THE NEW NORMAL

Artwork by Shutterstock, defaced by Sean Mosher-Smith. 
Words by Anna Varshavsky

“I want to be normal.” 

Sean, my partner, winces in pain. His Achilles tendinitis keeps getting worse and worse. He has been a competitive runner since the age of 12, and now, walking ten blocks to Trader Joe's is agonizing for him. Yet that doesn’t stop him from continuing to run every time his pain level goes down from a nine to a six. The next day, as always, his injury is at its worst. 

However, when Sean gets a little better, he’ll once again say, “it’s all good, look, I’m walking normal.” That normal lasts until the next time he’s in pain. This has been an ongoing cycle for quite a few years, each year worse than the last. 

We consulted surgeons, some of whom said that after surgery and 6 months of recovery and physical therapy, Sean could go back to normal, meaning running not only ten miles a few times a week, but training for and participating in grueling Ragnar races and half marathons. That definition of normal, the lack of acceptance of the condition, the over-promising, and the lack of mindfulness about the consequences in both Sean’s and his physicians' attitudes made me livid. Treatment without behavior modification will eventually lead to worse injuries. As a healthcare marketer, I see this too often in market research when interviewing HCPs and patients for various conditions and diseases.

This lead me to question: what is “normal?” 

Shiny Happy People Holding Hands

Philosophers, psychologists, and physiologists have struggled to define that phrase to set a standard—a parameter—whether it’s treating mental or physical illness. In 1978, Czech physiologist Jiří Vácha distinguished the meanings of normality; it could mean adequate as in free from deficiency or defect or optimal in the sense of being physically fit or mentally sharp. Georges Canguilhem, a French philosopher, writes, in "Le Normal et le Pathologique" (1943): The meaning of normal, often slip-slides among different meanings and tropes, from the orthodox and standard to what is expected and good and as important consequences, especially if it is given a privileged position in the world.

“Normal” seems to have a dramatic inflection and a deeper meaning when it comes to healthcare: “I want to be what I was before the diagnosis/treatment/injury.” Perhaps that’s why the pharma ad space is flooded with happy, smiling, shining people doing yoga, walking dogs, and being surrounded by family-centric, Norman Rockwell-esque scenarios. It’s a speculated and generalized normalcy—a solution that attempts to offer a resolve to the emotional impact and burden of a disease. It’s a catchall.

There’s a great passage from Murakami’s "Kafka on the Shore." A character is walking in the desert. In the distance, he sees a sandstorm. He can’t outrun it, and there is no shelter. He realizes he must brave through the storm. So, he goes through it and lets the storm overtake him. He feels the abrasiveness of the sand grate his face and his exposed limbs. He feels the force of the storm, the pain of it. And, when he emerges on the other side, he realizes he is no longer the same man. He has changed. The experience has changed him. 

This metaphor is perfect for a patient’s transcendence into an illness or injury. If the storm is representative of a malaise, the patient’s perception of self is divided into the Before and the After: the idealistic normal before the storm, and the problematic and unfamiliar after. 

That before and after perception is perhaps the reason patients delay getting diagnosed—the patient wants to live in the “normal” longer, denying that something is wrong. Or, if diagnosed, the patient will not adhere to medicine or treatment regimens in the quest to regain that illusive “normal”—the idealistic vision of themselves and their lifestyle, which doesn’t include swallowing pills, getting injections, adhering to a diet or exercise plan, and/or managing side effects that may come from the medicines. 

Everybody Hurts Sometime

Eventually, we all become patients, HCPs included. The oldest millennial is 42 years of age, and Gen X is encroaching on retirement. Our bodies are vehicles for our organs. Wear and tear through the years is the normal state of the aging process. The body breaks down with overuse. At some point in our lives, we will face a breakdown in our bodies and even our minds. It signifies that we are aging. That, in itself, is the normal process of a life.

Denying the new “normal” is a way to deny the aging process. It’s the refusal to realize that pleasures enjoyed and taken for granted when younger are either no longer attainable or must be modified, such as eating an extra piece of cake without gaining weight or compromising blood sugar levels, or setting a new self-record running a half marathon without physical repercussions. This rebellion leads to behavior change roadblocks, because instead of embracing the change in our bodies, we deny the ailment’s existence. But, that sandstorm will eventually catch up to all of us. 

Addressing the elephant in the room and acknowledging the emotional aspect of a disease is essential to behavior modification, because normal is not some ideal from the past perceived with the eyes of the present. The concept of normal shouldn’t be static—it is a goalpost that moves with us as we progress through life.  

Identity Crisis

The individual’s identity also changes to a patient or a survivor. Some diseases, such as type 2 diabetes, come with preconceived prejudices—labels society sticks on individuals suffering from the condition. 

