I recently received the following plea for help from a reader; all identifying details have been changed. As you read my response – as always – keep in mind that I am not a psychologist nor am I your doctor:
I am grateful to have found websites such as yours, Britt Hermes
‘, and Dr. Harriet Hall
‘s recently, for they give me some hope in my nearly-everyday struggles with a CAM [Complementary and Alternative Medicine]
subscriber who is dear to me. As a medical doctor who frequently evaluates victims of the CAM monster, can you provide any advice on how to help someone out of the CAM rabbit hole? Your experience in endocrinology would be especially valuable in my case.
Basically, my child was born almost 2 years ago with a genetic disorder, and my partner stresses to me that the baby’s thyroid must be monitored carefully. After a recent blood test, he has concluded that certain levels are not good, has decided that the local doctors’ (plural, yes) prescriptions for levothyroxine are worthless, believes the twice daily servings of “natural” vitamins and supplements cannot possibly be interfering with the levothyroxine and are better anyway, and wants to spend an outrageous amount of money for an online consultation with a naturopath from across the country to help balance the levels.
I do my best to argue against these approaches, but I only ever seem to achieve cease-fires on the good days (never full armistices, just suspiciously quiet fronts waiting to launch attacks again in the future), and new gimmicks appear faster than I can keep up. For the most part, I find that reason and medical advice provide almost no persuasion to someone who wants to believe in CAM, and I do worry that we are, in fact, not doing the best for our child.
My partner means well, of course, and is still a far cry from a true believer in CAM. However, he appears to believe that everything must be tried to help our child. He has always had an affinity for the “natural” stuff but does not completely disregard scientific medicine (occasionally, but not all the time).
Have you had any success in converting patients away from CAM, apart from nearly fatal circumstances, and if so, what did you do? Have you heard if counseling offers any help (emotions seem to be at play in all of this)?
As soon as I read this email, I knew that my response would have to be a post of its own. The topic brings up so many important concepts regarding the crusade against quackery, and there is much nuance to explore:
Assume Good Intentions
You acknowledge that your partner “means well,” which is critical if you want to get anywhere, so kudos to you – if you have truly internalized that sentiment. Too often with disagreement – whether at work or in our personal lives – we assume malice when we should be assuming ignorance or incompetence. For example, how many times have you spent days waiting for a response to an important email, becoming increasingly certain with each passing day that the receiver of your email is deliberately ignoring your inquiry in classic passive-aggressive fashion? Then, how many of those episodes culminated in the reception of an email apologizing for the delay in responding, but the person was on vacation/hospitalized/missed your message in a voluminous inbox/etc?
I think we should all agree that most parents have good intentions when it comes to their kids. Maybe not this couple
, but most. If you can embrace the idea that everything your partner wants to do for your child is borne out of love, it may soften your attitude, posture, facial expressions, and your words. This has the potential to deescalate the situation before it ever escalates, so that you might have a conversation instead of an argument. In a heated argument, we typically stop listening and just focus on winning. In a conversation, we can still disagree, but there is a better chance that each of us will be able to “hear” the other person. Warning: you must remember to remember your partner’s love for the child every
time you sense an impending argument.
Put Yourself in His Shoes
One of the first steps to achieving resolution of any conflict is understanding your opponent’s position. Of course, it helps if you start by considering that this is your partner in life, not really your opponent! When we are up against an opponent, our instinct is often to crush them. Sadly, if we allow our lizard brain to guide our behavior toward our loved ones, said loved ones may not stick around. Even if they do, the atmosphere is likely to be unpleasant, and who wants to live like that?
In order to better understand your partner, accept this truism: as obvious as it is to you that his position is wrong, he feels the same about yours. CAM subscribers likely feel that we are narrow-minded, too rigid, too trusting of authority figures like doctors, not curious enough, not questioning enough, and not willing to experiment. Encourage your partner to verbalize his impression of you and your position, without interruption. If he is hesitant, try drawing him out by gently asking if he thinks that you are too rigid and too trusting of doctors. Allow the conversation to move in a direction that will help explore your partner’s true concerns. Has he had negative experiences with conventional medicine? Are there similarities between his prior negative experiences and the current situation with your child? Importantly, are there differences that you can help flesh out to help him unlink your baby’s conventional care from his prior poor experiences?
Continue to ask questions in nonjudgmental tones, focusing mostly on why your partner believes what he believes. By maintaining a focus on what he believes – as opposed to what he doesn’t believe – you keep the tone positive and allow him to fully elucidate his position. Hopefully, this results in you really hearing him and him feeling heard by you. I realize that you’ve probably had conversations about your child’s health ad nauseam by now, but I do think it’s remarkable how many talks we can have with our partners without actually understanding their motivations. If we don’t understand what makes them tick, it is infinitely harder to have productive interactions that lead to acceptable compromises.
