Personality trait endogeneity (diabetes)

I’ve touched upon how a large number of more or less external factors impact the formation of the political opinions of people before, and as political opinions (and religious views) are huge drivers of behaviour more generally, naturally we should also expect such variables to impact ‘personality’ more broadly. Young males are less risk averse than young females and older males. Where you are born matters a lot when it comes to which religion you’re supposed to join, and thus matters when it comes to questions like whether you think women should be treated like crap or not. But there are lots of ways our lives can be formed by things that ‘happen to us’, and it has come to my attention that one of the variables which has likely impacted me a lot over time is a factor I’ve only mentioned once or twice in passing in this context here on the blog. It deserves a bit more attention I think. It is of course my disease.

I shall admit from the outset that most of the effects are speculative, because in terms of what might be termed the personality-relevant range of my life, I’ve never lived without the disease; I got it at the age of two. The alternative scenario is very different to imagine. Nevertheless there are some things I’ve noticed along the way which I thought I should write down somewhere. Note that the disease can progress in many different ways and that the variation in outcomes both relate to inherent biological characteristica and individual behaviour; i.e. don’t read this like ‘the story of how diabetes affects people’ – I can only speak for myself.

Diabetes has without a doubt increased my level of risk aversion compared to the disease-free baseline. Diabetes can cause hypoglycemia, and severe hypoglycemia can cause brain damage or death. I’ve been close to those latter outcomes ‘a few times’; how many times depends a lot on stuff like how long the duration of unconsciousness/coma from hypoglycemia would have to be for you to consider it life-threatening and whether simply being admitted to the hospital with a hyperglycemia-related tonic–clonic seizure is significant enough to ‘count’. Most of the bad stuff’s in the past, I’ve had very few problems over the last 8 years or so, but in terms of how I behave I have some baggage here.

Openness to new experiences‘ and similar variables relate to risk aversion, so these traits have also likely been implicitly impacted. It’s hard to know how things would have played out differently if I hadn’t been sick, but these remarks are not just related to hypothetical effects; I know of some specific ways they had an impact on behaviour. One was that I drank quite rarely in the first years of high-school and did not ever spend the night someplace else (a common way to solve the logistics problems related to living far away from the action for a lot of other people (classmates, my brothers)), because I was afraid I’d actually die if I did something stupid. Perhaps even if I didn’t; the combination of alcohol and diabetes is hard to get right, especially when consuming the amounts people usually do in order to get drunk. If I hadn’t been too afraid to sleep elsewhere my parents would probably have said no, but they didn’t need to. Both my brothers were very different, but needless to say our differences don’t all relate to the disease.

Another closely related aspect is the level of control I need to have over events in order to feel comfortable. Some types of spontaneity are okay, but they all involve doing stuff you didn’t plan on doing – and if you’re not doing what you planned on doing, as a diabetic you almost always need to adjust insulin and take precautions. ‘Let’s go for a walk this afternoon’, my mom will say right after lunch – after I’ve taken insulin. I did not plan on going for a walk when I took the insulin, so now I either need to take some juice or glucose with me before joining my mom, to avoid hypoglycemia, or I need to tell her it would be better to postpone the walk a few hours. Just joining her without any adjustments is not an option. This is something she still forgets sometimes, btw., presumably because it’s easy to tell yourself that these days ‘he can always adjust the dosage’, whereas it’s a bit harder to remember that ‘dosage can not be adjusted after it has been injected’.

If I eat something I’ve never eaten before, I’m basically guessing what the effect will be on the blood glucose level. As a diabetic you get very good at this over time, because the link between the level of carbohydrate intake and the insulin requirement is more or less fixed, but you don’t always get it just right, also because of timing issues. For instance, I learned after a dinner and a trip to the movies with my big brother that the brown rice we had at his place affect my blood glucose in a different manner than the white rice I’d become accustomed to eating; I almost had a hypoglycemic incident in the cinema, because it turns out that the carbohydrates in brown rice take longer to impact blood glucose, meaning that the fast-acting insulin I’d taken to the meal was working before the food had really had a significant impact on my blood glucose. Another factor complicating matters a bit is that there are interaction effects here that people don’t usually think about (why would they?); for instance, fast acting carbohydrates will generally act slower (again postponing the insulin requirement) if they’re eaten together with food containing complex carbohydrates or fats. As long as you have full control over events and your environment, the kind of stuff that happened at the cinema just doesn’t happen, and every time you deviate from the plans you’ve made, you take on additional risk. Most of the time it’s worth it, but the extra risk is there and it needs to be managed and controlled. If the risk is particularly hard to control for some reason or another, it can make social isolation look like a more desirable state of affairs than it otherwise would. I mention this because my disease was very hard for me to control in my early highschool years, because of the hormonal changes which took place during that period, and I did tend to isolate myself from others to some degree, presumably at least in part as a consequence of that. One interesting sidenote here is that the additional risk related to participating in various social events that i faced also meant that other types of risk got a lower priority; when I attended the third year high school prom, my biggest worry was that I would have a hypoglycemic episode. It was a lot more present in my mind than the worry that some sweet girl would turn me down if I asked her to dance (..or whatever. I don’t dance.)

