active coping

Just Sitting ...

Sitting... There are so many associations that come to mind when thinking of the word sitting. I visualize sitting on a park bench enjoying the peaceful moments of spring. I think about the relief of sitting down after a long day's work. Sitting can also be an act of boredom or complete laziness, as one plops on his/her couch and watches countless hours of mindless TV. But for people who live with chronic physical illnesses, sitting may carry additional associations.

Imagine feeling a heaviness in your body so powerful that you cannot move. Sitting loses its appeal and is no longer perceived as a great pleasure but rather as the outcome of being held hostage by your physical limitations. One sits because one literally cannot move because of paralysis or incapacitation. One sits because it hurts too much to stand or walk. One sits because the fatigue is so unbearable that there is no energy to do anything but sit. One sits because of a fear that s/he will faint or have a seizure and will fall. The associations for sitting when living with a chronic physical illness goes on.

I also associate sitting with meditation. One sits quietly and focuses on breathing or on a mental image or remains simply in stillness. There is much discomfort that can arise while meditating. One's back begins to ache, one's arm may get itchy, one may feel the impulse to shift or squirm. Of even more discomfort can be the thoughts, feelings, or sensations that arise when attempting to quiet the mind and body. It is not an easy thing to sit and remain still physically and mentally, yet a part of meditation is finding a way to make one's self as comfortable as possible and to then find a way to just be-- be with whatever comes up, acknowledging that it is there and then letting it float away. Not an easy task but certainly a possible task for all.

There is a large amount of research demonstrating that meditation has profound effects on the brain. Meditation may not eliminate one's physical illness but can play a large role in one's coping with living with the illness. It is a method of learning to better tolerate difficult feelings, both mental and physical. I imagine that if one is held hostage by his/her physical illness and has no choice but to sit and sit and sit, it may be quite beneficial to use that time sitting to practice various forms of meditation. It can be challenging at first; maybe even be experienced as adding more uneasiness or difficulty to the day; however, with time it may serve as a very valuable tool.

Who would think that sitting could be so powerful or that there would be so many associations with sitting? All human experience carries a multitude of meaning. One can choose to be as creative or not with what s/he does with each experience. How will you choose to sit?

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!