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Your Emotions and Self Image with Lymphedema

In this page I have provided a wide variety of articles, tips and info on dealing with your emotions, working through the frustration, anger and fear involved with lymphedema, whether it be arm lymphedema or leg lymphedema. I hope it can be a positive encouragement in overcoming lymphedema.

Lymphedema in Children represents a special need and requirement that is uniquely different from adults. take a look at our page on children for help and suggestions.

The Emotional Impact

Little is said about the psychological affects of lymphedema, despite its profound impact on the person dealing with it.

Lymphedema can cause pronounced social inhibitions because of being self conscious, it can cause depression, embarrassment, disfigurement, feelings of hopelessness and helplessness. You often go through tremendous life style changes and feel worthless and useless. It can cause sexual dysfunction as both male and female lymphedema patients can acquire genital lymphedema.

You go through periods of struggling with feeling humiliation, despair and you can experience terrific pain.

You also go through a lot of anger. Anger at why you have this, why the medical world knows so little about this condition and sometimes seems to care little either.

For cancer patients, its a double impact. While you are dealing with cancer, its side affects, whether or not you are going to live, the affects of radiation and chemo… now all of a sudden your body starts swelling out of control. What is going on???

If you are going through these emotions, please don't be afraid to let your doctor know. You may need professional help to get through this. You may also find a lot of comfort and encouragement in joining a support group. Contact the National Lymphedema Foundation to see if there is one in your area.

You may also wish to join an online support group. There are several mentioned in our site. As a member, myself, I have found a wonderful and supportive family of fellow lymphedema people. I cannot tell you just how much my new family has come to mean to me and how much I have gained by being a part of these groups. THERE IS HOPE……..AND YOU ARE NOT ALONE!!

The Lighthouse

Let your life be as a lighthouse that pierces the darkness of the storms of life to bring others to safety.

Allow your spirit to be a harbor of peace and tranquility amidst the turbulence and chaos. Let your heart be a refuge….a sanctuary of calm.

Reach out and embrace the heart of a child…bring companionship to the loneliness of the old….share a tear and bring comfort to those who mourn….bring joy to those who know sorrow….and bring hope to those who know only the black futility of despair.

A lighthouse never focuses in on itself…but always, selflessly reaches out to guide and help….

Let your light so shine, that others are drawn to you….not by mere words….but by your life and the richness of your spirit.

Pat O’Connor October 2005

REMEMBER:

Life is meant to be a celebration of the things we can do, not a requiem for this things we can not do.

The great Native American chief Tecumseh once said, “When you arise in the morning, give thanks for the morning light, for your life and strength. Give thanks for your food and the joy of living. If you see no reason for giving thanks, the fault lives in yourself.”

Psychosocial Considerations

There are multiple psychosocial and adjustment issues faced by cancer patients and survivors with lymphedema. Because lymphedema is disfiguring and sometimes painful and disabling, it can create problems in many aspects of functioning, e.g., psychological, physical, and sexual. Until relatively recently, however, inadequate attention has been directed toward its psychosocial impact. Several articles have noted that women who develop lymphedema following treatment for breast cancer encounter more difficulties in each of these aspects than women who do not develop the condition after such treatment.[19-21] Additionally, because the treatments for upper extremity lymphedema can be uncomfortable, arduous, and time-consuming, the presence of psychological difficulties can significantly interfere with treatment efforts. Upper extremity pain in women following breast cancer can have a highly complex differential diagnosis. One study has highlighted the deleterious impact of pain on quality of life and coping in patients with upper extremity lymphedema.[22]

Another study highlighted the factors associated with psychological distress within a group of patients who developed upper extremity lymphedema after breast cancer treatment. Risk factors for poor adjustment to the condition include poor social support, use of an avoidant and reclusive style of coping (some women seek to avoid social situations in which their lymphedema causes a constant reminder of their cancer experience), and the presence of pain of any intensity.[19] Group and individual counseling that provides specific information about preventive measures, the role of diet and exercise, advice for selecting comfortable and flattering clothing, and emotional support can be helpful to women coping with lymphedema.

Cancer.gov

Coping With A Chronic Illness

This is adapted from the book After The Diagnosis by Dr. JoAnn LeMaistre. Copyright  1985, 1993, and 1999 by JoAnn LeMaistre.) JoAnn Le Maistre received her Ph.D. in clinical psychology, delivered a daughter, and learned she had multiple sclerosis all within the period of a few months. Dr. LeMaistre has developed a successful practice counseling patients and their families. She is a sought-after speaker, lecturer, and teacher. Her books, After The Diagnosis, and the hardbound edition, Beyond Rage, have helped thousands of chronic illness patients, their families, and health care providers to cope effectively. Her daughter has now graduated from college. And Dr. LeMaistre has learned to live a full life, in spite of the handicaps of her MS. She is an inspirational example of what it means to be able-hearted when you can no longer be able-bodied.

Introduction

Traditionally, the experience of serious illness has been approached in two ways: (1) a gloomy perspective of resignation, self-denial, and helplessness, or (2) a Pollyanna approach that denies altogether that there has been a real trauma. Both of these perspectives distort and disguise the reality of chronic illness.

The first perspective views the chronically ill person as a failure. This is the patient who does not respond to the “miracle” of modern medicine, and somehow the lack of recovery is often perceived as the patient's fault. This attitude of blame accounts for some of the worst psychological abuses of patients by health practitioners and caretakers, an attitude typified by the too-frequently heard statement, “Stop complaining. You simply must adjust.” Unfortunately, the sick person may also adopt this punishing attitude toward himself or herself. Sadly, the word “adjust” too often means “resign,” “settle for less than a desirable existence,” and “surrender.” At its worst, “adjust” is just another way of saying “You are now a nonperson without the right to experience strong passions, desires, or fierce and unyielding hope.” All the anger and blame inherent in this attitude is misdirected: the patient rather than the disease becomes the target. The Pollyanna approach is typified by – and fueled by – personal stories or testimonials of complete recovery from extreme illness or disabling conditions. These stories tug at the heartstrings and catch the fancy of all who read them. Besides creating false hope by overplaying the likelihood of complete recovery, these stories consistently underplay the sadness and feelings of worthlessness that are part of the legacy of any physical or emotional trauma.

Sometimes, it is useful in social situations to present yourself as a Pollyanna. When meeting new people and situations, it may be an advantage for you to let others think you have mastered your disease. The anxiety of other people is reduced by not having to confront illness. The danger is that this Pollyanna image may create a barrier between you and the people who can offer real help.

The resignation viewpoint holds little hope; the Pollyanna viewpoint holds little reality.

The approach I propose took shape as my own understanding developed. My experience as a patient, observer, and psychotherapist has allowed me to see the many ways in which people creatively adapt and use their individual internal powers of wholeness (the sense of being emotionally intact) to reduce the destructive effects of severe physical limitations and accompanying depression, rage, and fear. The wellness approach I present stresses both the subjective experiences of loss and your responsibility for looking outward to reestablish quality in your life.

Central to wellness is the concept of adaptation – the flexible, creative use of resources to maximize your choices and experiences of mastery. This is the key to creating and sustaining a sense of inner tranquility in the face of difficult realities. There is no need to deny grim facts of existence or to pretend to others that all is well when inside there is little except torment. To be psychologically well while physically sick involves the belief that your personal worth transcends physical limitations; you need positive self-esteem for true adaptation. This belief in your self-worth rarely emerges until what you have lost and grieved for stands second in importance to precious moments of inner peace and joy.

Each stage in the progress toward wellness involves loss, grief, and acknowledgment of internal pain. During difficult times, emotional pain can engulf your life. All sense of time and proportion fade. The scope and intensity of the psychological pain fluctuates day to day. At times, it carries you closer to invaluable inner resources. At times, like a dangerous undertow, this pain drags you far from your recognizable self. It may seem that you have no reason for living or that you are living only to experience pain. Even so, the reason for living is life. The incentive for becoming psychologically well is the potential for the future.

Illness is an emotionally as well as physically depriving experience. It can do lasting harm by threatening a person's sense of well-being, competence, and feelings of productivity. At their worst, emotional reactions to illness may culminate in the feeling that life is meaningless. I do not share this belief; but I recognize how stress can make you feel this way.

Illness is a process, and like all processes it has different stages with different characteristics. We will discuss the stages below. The stages can occur in varying orders; often they are repeated. If a sick person lacks emotional support or a necessary feistiness, the process can stagnate, and one may be mired in one or another phase of the emotional transitions taking place. The emotional process begun by illness is a highly varied and individual one. Not everyone gets bogged down. Not everyone experiences all the stages discussed in the following sections. The stages are not part of a once-through program, but are repeated as symptoms recur or losses come about.

The level of adaptation is an upward spiral in which coping mechanisms, learned one at a time, can be combined with strategies learned at other times to make each bout of illness less emotionally upheaving.

How people react to chronic illness depends on many conditions. Three deserve note. The first is the severity of the illness. The very sick must put all their energy into healing and may not have the luxury of energy left over for emotional growth. The second is the social support available. If you are willing to ask for help and you have a wide support network, you'll have an easier time than if you are isolated.

The third condition is the preillness personality of the person. If you have always been pretty resilient, you are likely to have resilience in coping with the illness. The emotional trauma of chronic physical illness is caused by loss of a valued level of functioning, such as the ability to drive or dance, for example. The chronically ill person not only suffers the loss of immediate competency but is deprived of an expectable future. No one's future is ever guaranteed, but most people become accustomed to looking at the odds; if I invest my energies in a particular direction, I can be reasonably certain I'll reach a desired goal in that direction. When illness intervenes, all past efforts may seem irrelevant – and in fact they may be.

In the face of such losses, to experience fear, anger, depression, and anxiety is normal. It would be abnormal to deny that your health and your life had changed for the worse. Serious emotional difficulties are more often the lot of people who do not acknowledge the emotional stress they feel and thereby bottle up depression or anxiety until these feelings are so powerful they break through their defenses. By the time an emotion becomes this powerful, it is much more difficult to survive its impact without severe scarring.

Is there anything that can help overcome the displacement and depression caused by physical loss and the loss of goals and dreams? I think the answer is an unqualified YES!

Goal-oriented striving, any experience of mastery, any outside acknowledgment of competence, a well-tuned sense of humor, any experience of joy, and the constant striving toward an inner state of tranquility are the aids that help overcome the displacement and depression of chronic physical illness.

These aids are of critical importance in the stages of the ongoing emotional process. I identify these stages as crisis, isolation, anger, reconstruction, intermittent depression, and renewal.

These are good summary categories for the whirl of emotions triggered by illness and we will take up each stage in turn, although in the course of an individual illness they may not always proceed in this order.

CRISIS

In the crisis stage, the patient is seriously ill and very frightened. Both psychologically and physically he or she has a decreased ability to respond to others. The sick person's energies are directed inward toward healing, and controlling panic. The patient is often too sick to even be frightened. Events are often confused. Time is distorted. Disorientation is common. At these times we fall back on our innate biological ability to heal. The support network, on the other hand, is feeling a highly stressful increase in anxiety, especially as it must carry the full responsibility for arranging for medical care, covering finances, and seeing that children's lives, if children are involved, can go on with a minimum of disruption. The family's anxiety can be energizing. The family may feel a need, sometimes an obligation, to be highly supportive of the patient.

