Guest Blogger: Tammy Fletcher
This article builds on the discussion in my last Topic Expert article where we explored the experience of new diagnosis and its effect on emotional wellbeing. Another way in which receiving a diagnosis, either psychological or medical, impacts us is in terms of identity.
Coming to terms with identity can be challenging for anyone. Developing an understanding of “who we are” is a lifelong process. Our sense of self solidifies as we age and gain life experience, however, that same life experience brings fluidity to identity. For example, a young girl struggles through her teenage years to become a young woman. A man in his 20’s goes from student to husband to father. An elderly couple moves from long-term relationship to widowhood. Cocktail party information looks like “Hi, I’m Jane. I’m a _______” – filling in the blank with your occupation, your family or marital status, your project du jour. All little pieces of what make up your identity.
Life is a series of changes, and as we move and adapt through what life brings us, our sense of who we are in the world shifts as well. Twenty-two years ago, I was a wife, a friend, a daughter. In a heartbeat (plus 13 hours of labor), I became something entirely new – a mom. I welcomed this identity shift, and while it was certainly new and sometimes even scary, there was support and advice everywhere I turned. It was an expected and celebrated change. I was still me, but this new life experience permanently altered my sense of self.
A few years later, I had another instant identity shift. A grim-faced neurologist sat down and told me, “You have multiple sclerosis.” Me? But I had things to do, a daughter to raise, a book ready to publish. This unwelcome verdict and whatever the heck it had in store for me was not in the plan. Right. Try telling that to a diagnosis. “Um….hi. I have other plans. Can you come back later? Or better yet, not at all?”
Sometimes life thrusts upon us the mother of all life changes – a serious medical or psychological diagnosis. As both a patient myself and a mental health clinician, I have seen the impact of diagnostic conclusions, and how we struggle to regain our footing. My last article outlined the logistics of a new diagnosis, including how to talk to your doctor and where to find more information to help you become an informed consumer. Now, let’s talk about the impact of a diagnosis after the calls have been made, the treatments scheduled, and the news begun to sink in.
“Who am I now? I was Mark. Now I am Mark, the-guy-who-just-had-a-heart attack. People treat me differently. My life changed, and of course I changed. But I am still Mark. Right?”
“I knew I had some problems with depression, but hearing ‘It’s Bipolar II Disorder’…wow. Now I’m officially a ‘psych patient.’ I stopped trying to explain it to people when I saw the look on their faces. Like I’m contagious. My therapist tells me to accept it and move on, make the best of it. How do I do that?”
“I’m an addict. I get that. Sometimes I want to be just ME again. I am not sure who that is now.”
Sometimes, receiving a diagnosis can feel like the person you were prior to the news doesn’t exist anymore. Or exists in such an altered state that you have trouble recognizing yourself. Friends, family, co-workers, and even your clinical support team have their own ideas about your diagnosis. Cancer, Major Depression, Lupus, Schizophrenia, Traumatic Brain Injury….the list is endless and the perceptions about each vary widely, influenced by each person’s personal experience, culture, exposure in the media, and personal beliefs about illness in general. It can be a challenge to dig yourself out of a mountain of perceptions, labels, and misinformation to re-connect again with people in your life, and with yourself.
Some suggestions that may help you through the process of physical or psychological illness:
1) Stages of Grief – Dr. Elisabeth Kubler-Ross outlined five stages that many people experience after loss. These stages can apply to any major life change, as well. From job loss to divorce to learning you are facing physical or mental illness, you may go through Denial, Anger, Bargaining, Depression, and finally, Acceptance. The stages do not always appear in order, and reaching the Acceptance stage doesn’t mean that you may not slip back into Anger or another stage. Those feelings are part of the process.
2) Find support – Whether you join a support group of others facing similar circumstances, or seek individual therapy, bolster yourself with support in whatever way works for you. Patients need emotional support after receiving serious health news. Family and friends may be dealing with the diagnosis in their own ways. Before worry, isolation, or depression take hold, reach out to others for support.
3) Find ways to still be you – Treatments, lab tests, hospitalization, appointments, side effects…all these can crowd into your reality and leave little time or energy left. You are still you. If you love music, take your iPod with you to an appointment. If reading relaxes you, visit the library or ask a friend to bring you some reading material. Books on CDs are available if reading is difficult. Stay connected to what matters in your life.
4) When loved ones offer to help, let them - People often don’t know what to say or do when a friend is ill, but they would like to help. Sitting and talking, driving you to an appointment, throwing in a load of laundry or bringing a meal – all are little ways to stay connected to others who are important in your life.
It would be false to assure you that everything stays exactly the same after you have been handed a significant medical or psychological diagnosis. Every piece of information we take in changes us somehow, and this one is a doozy. You may feel overwhelmed with information about what to expect. Remember, this is your journey. No one else’s will be exactly the same. The diagnosis impacts you; however, you also impact the disease or condition. You come to the table with your own set of strengths, experiences, and goals.
