Old mindset, new limitations
Against the advice of her parents, Karen Horney decided to attend medical school in 1906, at the University of Freiburg in Germany. At the time she was one of few women seeking a career in the traditionally male-dominated discipline of medicine, and one of even fewer women involved in the burgeoning school of thought called Psychoanalysis.1
Karen Horney is an important and often overlooked author of 20th-century psychology. As a whole, her work is fascinating, particularly on historical grounds. At the same time, I take issue with psychoanalysis as a school of thought. Many of its claims rely heavily on anecdote and appeals to authority, with terminology that is often vague and obfuscating. From a historical perspective, however, I enjoy reading about it.
As a metaphor, there are two concepts of Horney's that I find pretty straightforward and useful: The ideal image, and The Tyranny of the Shoulds.2 The first holds that some event in life, or some ongoing situation, leads one to imagine the ideal of who they need to be in order to escape the difficulty. The Tyranny of the Shoulds is what maintains striving towards the Ideal Image. For example, if one is striving towards the ideal of perfection, they might come to think, "I should be prepared for all possible negative outcomes, I should not let people see me like this, I should do better than that, I should not make such stupid mistakes, I should have known, I should look better than I do, I should try harder, I should be able to do what ever I set my mind to," and so on.
Since my RAdiagnosis, I often have my own tyranny of shoulds. For example I often think: "I should still be able to compete in the sports I love, I should be able to ignore this pain and keep going, I should be able to read without getting tired, I should be able to carry the groceries up the stairs, I should be doing more than I am, I should set a better example, I should get up and keep going," and so on. The "shoulds" stem directly from the contradiction between my reality, and my ideal.
The unfortunate truth is that my image of who I am and who I strive to be was built during my lifetime before I developed rheumatoid arthritis. The knowledge of what I am capable of persists, despite the new limitations. The harsh truth is that I can't start over, work really hard, tackle difficult tasks, and end up with the exact same ability I had before. Yet, I can persevere. The disease continues to surprise me and knock me flat, and I keep getting up again. The frustration the disease brings is a constant battle. We don't need our own tyranny of the shoulds and self-imposed guilt making it worse. It is enough to do the best we can.
Right now, what RA tips would most be helpful for you?