By and large, everyone responds well in a crisis. Everyone knows the patient is terribly ill. And they respond. Unfortunately, those most affected by the patient's illness do not always receive the support and help they need at this time. Friends sometimes respond by showering the sick person with cards, flowers, and get-well-soon wishes. Unfortunately, much of this is misdirected. The very ill person often cannot appreciate these signs of concern and affection. Patients often feel burdened by all the thank-you notes they cannot send. Friends can often do more by helping the family and other members of the support network to deal with the medical system, the incoming phone calls, and to give direct support when it becomes clear that the idea of “get well soon” has no relevance to chronic illness.

During the crisis stage almost all of the patient's energy and attention are focused on responding to the physical onslaught of the illness. Surviving is the primary concern.

In addition, the patient and the family must cope with the fear of an unknown and unknowable future. It is all too clear that the comfortable patterns of the past have been shattered. It is not clear at all what may lie ahead.

ISOLATION

In time, the acute nature of the illness may abate. But total recovery does not occur, and the illness persists. There is a dawning awareness of everyone's part that the situation has become a chronic one. There will be no full recovery. There is so much uncertainty about the future that the patient may not be able to sleep at night and may seem restless and distracted during the day. The lack of an expectable future constitutes a major assault on one's self-image.

The patient's anxiety often produces a stiffness or frozenness in dealings with others and oneself. There is a belief, usually partially justified, that no one can understand the devastation of the losses. Isolation most troubles patients who have been the most independent.

The family has often exhausted itself during the acute crisis stage. Family members may become aware that they are angry, fearful, and disgusted about the sick member's situation. Both patient and family members retreat into themselves and their thoughts, now haunted by the knowledge that life may never be the same.

Friends also tend to give out at this point – the idea of chronic illness is really terrifying to most people. After an initial burst of energy, some friends may find it too overwhelming a personal struggle to continue having contact with either patient or family. Some patients have been devastated by an apparent lack of concern shown by people for whom they care. I say apparent because often failure to contact the patient means that friends may care but don't know how to act.

This leads to a thorny question. How comfortable are you in asking for help? What does it mean to you to have to ask for help?

These questions begin to surface during the isolation stage, but actually they are part of everyday living for most chronically ill people. To feel really comfortable allowing others to help you is an art that must be learned and practiced. It is difficult to understand that relying on other people when it is necessary does not indicate weakness or failure. One of the emotional barriers to asking for help is a strong feeling of guilt about having a disease that makes one need help. During the isolation stage, patients look inward and experience many negative feelings about themselves.

In the isolation stage open communications are vital. Blame must not play a part. Talking about feelings is very important. Communication and sharing are ways to break the isolation.

ANGER

The sick person has been suffering severe upset, terror, anxiety, and helplessness. Add to this the sense of injustice, unfairness, and senselessness of being struck down by a disease, and the result may be a rage reaction of tremendous proportions. Often the target of this rage is the patient himself or herself. The ultimate, most dangerous, expression of this rage at self is suicide. The commonly experienced feelings of despair may result in contemplation of suicide.

There are two reasons why the patient targets himself or herself for these feelings of anger and despair. First, it is almost impossible to be furious with fate; there is no external opponent. In order to provide some meaning for what has happened, many people irrationally conclude they have bought disease on themselves by being faulty or wicked in some way. It is difficult to keep clear that it is the disease that introduced the disruption into one's life.

Another reason for suicidal thoughts is that illness breeds a sense of helplessness. The chronic disease cannot be wished away. The disabilities are there to struggle with every day, and the threat of a major recurrence or increase in symptoms may be a constant anxiety tucked away not far from consciousness. With the feeling that the underlying problem cannot be solved and the belief that it is the patient's fault, many patients suffer intense unhappiness. Sadly, the patient's feeling of self-blame is greatly reinforced by society. Often families are unable to help because they are angry at the patient. The changes in their life style are directly attributed to the patient and not to the patient's illness. Even supposedly neutral medical personnel may be furious with the patient for having a chronic condition they cannot cure.

This anger directed at the patient from all sides is psychologically understandable but it is very destructive.

The flirtation with suicide, the patient's worst hazard of the anger stage, is a statement of the extent of one's rage with oneself and with those one cares about. Another serious problem of the anger stage is the strain on the family. Families who fare better during this stage understand that the sick person is not the same entity as the disease and they see that the whole family is in this predicament together and are committed to coming out of it as well as possible. Family members need to devise ways to nurture and adequately support each other in order to cope with both the anxiety and the practical life changes accompanying chronic illness.

Anger is the stage most hazardous to your emotional well-being. It is also where most people get trapped. Fear and anger are disruptive emotions egendered by a sense of loss of control. Take back control in small steps. The basic reasons for the anger, in most cases cannot be avoided. It does no good to assign blame. The response must become task-oriented. “Today I will walk the length of my room, or call a friend, or answer one inquiry.” Striving toward a goal, even in small doses, is an antidote to anger. Patients, family, friends, and helpers should all focus on the strengths that remain, on the accomplishments that can still be achieved. This basic rule is a key to dealing with anger.

RECONSTRUCTION

The sick person may now be feeling much stronger physically or may have had enough time to begin mastering new living skills. Important decisions or new social contacts may be in the picture. What is common is a growing sense of safety based on new competencies. Moods are happier and the difficulties seem a bit further away. The sick person is learning the possibilities and limits of the new competencies. Friends are selected on how well they react to the fact of illness. The family establishes new routines – or it dissolves.

What exactly has been reconstructed? Certainly it is not life like it was before.

Instead, it is a reconstruction of the sense of oneself as a cohesive, intact entity. The reconstruction takes on many concrete aspects, such as the development of new skills, but the most important value is emotional. When a customary pattern of living has been shattered by illness, the patient fears that he or she is longer recognizable as a whole being. It is the reemergence of a positive self-image that constitutes reconstruction.

Often people do well for a few weeks and then are devastated by some incident. But each experience with trusting and succeeding is a building block for the next step of reconstruction.

INTERMITTENT DEPRESSION

Now that everything is looking brighter, everyone is tempted to relax and may, therefore, be caught off guard when a significant depression recurs. The elation associated with new skills can give way to new feelings of despair as the patient recalls how much simpler it was to do routine things the old, preillness way. Nostalgia and grief may combine to produce sadness and discouragement.

Many people know exactly when they expect to hit these rough spots. Medical appointments and anniversaries are notable examples. Seeing a doctor, who confirms your intuition that your condition is not improving or is worse, often leads to depression. So may the third anniversary of having to give up the car, the first anniversary of a divorce, the time of the year the physical problems first occurred – the list is endless. It may be best to seek counseling during these difficult times as a way of shortening their duration and providing new understanding of what all the feelings of loss are attached to. New understanding brings new resilience; it does not make the losses go away.

Intermittent depressions seem to combine two feelings. One is the awareness of loss of function that occurs several times a day in the course of ordinary living. But clearly, an amputee does not become depressed each time there is a reminder of the inability to walk normally. There is a second element involved. If the awareness of loss arouses a distinct image of what life would be like if the amputation had not occurred, and if this fantasy has strong emotional meaning for the person, depression is very likely. This image of how you would be without the illness I call the phantom psyche.

The phantom psyche is usually not far from consciousness. It is the self-punishing mechanism whereby the chronically ill person continually erodes his or her own self of self-worth and competence. “If only I didn't have this arthritis [or whatever illness] I could still be mountain-climbing [or whatever activity].” “If only” statements are the bread and butter of the phantom psyche. They contain harsh judgments of worthlessness. In a happier mood, you might experience the same feeling of loss, but say to yourself, “I really miss mountain climbing, but at least I can take a walk today.”

When the phantom stalks, the soul is uneasy. Doctors and friends often mistake the desperate pain of knowing one's hopeful fantasies will not be realized for self-pity. “Just stop feeling sorry for yourself” so completely misses the point that it is tragic. It is very difficult to have a sense of self when you're depressed and are afraid that you'll never again be of value to yourself and others.

Self-esteem increases proportionately to successful experiences of independence and purpose, whether the success is remembering what time to take a certain medication or walking better after months of physical therapy. The phantom psyche – those unrealistic expectations you have for yourself – cannot compete with the heady gratification of hard-won success. If family, friends, and medical personnel can appreciate the triumph in being able to struggle, you feel even more triumphant. Well-wishers too often make the mistake of praising a sick person for progress without acknowledging how difficult is the ongoing battle against the inertia of chronic disease.

We all have periods when we feel overmatched and not up to the struggle. But as long as we pay attention to the struggle, we will get through the day. We flounder when we set unrealistic standards, or cannot grieve for what has been lost, or cannot start each day afresh. Depression can be tackled despite the physical complications that try to drag us down.

RENEWAL

The losses, and the sadness they cause, never go away entirely. There is a sense of lingering regret for all the capacities that have been lost. A person who has mastered the technique of using a wheelchair can feel very proud of this achievement and know full well that this device is essential for retaining an active life. But the person does not have to like it.

It is not necessary to like or to resign yourself to the compromises you need to make to get on with living. It is only necessary to acknowledge that changes in life style and skills have to be made. Acknowledging that your skills are different from your preillness days is not the same as “adjusting” to illness. There is no surrender involved, only growth – the creation of new options through new means.

The creation of renewal comes from the experiences that teach us not to waste the present on fearing the future.

The truly handicapped of the world are those who suffer from emotional limitations that make it impossible to use the capacities and controls they possess. If you have a chronic disease, you need not be emotionally handicapped if you continually strive to be able-hearted. Able-heartedness is within the grasp of all of us. I don't think of able-heartedness as a permanent, static state, however. Developing and maintaining this quality is a process that ebbs and flows, depending on how helpless you feel. Even if you feel in the grip of hopelessness, you are behaving in an able-hearted way by any expression of interest in another. Shared interest and compassion is what establishes meaning and purpose in life.

When you feel discouraged, you feel all alone – and there is some truth to this feeling. But in many important ways you are not alone. There are hundreds of people in your city who have similar feelings at times. If disturbing thoughts wake you in the night, know there are other struggling with their pain. No one can share your unique experience, but there is kinship and a strength among all of us who are no longer able-bodied.

There are some positive coping skills that are required by unavoidable health changes. These are summarized below.

Make Your Expectations Realistic

The most important aspect of making expectations realistic is the recognition that they are time-limited. “What can I do now on the basis of the way I feel at this moment?” If you have two minutes, what are you going to do? I counsel people to check with themselves to find out what they want to do. Illness can make you feel that you must surrender all goals, all wishes. But that is not necessary.

Make your expectations run like this. “Within the limits of my physical ability I will do whatever it is I want to do for as long as I can.”

Approach Problems Actively

A second essential skill is an active approach to problems. What is an active approach? It consists of defining the problem and determining the outcome you want. It involves trying to ensure that any energy expended constitutes a step toward the solution. Rarely does it constitute the complete solution. The admission “I cannot do something” is often the first step in solving a problem realistically.

Define what you want and then use every ounce of creativity you possess to determine how you are going to make it happen. Creativity is not impaired by illness. When you define the problem you figure out how many facets there are to achieving some kind of resolution, and then you expect yourself to make only that part of the effort that is realistic. What this means is that you need a broader sense of community.

There are going to be a number of things you cannot do alone. Your dreams do not have to change. How they are realized will probably change. The creative, flexible use of your energies and creativity to get as much satisfaction as possible is your mission.

