Auto-Immunity: stop hitting thyself?

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An auto-immune disease is, as far as I can tell, the disease equivalent of accidentally biting off a chunk of your own tongue.

My particular auto-immune disease causes inflammation in various key joints, resulting in mild-to-excruciating levels of pain that erupt seemingly at random throughout the course of the year.

Each doctor I’ve spoken to has been more or less firm about the association between stress or negative affect and flare-ups of the disease; firmly against any such association, I mean. There is no evidence to suggest that the progression of diseases like mine is in any way linked to psychological factors, though there is good evidence that the experience of pain can be moderated by psychological factors.

Needless to say, I’m not content with this and rest somewhat assuredly on the dictum “absence of evidence is not evidence of absence”, taking some confidence in what I know to be the limitations of evidential standards and processes, such that if I find a personal or subjective association, I’m not going to dismiss it on the basis of insufficient peer-reviewed studies.

At the same time, it’s somewhat dismaying to see people dismiss actual studies from a position of willful ignorance and wishful thinking. I’ve seen plenty of people embrace conspiracy theories or other combative attitudes towards established medical and scientific practices and institutions. It’s not a pretty sight. Ideally we should know and understand the things we criticise, and be aware of the limitations of our own knowledge, n’est-ce pa?

As such, I’m not going to tell people that their auto-immune condition is the result of stress and negative affect. What I can tell them is that I’ve noticed in myself that my bouts of inflammation seem to correspond with periods of self-imposed stress or pressure.

It seems I am of a temperament which is inclined to say to itself: “Now you know what you ought to be doing, so do it; do it without ceasing. Do nothing else. Nothing matters but that you do this, and do it diligently forever and ever, Amen.”

For example, I had a flare-up some time after deciding that I ought to pursue my writing more seriously. ‘More seriously’ as in, unceasingly and compulsively without any concept of an end point. On the positive side, that helped me produce an unprecedented number of articles – if I remember correctly: 12 published articles in a one month period.

But as my productivity began to decrease, the conviction that “I must write” slowly devolved from a genuine motivation into a mere sense of grinding necessity. Grinding is perhaps the operative word, as my joints inflamed and it became painful to move.

I’ve noticed since that the pain seems to coincide with these bouts of grueling yet unproductive urgency, the sense that I must get something done without excursion or delay.

Yesterday I noticed a growing sense of urgency relating to ‘getting things done’ with respect to domestic production. I’ve been meaning to make some cheese, but have struggled to find a good local source of necessary ingredients. The delay and the awful heat (42 degrees C yesterday) left me feeling unproductive, and this morning I woke up with the telltale stiffness and pain in my lower back.

As tentative as I am to try to dictate the cause of my illness to others, I’m equally cautious in extolling a particular treatment. I’m not trying to sell anything.

However, I have found it personally beneficial to treat the pain as a symptom of the underlying urgency, and therefore to treat the urgency directly. I do this by making a conscious effort to defuse this compulsive state of mind. I reflect on the fact that it doesn’t actually matter if I make a cheese today/write an article tomorrow, or if I do these things next month, or in all honesty if I never do them ever again.

By ‘reflect’ I mean it’s not enough to simply tell myself that it doesn’t matter. I have to really feel that it doesn’t matter, because feeling it means I can let go of the stress, tension, and urgency. Feeling that it doesn’t matter reveals how truly tense and stressed I have become – winding myself up into a state of impossible and unnecessary tension. I can feel the tension now through my whole body, yet I was oblivious to it until I started to focus on ‘letting go’.

Does ‘letting go’ fix the problem? Objective analysis would be nearly impossible. The factors at play are highly subjective, and would be very difficult to study or isolate under experimental conditions. But like Pascal’s wager, if I’m wrong about the connexion I’ve nonetheless benefited from becoming aware of my stress and tension and reducing them to more salubrious levels.

Feeling more relaxed, happier, and healthier is a pretty benign form of treatment. There’s not really anything to lose.

