Chronic Illness

Charles Burnett, PhD

Living with chronic illness is challenging in many ways. Although great strides have been made in treating diseases and trauma, even high tech treatments often leave some residual illness. Chronic pain, decreased function, or a complex medical regimen may continue for a long time. There are also functional disorders such as irritable bowel syndrome where the function of the gastrointestinal tract is disturbed without a specific disease or injury having caused the dysfunction. Finally, there are the chronic illnesses that accompany aging such as diabetes, arthritis, and heart disease that present their own unique challenges to quality of life. Even though the broken leg has healed, we still may experience pain when the weather changes. An individual with diabetes may have his or her disease well under control with diet and medication, but also may experience substantial distress attempting to cope with the demands imposed by the illness.

An especially helpful way to think about the stresses associated with chronic illness is the concept of threat. We are predisposed to pay attention to threats in preference to neutral things. Thus, it is more important to pay attention to the rattlesnake in the woodpile than to the stick on the ground. We are under powerful threat when our body is not functioning properly.

Pain is a prime example of a threatening experience. We are designed to pay preferential attention to pain, just like to the rattlesnake. Acute pain, such as touching a hot stove, conveys information: stop doing what you are doing, because it is causing damage. Chronic pain is another thing, though. The pain of arthritis, for example, is not helpful in telling us to stop doing something. In fact, the pain can prevent us from doing things like exercise that can eventually help reduce pain and improve function.

The natural response to threat is psychophysiological arousal, commonly called stress. Our bodies produce a cascade of stress hormones like adrenalin when we are threatened. When the threat is acute, like a close call while driving, we react to the threat then quickly calm down again. When the threat is long lasting, like a chronic illness, we remain in a state of threat, and constant heightened psychophysiological arousal. After a while, the frustration and fatigue of being constantly under siege take their toll, and we may become chronically anxious or even depressed. The anxiety or depression then become additional sources of threat, and make everything worse and harder to cope with.

Fortunately, there are a number of things that can be done to reduce the impact of chronic illness by reducing the sense of threat, and by dealing with the anxiety and depression that may accompany it.

First, it is important to deal with expectations about health and illness. We are constantly bombarded by commercials that tell us that pain and illness are bad, and there is a fix if we only use the right drug or do the right thing. Unfortunately, by their very nature, chronic illnesses tend to be chronic. There is not a miracle cure, and the treatments often have side effects that complicate coping with the symptoms of the disease. As hard as it may be, accepting the way things are is often the first and most difficult step in successfully managing a chronic illness.

Second, learning techniques for reducing psychophysiological arousal can go a long way toward maximizing well-being. Especially important are active relaxation like progressive muscle relaxation exercises where muscles are tensed and relaxed, to dramatically lower stress levels. Passive relaxation techniques such as calming imagery can also be helpful. Other ways of relaxing, ranging from saunas, Jacuzzis, massage, yoga, long walks, music, and meditation, are examples of other potentially effective ways of reducing the stress of chronic illness.

The psychological consequences of chronic illness may benefit from consultation with a mental health professional. We develop patterns of thinking about ourselves, illness, and threats that may or may not be helpful in managing a chronic illness. For example, a specialist in health psychology or behavioral medicine is trained in helping to sort out the threat, arousal, and thought components of dealing with a chronic illness. Seeking support from a mental health professional is not a sign of weakness. We consult a mechanic if our car is not functioning properly, so what is wrong with consulting a mental health specialist if we are facing a difficult life situation like managing a chronic illness? A consultant who is familiar with the psychophysiological aspects of illness can help to develop a strategy for reducing stress, managing negative thoughts and feelings, and generally improving quality of life.