Seek Appropriate Help

The next skill to learn is to ask for appropriate help. It is not a moral weakness to ask for assistance, but many can probably recognize the tendency to regard asking for help as shameful. It is a limitation if one does not know how to determine whether or not assistance makes sense. It is a limitation if one is harsh or angry with the helper. Asking for help can become a more and more graceful skill. It is certainly not the first choice for people who would rather do everything themselves, but it should be your choice if you are going to pursue what you need and want – when you cannot do it alone.

If you have a hard time asking for help, consider what you would do if you were fully able-bodied and a friend of yours had your particular problem to solve. What would you do? Do you see yourself denying help as you gear others might deny you?

Would you be upset if your friend asked for the specific help that was required? Chances are you would feel fine about helping out if you could. You would just do it. Try to be as kind to yourself as you would be to another when it comes to asking for help.

Handle Your Anger

The next skill involves learning how to become emotionally efficient and energy conscious. Energy is a tremendous problem for those with chronic illness. There is none to waste. Some of the most wasteful expenditures of energy are for resentment and anger. These emotions are not bad in themselves, but they do wear you out. If you are angry, it helps to have some consciousness of what you are angry about, and whether you want to angry about that. Sometimes you will want to be angry because that is the appropriate response. Sometimes you will want to be angry because it is more efficient to be openly angry than to deal with bitterness or other forms of calcified anger. The better you get at being direct about anger early, the more energy you save and the more efficient you are. Surprisingly, many people do not know how to recognize their own irritation or anger. If you are feeling irritated, it might be helpful to be assertive, even if in the short run you feel uncomfortable.

Participate

Another skill that is especially restorative for those with illness is to put positive energy back into the world. You can do this with family, friends, with self-help groups connected with your illness, or with community groups. Put your talents, your compassion, your knowledge, and your experience out there in a way that can benefit others. Be a good friend to yourself and don't overlook your finer qualities.

If asking for help is a skill you possess, then there is even more constructive energy available to invest in the world around you. Obviously, one of the things illness can do is to constrict your social world. Sometimes, this leads to the perception that there is nothing you can do for others. That is just flat-out wrong.

If you have exhausted your own resources in looking for ways to participate, you can call organizations that are concerned with your illness, like the Arthritis Foundation or the National Multiple Sclerosis Society, as well as other national and local self-help and research organizations. They can offer suggestions, and may have specific ways that you can help them. People volunteer because it feels good.

Live In The Present

Another skill, that is a challenge to learn, is to look neither too far backward or too far forward. If you are only looking backward, you are giving up on yourself emotionally. Your losses are major issues, but losses do not get people through one day at a time or one day after another. Losses are not a good reason for living. If you use all your emotional energy considering how things were before the illness and comparing it to how things are now, you are being very self-punishing. If you sense this going on, you need to be extremely aggressive about rejecting this.

Illness does not diminish one's humanity. Mobility and physical comfort decrease with illness. Fear and worry increase. But illness does not diminish humanity. Be humane to yourself. Avoid dwelling on how good things were I the past compared to now. Also avoid distant future fantasies. There is no way to know what will happen some years hence. And you know, there never has been a way to know the future. If you are not stuck in the past or tormented by distant future images of what should be, you have the opportunity to manage this day with awareness. Living in the moment with consciousness, patience, compassion, and appreciation for yourself and others lets you get on in a creative way, in spite of the pain of your losses.

Cherish The Good Times

The last skill I would commend to you is to pay attention to the positives. This can only be done if you have already mastered the skill of living fully in the present moment. You go through every twenty-four hours with enough of yourself available to the world that when something positive happens you let it in. There was a rainbow yesterday. There may have been an interesting interaction between you and the grocery clerk, or you had a close, warm exchange with someone you care about. These are the kind of positive moments I mean.

These are moments that need to be framed and stored to be used on days that are much harder. If we are in a quagmire of negative emotion, we can turn anything into proof that there are only painful things in the world. This final skill is learning how to hold onto the positives, to cherish them sufficiently that they do not drop out of your repertory of significant life events.

Once you notice the positives, how do hold on to them? The best way is to slow down – to use relaxation, meditation, and your own internal capacity for joy to feel that moment inside. Let it resonate within. This allows your emotional commitment to be fully focused on the process of life. Be as emotionally able-hearted as possible, despite physical limitations.

What all these coping skills have in common is that they are daily necessities. You don't just get them down pat once and then forget about them. You need to use these skills frequently. Every day is going to give you something different to try to manage. You need these well-practiced skills to succeed.

The circumstances you face may at times be miserable. Nothing can alter this reality. Trust that you will learn from each stage and from each cycle through the stages. Learn to trust others enough so that when the situation seems unbearably stressful, outside counseling and psychotherapy can be sought. Renewal cannot always be attained without help.

If these ideas have reached you at any level, you have already begun the process of renewal. You are adapting in the face of great difficulties. There is no right way to come through the ravages of unavoidable health changes. But I have tried to show you ways to remain an active agent in your own life.

You are not alone. None of us is alone. We may not know each other yet, but there are kindred spirits. A single treasured personal relationship makes the path bearable.

I wish you a safe and thoughtful journey on what is truly a road of hope. I travel it with you. You have a companion and you have hope.

http://www.alpineguild.com/COPING%20WITH%20CHRONIC%20ILLNESS.html

Acceptance of an Illness is Not a Surrender

Vijai P. Sharma, Ph.D

Replace negative thoughts with acceptance thoughts such as, “I don't like being sick, but I can live with it.” We wrongly fear that acceptance of our illness amounts to surrendering to it. Acceptance does not mean that we have given up fighting or that we are inviting the illness to stick with us for ever. On the contrary, when you accept your illness, it frees your powers to work on recovery and rehabilitation that were earlier being used to protest and fight against the disease. An acceptance of the disease may even release the powers that were dormant which you had no idea you had. It is the the freed up powers and the dormant powers that enable a person to “ride the tiger.”

What we regard as limitations and restrictions caused by an illness may lie, to a great extent, in our belief system, rather than in our body. Our beliefs create our reality, and the mind and body take that to be the truth without further questioning. We act as if that is true. Our actions provide confirmation of our beliefs. Take for example a man with a severe heart condition who is unable to hold down the job he had previously handled for years. Physical tasks, such as chopping the wood in the winter or tilling the yard in spring have become not only arduous, but tortuous. In addition to this his sexual drive plummets to zero. He begins to think about himself in such terms as, “I am not a man anymore,” which then results in chronic depression.

The man in the above example now has depression to deal with, in addition to his heart condition. Such a man is heading for total disability. However, if he alters his belief about himself by affirming, “I am not able to do some things just now, but I am going to build from ground up and do what I can.” In this way he may be able to ride that proverbial tiger, called long-term or life-long illness.

Accept that you are 100% responsible for what happens to you. Freeze the blame at point zero. However, accept help from others with a gracious “thank you.” You don't have to do it alone. Give others a chance to help you. Learn practical tips on how to manage your symptoms and emotions on a daily basis. Grow a plant. Marvel at a sunset. Such enjoyments are offered to all of us by Mother Nature free of charge. Seek out things that you can enjoy. Find your “heroes,” that is, people who are coping successfully from disabling and painful conditions. Appreciate your assets and realize that it could be worse. Look at those with compassion who have it worse than you and look for opportunities to help them cope with their illness.

Lack of acceptance leads to out of control emotions. Some people who are chronically ill begin to take their anger out on their spouse and children. In many cases, it is men who refuse to accept help for their out-of-control emotions. Their spouses are compelled to seek help for themselves so that they can somehow cope with the situation at home. It is unfortunate that for some, accepting help equals defeat. For some medical patients who are going through an emotional turmoil, the suggestion of psychological help amounts to adding insult to injury. A physician is hard put to recommend psychological help lest it should offend the patient.

Perhaps, patients in such a situation feel that the control of their body is already taken away from them by their illness, and “now my doctor is telling me that I have also lost my mind.”

Unfortunately, many of us still view psychological help as a threat rather than a help. According to them, psychological help is only for the people who are losing their mind or are already “crazy.” A lady who was losing her sight due to diabetic complications was having a difficult time in dealing with the fact that she was at the verge of total blindness. She became severely anxious, depressed, and angry. She didn't care whether she lived or died. She overdosed on her medication. At this point her doctor recommended psychological help. The lady declined the suggestion saying, “I am almost blind but I am not crazy.”

This lady was having nightmares which consisted of getting lost, stumbling in the dark and being mugged and beaten up on the street. She didn't want to get out of her house or go to a store even with an escort. She was afraid of stumbling over something and falling down, and thus “make a fool of myself.” She was obsessed that her escort would make a mistake in navigating her or not support her firmly enough to help her walk steadily. These are all very normal concerns when a person must make a major shift from a “seeing” person to a “sensing” person–from being self-reliant to other-dependent. However, the dependence on others may be only a temporary phase. When you accept help from others, you can concentrate your powers in learning how to use other senses and resources. Agrippa in 1510 said, “So great a power is there of the soul upon the body, that whichever way the soul imagines and dreams that it goes, thither doth it lead the body.”

http://www.mindpub.com/art193.htm

The Serenity Prayer

God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. Living one day at a time; Enjoying one moment at a time; Accepting hardships as the pathway to peace; Taking, as He did, this sinful world as it is, not as I would have it; Trusting that He will make all things right if I surrender to His Will; That I may be reasonably happy in this life and supremely happy with Him Forever in the next.

Amen.

–Reinhold Niebuhr

Depression Caused by Chronic Illness

A chronic illness is an illness that lasts for a very long time and usually cannot be cured completely. However, chronic illnesses can often be controlled through diet, exercise, and certain medicines. Examples of chronic illnesses include diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis.

Why is Depression Common in People With a Chronic Illness?

People diagnosed with chronic illnesses must adjust to the demands of the illness itself, as well as to the treatments for their condition. The illness may affect a person's mobility and independence, and change the way a person lives, sees him or herself, and/or relates to others. For these reasons, a certain amount of despair and sadness is normal. In some cases, a chronic illness may actually cause depression.

Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. Depression and illness may occur together because the physical changes associated with the illness trigger the depression, the individual has a psychological reaction to the hardships posed by the illness, or simply as a coincidence.

Which Long-Term Illnesses Can Lead to Depression?

Any chronic condition can trigger depression, but the risk increases with the severity of the illness and the level of life disruption it causes. The risk of getting depression is generally 10-25% for women and 5-12% for men. However, those with chronic illnesses face a much higher risk – between 25-33%.

Depression caused by chronic illness often aggravates the illness, especially if the illness causes pain, fatigue, or disrupts your social life. Depression can intensify pain. It causes fatigue and sluggishness that can worsen the loss of energy associated with these conditions. Depression also tends to make people withdraw into social isolation.

The rate for depression occurring with other medical illnesses is quite high: · Heart attack: 40-65% experience depression · Coronary artery disease (without heart attack): 18-20% experience depression · Parkinson's disease: 40% experience depression · Multiple sclerosis: 40% experience depression · Stroke: 10-27% experience depression · Cancer: 25% experience depression · Diabetes: 25% experience depression

What Are the Symptoms of Depression in People with Chronic Illness?

Patients and their family members often overlook the symptoms of depression, assuming that feeling depressed is normal for someone struggling with a serious, chronic illness. Symptoms of depression are also frequently masked by the other medical conditions, resulting in treatment for the symptoms – but not the underlying cause of the symptoms – the depression. It is extremely important to treat both forms of illness at the same time.

What Can Be Done to Treat Depression in People With Chronic Disease?

