Active Coping or Destructive Manic Defense?

When living with chronic physical illness it is sometimes very helpful to distract the mind from focusing on the illness or the pain, and to refocus thoughts on pleasant activities or tasks. This is a form of active coping and it can be extremely successful in alleviating one's pain associated with the illness. Focusing on pain that accompanies one's illness can actually intensify the pain and can contribute to feelings of helplessness and depression. On the other hand, attempting to maintain as normal or as satisfying a life as possible despite one's illness can minimize the intensity of physical and emotional suffering.

It is generally understood--active coping is a good thing! However, like many other situations or constructs in life, too much of something or too extreme of a position can become harmful and can distort the benefits originally intended. With respects to active coping at an excessive pace, one might be engaging in what psychodynamic literature identifies as the manic defense. Broadly speaking, the manic defense is an attempt to deny feelings of sadness or depression by adopting an overly active and/or triumphant position. It is similar to denial but is manifested not only through words but through actions as well. For example, a person may be experiencing a situation that calls for sadness or loss, and which others around this person can identify as a difficult situation. Loved ones may inquire as to how the person is dealing with the particular experience and that person may respond by saying "everything is fine" and then proceed to invite others along on a series of back to back activities that leave no time for rest and reflection.

Some may wonder, so what's the big deal? Defenses are in place to help people defend against anxiety and are basically ways of coping. However, again it is the extreme use of the defenses that could be problematic. Imagine, if one continuously engages in a manic defense by constantly putting his or her body through activities and tasks; when does that person rest? Eventually that person will rest and it will hurt and most likely more than if the person paced him or herself a little more and took adequate breaks between activities. So there is the physical consequences, but there is also the emotional consequence. Every time one pauses and allows some space between activities, it is a reminder of the fact that the body needs rest, that nobody has a healthy body forever, and that as people we have limitations--we are not immortal superpeople. This type of reflection is difficult, but over time this paced reflection and processing allows for one to come to terms with his or her condition. If the opposite occurs and there is no gradual reflection time, the sadness or feelings of loss associated with the illness are denied. Eventually when the person does rest, depression may hit the person like a ton of bricks. Reality can not be escaped forever.

Solution=balance + pace. Living with chronic physical illness is undeniably sad at times and can involve a sense of loss. Similarly there can be a lot of physical pain and/or discomfort. Paced active coping can certainly help one live a fulfilled and active life, and can ease physical pain and discomfort. However, there needs to be a balance between activity and rest and reflection. With rest and reflection comes wisdom about what experiences and events really matter. There is a difference between fearing that life is short and therefore wanting to live it to the fullest, versus fearing death and wasting life engaging in as many things as you can, so you don't "miss out" when in actuality you may very well be "missing out" on things that really matter to you. Don't let life pass you by. The illness, the pain, and the discomfort although unwanted is part of your life. It is evidence that you breathe, have a heart beat, and a body that is mortal. Embrace it in order to accept and let it go when you want to do things that have meaning to you. LIVE!