Can a “Failure of Imagination” Kill You?

25 Aug

A strong imagination is a vital asset
Published on July 26, 2012 by Katrina S. Firlik, M.D. in A Spoonful of Sugar 

A strong imagination is a vital asset.

A brief article in Wired magazine last year explained that our classic failure to save enough for retirement is, at least in part, due to our failure to imagine our older selves. In other words, it’s hard for a thirty-year-old woman to truly imagine herself as a seventy-year-old woman.

Because the seventy-year-old is a complete “stranger,” the ability to see past the present and save for future needs is hampered. It’s hard to care about something or someone you cannot envision very well.

The article describes a study that concluded: simply being presented with an age-progression image of yourself—decades older—can motivate you to save. The image aids imagination. Your older self is no longer a stranger or a complete abstraction.

I believe a similar issue is at play when it comes to the public health crisis of medication non-adherence (failing to take important prescription medications, particularly for chronic conditions).

Your physician can explain to you, for example, that you need to take your blood pressure medication in order to prevent a heart attack or stroke years down the line. However, even if you understood that message, intellectually, and can verbalize the message back to yourself, there are psychological barriers to following through.

I focused on the adherence problem in my last two posts, particularly on the issue of short-term vs. long-term rewards, and our hard-wired “present-bias preferences.” The “failure of imagination” barrier is related, but distinct (and distinctively interesting).

Case in point: I am fairly fanatical about applying sunscreen. Why? For one, I’d like to prevent the premature aging that naturally accompanies the deceptive “healthy glow” of a tan. I believe it ages your skin more than age does.

More importantly, though, I can easily imagine what it would be like to suffer from malignant melanoma. In my career as a neurosurgeon, I’ve treated a small handful of patients with melanoma that metastasized to the brain. I remember one fairly young patient quite well. I can recall how she looked, what the tumor looked and felt like, how much it bled while we took it out, and what the conversation with her family was like when they decided on no further treatment when the cancer progressed despite aggressive intervention.

In other words, I have no failure of imagination when it comes to melanoma. It is not an abstraction for me.

Similarly, if I were diagnosed with high blood pressure, I would have no failure of imagination when it comes to imagining what it would be like to have a stroke and to live with the resulting disability. I have seen plenty of strokes. I would take my medication.

But not everyone can overcome a failure of imagination by treating patients. Plus, even physicians who have seen it all can still suffer from the “it will never happen to me” denial in their own lives—yet another psychological hurdle, but not for this post.

So here is the challenge: how can we get people past this failure of imagination? How can we enhance imagination skills? How can we help people to not only imagine their older selves to better save for retirement, but also to imagine themselves years down the line with the complications that can stem from medication non-adherence (or poor eating habits, a lack of exercise, or smoking) to inspire better health behaviors? If you have the answer, then you have a game changer. 





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