Treatment of depression in people with chronic disease is similar to that offered to other people with depression. Early diagnosis and treatment for depression can reduce distress, as well as the risk of complications and suicide. People who get treatment for depression that occurs at the same time as a chronic disease often experience an improvement in their overall medical condition, a better quality of life, and are more easily able to stick to their treatment plans.

If the depressive symptoms are related to the physical illness or side effects of medicine, treatment may just need to be adjusted or changed. If the depression is a separate problem, it can be treated on its own. More than 80% of people with depression can be treated successfully with medicine, psychotherapy, or a combination of both. Treatment with antidepressant drugs can start to work within a few weeks.

Tips For Coping With Chronic Illness

Depression, disability, and chronic illness form a vicious cycle. Chronic illness can bring on bouts of depression, which, in turn, can lead to a run-down physical condition that interferes with successful treatment of the chronic condition.

Following are some tips to help you better cope with a chronic illness: · Learn how to live with the physical effects of the illness. · Learn how to deal with the treatments. · Make sure there is clear communication with your doctors. · Try to maintain emotional balance to cope with negative feelings. · Try to maintain confidence and a positive self-image. · Get help as soon as symptoms of depression appear.

Next: Diagnosing Depression >

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.

Edited by Charlotte E. Grayson, MD, Jan. 2004.

Portions of this page copyright ©The Cleveland Clinic 2000-2004

http://my.webmd.com/content/article/45/1663_51215.htm?z=2946_00000_5022_pe_02

Body Image: The Inner Mirror

James W. Breakey, PhD, CP

ABSTRACT

Each individual holds an idealized mental picture of his or her physical self; he or she uses this image to measure concepts related to body image. Once an individual's percepts or concepts of this body image are altered, emotional, perceptual and psychosocial reactions can result.

Psychosocial well-being often is affected by such factors as anxiety and depression, concerns with self-esteem, and satisfaction with life. In the general population, a person's positive or negative feelings toward his or her body have been found to affect his or her well-being.

Living in a society of mostly able-bodied persons, individuals who have disabilities must contend with comparing the appearance of their bodies and functional capabilities to those of others around them. Mental health practitioners often see physical deviation from the norm as central to people's behavior and personality.

The following article strives to provide prosthetists and orthotists with insight into the relationship between body image and psychosocial well-being.

Key words: Amputee; Psychosocial; Body Image; Self-esteem.

Introduction

American society is preoccupied with the perfect human form. Anyone who deviates from this ideal image is labeled different. Many relatively normal individuals have difficulty dealing with this issue of body appearance. In essence, whether a person is overweight or underweight or has a large nose by society's standards is not the determining factor in psychological health; instead, how a person perceives his or her physical uniqueness influences his or her subjective well-being.

Knowledge about the self is established primarily through sensory experience and perceived viewpoints of others. As a result, the body may become invested with significance well beyond its functional capabilities. Because a person's physical appearance is his or her calling card, it is reasonable to hypothesize a significant relationship would exist between our evaluations of our bodies and our subjective well-being.

Body image is the mental picture a person forms of his or her physical self. According to Kolb (1), each individual holds an image of the body that he or she considers the ideal in relation to his or her own body. An alteration in a person's body image sets up a series of emotional, perceptual and psychosocial reactions (2). Loss of a limb through amputation will, Kolb suggests, probably lead to a long-term disorder in body experience (2).

The perceived discrepancy between the altered physical state (e.g., caused by a mutilating injury) and the former physical state produces emotional tension (3). This tension is experienced as anxiety, which becomes chronic as long as the discrepancy continues (3).

Results have led to a better understanding of ill-being–specifically, anxiety, depression and unpleasant emotions. Research has been conducted on the construct of subjective well-being (4,5). Two broad aspects of subjective well-being have been identified: an affective component, including pleasant affect and unpleasant affect (6); and a cognitive component (7), referred to as life satisfaction.

In their extensive body-image survey, Cash et al. (8) included several items they identified as comprising psychosocial well-being. The items addressed self-esteem, life satisfaction, depression, loneliness and feelings of social acceptance. Persons with positive evaluations about their body image reported favorable psychological adjustment. In contract, those with negative feelings presented lower levels of psychosocial adjustment (8).

Single characteristics have the power to evoke a wide range of feelings and impressions about a person (9). This concept, called spread, suggests physical deviation from the norm is frequently the key to a person's behavior and personality. Furthermore, such deviation can be largely responsible for many important developments in the life of a person with a physical disability (10). The concept of spread is valid both for someone who has a disability and for those evaluating that individual. Some may view the disabled individual as less worthy and less capable. The individual also may take this view. Thus, physical form may affect self-perception of an individual's capability as well as his or her acceptability to others.

Those who have disabilities often must contend with the effects of stigmatization. Stigma refers to an attribute, either physical or psychological, that makes a person different from others and therefore less desirable (11). Considering the stimulus that a person presents and the feedback received purely on the basis of physical appearance, it is conceivable that others' reactions to a newly disabled individual may influence how the individual perceives him- or herself. For instance, if the response is negative, the person may begin to view him- or herself as deformed, incompetent and inferior. A comparison of his or her body appearance and capability with those of others, combined with the potential effects of spread and stigmatization, may lead him to a negative body image, which also may affect his or her subjective well-being.

A person who has lost a limb through amputation tends to compare his or her appearance and functional capabilities to others', the majority of whom are able-bodied. Based on these comparisons, one could speculate it would be difficult for an individual who has a disability to develop a positive attitude with respect to his or her body.

Review of the Literature

Body Image

Body image is one's psychological picture of the physical self. The noted neurologist Sir Henry Head was the first to describe the concept of body image. This image, or body schema, is a unity of experiences of the past, coupled with present body sensations, which are organized in the sensory cortex of the cerebrum (12).

Each individual develops this body schema: a model or self-picture that can be compared to others in terms of body postures and body motions (13). Body experience is important to normal psychological development and behavior (12).

Body image is more than a reference model; it also has emotional and symbolic significance (14). Schilder defines body image as the picture of our own body which we form in our mind (14). Practicing as a psychiatrist, he realized distortions in body experience attributed to brain pathology needed to be studied not only from the perspective of brain physiology but also from the psychological viewpoint. The many variables associated with body image have principal relevance in both the pathological aspects of daily life and in ordinary everyday events. Because body image lies at the center of personality, body experience is the nucleus of psychological life (14).

Further, body-image development is influenced by several factors: · optic and tactile sensations; · emotional experiences and their influence on the relative value one has for the multifaceted body image; · social experiences, with ongoing interchanges between the impressions others have about our physical appearance and our personal reactions to these impressions; and · our own attitudes and values we place on our bodies as derived from comparisons wi>th others, our own introspection, and past positive and negative experiences (14).

Body image is capable of extending beyond the physical boundary to envelop external objects such as clothing or a walking stick. The more rigid the connection of the body with the object, the more easily it becomes part of the body image (14). In summary, body image as defined by Schilder is the picture of our body we form in our minds as tridimensional units, including interpersonal, environmental and temporal factors (1).

According to Fisher and Cleveland (15), Freud considered body image instrumental to ego development; Fisher and Cleveland agree with Schilder that personal symbolic significance can be attributed to body regions. Sensations from body regions to which an individual is especially sensitive arouse attitudes proportional to the psychological significance placed on the body part.

Similarly, the more a person accepted his body, or liked it, the more secure and free from anxiety he felt (16). Therefore, Jourard postulates, a high degree of body cathexis [ratings of body parts] would contribute to an individual's acceptance and approval of his or her own overall personality. Evaluative feelings about the body affect the individual's psychosocial, social and physical exchanges with the environment (17). The degree and direction of one's feelings toward the body are related to anxiety, insecurity and stability. There is a high correlation between body cathexis and self-cathexis (ratings of aspects of self).

A relationship exists between the body's personal security, mitigation of anxiety and positive feelings of self-esteem. Personal appearance is a means to many highly valued ends in our society, and, if a person is not physically attractive or perceives him- or herself as unattractive, his or her access to these goals is diminished, leading to anxiety and a general self-devaluation (17).

The concept of body-image boundaries is an important dimension of the body image (15). In normal perceptions, an individual's body limit or boundary is unconscious and allows a sense of a fixed separation from the external environment. Using projective tests, such as Rorschach or Holtzman ink blots, perceived body boundaries may be studied (15). More specifically, Fisher and Cleveland report on a method they developed to sense perceived boundaries using ink blots. Their method assessed two separate responses: the barrier response (which stresses finiteness of boundaries, called barrier scores) and the penetration response (expressing indefiniteness and penetration of the boundaries, called penetration scores). Fisher and Cleveland gathered a good deal of evidence that revealed the way people picture the boundaries of their ink blot responses mirrors how they feel about their own body boundaries. The ink blot responses closely linked with body events, specifically with the psychological and physiological contrast between interior and exterior body regions (18).

Barrier scores have been found to be correlated with effectiveness in coping with the ability to adapt to insults of the body integrity. For example, barrier scores have correlated positively and significantly with effective adjustment to amputation (19).

Body awareness is another dimension of the body image. Fisher (20) describes his body prominence measure, which he has used to quantify body awareness. Subjects are instructed to list 20 things they are aware of at the moment. All references to the body or body functions are scored. The rationale for this measure is simple: The greater the focus an individual places on his or her body, the greater the number of references to the body he or she will make in the 20 things. Some people disregard body perceptions while others are tuned into their body messages. Meanwhile, hypochondriacal individuals tend to demonstrate heightened body awareness and view these sensations as threatening.

Fisher also uses another investigative tool, the body focus questionnaire, which consists of 108 pairs of body parts divided into eight scales. Subjects are asked to choose the one pair of body parts of which they are most aware. A score is derived for each of the eight scales equal to the number of times a particular pair of body parts is picked (e.g., heart or stomach). According to Fisher, an individual places a special value and symbolic meaning on body parts that tend to be unconscious and may reflect intrapsychic defenses and conflicts (20).

The disturbance of a normal body image, as occurs with an amputation, sets up a series of emotional, perceptual and psychological reactions in the individual (1). Individuals who have undergone amputation of a limb may experience anxiety and depression (1). Psychological dysfunction can result when body image changes (21) because body parts carry conscious and unconscious symbolic meaning for an individual (22). If the body image is altered, such as through limb loss, psychological and psychopathological responses can occur. Patients, including amputees, manifest body-image disturbance (3). The types of problems Henker most frequently observed were anxiety, depression, guilt, projection and scapegoating. He concluded the value placed on the lost anatomical part influences the reaction to the altered body appearance. The discrepancy between the perceived altered physical state and the former physical state produces emotional tension. This tension is experienced as anxiety, which becomes chronic as long as the discrepancy continues (3).

Body dysfunction has personal meaning for the individual who places value on the body part(s) and function(s) (21). This subjective value is the result of 1) past learning experiences about body dysfunction, either personally or from others; 2) how successful one is in coping with these experiences; 3) positive or negative reinforcement received from others about one's body appearance, skills and behavior; and 4) cultural agreement on attitudes held toward body parts.

Individuals value certain body parts or functions for several reasons: They provide a source of self-esteem or sense of competence; help contend with the environment; enhance self-concept and stability of body image; and allow the individual to continue social, sexual and vocational functioning. Sometimes the value has unconscious symbolic meaning which imparts of it a vital value. Any disability that disrupts any of these personal values will have a deep psychological effect on the individual (21).