Side note/long shot: at this point, there is a minuscule chance that you will come to realize that your partner is more committed to defending the position he has staked out than he is to the actual implementation of alternative medicine modalities. All long-term relationships have some funky dynamics, and this is one of those times that weird dynamics come into play. Perhaps your partner is sensitive to feeling “wrong.” Maybe whenever you have a disagreement, your partner feels condescended to, as if you think you’re smarter. It is possible that your partner just doesn’t want to be called stupid, and that’s what he hears when you argue against inflicting CAM on your child. Even if defending his position does not overshadow his belief in CAM, you may be able to redirect the conversation (later) if you sense that this is a significant component of his motivation.
Validate, Validate, Validate
By now, you’ve assumed your partner’s intentions are honorable, adopted a posture and tone reflecting that assumption, and allowed your loved one to lay out his case in favor of CAM.
OK, HD. Like William Wallace in
Braveheart, I’ve been holding, holding, holding…now it’s time to pick up the long spear and attack, attack, attaaaaaaccccckkkkkkkk!!!!!!!! Right?
No, absolutely not. If you try to “win,” you and/or your child will almost certainly lose. Now is the time to reassure your partner that you firmly believe his intentions are good. This is a tricky tightrope to walk, as there is a fine line between validation and condescension. Choose your words carefully. Very carefully. I suggest something along the lines of, “Listen, I know you want what’s best for our baby. I completely understand and appreciate that, and I love you for it.”
Next, I suggest restating your partner’s argument in favor of CAM to communicate that you have, indeed, heard him. Along the way, ask him to verify that your interpretation of his points is accurate. Once you have finished validating his intentions and confirming that you have heard everything he wants you to hear, then –
[Sigh] No. And please, lay off the caffeine before initiating this conversation. Now, it’s time to ask permission to say a few things. By this point in the conversation, both of your emotional temperatures should be well under the simmering threshold, and he should be inclined to grant you permission to speak, especially in light of your demonstrable respect.
If you don’t believe that asking permission to say something during a contentious conversation can be a powerful form of verbal jiu jitsu, check out this 1969 video
of Mr. Rogers testifying before the Senate Subcommittee on Communications, pleading for adequate funding for public television. Note how he says “if that’s ok?” a couple of times near the beginning, with respect to what he’d like to present to the chairman. The initially antagonistic chairman curtly replies “sure.” By the time we get to 5:02, when Mr. Rogers asks permission to tell the chairman the words to one of his songs, “…which I feel is very
important,” the chairman is clearly on the edge of his seat and immediately responds “yes.”
Ask for Validation of Your Intentions
Just as you have made it clear that you believe your partner wants what is best for the child, ask him if he believes that your intentions are the same. I expect the answer will be yes. Now, you share at least a tiny bit of common ground. Hold onto that, as you’re going to use it later.
It’s Question Time
When we are passionate about our beliefs, we tend to make a lot of statements in support of our position. In your case, making more statements is most likely to lead to more conflict. The more you try to convince your partner that your way is better and CAM is madness, the more likely he is to dig in his heels. Over the years, I’ve learned that asking questions can be a more effective method for leading a “hostile witness” to more carefully consider the opposing viewpoint.
While “putting yourself in his shoes,” you were asking questions regarding why CAM resonates for him. Now, your questions should focus more on helping him understand your side of the story, without actually telling him your side for the 500th time.
For example, you might ask him to tell you about the sources he’s been reading that support the use of vitamins and supplements over levothyroxine. You might then gently ask (mind your tone!) why he thinks those sources recommend what they do. Most likely, he will say something like “because it works!” or “because our thyroids need these vitamins to work properly!” Use your judgment at this point. If you see his pupils dilating and his posture stiffening, work on deescalation before proceeding any further: “OK, OK. I hear what you’re saying. Our thyroids need these vitamins and supplements to function properly. [Pause] May I ask you another question?” The answer should be yes, but if it is something other than a clear yes, you might try this: “I want to understand more about where you’re coming from on this issue, and I’m not trying to attack you. I just want to talk about the information you’ve read or heard.”
If your partner is at all reasonable, he should be back in conversation mode now. Try this: “Can you tell me whether your sources differentiate between usual dietary amounts of these nutrients and the higher doses found in the supplements?” Now you can focus on exploring whatever your partner has read, hopefully allowing him to begin discovering some of the holes in his sources’ argument without invoking a major defensive response. Remember, you’re attempting to allow your partner to discover these deficits on his own, so you need to continue framing everything as a question: “OK, it seems like these sites don’t definitively say whether it’s possible to encourage good thyroid function through normal dietary intake of these vitamins and minerals, as opposed to high doses. Can we agree that the answer to this question is important and should be researched further?” If the answer is yes, then you might consider the following: “If I do some research, would you be willing to review what I find and talk about it with me?”
