Ruminating and Rheumatic Disease

Do you ruminate? Wow, I do, and I hate doing so. For those who are unfamiliar, rumination is replaying words, events, or situations over in your mind. It is like feeding a small bump until it becomes a giant mountain.

I have done it all my life. It might be because I am an only child and was often alone throughout the day and night. My mother was hospitalized for much of my youth from age 8 through high school and my father spent time working and being with my mother. However, I cannot say that my rumination was only caused by being alone. It was not. My father and grandmother suffered from it, as does at least one of our sons. My experience has led me to believe that rumination is both a chemical and learned behavior.

My repetitive thoughts began early in life

Like all learned behaviors, rumination is not altogether harmful. The thing about rumination is that it worked for me. It was, at times, motivating and kept me on task as I worried about something important. For instance, if I needed to complete a significant paper, cram for a test, or complete a project, rumination was often the first thing I would tap into so I could stay on course to completion.

I do not recall when it started exactly, but I remember ruminating about how I was doing in first grade. I suspect I had already begun ruminating before that. I also guess that even before 1st grade, if someone had checked, I was depressed. I believe depression led to rumination, and rumination to more depression.

Rumination and depression

I am not alone in having rumination as a comorbidity of depression. In a study, Nolen-Hoeksema tied the progressive levels of rumination to worsening depression.¹ That may seem obvious, but the relationship was not well established until this study. In my case, I do not believe rumination led me to depression. Rather, I believe that the more depressed I became, the more I ruminated.

Depression followed me my entire life. Even as my life became more secure, I could not stop thinking about how badly I might be performing in my job. It was a terrible trap. What started as a coping mechanism turned into a dark hole that required ongoing maintenance to overcome. That is when I sought professional help, including therapy and medication. These steps lessened the combined impact of worry and helped me find new coping skills. However, it still happens today as I ruminate about the past. I turned 65 in June, and it has been 13 years since I worked, yet I still ruminate about the decisions I made and how I wish I could change things.

Diving into the science

Rumination is challenging to quantify, and that makes it difficult to study. But one excellent study did occur in 2021 when loneliness was identified as a significant factor that predicts rumination. When people identify as lonely, they are more likely to be impacted by rumination.² That is not surprising, but it was an especially important milestone to crack the nut of understanding rumination like the previous study.

Is there a link to rheumatic disease?

While rumination is often tied to the fear of medical issues, and I certainly ruminated about diabetes, my ruminations kicked into high gear when rheumatic disease (RD) entered my life. Would this or that happen? When did I have to stop working? Am I on the fast road to an inability to support myself? These questions burned inside me.

Coping with RD and rumination

For a person prone to rumination, one might imagine how crippling that dialog became. Play any negative thing in your mind over and over, and eventually, you become crippled, unable to move.

Standing still is no way to face an illness like RD (or any condition for that matter). Even if it was a coping mechanism in the short run, the crutch ate me alive eventually.

While rumination may always be part of me, I know that with maintenance, including medication, I can lessen its grip on my life. I do this by engaging truthfully in therapy and taking medication for depression. Both of which are needed to help me function.

Do you ruminate? What are your thoughts on the association between rumination and depression? Have you ever used rumination as a coping mechanism for rheumatoid arthritis?