MARY SHOMON: Q: Can you talk a bit about the emotional and mental effects of chronic illness in general?
JAN NICHOLSON, EdD: Symptoms of depression and anxiety go hand in hand with chronic illness for many people. It is so demoralizing to be tired much of the time, to have poor concentration and memory, to have to cut back on doing things including the things you love most, to not be able to perform up to one's former level of competence, to have to say no to friends and family over and over in order to take care of yourself, I could go on and on.
It is easy to get into self-defeating thought patterns that actually reinforce a state of illness, such as "I might as well give up, nothing ever works out for me." Research has shown that chronic pain ages the brain up to 20 years; a huge complaint for people with chronic pain and/or illness is brain fog, a compromised ability to focus and concentrate or to remember things. This affects one's self-esteem and self-confidence. For some people, becoming isolated from others becomes a problem; for others, becoming perhaps even overly dependent on others can become a problem.
MARY SHOMON: Q: Even with treatment, many of us with chronic thyroid disease face long-term emotional symptoms that affect our daily life, including depression and anxiety. Do you have any thoughts on how men and women with a chronic illness should approach coping with or even overcoming these sorts of chronic symptoms?
JAN NICHOLSON, EdD: Support groups have proven to be enormously helpful for people who are ill, so seeking a group of people with a similar illness who hold regular meetings can be a great source of social support; also, participating in chat rooms online can be greatly helpful. In either, it's important that the people involved tend toward being proactive, sharing helpful suggestions with each other, keeping each other's spirits up. Some venting can be helpful but if the group tends to only do that, it can become depressing in itself, so watch out for that.
Doing healthy things for mind and body, such as yoga, meditation, exercise, nutritious eating, and regular sleep is important. Be mindful about negative self-talk and try to shift it into a more positive attitude. Seeing holistic providers who do massage, acupuncture, and other healing methods such as mind/body therapies (e.g., hypnosis, guided imagery) can help with both symptoms of the illness and of mood.
Psychotherapy with a psychotherapist who has a strong background in mind-body approaches can be highly beneficial. Sometimes, particularly if symptoms are intense and long-lasting, medication is beneficial to address anxiety and depression.
There are excellent books out there, for instance, The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn. A wonderful resource involving guided imagery CDs and downloads for nearly every illness as well as depression, anxiety, weight loss, general wellness and so on is Belleruth Naparstek.
There are mind-body things you can do to help yourself such as experimenting with imagery to shift your experience of symptoms; learning to manage symptoms to some degree alleviates feelings of helplessness and thus, of depression and anxiety. For instance, if you imagine that your hands are warming up to the point that they actually do warm, you can alleviate vascular constriction in your body, which can help with a symptom such as a headache. If a painful area feels sharp and prickly, you can imagine something occurring that shifts it into feeling more smooth and calm; this can actually reduce the intensity of the pain. If someone with a burn immediately starts thinking about coolness, the burn may not progress into being as serious as it might have been. That is how powerful the mind-body connection is.
MARY SHOMON: Q: When someone has a chronic illness, one of the most overlooked people in the equation is the spouse. Some people have spouses who end up overfunctioning -- taking care of everything -- i.e., children, housework, etc., because the one with the illness is simply too exhausted. On the other end of the spectrum, we see spouses who are unsupportive, and because someone with a chronic thyroid problem typically doesn't look obviously ill, they don't understand the illness, believe the spouse is truly sick, or even think that their spouse is "malingering." Do you have any specific thoughts directed at the spouses of someone with a chronic illness? And do you have any thoughts directed at someone with a chronic illness, regarding how best to effectively live well with both their spouse and a chronic illness?
JAN NICHOLSON, EdD: It is important for a spouse to become informed so that they do understand the illness, so they have a sense of when the person with the illness can safely do more and when they cannot, so that they have more compassion. The person who is ill needs to ensure that their spouse is educated and that he or she does understand as much as is possible without firsthand knowledge of the condition. This might mean asking (and pushing if necessary) a spouse to be more involved, perhaps in attending some medical appointments, doing some relevant reading, attending a lecture.
If it is something they can afford, it is helpful for a couple to decide what they can hire someone else to do for them so the healthy spouse does not feel overly burdened. Learning how to cope with stress is as important for the spouse as it is for the person with the chronic illness. Once having learned, make sure to practice the favorite stress management technique(s) on a daily basis. Taking time out to re-fuel is crucial, whether that is taking a walk, a bubble bath, exercising, sitting in stillness in meditation or prayer, getting together with friends, taking a vacation, going on a retreat.