Does the pain go away? As strange as it might sound: I hadn’t really noticed. In hindsight, it must go away because I notice its subsequent return. But I’m usually so caught up in the great sense of relief and relaxation, the sheer pleasure of ‘letting go’ all the stress, strain, and slowly mounting pressures of life, that the pain, the stiffness and the sense of disease seem to just dissolve away.

Stress and the melancholic temperament

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Last week I was talking to a friend and fellow melancholic, stressed out in the middle of her Med exams, overwhelmed and fearing the worst.  Why do melancholics get so stressed and what can we do to alleviate stress?

Melancholics are always fearing the worst.  We’re haunted by thoughts of what could go wrong, as if by anticipating it we can avoid it.  But in practice we just end up plagued by worries, anxieties and an overriding pessimism.

It’s a lot like watching my toddler son in a new environment. I take it for granted that I have to watch him constantly. I literally cannot take my eyes off him for a moment. At the same time I’m hyper-vigilant for anything within reach that he might damage or that might damage him.

My wife is the opposite.  She finds herself easily distracted, and is often taken by surprise when our son reaches some precarious object or takes a tumble over an obstacle.

It’s not that she’s any less caring, in fact she’s much more caring than I am, but she doesn’t have the same lifelong practice of expecting things to go horribly wrong.

I’ve found I can’t really help it, but my mind is almost always preoccupied with thoughts of how things could go wrong, have gone wrong, or will go wrong. It’s partly a side-effect of trying to understand how things work: if you know how something works you’re immediately much more conscious of how it might cease to work.

But it’s also because melancholics are a little slower at forming impressions and reaching conclusions compared to some of the other temperaments. In practice it might mean that a conversation with a choleric, a sanguine or phlegmatic unfolds with the melancholic experiencing a definite but incomplete sense of something wrong with the other person’s logic or intentions.  It might take days or weeks for the melancholic to unravel the errors and clearly define the problems in the other person’s proposal.

This increasingly wary attitude to human interaction seeps into everyday life. Whether I’m driving, working, going to the shops, not going to the shops, talking to people, cooking, exercising, reading, or just sitting still – I can’t help but be acutely aware of the possibility of error, an awareness of all the possible threats, dangers or pitfalls in what I am doing, not doing, or planning to do.  The resulting hyper-vigilance is a little like having PTSD but without the flashbacks.

I’ve found it is possible to ‘switch off’ this wariness, but it requires a concerted effort. Doing nothing is hard work.

In times of acute stress it’s not the fear per se that makes life unbearable, it’s the effort to avoid the feared outcome within a condition of uncertainty.  What stresses us is the effort to, for example, avoid failing an exam when the precise requirements for avoiding such an outcome are unclear.  ‘Study hard’ is the obvious answer, but how hard is hard enough?  For a melancholic these situations become a terrible trap because we tend to err on the side of excess, downplaying the costs of stress, and demanding of ourselves an impossible effort as though feeling stressed and exhausted is itself the only valid evidence that we have worked ‘hard enough’.

Unfortunately this extreme and idealistic approach actually blinds us to more creative, considered, and efficient methods.  It doesn’t allow us the space to reflect on how best to prepare, and is especially difficult for young melancholics who are as yet unaware that their most efficient methods of studying might differ markedly from the mainstream approach.  It takes a great deal of experience before we learn to rely on our own idiosyncratic ways of learning.

The best way to make space for reflection is to embrace the underlying fear of failure: to identify the worst, most humiliating outcome, and embrace it as a possible reality.  If you fail your exams you will indeed be humiliated and set back a year, but as undesirable as such an outcome would be, it would at least bring certainty and with certainty an end to the stress.

Taking time to really face such fears soon shows that they are not as dire as they seem.  Remember: it’s not so much the feared outcome that causes stress, it’s the self-imposed effort to avoid the outcome without really knowing whether one’s efforts are efficacious.

