No Catastrophes Here

I’m minding my own business. Given that I live with rheumatoid disease, things are going pretty well this morning: I’m up, moving around with only minor stiffness or pain, I’ve had my breakfast, and now I’m settling down at the computer with a nice cup of coffee. I’m going to get some writing done.

Gazing at the blinking cursor on the screen, I pick up my coffee mug. PING! Pain shoots through the tendons along the back of my hand and straight into my knuckles, making me gasp and cry out. I put the mug down fast and cradle my hand instinctively. I rock a little. And into my head leaps this unwelcome thought: “Not now! I have work to do!”

On top of that happy thought come other, even darker ones. They’re subtle, like whispers in the background: “Will it get worse? How will you cope? Should you stop working?”

I try to ignore these thoughts. I give my hand a gentle shake and start typing. The tendons pull and yelp; the knuckles grate. My thoughts are shouting, now. “You can’t stop! You have to get this work done! If you don’t, you can’t pay the bills!” Then they get darker yet: “This pain is never going to stop! Why don’t my meds work better? Nothing ever works on this crap disease! How can I live with this for the rest of my life?!”

If you have rheumatoid disease, thoughts like these that spiral down into fearful places are probably fairly familiar to you.

According to an article in the scholarly journal “Arthritis Care and Research,” published by the American College of Rheumatology, this sort of thinking is “catastrophizing.” It’s “a set of cognitive and emotional processes encompassing magnification of pain-related stimuli, feelings of helplessness, and a generally pessimistic orientation to the experience of pain and pain-related sequelae across several rheumatic diseases.” 

The Oxford Dictionary states that “catastrophe” means “An event causing great and often sudden damage or suffering; a disaster.”

There’s no doubt that the pain, stiffness, fatigue, and other symptoms that go along with an RD flare can seem like a disaster. It has a real effect on our lives, too: missed work, canceled outings with family and friends, days spent indoors feeling like crud when everyone else is out enjoying themselves.

Is it any wonder that we tend to fear the worst? None at all. But here’s the rub: by doing it—by thinking about the ever-worsening consequences of our RD symptoms, by catastrophizing—we aren’t doing ourselves any favors. These thoughts bring us down, lower our mood, and set up an ever-cascading cycle of fear. Catastrophic thinking leads directly to more catastrophic thinking, and that does nothing but harm.

So what can we do about this most human of reactions to unwanted, unmitigated chronic pain and disability?

First, we can learn to recognize catastrophic thinking when we see it. At that first “Not now!” we can think, “Wait, hold up. This hurts, but how many times have you felt RD twinges in your joints that came to nothing? Lots!” We can turn them from negative to positive, or at least, to neutral. There’s nothing wrong with acknowledging the pain—that’s just being honest. But rather than worrying at it: “I have work to do! You (my hand) can’t start hurting now,” why not ease off and say to yourself “I’ve worked with pain a lot worse than this before!” and keep at whatever you’re doing, because you know, without a doubt, that by distracting yourself from the pain, you won’t notice it as much.

There may be a point when you do need to stop working and start self-care. Maybe you’ll need to use a heat or ice pack on your yelling joints. Maybe you’ll need to pull on your compression gloves or wear a splint, or both. Maybe you’ll decide now’s a good time to take a pain med. These are all positive steps.

What you won’t do is let your head wander on into the RD Badlands.

The end result of nipping catastrophic thinking in the bud is this: by saying to that you can instead of that you can’t, you’ll set yourself up for a far more optimistic future, even if that future is only ten minutes from now. You may even lessen or stop your pain. And, at the same time, do everything you can to take positive steps toward coping well with your disease: take your RD medications to slow its progression, eat as nutritiously as you’re able, move your body as much as you can, take painkilling meds if necessary, and don’t worry about a future that hasn’t happened yet. Acknowledge that bad things happen—and move on.

It can only help.