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Hanging In There: The Psychological Impact of Chronic Illness

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No one likes to be sick. Colds, flus, injuries, and other seasonal illnesses are a physical and mental drag. When we’re under the weather, getting through the day is a psychological challenge. All we want to do is rest and recover. We eat chicken soup, watch The Price Is Right, and go to sleep hoping we’ll feel better in the morning.

And when we do wake up feeling better, it’s more than just physical. The mental load of being sick has been lifted. We can go about our regular life free from the interference our previous illness brought to our lives.

For some people, though, waking up the next day doesn’t mean feeling better. It means more of the same—the same symptoms, the same pain, and the same psychological struggle.

For many people who live with a chronic illness, this is their reality.

There are a myriad of conditions that qualify as chronic illnesses. There are autoimmune disorders such as lupus or Graves’ disease, progressive neurological disorders such as ALS, inherited conditions like cystic fibrosis, and countless others. These disorders each have diverse symptoms and affect our lives in unique ways, but they all have something in common: they are permanent.

In most cases these conditions have no cure. And while their symptoms can be managed, they cannot be completely eliminated. In many cases, the symptoms will go from more to less severe and back again over an indeterminate period of time—sometimes days, sometimes weeks, sometimes hours.

When symptoms are in a mild phase, individuals may be able to function more or less “normally.” They may be able to work, go out with friends, and get through the day like everyone else. Outwardly, at least.

But when symptoms do flare up, sometimes as a result of trying to function “like everyone else,” they can be debilitating. Individuals with chronic illnesses may suddenly drop plans with friends, miss important appointments, or be unable to maintain a regular job. These instances can be perceived by outsiders as laziness, inconsistency, or selfishness, and these perceptions can be quite harmful.

Thankfully, there is much more awareness among the general public about the existence of chronic illnesses and how they impact people’s lives. Most people are aware of at least one person in their lives who has one.

What fewer people are aware of, though, are the mental health challenges associated with living with a chronic illness—and these challenges can be just as debilitating as the physical symptoms. Here are just a few of the most common mental health symptoms.

Depression. According to recent research, more than one-third of individuals with a chronic illness will also receive a diagnosis of depression. This is a significantly higher prevalence than what is seen in the general population. Depression can cause symptoms of chronic illnesses to become more debilitating and can make it more difficult to work or maintain relationships.

Anxiety. The uncertainty of not knowing when your symptoms will flare up, and the guilt of “letting people down,” can lead to ongoing anxiety. People with chronic illnesses are more than twice as likely to be diagnosed with anxiety disorders, which can cause their condition to worsen.

Brain fog. Especially in disorders with an element of chronic pain, brain fog (characterized by a difficulty with problem-solving, a lack of mental clarity, confusion, short-term memory loss, and a general “fuzziness” in thinking) can be present as well. The mental load of being in constant low-level—or high-level—pain can overwhelm our brains and prevent us from thinking clearly. Brain fog often results in difficulty communicating, fulfilling our work or relational obligations, and can lead to worsening symptoms as well as an increased risk of additional symptoms of depression.

As you can see, while chronic illnesses already make it difficult to live up to one’s obligations, the accompanying mental health symptoms can make it much worse, affecting employment, relationships, even the rest of our physical health.

These mental health symptoms can be exacerbated by other life factors. Poverty, for instance, can greatly increase the mental health impacts of chronic illness. Research shows that people with lower socioeconomic status typically experience greater impacts on their finances and quality of life. This is certainly because they have fewer resources to support themselves and their families during times when they are unable to work. For people with chronic illnesses, this can result in a cycle of worsening symptoms, worsening depression and mental health, and worsening finances.

Family members of those with chronic illnesses aren’t immune from the mental health impacts. Research for decades has indicated that people who live with family members with chronic illness, especially those in caretaker roles, have their own high rates of depression and other mental health issues.

A myriad of resources exist to provide help. General mental health supports, as well as specific resources through non-profits and government programs, have been being built for generations. While more supports are still needed, at least care pathways are in place.

For everyone else, what can we do to support our friends, family members, and fellow citizens who are living with a chronic illness?

First, be understanding of their condition, and believe them when they tell you about their limitations. One of the worst things we can do is to tell them that they “look so good” or “don’t seem sick.” This can increase their own frustration over their unpredictable symptoms.

Second, avoid minimizing or downplaying their symptoms, even if you’re trying to help. Telling them “It could be worse” or “You’ll feel better soon” is both untrue and can feed the mental health symptoms they’re struggling with. Instead try expressing that you believe them, acknowledging their efforts, and confirming that you are there for them if and when they need support—or even when they’re ready to spend time together.

Finally, ask if and how you can support them. It can be harmful to assume that others need your help as an able-bodied person. This is often referred to ableism. But showing understanding and letting people know that you’re there for them if needed can be a positive way to provide help. Adjusting your expectations based on what you’re told, and providing the help that’s asked for, allows you to be a tangible support for the person you care about.

Chronic illnesses rarely go away, and they’re rarely cured. But by walking with each other in kindness and with understanding, we can ensure that loneliness is not a factor.

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