Another way to diminish the uncertainty is to build a sense of context, or a set of parameters which might give at least an approximate sense of certainty.  For example, you may not know if you’ve studied hard enough to avoid failure because you expect that studying ‘enough’ should bring with it some magical sense of competence and sufficiency.  But you can start to build a context by asking yourself whether you have consciously chosen or allowed yourself to not study as much as you usually would, ie. are you slacking off according to your own usual standards?

Alternatively, you can imagine what it would be like if you were trying to fail.  How different would that be from your current level of work?  It’s often reassuring to realise that you would find it hard to do nothing; you would struggle to really give up and let yourself fail.

There’s a measure of self-honesty required here, but I think for melancholics self-honesty is not a problem, rather the problem is knowing what questions to ask ourselves, or the broader context we need in order to put our problems in perspective.

The ultimate perspective for a melancholic is the idea that we are all going to die one day, and that nearly every stress we face in life pales in comparison to our final destination.  As morbid as it might seem to other temperaments, the thought of death can help a melancholic regain a healthy perspective on otherwise stressful situations.  The fear of failing an exam is ultimately misguided once we realise that no exam result, medical or other career, nor most of the things that cause us daily anxiety and stress will matter at all when we are gone.

As Marcus Aurelius wrote:

Soon you will have forgotten the world, and soon the world will have forgotten you.

And:

Consider thyself to be dead, and to have completed thy life up to the present time; and live according to nature the remainder which is allowed thee.

As idealists and perfectionists, life for a melancholic is never straightforward or easy.  We need these creative and eccentric approaches to help us navigate a complex world replete with sources of anxiety and stress, a world increasingly dominated by the worst tendencies of other temperaments.

 

 

Finding a balance

This morning I managed to give myself a migraine.

At first I thought my eyes were just a little blurry from sleep. I was reading the news online, but there was something wrong with the text.  Soon a ‘crack’ appeared to my left, hovering in space and moving gradually forward, like a kaleidoscopic worm made of bees.  The proper name for this is an ‘aura‘, which gives entirely the wrong impression.  It should be called ‘a visual representation of the pain you are about to experience’, or ‘doom vision’; something like that.

Fortunately I knew exactly what it was, and why I was experiencing it.  The past month or so I’ve been struggling with the self-imposed pressures of being a freelance writer.  I made myself sick within a couple of weeks through the simple thought that every moment I wasn’t writing was a moment wasted.

Eventually I realised what was going on and recalibrated my sense of urgency.  I don’t after all, have to write an article every 1.5 days. To do so is neither feasible nor desirable.  Even 1 per week would be a vast improvement on my previous output, and a sustainable increase in my freelance career.

But last week the situation changed again, as my wife was offered a day per week of work at her old job.  I ended up looking after our son for the day and a half that she was busy, thus cementing my role as part-time stay-at-home dad.

It turns out that looking after an eighteen month old is one of the most exhausting things I have ever experienced in my life.  Without sounding like it ought to, being alone in the house with my son for so long left me mentally exhausted.  I don’t know how my wife managed to do it while I was working, though I now understand why I typically had to pick her up off the floor by the end of each day.

So with my wife out of the house for one or so days this week, I added another ingredient to the strange part-time stew I’m cooking.  I’m now trying to balance being a part-time freelance writer, a part-time PhD student, and a part-time stay-at-home dad.  Thus far they add up to more than a full-time load hence my lack of activity on the writing and the PhD front this past week, hence my all-consuming sense of urgency to nonetheless get ‘something’ done, hence my fruitless staring at the computer screen first-thing this morning, and hence, I believe, the premonition of cranial catastrophe that followed.

Fortunately, knowing the cause meant I could immediately drink some water, go lie down, and tell myself reassuring things like that it doesn’t actually matter whether or not I have an article published this week, that looking after our son is a far greater challenge and will take some getting used to, and that these are still early days, and we have much to learn toward building a life that is as good as we would like it to be.