I think you get the idea. For every bit of quackery your partner endorses, you can gently question him about it until he agrees to at least factor additional data into the equation. This may seem like a thoroughly exhausting way to negotiate – it is. But it is no worse than the cumulative exhaustion incurred by shorter, daily battles in which both parties wind up frustrated and resentful. In my experience, hardcore CAM-subscribers are almost never amenable to a frontal assault using logic, science, and medical evidence. While I have been quite successful at reeducating people who have simply perused the wrong websites when doing their “research,” I have been forced to redefine success when it comes to patients who see me only because their primary doctor/spouse/child insisted they see an Endocrinologist to comment on the wacky treatment regimen instituted by their alternative practitioner.
Speaking of seeing an Endocrinologist, hopefully you have a patient pediatrician and/or pediatric Endocrinologist for your child. If – and this is a big IF – your partner is willing to make a list of disputed questions and bring it with you to the next doctor’s appointment, it could be helpful to have him ask all the important questions. That could engage your partner more in the process, feeling less like it’s you and the doctor vs. him. If your doctor is extremely patient and willing to entertain your partner’s queries, it’s possible that your partner may “hear” the doctor better than he “hears” you, as the doctor doesn’t have any emotional skin in the game.
The Hardest Part, aka Negotiating the Plan
If you thought “Question Time” was a series of brutal switchbacks on your way up the mountain, this is where the route turns almost straight up as you attempt to summit. First, remember when I said I have had to redefine success when it comes to trying to help alternative medicine-obsessed people? You need to do that as well. I recommend keeping expectations low, such that any result other than total failure can be viewed as a win for your child. So, decide what you want, then decide what you can accept. Though I cannot make this decision for you, it stands to reason that the minimum expectation should be preventing your partner from doing harm (unintentional, of course) to your child.
So, let’s talk worst-case scenario, as that is the best way to prepare. After all the work you’ve put in using strategies from earlier in this post, it is quite possible that you’ve achieved nothing more than establishing the common ground of “we both want what’s best for our child.” This is the time to use that fact to reach an acceptable compromise. Throughout negotiations, when things get tense, you will want to pause and remind both of you, “We just want to do what’s best for our baby, so let’s figure out how to compromise.”
What does a compromise look like for you? Well, if your doctor has made it abundantly clear that levothyroxine is a life-sustaining therapy for your child, then that’s the chip you can’t afford to bargain away. Make it clear that you are willing to entertain some form of complementary care as long as your partner accepts that the physician-mandated use of thyroid hormone is non-negotiable. If your partner is absolutely unwilling to give up on the supplements and whatever additional quackery he endorses, then it would appear the best you can do is negotiate down the doses and frequency of administration to the safest levels possible. Asking for guidance from your doctor will be essential to determine where that point lies. Of course, if your partner is unwilling to negotiate down to safe levels, and your doctor thinks your child will suffer toxicity, then you have to make some much tougher legal decisions that are beyond my scope.
Stuff that Doesn’t Work
I realize I’ve spent a couple thousand words explaining what you should do. I would be remiss to not mention a couple of the things you should not do.
In your email, you asked if counseling can help. For the love of all that is holy, do not suggest that your partner should go to counseling to cure him of his CAM obsession. That would be about as well-received as him telling you that you need counseling to deal with your inability to think outside the box of evidence-based medicine. On the other hand, if you meant that the two of you should attend couples counseling, as a means to better sort out your disagreements, then go for it. Just be careful, as even counselors can have biases. If you get some hippy-dippy counselor with a dream-catcher necklace and Birkenstocks, you might find yourself in an unpleasant two-against-one situation.
You acknowledged that reason and science are not persuasive when it comes to alternative medicine enthusiasts. Remember that during “Question Time” when you are tempted to impugn the motivations of CAM practitioners. One would think that pointing out obvious sources of bias should be persuasive – she’s selling a book! he sells supplements out of his office! she’s asking you to sign up for a pricey 20-step program! – it’s not. In my office, CAM subscribers shrug this off in one fluid motion and accuse me of being brainwashed by Pharma to prescribe expensive drugs in the next motion. Never mind that I don’t make money off any of the drugs I prescribe, and most of them are cheap generics anyway. The lesson here is: CAM enthusiasts believe their sources’ motivations are pure, full stop.
So, dear reader, thank you for submitting this question. I feel for you, and I wish health and happiness for you, your partner, and your child.
It’s your turn now. What advice would you give this person? What have I missed? What did I get right or wrong? Do you have any anecdotes of your own to share, when it comes to dealing with CAM-obsessed loved ones? Comment below!
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