Dealing with mental or physical illness changes us. What we do with that is up to us. I chose to grow and find the life lessons hidden underneath the label of illness. However, I refuse to be the label. I have multiple sclerosis. It does not have me. That part of my journey involved conscious choice, and yours can too. Be kind to yourself as you go through any disease process. Allow it to teach you about yourself, others, and what matters most in your life. It’s okay to feel overwhelmed, angry, and to wish sometimes it would just go away. Stay anchored through those feelings and know that you are a person, not a diagnosis.
Thursday, February 24, 2011
Chronic Pain – All in Your Head?
Guest Blogger, Tammy Fletcher, MA
According to Carmen Green, M.D., a pain specialist at the University of Michigan’s Health System Center for Interventional Pain Medicine, as many as one-fifth to one-third of Americans live with some form of chronic pain (Gazella, 2005). Let’s say there are about 300 million people living in the United States right now, that means that as many as ninety-nine million people may be experiencing physical pain, many on an ongoing basis.
Why so many? And why do the numbers seem to be increasing? A few reasons come to mind. One, on average we are living longer. Conditions that used to result in death are now more treatable, extending our lifetimes. With increased longevity may come chronic pain related to these conditions or simply to the aging process. Another reason for the increase in our pain is the increase in obesity in the United States. According to the Centers for Disease Control (CDC), as of 2009 only two states had an obesity rate of less than 20%: the District of Columbia and Colorado (Centers for Disease Control and Prevention, 2009). The CDC reports that obesity may lead to diseases that may include chronic pain.
With chronic pain intruding on so many millions of lives, you might imagine that the practice of medicine has kept up with these trends, and that a patient experiencing moderate to severe pain on a daily basis might have an array of effective, cost-efficient choices in care to assist in enhancing quality of life and restoring a desired level of activity and function to the patient’s life. There are a growing number of specialists in the effective treatment of pain, including medical doctors and osteopathic physicians who complete specialized education and certification in this area.
Given this information, why do so many patients report difficulty in finding adequate medical care for their pain? I hear again and again from clients who feel they are not taken seriously, seen as drug seekers, or told their pain is “all in their head.” So in addition to living with a condition like diabetes or fibromyalgia, they experience the added stress of feeling no one understands their chronic pain. Chronic pain patients often feel as if their doctors don’t believe them, or see them as malingering.
This is not to say that patients don’t abuse health care systems. There is such a thing as “drug seeking behavior” as well as patients who embellish their symptoms or concoct stories of illness for various reasons. This article is not about those people. This article is for those who experience severe or intractable pain on a regular basis. Their lives have been disrupted. Their relationships have bent under the stress of their pain. Their careers may be on hold, or greatly hampered. These people want nothing more than to function. They want to be believed.
As I mentioned in my last blog, I am a chronic pain patient as well as a therapist. I was diagnosed with Multiple Sclerosis in 1996. Prior to my diagnosis, even I was told it was “all in my head” by my primary care physician. Guess what? It was. I had lesions on the nerves in my brain. After a very satisfying moment of firing that doctor, I set out to find one who knew what pain was and how to treat it. It took me several more years, but I found her. As patients become more educated and empowered, the medical field is going to have to keep up with us – even those of us with chronic pain.
Speaking of my own pain specialist, she reminded me to add here that there are a number of pain-causing conditions that simply defy definition or clear diagnosis. A patient wakes up, sneezes, and ends up with a ruptured cervical disc. Those cases are even more likely to be undertreated, as they don’t necessarily show up on an x-ray or a blood test. A confusing or hard-to-pinpoint diagnosis can complicate the patient’s ability to have his or her pain symptoms treated.
There is no question that chronic pain has emotional repercussions. Depression and anxiety are common among pain patients, especially those whose pain is not managed adequately. I have noticed that in therapy sessions, often just allowing the client who experiences chronic pain to talk about what it is like is a catharsis in itself. Respect, acceptance, and the ability to hear the person’s story with empathy are all healing tools that any therapist can use for the chronic pain client.
Cognitive behavioral therapy has been shown to positively effect chronic pain, while providing clients with techniques to control pain in whatever ways they are able (Keefe, 1996). Narrative therapy is making strides in supporting clients in developing a different relationship with pain, as well as coping with feelings like anger and depression. Whatever your theoretical orientation, I encourage you to learn as much as you can about chronic pain, treatment options, and the ways in which pain impacts our clients’ daily lives. Keep in mind that your client may have been told that his or her pain is unfounded, imagined, or otherwise minimized by health care providers. Your caring, professional support can be a vital part of a chronic pain patient’s health care team.
Here are some helpful resources for anyone seeking additional information about chronic pain:
* The American Academy of Pain Medicine: http://www.painmed.org/patientcenter/main.aspx
* The American Chronic Pain Association: http://www.theacpa.org/default.aspx
* The American Pain Foundation: http://www.painfoundation.org/
Works Cited:
Centers for Disease Control and Prevention. (2009). U.S. Obesity Trends.
