There are two types of people – internals and externals. Internals take the blame for everything because they feel that they are in control of the world around them, of how they react, how they behave, and even what happens to them. Externals look to the world around them for answers, when things aren’t working they blame others. The truth isn’t really so black and white as most of us are actually somewhere in the gray area – internals in some parts of our lives and externals in others.
The question is are you an internal or an external when it comes to your health?
Do you believe you can have an effect on your health through changes you make? Or, are you simply relying on (and waiting for) doctors to have the answers?
It’s hard not to get frustrated (angry) when our health gets in the way of life. As a result we often end up changing our goals. I went from a goal of trying to finish a dual-degree program to a goal of just trying to feel well enough to leave the couch. Our illness gives us a new goal set, goals focused on health. But, what are those goals? You’d think they’d be the same for all of us – to feel better. But, they go a little deeper than that.
A 2004 study assessed the health goals of 71 women with Fibromyalgia in an effort to determine if our health goals correspond to our pain and fatigue levels. Obviously, all the patients want to feel better, but the focus here is on how they went about doing so. Patients were asked to rate a list of goal items in order to create a hierarchy of goals. Goals focused on symptom reduction, seeking treatment from traditional medicine, alternative practitioners, self-sufficiency, and social validation. The researchers found that the patients fell into one of three categories with their health goals.
Cluster 1 – Focused on goals related to seeking healthcare (to find a healthcare provider that can cure my FMS) and focused on symptom reduction. These patients ranked social-validation as the least important. These patients were most focused on simply feeling better and getting a more accurate diagnosis, better answers from doctors.
Cluster 2 – Goals related to self-sufficiency. These patients were focused on items like learning how to get on despite FMS, increasing energy, controlling symptoms, and feeling less pain. These patients were also not concerned with social validation, and were more likely to seek alternative medicine than traditional medicine.
Cluster 3 – Goals related to social-validation. These patients were focused on goals that require the cooperation of others, desire to prove to friends/family that illness is real. The lowest ranked goal for this group was to find a healthcare professional that could cure their FMS.
Surprisingly, the majority of patients fell into Cluster 2 (self-sufficiency goals)
The researchers hypothesized that healthcare and social-validation goals would correlate negatively with symptom severity. That is that those who reported higher levels of those types of goals would have worse symptoms because those types of goals lead to higher stress. Alternatively, they believed that people who more focused on self-sufficiency goals would have higher ratings of both physical and psychological health.
Generally, past research has shown that people who are focused on self-sufficiency, and who feel they have a choice and ability to affect their own outcomes, are more focused on goal accomplishment and have an improved sense of general well-being. Basically, they tend to feel better mentally, which can lead to feeling better physically.
The researchers in this study found that patients in Cluster 3 (social validation) reported the highest levels of negative affect (depression). Patients in Cluster 2 (self-sufficiency) reported lower levels of pain than those in Cluster 1 (health-related goals). Additionally, patients in Cluster 2 reported that their friends and family were more supportive of their efforts to work towards their goals. Whereas, patients in Cluster 3 (social validation) reported more interference from family and friends towards reaching their goals.
So, what does all this have to do with external or internal. The patients in Clusters 1 and 3 are externals. They are looking for the answers from sources outside of themselves. They want to validated by others, they want a cure from a doctor. At the same time those in Cluster 2 are internals. They are looking for the ways that they can feel better through their own efforts. In doing so, those in Cluster 2 actually do feel better both physically and mentally. I believe that this is likely as much a matter of not being focused on the pain and the illness as much as anything else.
It wasn't until I focused on being self-sufficient that I began to feel better. Share on XWhile I’ve never been a member of Cluster 3 I have been a member of Cluster 1 and I am a member of Cluster 2. When I was a member of Cluster 1 I was seeking the answer, the magic pill. I read every “cure” book” I could get my hands on wanting to find the answer I was missing. Then I ran out of cure books and I finally had to look at the not so easy options, the options that require effort. It was when I was finally ready to be self-sufficient that I began to feel better.
Elizabeth says
Thanks for this article! When I was first diagnosed I filled my days with research. Now, I fill most of my days trying to help others cope and finding ways to make their daily living easier and I love it. It gives me a feeling of self worth, which I lost when I was first diagnosed. I spend so much time helping others it actually takes my mind of my own pain. You have a great site here, keep up the great work!
Julie says
I feel the same way. It’s a lot easier to distance myself from my own pain/ fatigue when I have goals to help others.
Marline says
Thank you for your post on this research, Julie! I believe your commentary on it is quite valid. The only problem is that pharmaceutical drugs can play a useful role for many of us, but only doctors can prescribe them. The key is to not expect the doctor to do the things you can only do for yourself!
Sue says
I belonged to cluster 1 in the beginning and progressed to cluster 2 after time. It would be interesting to know how many in the study also belonged to cluster 1 before they got to the self-sufficiency stage.
Julie says
I bet most people start in Cluster 1. I’d have a hard time believing that even those who typically stay in Cluster 2 don’t hit cluster 1 for a while after a chronic diagnosis. I see a few people who are just super positive from the beginning and I definitely think it helps their outcome. But, I think those people are pretty rare.
Carole says
I was the same went from cluster 1 to cluster 2 and then social validation cluster 3 was very important and back to cluster 2 when I reaised cluster 3 was of no use,. across a 20yr span though!
Donna says
I have been there in cluster one and all it did was cause stress, upset and frustration. Because for as much as I wanted there to be, there is no pill or fix someone can give me. It took a lot of learning and reflection but I finally got into group 2 and that’s when I’ve made the most progress. I became accountable for myself and I realised I do have the control to help myself feel better. I finally believed it was possible too and I became more relaxed and patient about it whilst trusting the process. I just wish I had got there sooner but I guess sometimes you need to hit rock bottom to find the motivation to do it.
Julie says
Right there with you Donna. I had to hit rock bottom to finally realize that I had any control over the situation.