With the immense challenges of the past several years forever embedded in our collective psyches, the question of how to cultivate resilience, perseverance, and grit amidst adversity feels especially relevant. In the type 1 diabetes community, these qualities are essential in combatting the increased risks to mental health for people living with this condition.
As a parent of a teenage son with T1D, a psychotherapist, and a school counselor, I often reflect on the net effect of my son Jack’s life-changing diagnosis and whether it made us weaker or stronger as individuals and as a family. I am happy to say that we are the latter. A recent book by University of Pennsylvania professor Katy Milkman, Ph.D., resonated with our experience. In it, Milkman explains “tabula rasa,” or blank slates, that often materialize after significant changes such as the birth of a child, a move, or a diagnosis. Even if an event is sorrowful or fear-inducing, it can serve as an inflection point for positive change, according to her research. For those who feel they or their child are unable to cope with this new life chapter, there is hope. Behavioral science can help us “engineer” our success by surrounding ourselves with the right people, creating accountability, and allowing for our occasional mistakes.
Jack would not be the person he is today without having had to cope with the mental and physical challenges of his diabetes. It turned him into a fierce person since it put the specter of daily risks right in his lap. When your disease can throw your blood sugar and body around like a rag doll, you either succumb to the pressure or you develop a thicker skin. I recall during the first few months after Jack’s diagnosis when the honeymoon period made insulin dosing confusing and stressful, one night he awakened in a pool of sweat from a low blood sugar. The following morning, he recounted to me what went through his mind. Soaked, weak, and struggling to get out of bed to grab a juice box across his bedroom, he said he pictured our family friend Andy, a WWII B-17 pilot, and how brave and strong he had to be when doing his intensely dangerous missions. Although I was saddened by how Jack identified with someone who had been in such danger, I was moved that he was inspired by how our friend answered the call of duty with incredible bravery. I cautioned Jack to always call for us and not go it alone, and he reluctantly agreed. But clearly, he wanted us to know he was not going to let fear rule him.
Seven years later, I watched in awe when one rainy night while we were vacationing in Italy, Jack turned on a dime to chase a thief down a crowded Roman street after he was pickpocketed; the thief had just unknowingly stolen Jack’s insulin pump rather than the desired target, his wallet. In a fight-flight-or-freeze moment, I froze while Jack fought, ready to recover his “pancreas” which had just been stolen by the bandit. Even though I brought a spare pump, I was emotionally affected by this event for days while Jack internalized yet another tangible example of his resilience and grit. My preoccupation with making plan Bs was no longer optional, and that made me feel taxed and vulnerable, especially since we were so far from home. However, by witnessing Jack’s courage, I felt my mood shift from scared victim to hardy warrior mother. Somewhere along the line, I had transmitted a message of “Keep Calm and Carry On” to my son.
In addition to developing a fiercer spirit through the years, Jack ultimately enhanced his planning and organizing capabilities. Spontaneity and T1D are not fast friends, yet he has rarely ever lamented this fact. Rather, the scouting principle to “be prepared” has prevailed in his consciousness and added to his toolbox of resilient life skills.
I use multiple lenses in my work with youth: listener, helping professional, advocate, and cheerleader. I am fascinated by the individual differences in my clients and students and how they impact growth versus “stuckness.” Research tells us that for many individuals living with T1D, there are elevated risks to mental health in terms of higher levels of anxiety and depression. Like many diseases and conditions, the emotional toll can be as significant as the physical. To counteract these risks, a gritty, can-do approach can be cultivated that can help put T1D in its place.
When I see clients in practice who feel that they are less-than or incapable, I can tell that they have fallen victim to the “natural talent” rhetoric that we as a culture embrace. Angela Duckworth, Ph.D., of the University of Pennsylvania, studied our cultural preoccupation with natural talent and did over a decade of research on what makes people successful. She unearthed that persistence, passion, and “deliberate practice” help get many more of us regular folks to goal attainment than simply being born gifted.
But what happens if you or your child aren’t the go-get-’em, worker-bee sort? How can you improve your mental outlook toward T1D and also enhance your physical well-being with blood sugar metrics such as time in range, lower A1C, and fewer incidences of hypoglycemia and hyperglycemia? You can learn from others you find relatable — not necessarily people who hold themselves up as diabetes superheroes who do everything right. Milkman’s research showed that positive change could be facilitated by pairing people with others they perceive as having realistic and achievable successes.
A great example of a relatable resource for my family is author Adam Brown. His book details with honesty and vulnerability how he overcame his frustration with his T1D and grew his grit and perseverance. Through a mix of self-compassion and trial-and-error experimentation, much like Duckworth’s conceptions of “deliberate practice,” Brown was unrelenting in his investigations of how food, mindset, exercise, and sleep affected his T1D. His journey became a passion project, so much so that it inspired him to change his career to become a diabetes mental health professional.
There’s a concept called the zone of proximal development (pioneered by Lev Vygotsky, a Russian psychologist born in 1896), in which a knowledge gap may be closed by exposure to a “knowledgeable other.” With a disease as complicated as T1D — in which Adam Brown himself identified 42 different things that contributed to his blood sugar fluctuations — we need smart and caring others, as well as robust skills and a gritty mindset to weather its storms. Parents, caregivers, doctors, and therapists of people with T1D can promote self-compassion while using the blank slate heralded by the diagnosis to improve the entire family’s health. Armed with the right tools, each new day living with type 1 diabetes can be an opportunity for kids to grow stronger, smarter, and more resistant to mental health risks and challenges to well-being.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.