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Ten Keys to Coping and Recovery9: Honor Your Emotions Strong emotions like fear, anger, grief and depression are normal reactions to having chronic illness. Such emotions are a normal response to being in a situation that isolates, creates tremendous uncertainty, brings loss and imposes limits. Illness isolates people both physically (because we spend large amounts of time at home, often alone) and socially (because we feel different from others). Chronic illness also brings a great deal of uncertainty. We all ask: Will I improve? If so, how much and when? Lack of control creates frustration and feeds a sense of helplessness. And illness brings losses of various kinds, which may include financial losses, the loss of the ability to work, and the loss of friends and sometimes family. Unfortunately, these emotional reactions to being seriously ill may be intensified by CFIDS and fibromyalgia, which seem to make emotional reactions stronger than before and harder to control. This reaction seems part of the physical basis of the illness. These effects seem especially strong in the early stages. The strength of emotions can create a vicious cycle. Emotions can intensify symptoms, which in turn may increase worry and depression. The increase in emotions can further worsen symptoms. So, just as in other aspects of illness discussed in this series, self-help can play a role in managing the emotional aspects of chronic disease. We will discuss two in this article: depression and anxiety. The final article treats grief. Depression in Chronic Illness Depression is very common in all chronic illness, for several reasons. First, chronic illness is isolating. Because of our limits, we cannot do as much as before and often have to abandon work and limit our socializing. This means that many of us spend much more time alone than before. Being alone for long periods can lead to depression. Second, chronic illness brings uncertainty about the future. The prognosis for CFIDS and fibromyalgia is varied and uncertain. Lack of control and feelings of frustration and helplessness can also lead to depression. Third, chronic illness means loss and limits. To have CFIDS or fibromyalgia means to have experienced many losses, often quite substantial ones. We often have to give up work, which provides meaning and identity and which puts bread on the table. We may lose relationships, since our ability to socialize is limited by the disease. Depression is a normal reaction to having any chronic illness. It is not surprising that depression would occur in people who have an illness as disabling as CFIDS or fibromyalgia. In addition, sometimes depression may be part of our illness, with real physical causes. Prolonged stress may alter the biochemistry of the body, causing depression. Notes: Depression is often divided into two types: situational and biochemical. Both may apply to people with CFIDS and fibromyalgia. Situational depression (depression as a response to a particular set of circumstances) lends itself to self-management strategies such as those described below. But not all depression is best handled this way. If you are deeply depressed about your illness or you have biochemical depression, which has its roots in the chemistry of the brain, medication and professional help are indicated. Self-management strategies may also be helpful. Responses to Depression Even though depression is a normal reaction to chronic illness, there are ways to manage it. Here are a some strategies used by people in our program. If you’re like most people, some may appeal to you but not others. I suggest you try what you think fits your situation. The important point is that there are usually actions we can take to help improve our mood. Rest: Some depression seems to be associated with our symptoms. Reducing symptoms through rest can help improve mood as well. Contact with Others/Getting Out: Calling a friend or getting together to talk, share a meal or see a movie counteracts the sense of isolation and the low mood often associated with chronic illness. Getting out of the house counteracts isolation and boredom, provides stimulation and can reduce depression. Medications: As noted above, some people are helped by taking anti-depressant medications. Consoling Yourself & Acknowledging How You Feel: Some people reduce the impact of a low mood by telling themselves that similar moods haven’t lasted in the past and so the mood probably will end this time, too. Also, acknowledging blue moods can sometimes break their spell. Paradoxically, saying “I feel depressed right now” may help lift the spirit. Doing Something Pleasant: Pleasurable activities counter depression and help create a good mood. Students have mentioned reading, listening to or playing music, spending time with friends, being out in nature, exercise, laughter and chocolate. Changing Your Thinking: Being ill over an extended period of time can be associated with a sense of helplessness. Changing our habitual ways of thinking to be more positive can change our mood. For example, you may be able to raise your spirits by finding things you are grateful for. For more on how to make thoughts work for you instead of against you, see Taming Stressful Thoughts. Planning Something Special: The anticipation of having something to look forward to counteracts the lowered mood of depression. Fear and Anxiety Fear and anxiety are other common responses to chronic illness. As Edward Hallowell suggests in his book Worry, these reactions are common in situations in which we feel an increased vulnerability in combination with a decreased sense of power. Because of having a serious illness, we experience a loss of control over our bodies and over our ability to plan and predict. Our illness brings uncertainty about the future. We may be unclear about our prognosis and wonder whether we will improve and, if so, how much. We may worry about how far down we might slide and about becoming dependent or financially destitute. There are several strategies that may be helpful with fear and worry reactions. One is problem-solving. Achieving practical solutions to our problems has a double payoff. We reduce or eliminate a practical concern that is bothering us, and the process of taking action often reduces worry. Learning relaxation and other stress reduction techniques can help reduce the intensity of our emotional reactions and, by doing so, reduce the echo effect in which emotions and symptoms amplify one another. A regular stress reduction practice can also lower “background worry,” the ongoing anxiety we may carry with us. (For more on this, see the article on managing stress.) Changing habitual ways of thinking can reduce worry. If we have a tendency to think of the worst that might happen, we are likely to increase our anxiety. If instead we learn to speak soothingly to ourselves, we can reduce our worry. Several other strategies may also be useful. Contact with other people can change your mood. Exercise is both relaxing and distracting. Music and other activities in which you can become immersed help change mood. And, as with depression and sleep problems, some people find that medications help them deal with anxiety. Panic About 10 percent of people with CFIDS experience an especially severe and frightening form of fear called panic attacks. These are brief episodes of terror in which a person may feel he or she is about to die. Symptoms may include chest pain, heart palpitations and dizziness. In spite of overwhelming fear, people survive but may live a life of dread, apprehensive about when the next attack may occur. This kind of fear is treatable. For discussions on how to conquer panic, see Edward Hallowell’s book Worry or Martin Seligman’s What You Can Change and What You Can’t. Summary In sum, you aren’t crazy to experience strong emotions in reaction to having your life turned upside down. It would be surprising if you didn’t respond that way. Emotions like fear, anger, grief and depression are common responses to situations of loss and uncertainty. But there are many things you can do to reduce the strength of the emotions associated with chronic illness.
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