The Velcro Effect
One of the most formidable challenges to the health care field is the job of changing a patient’s behavior. Once a health care provider has completed the process of evaluating a patient and has arrived at a diagnosis that calls for treatment, it is very tidy when that treatment can be accomplished by selecting an available intervention, such as the writing of a five-day prescription for a urinary tract infection or by making preparations for a two-day hospital stay for removal of an obsolete organ. Such steps as these are often likely to cure the patient of their malady and therefore satisfy the provider’s professional obligation. However, it is estimated that over half of all reasons why people consult their healthcare providers is for calamities that are the direct result of the patient’s own behavior. While symptoms may be mitigated by various forms of available treatment, the cure in such cases requires the commitment of the patient to change their behavior. In some cases this task might as well include rearranging the continents.1
Conveying to a patient that their treatment requires a change in their habits can appear to minimize the obstacles they face in doing so. If one ever doubts the difficulties facing a person needing to make changes in their daily routine, a person needs only to consider one’s own grip on one’s habits. The clothes we wear, the breakfast we prefer, and the T.V. shows we watch are all parts of the puzzle that describes our individuality. These preferences evolve to a considerable degree from our experiences, but also from certain inherited capacities and “Achilles-heels” that render us more or less likely to step into potholes that inevitably will complicate our paths. Recognizing our susceptibilities, whether we are predisposed to substance abuse, over-eating, cancer, short temper or learning disabilities, requires deliberate attention to those risks. Behavioral change requires the recruitment of both our biological hardware and software resources. To expect a patient to stop smoking tobacco simply because the physician instructs them to do so is delusional thinking.
Here resides the imaginary zone between medical care and mental health care. It is a wide boundary that overlaps to such an extent that eventually we recognize that these treatment modalities are one and the same. While it has been shown that the rate of self-injurious behavior may temporarily increase after certain antidepressants are first taken by depressed patients, after two or three months the rate of self-injurious behavior actually drops below the level prior to the initiation of antidepressant therapy. The early increased rate of self-injury can be mitigated by effective counseling during the early period of pharmaceutical treatment. In this way, the best outcomes will result from the artful combination of pharmaceutical and behavioral therapy.
The success of behavioral therapy can be significantly increased by what might be termed the “velcro effect.” If you ever have a chance to look at a microscopic enlargement of a velcro bond, you will notice that velcro adhesion is accomplished by innumerable attachments representing nothing more than a curling piece of nylon tangled into a fuzzy mess of fibers. The beauty of the mechanism is that each individual pair of tangled fibers is pathetically weak and that each individual attachment is accomplished in the setting of random chaos (i.e. the fibers are not aligned by any formal organization), but that together the sum total of these innumerable attachments is an adhesion that provides security sufficient for binding ski-boots to a skier or gloves to a NASA astronaut.
In order for a person to mount the conviction required to change a habitual self-destructive behavior, there are limits to what can be accomplished during several half hour therapy sessions. It may take years and possibly multiple incidents of injury to the person – damage to their relationships, to their occupation or to their health – before the effective intervention to change behavior is encountered, or it may never be encountered. Regardless of the reasons for why a person finally and mysteriously accomplishes a change in behavior (if they ever do), there is no question but that the likelihood of this change is increased by the shear mass of the individual attempts, no matter how individually weak they might be, to motivate the person to accomplish that change. The velcro effect should encourage us to not despair if our individual attempts to change the self-destructive behavior of our loved ones seem futile. Keep trying.
Inevitably, the responsibility for successfully changing one’s self-destructive behavior resides with the individual. However, the velcro effect can make the difference between a person seeing the pathway to success or remaining in the dark. Intervening with a person to encourage them to take better care of themselves requires caring for that person in a non-judgmental way, and it requires enough optimism to envision that person being successful. Even though success is not guaranteed, together each one of us nylon fibers, even in a community of random interactions, can exert a tremendous influence on helping others to engage in healthier practices.
1 It is appropriate to recognize here that in this country we now enjoy and expect to always enjoy the freedom to make decisions that may pose a risk to our own health, with limitations.