Dé jà Vu: Beware the Forces of Familiarity!

Explore four key takeaways about the force of familiarity and how it works for and against diabetes care.

Thirty years ago, my clinical supervisor asked me a question. “Do you know that funny feeling where the hairs on the back of your neck tingle?”

“Yes,” I replied.

“ALWAYS listen to it.” She instructed, her voice emphasizing the importance of paying attention.

The conversation remains seared into my memory. Fast forward to the present day, and I am working with clients with diabetes. Their story feels familiar; I slip into a thought and realize, dang it! I am not listening.

Familiarity is easier to understand as a force instead of an experience. There are forces in the world that are so common we don’t even notice them in our daily lives. Gravity, the largest force in the world, is a good example. Gravity is everywhere and touches every object on Earth, yet do you wake up in the morning wondering about gravity? I guess familiarity is the second largest force in the world because it changes our neural network in ways that appear to be coded into our DNA, behavior, society, and culture!

My counseling supervisor told me 30 years ago that familiarity is a complex concept because it is a somatic experience within the body that emerges from the deep neural connection that uses multiple systems, including the brain and vagus nervous pathway.

The Experience of Belonging

When something feels familiar, a seductive mental narrative is created that might sound like, “Oh, this is familiar; I know what to do or expect.” For individuals who have experienced hardships or are trained at spotting problems, they might say, “Oh, this is a familiar problem.” The critical difference is your familiarity with an experience is what is sorted, not the issue itself.

Clients are sorting out how they feel which is a somatic, not cognitive process and it has nothing to do with the information presented.

The problem is familiarity can work with or against us as we try to create a more inclusive space for people with diabetes. For example, if it is familiar to not care for diabetes, then the narrative may sound like, “Warning! This experience is unfamiliar!” Even if the unfamiliar experience is pleasant, good, and effective. Even if you do everything well, compassionately, and with good intentions, you are still unknowingly trying to overcome the force of familiarity.

Familiarity is a factor in diabetes care that is overlooked. So while you are talking, your client is sorting out if getting medical care is familiar. Is seeing a diabetes educator familiar? Is managing health familiar? Is being included in medical decisions familiar? Is knowing what to do to foster health familiar? This buried internal sorting is deciding an even larger question, “Do I belong?”

Inclusion and the sense of belonging may not be familiar to all our clients with elevated blood sugar. While I don’t pretend to understand them all, it is clear to me that my clients don’t like the moniker Person With Diabetes, PWD. If having diabetes isn’t something you want to BELONG TO, then it makes sense that there is resistance to joining Club Diabetes. This feeds the dominant narrative that clients can ‘beat’ ‘cure’ and ‘defeat’ diabetes if they exercise, eat more protein, low fat, no salt, high fiber, and lose weight. Yet the Diabetes Prevention Project shows in fifteen years, only 27% of people could prevent diabetes. For the other 73% of participants, diabetes was simply delayed.

Unrealistic Expectations

It is unrealistic to tell clients they will beat diabetes if they lose weight or change their diet. This over-exaggerated fact has become so familiar that it is now believed to be accurate. Yet, it isn’t.

The 2023 ADA Standards of Care is our annual reality check that diabetes is a complex condition with lots of nuances, and within this report are hundreds of studies that explain diabetes is a chronic condition. It is managed - yes, sometimes with diet and exercise, but more effectively in conjunction with technology, medication, and consistent medical care.

Key Take Aways

• Familiarity is a powerful force that influences our perceptions and experiences.

• It is a somatic experience within the body, connected to deep neural connections.

• Clients sort out their feelings based on familiarity.

• Diabetes is a complex condition that requires a multifaceted approach to management.

What can you do? Remember that offering facts, information, and testing knowledge doesn’t foster a sense of ease, belonging or evoke change. Active listening, coming alongside our clients in partnership, acceptance, and compassion does.

At Inclusive Diabetes Care, we want to come together and understand ways to provide inclusive diabetes care. We are a membership program that offers professional training and dialog to address the social determinants of health and improve access to diabetes services. Learn more by visiting InclusiveDiabetesCare.com.