The degree of emotional reactions to body dysfunction correlates with the subjective value and meaning placed on the body part–both conscious and unconscious–and not the severity of the pathology or lost function (23). Mitchell's study supports Shontz's position. The relationship was studied between the barrier score and the ability to adapt to spinal cord injury (24). Using Rorschach ink blots, Mitchell determined barrier scores from 50 male paraplegics and 52 male quadriplegics. Barrier scores were significantly higher in the high-adjustment paraplegic subjects than in the low-adjustment group. In contrast, the barrier score did not present any significant distinction in the quadriplegic sample between the high- and low-adjustment subjects. When the impact of a disability is so destructive, as in quadriplegia, adjustment may be a function of variables outside of self, such as outside support systems (25).

Can a value be put on different body parts? Plutchik, Conte and Weiner (26) addressed this question by asking 203 subjects to determine a dollar value that would be acceptable if a body part were lost in an accident and an insurance claim were to pay off. The largest compensations were asked for the leg, eye and arm as contrasted with lower compensations for the finger and toe. The researchers have interpreted these responses as relating to an individual's ability to function and to interact with the environment. Other findings in this study indicate no significant relationship between the dollar value placed on a body part and the age of the individual. This appears to be consistent with the earlier findings of Fisher (27), who reported older people do not differ from younger people in the properties they assign to their body boundaries.

An analysis was made of a 2,000-person sample of a 30,000-person survey of the general public on body image (8). In the general population the authors found a relationship between psychosocial well-being and body image. Seventy-three percent of women and 62 percent of men who had a negative body image were well-adjusted whereas 97 percent of women and 95 percent of men with positive images of their physical appearance were well-adjusted. The authors included several items in their survey to tap what they believed constituted psychosocial well-being. These items asked about self-esteem, life satisfaction, loneliness, depression and feelings of social acceptance (8). Persons with disabilities or disfigurement exhibited a negative reaction on perceived appearance, fitness and health. Their increase in negative body image was 12 percent in men and 20 percent in women as compared to the rest of the group.

Based on the preceding literature review, body image appears to be a construct that is a product of pertinent experiences and that can exert regulating influences on behavior. Any significant change in experience relevant to the body would be expected to produce a change in perception and evaluation of an individual's body image.

Personality and Physical Disability

Three important psychological maneuvers act on body experience (20). The first is magnification and dampening of body experience. For example, people can focus on their bodies to the point of developing hypochondriasis, or, by contrast, become celibate (as demanded by some religious groups). A second maneuver is setting up a division between self and the environment. For some people, this differentiation between the body and the external world is necessary for development of a concept of self. The third maneuver is applying attention to dominant body areas. In short, patterns of body awareness provide the groundwork for the expression of personality (14,20).

Personality cannot exist without the body image any more than a house can exist without walls (27, p. 467). In an earlier discussion on personality and the disabled, Shontz (28), p. 36) states, The term personality refers to the way in which the person with a disability integrates the behavioral facts of his disability into his total life pattern. The reaction to disability is individualized, and a person's individuality overshadows all other variables, including those of etiology and magnitude of the somatic involvement (30). In an extensive review of the literature, Shontz (23,29) found no data to support a relationship between disability and degree of adjustment–that is, there was no convincing support or the proposition that disability produces or is correlated with personality maladjustment (29, p. 49).

In support of Shontz, Wright (10, p. 240), after a review and discussion of the literature in her book Physical Disability–A Psychosocial Approach, concludes, There is no substantial evidence to indicate that persons with an impaired physique differ as a group in overall adjustment from their able-bodied counterparts. She asserts, There is no clear evidence of an association between type of physical disability and particular personality characteristics (10, p. 241).

Earlier studies indicate similar findings. For example, Fishman (31) found no reason for identifying unique personality characteristics in amputees. Tizard (32) drew the same conclusion from a literature review on the personality of epileptics. Other authors have reached essentially the same conclusion: Harrower and Kraus (33) and Cohen (34) in multiple sclerosis and Moos (35) in rheumatoid arthritis. Later, Pringle (36) reports on his extensive review of the literature written between 1928 and 1962 on the emotional and social adjustment of children with physical disabilities. He found no evidence of an association between disability and behavior characteristics or that physical disability leads to maladjustment. Another study, Weinberg-Asher's comparison of able-bodied and disabled college students (37), found no difference in the way they viewed themselves.

In contrast, a number of studies dispute the above findings. Barker et al. (38) studied severity of the disability and found significant differences in self-esteem in groups of mildly, moderately and severely disabled. Ware, Fisher and Cleveland (39) noted a significant relationship between adjustment to poliomyelitis and body image. Cowen and Brobrove (40), in a study comparing partially and totally blind children, reported marginally impaired subjects display greater personality disturbance than severely impaired subjects. In a study of amputees, Weiss et al. (41) found severity of disability did affect the personality as well as physical functioning. Matulay and Pauloukin (42) studied epileptics and found them, as a group, to show increased anxiety, low frustration tolerance and depressive mood swings.

The following conclusions may be drawn about personality and the physically disabled:

1. There is little evidence that particular personality characteristics are associated with particular disabilities. 2. There is little evidence that the age of onset of a disability and the severity are correlated with psychological adjustment. 3. People who have disabilities, in general, manifest different personality factors than the non-disabled. These factors include increased anxiety, increased depression and impaired self-concept.

Psychological Levels and Functions of Body Experience

In his book The Psychological Aspects of Physical Illness and Disability, Shontz (23) suggests body experience occurs at four levels: body schemeta, body self, body fantasy and body concept. His observations are summarized below.

· Level 1: Body Schemeta. This is the most basic level of body experience and pertains to the perception of the body as an object in space. Amputation appears to interfere with perception at this level. Schilder (14) considers the phenomenon of a phantom limb experienced by a lower-limb amputee to be an expression of the body schemata.

· Level 2: Body Self. Body experience at this level develops from and incorporates body schemata. The individual develops a body-image boundary–personal space to buffer self from the non-self. A great amount of research has been conducted at this level (15,25).

· Level 3: Body Fantasy. According to Shontz (23), fantasy, while complicated, is a bountiful wellspring of information about body experience. In scoring inkblot responses, Fisher and Cleveland (15) and Fisher (20) used fantasy to determine body boundary characteristics. They used body fantasy to assess body experience. An example of this is a subject's seeing a turtle in an inkblot. The turtle's shell could be interpreted as a barrier or protection between the self and the environment.

· Level 4: Body Concept. Using signs and symbols, people learn to expand their understanding and begin to express their body experience. For example, human locomotion can be referred to as normal or abnormal depending on the accumulation of knowledge an individual has about the subject. This information helps an individual to enhance his or her self-understanding and allows him or her to make comparisons between him- or herself and others.

Seven normal functions of body experiences are described by Shontz (23,28)

1. Acting as a sensory register, the body realizes incoming sensation, interprets and integrates the information, and files the data for retention.

2. In response to stimuli, the body can respond as an instrument for action. This action can be as simple as a primitive reflex or as involved as jumping out of the way of an oncoming vehicle.

3. Humans come equipped with a source of drives adequate to assist survival. Additional needs are generated by learning. Bodily drives usually are automatic, such as hunger or thirst, whereas social drives are learned.

4. As a stimulus to the self, the body serves as a reference for self-identity. The body is heavily endowed with significance to be evaluated in relation to others.

5. Because the body self is greatly influenced by social values, it acts as a stimulus to others. As a result, the response from others can cause an individual to evaluate him- or herself in those terms. Physical appearance is a definite social stimulus.

6. The body offers a private world for the personal self to exist. Shielded by one's physical boundaries, a place of private expression is available, unique and impervious to others.

7. Besides being a protective shell, the body is a vehicle or an expressive instrument for individual expression. Countless and elaborate expressions are encountered daily in body language seen between interacting individuals.

Later, Shontz (43) affirms the levels and functions of body experience are integrated, as is any structure system, e.g., a corporation. Integration is mandatory if a person is to prevail and individuate. Body experience and personality operate together. If the body is disturbed, the personality or self is affected to some degree and vice versa. Most body functions are taken for granted, but when they are interfered with by illness or disrupted by disability their importance becomes more apparent to the individual (23).

Conclusion

The implications of one's perception of body image is important. Generally, the initial feedback and reinforcement we receive from others is about our bodies–their appearance, how they move, etc. Early childhood experiences and later development are essential to personality development and contribute to the perception of body image. The concept of self initially evolves from sensations and perceptions from within the body and later from the perceptions of self communicated to the individual via feedback from family, friends and peer groups. Blossoming of the body image is integrated with the socialization process, which involves internalization of social standards of attractiveness, capability and normality. Individual development of a positive or negative body image is thus influenced by the perception of oneself relative to these standards. Since the body creates the first impression, eliciting a large amount of feedback on which feelings of self-esteem are built, it is understandable a relationship would be seen between body image and self-esteem.

Through the concepts of devaluation, spread and stigmatization, the psychological assault with which the individual who has a disability must contend is understandable. This individual must deal with his or her perception of the disability, the spreading of the disability to other aspects of self, and the judgment by peers and society of his or her physical appearance and capabilities. Therefore, it is easy to understand why a person's body image may very well affect his or her psychosocial well-being.

I am Free

by Pat O’Connor

ORIGINAL POST 03/17/2005

I was born with lymphedema. Slowly over the years, I have watched helplessly as my body swells more and more, destroying so much of my abilities of doing “things.” Then came the cancers, the depletion of an already tattered immune system…. the slow ebbing of a life.

I know what it is to hurt so bad…your body screams to die just for relief. I have felt that despair that says, “if only I could go to sleep and not wake up.” I have wrestled with the anger that comes and cries out “if only this stuff would do its job quickly…instead of slowly stealing away my life.”

You struggle with the shadows of the night…the quiet tears that stain your cheek.

I know the shame of being made fun of….laughed at….rejected because my legs were so “wierd.” The heart break of being called a freak. The feeling of hopelessness and isolation.

Some would say I am prison bound…locked away in a body that is overwhelmed by pain, disfigurment, continually eaten up by non-stopable infections…sorrow and frustrations face my every day.

But, I am free.

I am free to embrace the dawn…to bask in the warmth of the morning sun.

I am free to wander through the stars at night…to behold the glory of my God and worship His goodness.

I am free to be intoxicated by the aroma of a rose…glistening with the dew. To rejoice in all the glory of a wonderous creation.

I am free to create beauty, whether through the pen, a camera…a brush…to create beauty in a world where so many create ugliness.

I am free to laugh and to bring laughter into anothers sorrowful life.

I am free to go beyond my own pain…to bring comfort to another…to bring healing to an aching heart.

I am free to go beyond my selfishness…to choose a life of selfless giving to others.

I am free to reach out and touch the heart of another…to bring comfort and hope.

I am free to wipe away the tears of another hurting spirit…to lift them up…to help heal their broken heart.

I am free to journey within…to face my fears…to overcome them with victory in my spirit…instead of living in fear and doubt.

I am free to allow bitterness….to be turned into a sweet nectar.

I am free…to be me. Free to say “I don't want to be anyone else, but me”

I am free to look into the mirror and respect the person I see, to like my values… to know who I am deep inside.

I am free…in so many many ways…seemingly to many to list.

But…perhaps most important…….

I am free to choose who I am and how I live.

I am free to choose life…instead of allowing myself to be destroyed by the shadows of despair or even death.

I am free to love…to dream…to forgive…to choose kindess and gentleness.

I am free…

Anger - A Few Random Thoughts

I originally posted this on another blog, but felt it was important enough that I wanted to share it here as well.