I don’t trust my body as much as other people do. The difference was probably a lot more pronounced earlier on, but it’s still a factor today. I know my body doesn’t always tell me the truth about how well I am, I know that I need to monitor it sometimes for it not to mess with me. I know that it has the potential to seriously mess with me, even though it would be very inconvenient for me if it were to happen. I’m implicitly much more aware of the link between behaviour and health than a completely healthy me would be, because my behaviour impacts my health literally on a day to day basis; if I don’t match insulin and behaviour, I will feel uncomfortable. I can not exclude the possibility that this distrust of myself and my own body has had spill-over effects on my social connections with others, making me less trusting generally, but this would be a much more theoretical effect on my personality than the others mentioned so far.

Guilt. Diabetes is all about tradeoffs. Generally, on the one hand we want Hba-1c, a rough measure of ‘average blood glucose’, to lie as closely to that of healthy individuals as possible. On the other hand, doctors don’t like to see diabetics in the emergency ward, which is where they tend to end up if they don’t care about anything except Hba-1c; it’s generally not possible to ‘normalize’ blood glucose completely due to side effects of the treatment. An Hba-1c close to the normal range will cause more frequent side effects in the short term, whereas disregarding Hba-1c to a significant degree in order to avoid all cases of hypoglycemia completely (including mild ones, which most well-regulated diabetics will have from time to time) will often eventually cause severe problems in the long run. How diabetics deal with these tradeoffs vary, but most of them will probably have some degree of guilt about not taking enough care of themselves. How well they deal with that guilt can have a significant effect on how well people manage their disease. I have felt much more guilty about my own behaviour in the past than I do now, and part of the reason is certainly that a lot of that guilt was misplaced, something I only later realized. Note that it isn’t just guilt about long-term stuff that goes into this; short term, everyday-life is relevant as well. If you get the dosis wrong, and sometimes you do, it will impact behaviour. If a diabetic is hyperglycemic, she might become more aggressive and irritable than she otherwise would be. Mild hypoglycemia might cause fatigue and difficulty concentrating. Disease affects behaviour, and it’s almost never ‘completely not your fault.’ So this is a factor too. Most of the very unpleasant arguments I’ve had with family members I’ve had while I was hyperglycemic; today I’ve learned to consider a ‘tendency to argue’ a symptom which needs to be checked out by means of a blood test. But even if you know that your disease affects your behaviour, it’s impossible to ignore the fact that your behaviour also affects your disease – so where does the blame go? Are drunk people blameworthy for what they do while they are drunk? The answer to such questions are not always clear-cut.

Last of all, death. I was quite early on made aware of the fact that I would not live forever. At the worst point during my high school years, I was in significant doubts as to whether I would still be alive at the age of 20-25; that’s the kind of thoughts that start going through your head when you wake up from a coma a couple of times a month in a hospital bed, and the doctor start asking questions like whether it’s okay if he scans your brain with the fancy MRI-machine to figure out if that last incident caused brain damage or not. Lots of young people think about death, but a lot fewer are forced to confront their own mortality by stuff outside their own control.

I’m very aware of the long-term damage that my disease might cause to me and I’ve always been. I think this is one of those things which has contributed to making me much less likely to engage with the opposite sex. Basically I had a ‘I’m sick and if she knew the truth about my condition, no right-thinking female would have anything to do with me and it would be deceitful of me to withhold that information from her’-approach to these things. Today I’m much less pessimistic, both about the health impact on dating outcomes and about my long-term prognosis, and I try not to make things harder for myself than they need to be in that respect – dating’s hard enough as it is. Thinking like that has been made easier by the fact that I’ve only had two diabetes-related hospitalizations over the last ~8-9 years or so, and neither of them were all that surprising in retrospect; they were both at least to a significant degree the results of other stuff going on in my life, not some freak out-of-the-blue episodes like some of those I had in the past. Which means that I’m much less fearful now and more open to experiment than I was at baseline (as long as I retain a sufficient level of control to feel relatively comfortable).

There’s a lot of stuff that goes into the question of which kind of person you end up becoming, and it’s probably harder to change yourself for the better if you don’t know how you came to become who you are. A significant problem is that we tend to pick narratives we prefer and the kind of explanations which best fit how we like the story to be told. But I still tend to believe observations like the above, even though effect sizes are unknown (unknowable?), are valuable.


March 30, 2012 - Posted by | Diabetes, Personal

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