I’ve been interested in how chronic illness impacts mental health for a long time. On the personal side, my husband began experiencing symptoms of an autoimmune disease early in our marriage, and received a formal diagnosis several years later. On the professional side, I’ve previously worked with several clients who had chronic pain, migraines, gastroparesis, and other physical conditions that seriously impacted their mental health.

Whereas an infection or broken bone can be diagnosed easily and have a fairly straightforward solution, chronic illness is trickier. You’re experiencing chronic pain or other symptoms that tap your physical and emotional resources while you’re trying to navigate the healthcare system to get help. Even just putting a name to the symptoms can be maddeningly complex: you wait weeks or months to see one specialist, hoping they’ll be able to tell you what you have, and they examine you and look at your labs and refer you to a different specialist. Even once you have a name for the symptoms you’re experiencing, there may or may not be a well-established treatment protocol (which, in turn, may or may not be effective for you). You may need to try several medications—often with serious side effects—in order to find the one that gives you relief. You may need to fight with your insurance company to get your medication or treatment covered.

It permeates your daily life. Relationships with partners, family members, or friends are affected. Some of your loved ones will show up for you in the ways you need; others will be unable to understand or unwilling to face the reality of your situation. A lot of people are desperately afraid of becoming sick or disabled, and this can come out in behavior that is at best clueless and at worst cruel to people with chronic illness. You are offered a lot of advice (“You should go paleo/vegan/keto…” “You should lose weight/start running/do yoga…” “You should take more/fewer supplements…”). You may be able to keep up with school, or not. You may be able to hold a job, or not. If you qualify for disability accommodations, your school or employer may meet their obligations in this regard, or not—and you may have the energy and resources to advocate for yourself, or not.

And when you have a chronic illness, you don’t control how quickly doctors can diagnose you, how effectively your symptoms can be managed, or how humanely others respond to your needs. Plus, we are surrounded by marketing that tells us we can be healthy, beautiful, and successful if we eat the right foods, take the right supplements, do the right workout, etc. We equate youth with health, and companies make billions selling products that promise to preserve/restore youth as we age. It makes a lot of sense, then, that a person—especially a young person—experiencing chronic illness would turn their attention inward and feel betrayed by their body. We generally have a sense of how a body “should” work. It may give a temporary sense of control back to the person: if the issue is my body, I’m in charge of solving it; if the issue is other people being unwilling to accommodate my health- or disability-related needs, I can’t make them change. 

All of which is to say: chronic illness is really hard. I don’t mean to be too grim. Life with chronic illness isn’t nonstop misery, and many people are able to find the right doctor(s), routines, and support network to regain a sense of well-being. I just want to be clear that chronic illness can be  complex, isolating, and exhausting. And that’s why it’s one of my clinical interests as a therapist. Having a chronic condition doesn’t automatically mean you need therapy. It does mean you’re experiencing a level of stress in your body, daily life, and relationships that may warrant getting extra help. 

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