It is 3:00am; Sunday Morning with the only sound is the clicking of the keyboard and the mellow sounds of BB King echoing throughout the stillness of the night.. What a beautiful time of the day, nourishing solitude and a special time for reflection.

Home at last after another week of being poked, prodded, disrupted and cut. I can’t help but wonder how long I’ll be able to stay out this time, and I remember what Dr. Stewart said about being caught in the cycle. For me the cycle goes only downward, and my eyes look upward, not downward.

We had an interesting incident in the Lipedema group this week, and I bade farewell to the group I founded. There was a member that simply in absolute anger went berserk over the fact that I questioned them on some treatment they had suggested.

How very very say to be so driven and consumed by such an emotion as anger. I have struggled against lymphedema, lymphoma, leukopenia…but there are worse things you can have…anger, bitterness and fear.

Those emotions have destroyed more lives then all the wars of human history combined and life is far too short to be eaten up by them.

It is easy to become angry when you have a serious illness and actually it is quite normal. What isn’t normal and what can be totally destructive is when you allow the anger to be predominant in your emotions.

Choose your path…choose your destiny…no matter what condition or situation your are in, you still have a choice.

Choose anger…and you choose death…lonliness….bitterness.

It may not be your fault, indeed it is probably no one’s fault that you have a terrible medical condition. But, it is your responsibility how you react to it.

You can also choose to be a blessing to others, or to be a curse. You can be remembered in their hearts with sweetness or with a relief that you are gone.

When you are consumed in anger, I do not have compassion for you or your medical condition. I do feel sorry for those who are going to be your victims. Those innocent people who come across your path that you hurt and lash out at to make yourself feel better. What a coward’s way to face life and you certainly don't have the right to take out your anger on others. Some interesting quotes about anger:

If you do not wish to be prone to anger, do not feed the habit; give it nothing which may tend to its increase. Epictetus (55 AD - 135 AD)

Speak when you are angry–and you will make the best speech you'll ever regret. Laurence J. Peter (1919 - 1988)

When anger rises, think of the consequences. Confucius (551 BC - 479 BC)

He who angers you conquers you. My mother used to say, “He who angers you, conquers you!” But my mother was a saint. Elizabeth Kenney

Of the Seven Deadly Sins, anger is possibly the most fun. To lick your wounds, to smack your lips over grievances long past, to roll over your tongue the prospect of bitter confrontations still to come, to savor to the last toothsome morsel both the pain you are given and the pain you are giving back – in many ways it is a feast fit for a king. The chief drawback is that what you are wolfing down is yourself. The skeleton at the feast is you. Frederick Beuchner

How much more grievous are the consequences of anger than the causes of it. Marcus Aurelius

People who fly into a rage always make a bad landing. Will Rogers

Anger dwells only in the bosom of fools. Albert Einstein

If you kick a stone in anger, you'll hurt your own foot. Korean Proverb

Anger is a killing thing: it kills the man who angers, for each rage leaves him less than he had been before - it takes something from him. Louis L'Armour

Consider how much more you often suffer from your anger and grief, than from those very things for which you are angry and grieved. Marcus Antonius

Anger is the handmaiden of self-pity and the toxin of death. Pat O'Connor

When you were born, the world rejoiced and you cried. Live your life so that when you die, the world cries and you rejoice. Old Cherokee Proverb

Pat O'Connor 01/21/2007

Overcoming Fear in a Critical Illness

Overcoming Fear in a Critical Illness

There are a lot of fears that overwhelm us when we learn we have cancer or if we are diagnosed with lymphedema.

The fears have to be dealt with, they must be faced and overcome. If they are not, life will become an unbearable experience of suffering innerwardly as well as outwardly.

I found this article and wanted to share it:

Fear is a universal emotion, if not a primal instinct. Each of us has felt it - recoiling from a sudden burst of flame or a snarling dog, for instance, or grasping at a railing and backing away from a sudden drop-off. But there's another type of fear: the fear that comes with serious illness and the prospect of death. This fear has less to do with self-preservation. It is fear of an uncertain future, fear of change, and perhaps most importantly, fear of facing one's life squarely and coming up empty-handed.

When Matt, a 22-year-old I knew, was stricken by a malignant lymphoma a few years ago, we talked about this fear, and those conversations have stayed with me ever since. Like most patients who have just been diagnosed with a serious illness, Matt was primarily concerned with his physical condition, at least at first, and peppered his doctors with all sorts of questions. What was the cause of the lymphoma? How effective was the treatment supposed to be? What were his chances of survival? What did this or that medical term mean? Within a few days, however, his overriding concern had changed to his spiritual state. It was as if he sensed that his life had taken an irreversible turn and that no matter what the outcome, he needed to set it in order.

Matt changed greatly over the following months. At the time he was diagnosed, he was a brash and often loud-mouthed joker; happy-go-lucky on the surface, but privately terrified. Six short months later, however, he was a different person. True, he never lost his silly streak, and was still scared at times, even near the end. But having gone through days and nights of the most excruciating pain, he had developed a new, deeper side. And having stopped looking for an escape from the hard fact that he was dying, he had come to terms with the thought, and faced it head on. In doing so, he found strength to meet the agonies of death calmly.

Not everyone dies peacefully, and it's not just a matter of emotional make-up or personality. Peace cannot be found solely by “working through” one's feelings on a personal level. After all, we are never alone, but are surrounded at all times by the cosmic forces of evil and good. And though the battle between them is played out in many arenas, I believe it is most intense wherever the soul of a dying person hangs in the balance.

Dorie, a close friend of my mother's who felt continually tormented by this conflict, lived with it not only at the end of her life, but for decades. Dorie lived next door to our family for many years, first as a part of my parents' household and, after their deaths, as part of my own.

The Dorie most people knew was a happy person who found great joy in helping others. When a baby was born, she was the first to arrive with fruit, flowers, and an offer to clean the house. It was the same when guests were expected. Nothing satisfied her as much as making sure the extra room was dusted and the bed freshly made. She was endlessly cheerful, it seemed, and willing to do the most mundane chore. She never expected or wanted thanks.

Underneath, however, Dorie was a nervous, anxious person. She had trouble sleeping at night and always wanted to have someone nearby. She worried over every symptom of aging and dreaded the prospect of physical ailments or disabilities. By fifty she was already worrying about dying. Thankfully, her determination to be of use to other people and brighten their day kept her afloat - and prevented the fears that plagued her from driving her to the brink.

Then cancer struck. Initially Dorie underwent several rounds of chemotherapy, and enjoyed several cancer-free years. Then came a relapse. This time the cancer grew rapidly, and we knew Dorie did not have long to live. She was in severe pain, and radiation provided only partial relief. Sitting with her and talking seemed to help more. With her, my wife and I sought for answers to her questions: What is death? Why do we have to die? Is there life after death? Together we read many passages from scripture about death and resurrection, searching for verses that would strengthen her. I reminded her that she had served God and those around her for decades, and said I felt sure he would reward her.

All the same, the last weeks of Dorie's life were an enormous struggle, both physically and spiritually. One sensed it was not just a matter of ordinary human anxiety, but a vital fight for her soul and spirit. She seemed besieged by dark powers. My wife and daughters nursed her for days on end and accompanied her through long hours of inner torment. Once she cried out that something evil had entered her room. With what little strength she had, she threw a pillow at it, shouting, “Go away, darkness! Go away!” At such times those of us with her would gather around her bed and turn to God in song or in prayer. Dorie loved the Lord's Prayer very much; it was always an encouragement to her.

One morning, after a particularly restless night, Dorie's fear was suddenly gone, and she said, “I want to depend on God alone.” She was full of joy and anticipation of that great moment when God would take her, and felt it would be very soon. She said, “There's a surprise today: the kingdom's coming! When it comes, I will run downstairs and outside to welcome it!” That same afternoon she exclaimed, “All my pain is gone. I feel so much better! Thank you, thank you, God!” A little later she said with a smile, “God will call me home tonight.”

In the evening, she called my family - her adoptive family - together and hugged each one of us in farewell. We sang and prayed by her bed, and she remained peaceful through the night. She slipped away from us for good as dawn was breaking.

Having fought as long and hard as she did, Dorie's departure was nothing less than a victory. She knew what it was like to be gripped by cold fear, but she clung to her belief in a God who was greater than her anxieties and never let them completely overwhelm her. And as she breathed her last, she did so with the calmness of those who have come to realize, as the first Christian believers expressed it, that the world is merely a bridge between earthly and eternal life: “Cross over it, but do not build your house on it.”

You may reprint this article free of charge providing you use the following credit box:

Article by Johann Christoph Arnold

Self-Acceptance Is Important for Your Self-Esteem and Well Being

“Self-acceptance means liking the entire physical you, and eliminating those cultural impositions to be proper or to merely tolerate your body when it behaves other than in a cosmetic fashion.” – Wayne Dyer

<http://www.mindperk.com/Affiliate/idevaffiliate.php?id=156_9_3_13>

A study states that the higher a person's self-acceptance, the higher is her self esteem. It is your willingness to love yourself and your body for all the limitations. You can never become perfect and therefore have to stop being self-critical.

Tips to develop self acceptance.

Refuse to measure yourself to people's expectations.

Take care of yourself and do not wait for others to do so.

Allow yourself to listen to other people's opinions and objections without holding grudges and learn to develop tolerance.

Accept compliments from others and trust that they are true.

Find the good and attractive parts of you. Reassure yourself that you are OK. Focus on the positive about you.

Compliment yourself for the task you have accomplished or allow yourself to accept your mistakes and shortcomings.

See yourself as a whole person, a gift and of value to yourself, in the eyes of others and in the eyes of God.

There are parts of you that you can change and work on improving. However, stress occurs when you focus on the parts that you think are unattractive to others.

You become attractive when you portray a remarkable personality, honest in your dealings and show other positive characteristics.

Self-criticism and picking yourself apart is only going to make you uncomfortable and pulls you away from happiness and a sense of wellbeing.

When you learn to feel compassionate toward yourself, you are letting go of wanting to get approval from others. Your willingness to admit and not evade what you think, feel and desire allow you to release your judgments and commit more on your personal growth and self actualization.

Your self-esteem and personal growth improves when you give yourself permission to embrace yourself for your weakness. You can start today in acknowledging your limitations in knowledge and skills and work on areas that allow you to find the solutions to enhance your strengths.

“Since the perfect human being has not been discovered, we all need to live with our hangups and our idiosyncrasies until they can be ironed out. One of the most important qualities in successful, dynamic living is that of self-acceptance.” - Denis Waitley

MindPerk

We Are Not Our Diseases

By Flylady

Dear Friends,

We put labels on ourselves all the time. Why do we do this? I feel that the use of these labels is another form of making an excuse. Let's not even talk about the labels we put on our children. Here are some of the Labels that are used often.

ADD ADHD MANIC DEPRESSED ARTHRITIC BIPOLAR FIBROMYALGIA ALCOHOLIC DYSFUNCTIONAL and many other disorders.

We are not our medical and mental problems. When we label ourselves with these, I feel that we give up and say there is no help.

We all have one problem or another. Would you put your problems in a hat with everyone else's on this list and draw out a new one for yourself? I would not. My goal for our group is that we establish new habits and routines in our lives. To do this we have to realize that there are things in our life that we have to learn how to work around. As one Dear Friend of mine calls herself. She is not handicapped, She is HANDICAPABLE. Let's use our problems to our advantage. See our glasses as half full instead of half empty. It is all in our attitude.