Gazella, K. (2005). Enduring chronic pain. University of Michigan Health Minute .
Keefe, F. J. (1996). Cognitive Behavioral Therapy for managing pain. The Clinical Psychologist .
According to Carmen Green, M.D., a pain specialist at the University of Michigan’s Health System Center for Interventional Pain Medicine, as many as one-fifth to one-third of Americans live with some form of chronic pain (Gazella, 2005). Let’s say there are about 300 million people living in the United States right now, that means that as many as ninety-nine million people may be experiencing physical pain, many on an ongoing basis.
Why so many? And why do the numbers seem to be increasing? A few reasons come to mind. One, on average we are living longer. Conditions that used to result in death are now more treatable, extending our lifetimes. With increased longevity may come chronic pain related to these conditions or simply to the aging process. Another reason for the increase in our pain is the increase in obesity in the United States. According to the Centers for Disease Control (CDC), as of 2009 only two states had an obesity rate of less than 20%: the District of Columbia and Colorado (Centers for Disease Control and Prevention, 2009). The CDC reports that obesity may lead to diseases that may include chronic pain.
With chronic pain intruding on so many millions of lives, you might imagine that the practice of medicine has kept up with these trends, and that a patient experiencing moderate to severe pain on a daily basis might have an array of effective, cost-efficient choices in care to assist in enhancing quality of life and restoring a desired level of activity and function to the patient’s life. There are a growing number of specialists in the effective treatment of pain, including medical doctors and osteopathic physicians who complete specialized education and certification in this area.
Given this information, why do so many patients report difficulty in finding adequate medical care for their pain? I hear again and again from clients who feel they are not taken seriously, seen as drug seekers, or told their pain is “all in their head.” So in addition to living with a condition like diabetes or fibromyalgia, they experience the added stress of feeling no one understands their chronic pain. Chronic pain patients often feel as if their doctors don’t believe them, or see them as malingering.
This is not to say that patients don’t abuse health care systems. There is such a thing as “drug seeking behavior” as well as patients who embellish their symptoms or concoct stories of illness for various reasons. This article is not about those people. This article is for those who experience severe or intractable pain on a regular basis. Their lives have been disrupted. Their relationships have bent under the stress of their pain. Their careers may be on hold, or greatly hampered. These people want nothing more than to function. They want to be believed.
As I mentioned in my last blog, I am a chronic pain patient as well as a therapist. I was diagnosed with Multiple Sclerosis in 1996. Prior to my diagnosis, even I was told it was “all in my head” by my primary care physician. Guess what? It was. I had lesions on the nerves in my brain. After a very satisfying moment of firing that doctor, I set out to find one who knew what pain was and how to treat it. It took me several more years, but I found her. As patients become more educated and empowered, the medical field is going to have to keep up with us – even those of us with chronic pain.
Speaking of my own pain specialist, she reminded me to add here that there are a number of pain-causing conditions that simply defy definition or clear diagnosis. A patient wakes up, sneezes, and ends up with a ruptured cervical disc. Those cases are even more likely to be undertreated, as they don’t necessarily show up on an x-ray or a blood test. A confusing or hard-to-pinpoint diagnosis can complicate the patient’s ability to have his or her pain symptoms treated.
There is no question that chronic pain has emotional repercussions. Depression and anxiety are common among pain patients, especially those whose pain is not managed adequately. I have noticed that in therapy sessions, often just allowing the client who experiences chronic pain to talk about what it is like is a catharsis in itself. Respect, acceptance, and the ability to hear the person’s story with empathy are all healing tools that any therapist can use for the chronic pain client.
Cognitive behavioral therapy has been shown to positively effect chronic pain, while providing clients with techniques to control pain in whatever ways they are able (Keefe, 1996). Narrative therapy is making strides in supporting clients in developing a different relationship with pain, as well as coping with feelings like anger and depression. Whatever your theoretical orientation, I encourage you to learn as much as you can about chronic pain, treatment options, and the ways in which pain impacts our clients’ daily lives. Keep in mind that your client may have been told that his or her pain is unfounded, imagined, or otherwise minimized by health care providers. Your caring, professional support can be a vital part of a chronic pain patient’s health care team.
Here are some helpful resources for anyone seeking additional information about chronic pain:
* The American Academy of Pain Medicine: http://www.painmed.org/patientcenter/main.aspx
* The American Chronic Pain Association: http://www.theacpa.org/default.aspx
* The American Pain Foundation: http://www.painfoundation.org/
Works Cited:
Centers for Disease Control and Prevention. (2009). U.S. Obesity Trends.
Gazella, K. (2005). Enduring chronic pain. University of Michigan Health Minute .
Keefe, F. J. (1996). Cognitive Behavioral Therapy for managing pain. The Clinical Psychologist .
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