The lifestyle of a patient changes dramatically. The patient is instructed to change everything, including eating habits, exercise, making time to adhere to medication/therapy, scheduling doctor check-ins, not to mention managing medicine side effects. The patient’s normal routine will never be the same again. They have to adjust their lifestyle to cope with the disease. 

So, is an ad with happy people walking on the beach a part of that patient’s experience? Although walking is a part of the activity needed to manage the disease, how does that image make a patient feel if walking on a beach has not been a part of their normal lifestyle? And what if the patient doesn't have a family, grandchildren, or a dog, and has no access to or interest in tai chi or yoga? In 2019, Pew research reported that most older Americans live alone and spend more than 10 hours alone. Just imagine what that number is now, post-COVID. So perhaps showing happy smiley shiny people isn’t aspirational. It may actually be depressing for someone who doesn’t have a support group. The ad/brochure that is meant to educate fails to identify realistic obstacles and barriers that are needed for behavior change. It’s not establishing an empathetic connection with a patient—communicating with them in a relatable and authentic manner. 

Identity experience (IX) plays a huge part in this narrative of normal, something that has been ignored for a very long time. The usual tropes of couples, families, racial and gender identities seem outdated. US is a microcosm of cultures. each with a diverse view on healthcare, health maintenance, and death. Yet we rarely see this reflected in marketing materials. Hopefully, now with personalized experiences, IX will be a welcome paradigm shift when creating patient journeys.

Mirror, Mirror

The visual or physical perception of normal is also a huge factor in this discussion. For example, after something as simple as a laparoscopic procedure, which leaves a small scar, or as dramatic as a mastectomy, the patient might look in the mirror and not recognize their reflection. The disease leaves a mark as a reminder that this is the new normal.

Cancer patients are perhaps the most ballsy individuals I have ever come across. Over the years, I have learned so much working with cancer patients about human strength and application of behavior modification. Rightfully, these patients have a plethora of support material to help them navigate their path. This includes: Professional support groups, a shift in priorities, acceptance, and humor. Yes, HUMOR. Laughing is one of the most human tools to turn a somber situation into a reprieve.

The best use of humor we’ve seen in a long time is in a patient education incentive called LiveToTheBeat, created by the CDC. I’m not going to opine about it, that’s fodder for another blog, but I urge you to watch and read. Not only does it have wonderful content, but it’s fun and funny, with an on-point strategy, and beautifully designed as well.

Lost in Translation

The doctor’s office can offer little support. An average doctor’s visit is approximately 13-16 minutes. A part of that visit is devoted to checking vitals, then gathering of topline information, which the doctor and/or their PA frantically types into the computer as the patient speaks. Then the exam. And then the tests, diagnosis, and a brief chat. 

Most in-office explanations are a breakdown of science translated into layman’s terms. Sure, there are visual aids, but let’s look at all this through the patient lens: you’re tired, and you’re not feeling well or in pain, or on pain medication. You’re either in shock from the diagnosis or you’re just overwhelmed. You have a sixth-grade level education. The doctor is talking AT you. It’s like school. I don’t know about you, but in these scenarios I always feel small, regardless of the doctor’s bedside manner. Then you’re told to go home and read brochures and websites on your own featuring smiling people on a beach doing yoga. 

Sean and I have a drawer full of brochures from our visits to doctors, surgeons, and physical therapists. I trashed them all about a month ago. I got tired of seeing the same royalty-free images with scenarios of unrealistic or generic expectations. We also got tired of reading the word-walls of copy that basically outlined the same thing. And in none of the websites or brochures did it actually explain what Sean could FEEL during and after surgery. The litany was only about mechanics. 

Normal Behavior

Brochures and/or ads of smiling patients aren’t going to inform or lead to continued engagement. Throw the racial, gender, and cultural experience into the cauldron, and it’s no wonder there is little information retention, engagement, or behavior change. Perhaps it’s because those tactics are not taking into account the emotional impact for a patient who is going through the A-to-B shift—not a problem to solution, but from NORMAL to DIAGNOSIS/TREATMENT.

As marketing professionals, it’s not enough to look at the data and statistics, we have to speak to patients on an emotional level, gaining empathic insights throughout their journey and plotting realistic barriers so we may develop better solutions. Let’s understand their experience and how to assist them with behavior modification instead of showing unrealistic or unreliable images of happiness. Let them identify what happiness looks like in their new normal: create their own adventure. 

For Sean, it is walking to Trader Joe’s without pain, because food shopping with me is painful enough. But it’s also rebooking our cancelled trip to Scotland. That’s the goal, that’s HIS happiness. 

In our professional life, we strongly feel we must develop educational materials for patients that are relatable, authentic, using UX and IX journeys that take culture and racial disparity as the true north. Why not use humor? Why not use gamification? Why not use edutainment? We in the marketing world need to go beyond the cool “omnichannel” soundbite and understand that happy smiling people aren’t representative of normal. Let’s reach beyond it.