Even on your worst days, if you think about others that are less fortunate than you, and look to help someone, your darkness will lift and your burden will be easier to bear. Don't forget to turn up the corners of your mouth and SMILE!!!!

Keep FLYing,

FlyLady

Nine Ways to Maximize Your Misery: The Don’ts of Chronic Illness (and How to Avoid Them)

Tom Robinson

The chronically ill can make themselves unnecessarily miserable, and in this article I’m going to tell you how. You will see the traps that the chronically ill can fall into, and by consciously avoiding them, you will be able to decrease your suffering dramatically. Below is a short course on what NOT TO DO:

1. Be critical of yourself for having your illness, and for not being able to do those things in just the way you did them before. This is an effective misery maximizer because it builds on the sadness and anger you may already feel about having your disease.

If you want to maximize your happiness instead of your misery, here’s a little exercise that will help. First, get a paper and pen and make a list of the negative or self-critical things you’ve said or thought in the last 24 hours. Whether it’s “I’ll never feel well again,” or “these people don’t care if I live or die,” write them all down. Next, pretend that a very close friend who has the same chronic illness you do and is suffering the same way you are is the one who said or thought those things you’ve written down. Now, for each item, ask yourself what you might say to him or her.

My guess is that you’ve come up with specific ideas for your friend on how to be kinder, gentler, and more forgiving to him/herself. You might even have wanted to tell your friend how much you admire the ways he meets the challenges of living and dealing with chronic illness. What advice would you give your friend when s/he begins to feel so low, and so self-critical? What are the remarkable ways in which your friend manages his/her illness? Finally, be your own good friend, and say these things to yourself.

2. Find as many ways as you can to relinquish the control you have over your illness and your life. This is an especially useful misery maximizer for the chronically ill. Their illnesses almost always result in a loss of control over parts of themselves and their lives.

Retaining a sense of that control is one of the essential ingredients of emotional well being. A well-known study of people in convalescent hospitals by Drs. Ellen Langer and Judith Rodin demonstrated that relatively small differences in control–such as what kind of houseplant to have and which night to watch a movie–made a dramatic difference to the happiness, alertness, and longevity. The study can be usefully applied to the chronically ill. It shows how much difference each small increment in control can make to an overall sense of well-being. Fortunately, there are opportunities for gaining more control in our lives if we can only become aware of them. Another exercise will help: First, make a list of 10 decisions you make every day. (Write down more if you like, so that you can see how much control you do have.) Second, armed with that list as a good beginning, begin to add one or two new decisions each day. Whether it’s choosing something simple like what to wear, or something weighty like which physician to see, the more control we are able to exercise in our lives the happier and emotionally healthier we’ll become.

3. Don’t let yourself feel or express gratitude to anyone for anything. A recent study by Dr. Robert Emmons at the University of California, Davis showed that gratitude improves emotional and physical health. So to maximize our happiness instead of our misery, expressing gratitude for the things and the people in our lives can really help.

One short exercise is to write down ten (or more) things for which you feel grateful. Maybe they include a comfortable bed and a good night’s sleep, or maybe a cloudless blue sky, or eggs cooked the way you like them. People can go on your list too.

The next step is to express gratitude for each item–whether that means a silent “thank you” inside your head–or gratitude expressed out loud to another. Saying “thanks” keeps us human, and helps keep us happy and healthy.

4. Don't have a sense of humor. This is another effective misery maximizer. A sense of humor and an appreciation for the absurdities of the human condition aren’t just things to possess; they are resources to use. In this case the admonition to “use it or lose it” is absolutely true, especially with a chronic illness.

Take out that pen and paper once more for another exercise: Write down ten things about life with your illness that a kind-hearted comedian could make something of. If you twist it just a little, even your adversity has a comic aspect to it. Once you find it, use it to make yourself feel better, and manage that next challenge with a lighter approach.

For an example, consider the adversity that Captain Al Haynes, pilot of United Airlines Flight 232, faced. His plane was carrying 285 passengers when an engine came apart and disabled all three hydraulic systems, rendering the plane virtually uncontrollable. By heroic aeronautical skills the crew was able to erratically weave to the Sioux City, Iowa airport to attempt an emergency landing. The tower controller told Captain Haynes he was cleared to land on any runway. Haynes response was, “Oh, you want to be particular and make it a runway?”

Do your health a big favor, and…lighten up.

5. Don't take time for yourself. It’s easy to see how following this dictum is good for maximizing misery. In our culture, women, and especially mothers, have a head start in using this misery-making suggestion. They learn that everyone else comes first.

While it’s easy to see that following this dictum is good for maximizing misery, what’s often hard to see is the possibility of finding a way out, without being punished by others, or feeling guilty yourself. Take out that paper and pen again: Write down 10 small things that you could do for yourself that make you feel better. Now, we’re not talking trips to Italy here, or major life changes, so keep it small. You want those things to be easily done without a lot of fuss. Armed with your list, you can proceed to the next step: DO ONE SMALL THING A DAY TO MAKE YOURSELF FEEL BETTER.

6. Don't take responsibility for your medical care. Obviously if you don’t get good medical care you’re going to be sicker and more miserable than if you do. What’s not so obvious is how many things you can do to greatly increase the quality of the care you receive.

Our culture has traditionally held doctors in high esteem, even awe. For many people this view has obscured the fact that the usual customer satisfaction rules apply to doctors just as they do to other service providers. For example, we demand a certain level of both courtesy and competence from our mechanic, and if we don’t get it we find another. I’m not suggesting that we change doctors the first time we don’t like what they tell us, but as consumers we need to remember that we always have the right to find someone who will serve us better.

The other thing we can do to get better medical care is find out as much as we can about our disease, treatments for it, and the latest research on it. The internet is an extremely powerful tool that can help us do this, and I’m sure many of you have made good use of it. For those of you who haven’t, I strongly encourage you to do so. The links on the Chronic Illness web site are a great place to start.

7. Dwell on your illness day and night. If you’re chronically ill, this is one of the easiest ways to get seduced into misery. When you’re sick all the time, it’s hard not to think about your illness all the time. Setting yourself free from a preoccupation with illness is sometimes tough.

One method that can help comes from a modified Vipassana meditation technique: Uncap that pen, and list the recurring thoughts you have about your illness. Whether they’re thoughts of feeling sorry for yourself, thoughts that you’re no longer attractive, thoughts of being afraid about the future; whatever they are, write them down.

The next step is simple: every time you have one of those thoughts, just count it by making a tick mark next to it on your list. You get to decide for how long to keep counting the thoughts. I suggest 24 hours.

This technique does two valuable things. First, it lessens the negative effects of the thoughts because it helps you step back from the emotion associated with them. Second, it allows you to let go of those negative emotions. Over time what usually happens from this simple act of counting those thoughts is that they and their corresponding emotions come up much less frequently, and you find yourself feeling freer. SO START COUNTING!

8. Isolate yourself. This is an especially good misery maximizer for several reasons. Isolating yourself makes it much easier to forget that no matter how serious your disease is, no matter how bad your symptoms are, there are always people who have it much worse. While knowing that won’t make your illness better, it will help put it in perspective. 9. Don't imagine a future beyond your illness. In order to have meaning, life has to be about more than just our immediate concerns. This may seem obvious when we feel well and happy and able to look forward to something, but when we are ill, life narrows, and our vision grows weak and myopic. Just when we need the future most, we tend to abandon it – and all the hope and excitement that can go with it.

Here is a final exercise to stop the tendency we have to narrow hopes and dreams: Write down ten (or more) things that you can look forward to doing in the future. They can be little things like a phone call to relatives, a planned outing, or that warm bath you’ve been wanting all day. They can also be bigger things such as activities that contribute to people and causes that are important to you–maybe cleaning up the environment, teaching reading to illiterate adults, or even taking part in finding a cure for your own illness. After you’ve made the list, read it. Think about those things that you are looking forward to and remind yourself that you could make a list of those big or little things every day. And maybe that’s the thing to do for a week or so until you get the knack of looking forward. After all, futures are made; they don’t just happen.

While you’ve still got that list, you may want to think about writing down activities that contribute to people and causes that are important to you. You may feel strongly about cleaning up the environment, teaching reading to illiterate adults, or even taking part in finding a cure for your own illness. People who are able to do these kinds of things are making not just their own futures, but their communities’ as well.

You’ve now learned several exercises that can improve the quality of your life. These exercises are only one of the ways that you can overcome some of the debilitating effects of chronic illness, and stop cold that misery maximizing. And that’s the secret, isn’t it: To rob the illness of its power to shape your life. Only you should have that power, and you can.

The internet can be a great help in preventing isolation and getting emotional support.

For example, the tom@chronicillnesscoach.com Chronic Illness or at 408-398-9422 or visit his website at Chronic Illness Website

Chronic Illness Coach

Overcoming Fear and Anxiety With Prayer and Spirituality

Fear is a reality of life. It is true for believers and anyone else. However, those who are grounded in faith and spirituality, find that they have God to lean back on when the going gets tough.

We don't have to let fear defeat us. We can triumph over it and feel safe.

For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind. (2 Timothy 1:7)

Building a Sense of Confidence

The faith can help us overcome fear. We can't expect God to protect us from every evil of the world during this life. But we can have utter confidence that we are, indeed, loved by God, and that, ultimately, we will be redeemed.

We can take solace in knowing that we are loved by God. That knowledge should provide us with reassurance.

Many theologians believe that fear is a form of suffering. The key is to accept it for what it is and not to indulge it. Think less of what may come to us and our loved ones and more of who God is and what God wants. Then we turn ourselves over to the love and the care of God.

God has promised us eternal peace. Do not be afraid.

“Peace I leave with you, my peace I give unto you: not as the world giveth, give I unto you. Let not your heart be troubled, neither let it be afraid” (John 14:27). The way to find and keep peace is outlined for us by the Prophet Isaiah: “Thou wilt keep him in perfect peace, whose mind is stayed on thee: because he trusteth in thee” (Isa. 26:3). We find God's will (and His peace) by staying grounded in our spirituality, where we find His will for our lives.

One of the most peaceful thoughts in the entire world was written by the Apostle Paul: “And we know that all things work together for good to them that love God, to them who are the called according to his purpose” (Rom. 8:28). If we truly believe this promise and appropriate it for our daily living, we will know complete and abiding peace. The divine promise remains true: “The Lord will bless his people with peace” (Ps. 29:11).

Countless multitudes have ridden themselves of their fear knowing the power in God's presence.

Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me. (Psalm 23:4)

Henry Ward Beecher says the Twenty-third Psalm is the nightingale of the Psalms. The nightingale sings its sweetest when the night is darkest. And for most of us death is the most terrifying fact of life. Death makes us afraid. We feel so helpless and alone.

Of course, “the valley of the shadow of death” refers to more than the actual experiences of physical death. It has been translated, “the glen of gloom.” It might refer to every hard and terrifying experience of life.

The Basque Sheepherder describes an actual Valley of the Shadow of Death in Palestine. It leads from Jerusalem to the Dead Sea and is a very narrow and dangerous pathway through the mountain range. The path is rough, and there is danger that a sheep may fall at any moment to its death.

It is a forbidding journey that one dreads to take. But the sheep is not afraid. Why? Because the shepherd is with it.

And so come those dark places in life through which we are compelled to pass. Death is one. Disappointment is another. Loneliness is another. Phobias, compulsions, obsessions, and reliving traumatic experiences fill us with fear.

