One of the things I have noticed in my decades of working with chronically ill people is that they learn to identify quite closely with their illness. They have to; it’s a survival strategy. The easiest way to adapt to pain or illness is to learn its patterns -- when it strikes, when it sleeps, what will provoke it, what will mollify it.
Psychologically, living with chronic illness or pain is like living with someone who is abusive, and from whom you have no power to escape. Eventually, you come to identify with your abuser, and make their patterns your own. This disempowerment of the self, the loss of the ability to see yourself outside of your disease, makes it far easier to live with it, yet at the same time makes it more difficult to improve.
The person who identifies with their disease is perhaps the most dangerous and difficult to help manifestion of chronic illness that I have seen, and it can take many forms. I’ve had beautiful women in tears in my office over the belief that no other would accept them as a partner because of their chronic joint pain, and I frequently see posts on social media from people whose entire public presence is built around coping with their disability. Once you have identified yourself as “I have X” (X being a diagnosis, like MS, fibromyalgia, sciatica, irritable bowel disease), separating self from disease becomes a monumental task.
Part of the problem is as a result of how we look at disease in this society. We turn health issues which are basically dysfunctional processes (an overgrowth of cells, excess deposition of fatty tissue, production of inflammatory cytokines), into a static thing: “I have IBS,” we say, or “I have arthritis.”
Once you have converted something from a process into a thing, you have made it much more difficult to change. A process is the B train on the Green Line; it can go fast or slow, make stops, let riders off and on. A thing is a rock; it does not move. It can be changed by the erosion of water and ice, but it takes eons and lifetimes will end before any discernable difference is made. Processes are malleable to time and space and changes of input. On the other hand, things don’t change, without application of saw and hammer and destructive acid.
The second part of the problem becomes how we describe ourselves. Instead of a person with high inflammatory potential and impeded antioxidant processsing, we say “I have arthritis.” Rather than being a person who reacts strongly to certain foods which influence neurotransmitter production, we admit that “I have depression.”
So there we have it. We have a thing which we cannot change, which is only sufferable by controlling our behavior in the most intrusive ways possible. You might as well proclaim “I AM HEART DISEASE.” Because that, in your heart of hearts, is what you’ve been taught to believe.
This self-identity can become so strong that I have, many times, had patients abruptly abandon successful care because it was taking away a part of their selves that they had come to accept as necessary and needed. I would call them on the phone, ask them, “What is wrong?” They would reply, “It was working so well, and then I felt so bad!”
This was my failure, because I failed to prepare my patients for what they could become in the absence of disease. They could become more, not less.
Over time, I have developed a method of helping patients to realize that which they can be, without illness, without pain, and without all of the benefits they may see themselves as getting as a result of their illness.
I call it Contemplation of You As You May Be.
Step 1: Sit somewhere quiet, where you won’t be disturbed for 10 to 15 minutes. Close your eyes, and form a mental image of yourself. See yourself, as your disease affects you, in stillness and movement, in shape and color, in smell and sound. Take a minute or two, and completely build this picture of yourself in your mind. Feel and explore the effects of your disease or your pain on your body.
Step 2: Take a piece of paper, and write down all of the attributes of your illness on your body. There will be different groups of sensations: There will be the appearance -- red, pale, swollen, scaly. There will be the sensations -- burning, achy, itchy. There will be the mental -- fatigue, forgetful, hyperactive. Then there will be the emotional -- sad, mirthful, confused, scared.
There will be more than you can think of, and the first time you do this exercise, it is best not to overwhelm yourself with too many attributes. Start with the obvious ones, that’s good enough for this time.
Step 3: Having written down all of those attributes, close your eyes again, and re-imagine the mental image of yourself that you developed in step one. Then, one by one, start removing the attributes of your illness. Start with the physical ones. See yourself without the swelling, without the redness. Take your time.
Once you have a strong image of yourself in your mind without the physical attributes, begin to remove the sensations -- the pain, the burning, the ache. What do you look like without those things? How does that image of yourself feel without them? Again, take your time. This may be as far as you get the first time you do it.
But if you can go further, keep removing more and more aspects of your illness, of your pain. Take away the sadness, take away the fatigue. In your mind’s eye, what do you look like? How do you feel? How does your voice sound? What is it like to move?
Once you have removed all of the attributes of your illness, what will remain in your minds eye is you. Your without the disease. You without the pain. You without that which has forced you to be something that you are not for so long. Be prepared; your mind will keep wanting to return you to the first image. Keep yourself fixed on the self without disease.
Know that this person, this aspect of you is alive and well, and strong. Every day, do this exercise, until finding the healthy you is a trivial matter. And as that you becomes stronger and more real, the you defined by your disease becomes weaker and weaker. Eventually, you will have divorced yourself so thoroughly from the process of your illness that your therapy -- whether it is chiropractic, or acupuncture, or exercise or diet, or all of the above -- begins to take hold. You are replacing sick belief with healthy belief.
And at some point, when you look at your reflection, you’ll realize that the you in the mirror has become the you in your mind.
Every patient who walks into my exam room receives -- at no extra charge! -- a critical evaluation of their exercise regimen, or lack thereof. At this point, regular exercise has been proven so critical in the prevention and treatment of so many disorders, from depression to cancer to heart disease to the cold and flu, that in my not-very-humble opinion, any primary care doctor who does not investigate, evaluate and manipulate their patient's exercise program is committing malpractice. Yes, it's that important. It's like not taking a patient's blood pressure or pulse. A person's participation in exercise is one of the vital signs of wellness.
Frequently, my job is to find exercises that will work within the boundaries set by a patient's existing disorder while at the same time optimizing it to reduce or eliminate the effects of that same disorder.