How Do You Feel Good When You Rarely Feel Good?
Rheumatoid arthritis is a physical disease that is harmful to emotional health. For most of my life I resisted this fact, mostly because I didn't want to be saddled with more problems than I already had. Whenever a loved one suggested that I was depressed I would answer, “If I am it is situational depression, once my situation improves I'll be fine.” And I believed myself. I told myself that I was lucky to have a laid-back, happy personality. I told myself that the pain would never defeat me. I told myself that I wasn't missing out on much during my teen years spent mostly alone. All of the things I told myself were true, at least to some extent. But by telling myself and the people around me how good I was feeling, I ignored a big part of the truth of my life. The truth that my rheumatoid arthritis creates challenges in all aspects of my life, not just the physical.
The emotional response of something physical like pain
If you think about it, the very idea that someone could experience rheumatoid arthritis with no negative impact on emotional or mental health is a preposterous one. Especially now that the medical community has been able to look at functional MRI's and see what happens in the brain when someone feels pain, the hallmark symptom of RA. When a painful stimulus is felt, the nerve transmitting the pain signal to the brain will spread out into three directions. Two of those branches lead to places that govern our mental and emotional well-being and stimulate them to have an adverse reaction. The reason for this is simple- our bodies are always trying to protect and heal us, and the majority of the time something that hurts is bad for us. So, when you touch a fire you immediately feel the burn and quickly pull back your hand (your physical response,) and then you think “that was awful, I'm never going to do that again” (your emotional/mental response). The reason you think and feel the way you do is that the neurons transmitting the pain go on to stimulate the limbic system, our emotional center in the brain, and the part of the cerebral cortex that governs higher learning and thought. Again, this is to increase our ability to survive, and we should all be glad about this.
Repercussions of chronic pain
But, when you live with chronic pain, all of these feelings can become a vicious cycle that turns into depression, anxiety, or a general feeling of unease. And this is only the tip of the iceberg when it comes to hits on our mental and emotional health. The number of losses and the speed at which they come is another thing that would get anyone but a robot down. Loss of independence, strength, the ability to feel hopeful about the future, loss of the ability to work, to have children, loss of social engagement, loss of treasured hobbies; I know you could add many more losses to this list.
And then there is the uncertainty factor.
How do you plan a vacation, an outing with friends, or even what to make for dinner when from one day to the next the level of inflammation and pain in your body changes so much? And how do you stay happy when you have to opt out at the last minute from so many activities that you look forward to? Which brings me to the final assault on your well-being that RA brings.
How do you stay content with your life when you constantly feel the need to explain yourself to those around you? Even after four decades I still feel bad when I have to say no to a family gathering, or a party, or any social engagement, and it makes it worse when the people around me don't understand. I've had to step back from friendships after being told I was “unreliable,” and I've suffered a hit to my self-esteem every time this happens. And then there is brain fog. Speaking for myself, I find it embarrassing and sad, and especially hard to explain, so I keep it to myself. Even thinking about mentioning it to others makes me feel like I'm making up excuses even though I know that I'm not.
With so many things conspiring to negatively affect our mental and emotional health it's a mini miracle that any of us can be happy. In reality, there are no miracles involved, only pro-active action. In order to be happy, and have rheumatoid arthritis, you have to make it happen by consciously counter-acting all of the negative influences that constantly bombard your life. You have to figure out a way to enjoy your life even when it is spent alone and in pain. You have to foster relationships that are supportive, and fun. You have to find things you do well, even in pain. You need a pain plan, and to take steps every day to help your body be in less pain. And during times when you have no energy for any of these things you have to hold on, and remember the saying, “This too shall pass,” which is one of my mantras. Life really is beautiful, but sometimes you have to make it that way.
Have you managed RA fatigue better than you used to?