Fear Factor: How Avoiding the Unknown Harms Health
They say what you don’t know can’t hurt you, but when it comes to your health, it can. See why facing your fears could save your life.
Fear of Finding Out
Fear can be healthy. It’s what keeps us from danger: the feeling in the pit of your stomach that something just isn’t right; the way your heart speeds up when driving down a windy mountain road.
But fear can also be detrimental to our health. It can keep us from seeking medical care when we desperately need it – leading to poor outcomes for both individuals and society.
The fear that keeps so many of us from going to the doctor isn’t rooted in a phobia of needles or a dislike of people in white coats, although discomfort with medical procedures certainly doesn’t help. This fear is more subtle, possibly even subconscious. It’s what’s been dubbed the “fear of finding out,” or FOFO.
We spoke with Alison Hardy, health behavior change expert and collaborator on Live:Lab, a program in the U.K designed to help people overcome FOFO, to uncover why one of the greatest barriers to health care may be all in our heads.
Q: What exactly is the "fear of finding out," or FOFO?
Alison Hardy (AH): We’re using FOFO as a catchall term for the psychological barriers to accessing health care. In England, health care is free to everyone at the point of need, and the National Health Service has done a great deal in recent years to remove practical barriers, like making sure that general practices are open for longer hours. But our research has highlighted that somewhere around a third of the barriers that keep people from getting the care they need, are actually psychological.
These could be, I don’t want to go because I think it will be a nasty environment; I don’t want to go because I don’t like the thought of somebody touching me... But for many people, the fear is I don’t want them to find something. It’s this irrational belief that if the doctor hasn’t seen it, it’s not there. It could also be a fear of, once I find out something is wrong, will my partner leave me? What if I have to tell my children that something terrible is happening?
“For many people, the fear is I don’t want them to find something. It’s this childlike belief that if the doctor hasn’t seen it, it’s not there.”
Q: Why does finding ways to address FOFO matter so much to public health?
AH: FOFO matters because it kills people. In the U.K., our cancer survival rates are still well below those of comparable European nations. A fifth of all cancers in England are diagnosed at the emergency room. People haven’t accessed any health services until they are so ill that they need to be taken by ambulance, which is so tragic because at that point there may be very little that can be done for them. And these are people who would have known, or suspected something was wrong but didn’t reach out for help.
Finding ways to address FOFO is important, because the longer you wait, the harder and more invasive the treatment is, and the less likely the chance of a good outcome.
Q: Is FOFO more problematic in certain cultures or socioeconomic groups?
AH: In England we talk about something called the inverse care law, which states that health services tend to be used disproportionately by people who are in the least need of them. Healthy, educated people – what some call the “worried well” – would be more likely to access services at the first sign that something might be wrong, whereas people who are most in need of services tend to be the slowest to access them. We also have continued inequities in life expectancies between men and women, which can be partly explained by psychological barriers.
Q: Most people don’t like to get lectured about their bad habits – is this part of the problem? People are just worried about getting told to stop smoking or exercise more?
A: The reasons are deeper than that. It’s about your optimism about your life and if you see yourself as someone who can change and fix things. If you’re a smoker, you may feel that if you go to the doctor, the doctor will most certainly tell you that you have to stop smoking and take away your cigarettes, which can feel like a really scary thought if you’re a heavily addicted smoker.
It also matters if you have a rather fatalistic attitude to your life. (We’ve found that) healthier, wealthier, empowered people tend to think that they can change the world; less healthy, less educated, less wealthy people may feel that what comes, comes. And when your number’s up, it’s time to go, and there’s nothing that can be done about this.
Q: What can be done then to fight FOFO? Can doctors do anything to help patients feel less fearful about seeking care?
I have a lot of sympathy for physicians. There’s a lot of thinking and attention in the medical community about how you break bad news, but you can only break the news if someone is there. A physician can only treat someone if they show up.
It’s not the physician’s job to fix this. It is society’s problem to fix, and perhaps we all need to fix this on behalf of the physicians.
To do so, we need to know a lot more about how these behaviors are learned and how they can be unlearned. We need to know if this is something that is picked up from the peer group – no one you know goes to the doctor, no one you know goes for health checks – but how would it be for you if you behaved differently and tried something new? We’re exploring ways to help people experience different ways of being, using techniques from gaming and virtual reality.
There is ample evidence that FOFO is a quite powerful phenomenon, but there isn’t much research on what you do about it. We’re hoping our work with Live:Lab will remedy that.
Visit https://www.live-lab.co.uk for more about Live:Lab and efforts to address FOFO.