Mental Health & Chronic Illness

It’s World Mental Health day. Lots of mental health illnesses are chronic and impact on people’s daily lives. But having a chronic illness in itself can have consequences on mental health, which people, including doctors, aren’t always willing to acknowledge or talk about.

A chronic condition is something which requires management every day. It’s hard work. There’s often too much emphasis on ‘getting on with it’ and ‘keep calm and carry on’ attitudes, which mean people don’t necessarily talk about the things which affect their mental health when diagnosed with a chronic illness. Here are some general ways mental health can be affected when diagnosed with a chronic illness:

  • Dealing with symptoms. The symptoms of a physical illness can wear you down mentally, and some symptoms can be quite scary to experience. If you’re constantly feeling terrible, it’s hardly surprising that mental health suffers.
  • Routines and regimes may need to change. People might have to take medication periodically in the day, eat a different diet, exercise more or less, do physio, stop doing activities they used to be able to do, attend more appointments, avoid certain situations, live by a strict routine, rest more, undergo invasive treatment or treatments with horrible side effects. All of which can have an impact on how people feel about their illness.
  • Physical changes to your body. Patients might put on or lose weight, hair might fall out or grow differently, there might be physical marks or ’embarrassing’ symptoms, mobility might get worse. Some might not look the same as they did before.
  • Situations might need to change. Work and family life might not be the same as before. Patients might feel guilty about what they’re ‘putting their family through’. Finances might suffer. There could be a lot of unknowns in their future.
  • Life could be put on hold. If patients undergo periods of intense treatments, they might feel like they spend all their time in a hospital/medical facility. They might not see the point in making plans because they have no idea what’s going to happen.
  •  ‘Old life’. For some people, they might not be the same person as they were and have to learn how to live with their illness. It’s a grieving process and it can be a lot to process and deal with.
  • Consequences and side effects. Some people’s lives might be shortened, medications to help might have an impact on other parts of the body and cause other problems, fertility could be affected or it could be a genetic illness.
  • Impact on physical health. The way you feel directly feeds into your physical health, which can create a cycle. If unexpressed, feelings surrounding a physical illness can then make the physical illness more difficult to manage.

The psychological impact of ‘mainstream’ illnesses (for want of a better term) is starting to be recognised, in that if you’re diagnosed with something like asthma, diabetes, cancer, heart disease etc there are organisations which can offer counselling and support. It gets a bit more complicated if you are diagnosed with a little-known or rare condition, like Adrenal Insufficiency, and the fact that it’s not a well known condition can bring about additional problems:

  • Isolation. Rare means fewer people who can relate to your condition, which can make you feel isolated.
  • Dealing with a complex illness. Chronic illness is hard. Dealing with complex or multiple illnesses is doubly hard because you never really feel ‘on top of it’.
  • Responsibility. You’re forced into becoming an expert patient, whether you want to or not, so that you can explain the ins and outs to people who are treating you. It can be a lot of pressure to ‘get it right’, and when things go wrong it can feel like it’s your fault.
  • Arguments and explanations. Some doctors are good at deferring to the patient when they come across an illness for the first time, some aren’t. You have to psyche yourself up mentally to argue and fight for what you need with some doctors. It makes asking for help a stressful experience, on top of the fact that you’ve got a serious condition.
  • Mental Health. This is where it gets complicated. Before a rare condition is diagnosed or when you come across doctors who don’t know it, the symptoms and problems can often be put down to a mental health problem and dismissed. Which means that if/when your mental health does actually start to suffer, you’re really reluctant to ask for help for fear of your physical illness being dismissed again.
  • Lack of awareness can mean lack of empathy. You get fed up of having to ‘prove’ your illness to people. Too often, people assume that because they haven’t heard of it, it ‘can’t be that bad’. Which adds to the feeling of isolation.

Adrenal Insufficiency also has an added bonus in how it affects your mental health:

  • Low cortisol (the hormone lacking in adrenal insufficient patients) can cause depression and anxiety, but depression and anxiety can also cause low cortisol. You can find yourself in a bizarre cycle where you have no idea what to treat because you have no idea what started the cycle off.
  • A panic attack could make you seriously ill. Reassurance that ‘nothing bad will come of a panic attack’ is a technique to help anxiety. Except, because of the point above, if you get too anxious, it counts as a ‘stress’ and therefore can bring on an adrenal crisis, which can be life threatening. Which adds to the anxiety!

There are lots of things to deal with when diagnosed with a chronic illness, and physical symptoms are just part of it. Thanks to the internet, patients with chronic illnesses, even rare ones, can find a lot more information and support than ever before. With the way we feel directly impacting on physical health, ‘keep calm and carry on’ mentalities need to take a backseat.

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