If you feel you are in “the valley of the shadow,” get off to a quiet place. Quit struggling for a little while. Forget the many details. Stop your mind for a little while from hurrying on to the morrow and to next year and beyond.

Just stop, become still and quiet, and in the midst of your “glen of gloom” you will feel a strange and marvelous presence more powerfully than you have ever felt it before. Many have felt that presence-they have heard the nightingale sing in the darkness.

Wherever my pathway leads, I will not be afraid, “for thou art with me.” There is power in His presence. Countless multitudes have ridden themselves of their fear knowing that eternal truth.

Excerpted from: God's Psychiatry by Charles L. Allen

Countless multitudes have ridden themselves of their fear knowing the power in God's presence

Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me. (Psalm 23:4)

Henry Ward Beecher says the Twenty-third Psalm is the nightingale of the Psalms. The nightingale sings its sweetest when the night is darkest. And for most of us death is the most terrifying fact of life. Death makes us afraid. We feel so helpless and alone.

Of course, “the valley of the shadow of death” refers to more than the actual experiences of physical death. It has been translated, “the glen of gloom.” It might refer to every hard and terrifying experience of life.

The Basque Sheepherder describes an actual Valley of the Shadow of Death in Palestine. It leads from Jerusalem to the Dead Sea and is a very narrow and dangerous pathway through the mountain range. The path is rough, and there is danger that a sheep may fall at any moment to its death.

It is a forbidding journey that one dreads to take. But the sheep is not afraid. Why? Because the shepherd is with it.

And so come those dark places in life through which we are compelled to pass. Death is one. Disappointment is another. Loneliness is another. Phobias, compulsions, obsessions, and reliving traumatic experiences fill us with fear. If you feel you are in “the valley of the shadow,” get off to a quiet place. Quit struggling for a little while. Forget the many details. Stop your mind for a little while from hurrying on to the morrow and to next year and beyond.

Just stop, become still and quiet, and in the midst of your “glen of gloom” you will feel a strange and marvelous presence more powerfully than you have ever felt it before. Many have felt that presence-they have heard the nightingale sing in the darkness.

Wherever my pathway leads, I will not be afraid, “for thou art with me.” There is power in His presence. Countless multitudes have ridden themselves of their fear knowing that eternal truth.

Action Steps

Kenneth W. Caine and Brian P. Kaufmann in their book 'Prayer, Faith and Healing' suggested several actions you can take to face and manage fear. Use reasonable precautions.

If you are fearful of crime, take practical steps to improve security at home and when we travel. This helps prevent crime. It also makes us feel better. Even small steps, such as leaving the light on at night, help soothe fears considerably following traumatic experiences.

Seek help.

Fears can develop into debilitating phobias if left unchecked. Seek professional help if you are having a hard time handling your fears. When fear becomes immobilizing or interferes with your normal functions, it's time to seek counseling.

Face fear head on.

A fear faced is often a fear defeated.

An old saying goes, “Boats are safe anchored in the harbor, but that's not what boats are made for.”

A person was frightened of speaking in front of groups. Her boss asked her to make a presentation at a staff meeting. When she stood up, she realized that she was nervous, and said so. Her throat was dry, and she took a drink of water. Then she began. Acknowledging her fears and focusing momentarily on something else-getting a drink of water-helped her through the moment. The next time she spoke, she wasn't quite so nervous.

The young woman had prayed to Jesus before the meeting, asking directly for His help in dealing with her fear.

Accentuate the positive.

The Apostle Paul in his letters in the bible wrote frequently of the need to focus on the good things in life, not the bad. “Whatever is true,” he wrote to the Philippians, “whatever is honorable, whatever is commendable, if there is anything worthy of praise, think about these things.”

To turn your mind away from your fear, make a list of pleasant thoughts and memories and add to it regularly. When you are tempted to start dwelling on something negative, you will have something that's good and true to put in your minds to replace it with.

Turn off sources of bad news.

The evening news is often full of stories about crime, horror, and terrorism. Following the terrorist attacks on the World Trade Centers, the US television showed the image of the planes attacking the world trade center repeatedly followed by the image of the towers collapsing. Exposure to this type of news and images are unsettling to many. Studies of television viewers show that people who spent lot of time watching television perceive a more violent world.

When you are overwhelmed by what you are seeing on the TV, turn off the TV. If you don't want to turn it off, close your eyes, or think of pleasant things.

Keep your spirituality strong.

Pay attention to your spiritual life. It will help you tide over the difficult times. Keep up regularly on prayer, worship, fellowship, and service.

A lot of our insecurities come from an unspoken awareness that we've veered off the path from God or from our inner fear that we're not living as we're called to live. Being strong spiritually, means that we feel that we are walking where we are meant to walk, and that we are being watched and protected by God. There's enormous security in that feeling.

Participate in community activities.

Spirituality allows us to being part of communities such as church. Communities can provide their members opportunities for mutual cooperation and support. Community is an important element of our spiritual security blanket. We can do much to allay our fears if we wrap ourselves tightly in a network of believers by attending services regularly, participating in church social activities, and doing volunteer service. Studies conducted in Duke University in the US has shown that church activities provided health benefits.

http://www.holisticonline.com/Remedies/Anxiety/prayer_overcoming-fear.htm

"Self-Rejection: Its Characteristics, Causes & Cures"

Charles Stanley January, 1990 Radio Message

- “Self-rejection is a form of bondage that causes you to project these feelings on others that they didn't feel them at all.” (Self-rejection, and all the so-called feelings associated with it, would be better defined (Biblically) as one's sinful response to ones circumstances and/or sin against him.)

- Uses Col. 1:21,22 as proof-text for this message and the thesis that people who suffer from feelings of self-rejection, “suffer from a very painful form of bondage.”

- “People in self-rejection syndrome have chronic feelings of unworthiness.”

- “Rejection is a form of control, manipulation, and domination; when someone needs acceptance and we deprive them of that, we are controlling, manipulating, and dominating them.” (The Bible, of course, knows nothing of this “need for acceptance;” its source in humanistic psychology.)

- Stanley's bottom line is that “people who suffer from self-rejection are willing to base their self-worth on opinion of others rather than on relationship to God.”

- “Dominating thought of person feeling self-rejection is this: 'I must please these people in order to feel good about myself.'”

- Characteristics of people feeling self-rejection: - Overemphasis on dress (a self-image problem) - Difficult time trusting God - Difficult time loving others/being loved by others (psychic determinism/childhood hurts) - Critical spirit - Feelings of inferiority/inadequacy - Anger - Perfectionism (“I must be perfect to feel good about myself; arrogance and pride feelings are really cover-ups for insecurity.”) - Easily hurt - Suspicious of others actions - Self-isolation (that way, the only one that rejects them is themselves) - Depression (because you failed your expectations) - Self-verification (of their worthiness/self-worth) - Sensual fantasies (not a matter of sexual morality, it's a matter of acceptance) - Domineering the circumstances

The above list should actually be labeled “sinful responses of people claiming self-rejection.” The above items in the list have no Biblical basis. Their roots are instead Rogerian/behavioristic psychology and Freudian psychic determinism.

- “So what if someone else rejects you, your self-worth is not based on that individual's opinion, but on God's.”

- Causes of self-rejection: (This scenario completely ignores an individual's responsibility for sinful responses to ones circumstances and/or to sinful actions against them.) - Early in life deformity - Deep emotional hurt from past childhood [psychic determinism] - Death of a parent (“Daddy died because he didn't love me” feelings.) - Abandonment (“You create awesome feelings of rejection that will go with that family the rest of their life, and you will be the ultimate reason for it.”) - Divorce - Child abuse - Guilt feelings from past sins/mistakes - Criticism from other people - According to Stanley, three feelings needed for one to be emotionally healthy: (a) Feelings of belonging (b) Feelings of worthiness © Feelings of competence - Self-worth should be based upon what God says, which according to Stanley is, “I have a sense of worth – Jesus died for me; I have a sense of competence – the Holy Spirit is working in me” (complete failure to recognize that Christ died for us, not because of our great worth, but because of our great sin!).

- Stanley's three steps to overcoming self-rejection:

(a) Identify the feelings of rejection (b) Reject the feelings of rejection (based on God having said, “I'm worthy ”) © Affirm the following: (sounds a little like positive confession) (1) “Father, I thank you that I am unconditionally loved” (2) “I am completely forgiven” (3) “I am totally accepted” (4) “I am complete in Christ” Biblical Discernment Ministries http://www.rapidnet.com/~jbeard/bdm/exposes/stanley/jan90.htm

Lymphedema and Coping External Links

How You Can Cope

Step Up Speak Out

Emotional Effects

Breast Cancer.org

Links for Further Information

Coping with Long Term Physical Illness and Pain

Brandeis

Coping with Illness and Disability

We have put together a collection of links to bring you hope and help. Knowing that we are not alone in our suffering and have someone to share it with, can make a very big difference

Soon.org

Coping with Chronic Illness

AlpineGuild

How to Feel Better About Our Bodies

Owning Pink

Who Me? Self-Esteem For People With Disabilities University of Wisconsin Counseling Services

UWEC

Body Beautiful/Body Perfect - Challenging the Status Quo

Where Do Women With Disabilities Fit In?

wifacets

Five Stages of Accepting an Illness

FirboFighter]]

Chronic illness - questions and answers

Irish Health

Disability, Body Image and Self-Esteem Some further links

Sex Support

The Path to Unconditional Self-Acceptance

“How do you fully accept yourself when you don't know how?”

Psychology Today

Lymphedema People Online Support Groups

Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe: AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor Lymphedema People / Advocates for Lymphedema

Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515 Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema… there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

Teens with Lymphedema

http://health.groups.yahoo.com/group/Teens_with_Lymphedema/

All About Lymphoedema - Australia

http://au.groups.yahoo.com/group/All_About_Lymphoedema/

Lymphedema People Forums

In our forums section, you will find over 3,000 posts with hundreds of additional articles encompassing every aspect of lymphedema you can imagine. Information, questions and answers that will enable you to discover not only how to live with lymphedema, but to manage it, overcome it and lead a life that is rich, meaningful and rewarding.

Visitors can read the forums, but only members can post and answer questions. Come and be a part of the largest lymphedema online network in the world.

Here is a list of the forums:

Welcome Family

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=1

Membership Rules in New Forums

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=28

Lymphedema People Administrative, Management

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=2

Registry of Lymphedema Doctors

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=25

Lighthouse Lymphedema Network Lymphedema Education & Awareness Program

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=33

Events Calender

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=32

Personal Stories

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=3

Family Talk

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=26

Daily Lives with Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=27

Lymphedema Information

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=4

Children and Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=24

Young People with Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=31

Leg Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=29

Related Medical Conditions (often associated with lymphedema)

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=5

Complications of Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=6

Lymphedema Infections

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=7

Treatment Information for Lymphedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=8

Therapists, Clinics and Hospitals

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=9

Skin care, conditions and complications

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=10

Lymphedema Wounds

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=30

Lymphedema Lifestyles

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=11

Lymphedema and Cancer

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=13

Lymphedema Articles

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=12

Advocacy and Governmental Resources

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=14

Genetics, Research, Lymphangiogenesis, Angiogenesis

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=16

Organizations, Support Groups, Vendors

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=15

Lipedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=18

Lymphangiectasia

http://www.lymphedemapeople.com//phpBB3/viewforum.php?f=19

Lymphatic Filariasis

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=20

Lymphoedema

http://www.lymphedemapeople.com/phpBB3/viewforum.php?f=23

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Updated Jan. 21, 2012

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