and taking medicines is a sign of vulnerability and weakness.  I promise you this is a destructive course to follow.  Alternatively, one can reframe their thinking to recognize that your health is a very precious and fragile commodity.  Twenty year olds are more or less invincible to the ravages of dietary indiscretion, alcohol excess, cigarettes, inadequate rest, and abuse of one’s body.  Human beings just were not made to put up with that for a long, long time and by the time people are still behaving in that manner in their 50’s and 60’s, the price becomes devastating.  Taking a pill and changing a few ways to keep one’s health is a wonderful bargain.  Reframing ones thinking to allow acceptance of this belief can be life saving and a comfort for years.  Clinging to false belief’s of  invincibility, invulnerability and everlasting health bestowed upon you by nature isn’t going to work for most people.