Stoicism, Anxiety and Chronic Illness

“Very little is needed to make a happy life; it is all within yourself, in your way of thinking.” Marcus Aurelius

I’ve hated holidays, weekends and especially my birthday ever since I was diagnosed with Ulcerative Colitis at the age of 11. There were emotional, social and physical factors that caused me to dread of these cultural happy events. I still feel anxious when my family mentions going on holiday or when my brothers are planning a fishing or hunting trip. The anxiety wells up because I want to participate but I know that pain, fatigue, fear of new environments, and changes of schedule will 9 times out of 10 back out of going or if I do go I’ll not enjoy myself. That’s because the problem with being chronically ill and in constant pain is that my body and mind are the cause of my miserable state. And I’ve been miserable most of my life and especially during these so called happy times.

I used to think that my reaction to life, my anxiety and fear surrounding holidays, weekends and my birthday was a character defect. I thought that I was mentally weak because I couldn’t consistently overcome my negative thought patterns to build a life I was proud of. During these “happy times” I was always reminded about how much was missing in my life because of my chronic pain and chronically feeling like shit. I don’t have a mate, I don’t have my own place, I don’t have a social life…The don’t have list was constantly on my mind during these events or prevented me from participating all together.

The mental anxiety was warranted because I would get physically ill because of changes in my eating, drinking and resting patterns.  This coupled with the host of negative emotions of being different, worrying about passing gas through my stoma (uncontrollably) and the prospect of experiencing the humiliation of filing someone’s home with the horrific smell that only an ileostomy can produce produced near panic levels of anxiety. Needless to say I’ve not been very socially active in the past 30 years.

I’ve only been to one Christmas party in the last ten years. And I was miserable the whole time. The bathroom was in the kitchen where a lot of people were congregated, there was almost nothing I could eat there without being sick, and on top of that I was in horrific pain. The anxiety of having to dump my bag in the bathroom right beside the kitchen was horrible. So I waited as long as I could but I finally had to give in or my bag would start leaking and then I’d have to tell my brother and his family I had to go home. Ruining other people’s good time is another one of my constant fears as well. I still feel sick to my stomach when I remember the anxiety of dumping my bag there. Going to new places and being away from my home bathroom is a huge deal to me. I’ve actually developed a small kit I carry with along with useful strategies that help me feel less anxious and more in control of my ileostomy variables. (I’ll share my tips and what I carry in my small kit in later posts)

Being chronically ill actually changes the way my brain functions. It has been shown recently that the immune system (lymphatic system) is directly connected to the brain. And nuero-plasticity science pioneered by Dr. Michael Merzenich author of  the book “Soft-Wired” writes about how the brain can be rewired throughout our lives. When we focus intently on something this can strengthen connections between certain neurons and weaken connections between others. These connections are associated with learning, actions and emotions.I’ve allowed negative thoughts to become runaway mental trains that soon overtake all other thoughts while I’m sick and these have create tracks or pathways that become easier and easier to fall in to each time I indulge negative thoughts and allow anxiety to overcome me. But I know that I have the power to further rewire my brain to undo the damage and  that’s one of the reasons why I’ve been drawn to Stoicism. Stoicism is an ancient belief that teaches that we are in control of what we determine is good or bad and that having a positive peaceful mental state is the only thing that is needed for a happy life.

http://www.soft-wired.com

https://news.virginia.edu/illimitable/discovery/theyll-have-rewrite-textbooks (article on the physical connection between the immune system and the brain)

The power to rewire the human brain can have be used for positive and negative effect. Unfortunately  when I’m really sick I tend to lose the rational ability to think and focus on concepts like neuro-plasticity and I fall into old thought patterns of what scientists call “sickness behavior”. In fact its been discovered that cytokines, the chemical messengers of the immune system, can have dramatic affects on the brain. The discipline of psychoneuroimmunology studies these effects on the brain. Sickness behavior is what drives animals to be alone when ill, lose their appetite, and display other behaviors like avoidance behavior that we identify with being ill. There are definite chemical changes that happen in the brain when large amounts of cytokines are released into the blood.

http://neuroschoolrome.univ-lille1.fr/faculty/dantzer/bbimmunity07.pdf (in depth look at cytokines and their role in inducing sickness behavior)

As I’ve grown older I’ve discovered ways of overcoming or at least mediating these anxious and negative feelings. Knowledge about my condition and learning how to lesson some of the more unpleasant aspects of having an ileostomy have all been helpful. But I still have trouble with my thought patterns, staying positive, planning for the future, and being active each day consistently working toward specific goals.. Being sick and in pain separates me from “normal life”. I have to force myself to reach out to my family when I’m sick. I have to force myself to try new things and to finish projects I’ve already started. There are certain biological factors that create my “sick brain” and the physiological changes do effect my behavior and thought patterns in powerful ways. Doing everything I can to lower inflammation or lower my over active immune response is key for me to lower the physical threshold I have for living a healthier and happier life, and that includes lowering my stress response to daily life.

https://en.wikipedia.org/wiki/Psychoneuroimmunology (good overview of this discipline that focuses on the connection between the brain and immune system)

Stoicism is an ancient belief system that developed during the Greek and Roman times. It is a philosophy that focuses on creating a peaceful internal mental state.

“You have power over your mind not outside events” Marcus Aurelius

These are some of the lessons of Stoicism I’ve learned and applied in my life:

  1. Emotions are generated from within
  2. The internal mental state is what is truly important
  3. Your thoughts are powerful and you should guard them accordingly
  4. You have the ability to label an experience good or bad
  5. Live in harmony with nature. Humans are not separate from nature.
  6. Don’t worry about the future. Now is the time to live.
  7. Failure is temporary. It is too be learned from.
  8. Adversity should be viewed as a vehicle for demonstrating virtue – patience, self-compassion, and strength.
  9. Gratitude for what we have is vitally important and creates a peaceful mind
  10. Our life is our responsibility
  11. Being a good friend is one of the best things in the world
  12. Expectations and anticipation can cause unnecessary suffering

“Expecting is the greatest impediment to living. In anticipation of tomorrow, it loses today.” Lucius Annaeus Seneca

A lot of times I’ve suffered needlessly because I’ve held on to the expectation that I would live a “normal life”. I missed most of junior high and high school. My biggest relationship I have is with my pain and illness. I’ve had only one serious girlfriend and that was almost twenty years ago. I don’t have kids or have a home of my own. But I can be happy and content in the present without accepting this as fate. Stoicism doesn’t teach apathy. It teaches strength, courage, and tenacity in the face of adversity and focusing on having a peaceful unperturbed mind even though storms rage outside, or rage inside for those of us who are suffering from chronic pain and autoimmune conditions.

“The wish for healing has always been half of health.” Lucius Annaeus Seneca

Health was a huge concern for the Romans as it is for humans in today’s society. Seneca is one of the three pillars of the Stoic tradition and he understood the connection between the mind and body two thousand years ago. Instead of focusing on everything that is wrong with me I try more and more now to focus on the state of health I want to experience. A strong body that is free of pain and all my organs performing their function properly. This idea also foreshadows the idea of visualization which a lot of health practitioners are recommending to their patients.

https://www.psychologytoday.com/blog/flourish/200912/seeing-is-believing-the-power-visualization

Below  is another one of my favorite quotes. All the Stoic writers were very intelligent and viewed the Stoic philosophy as a practical guide to maximizing a human’s experience on Earth while engaged in living. What I especially like about Seneca is that he participated in life. He was not monk or a priest. He acquired wealth and enjoyed the finer things in life but still he struggled with what I struggle with as well. He suffered later in life with chronic pain and even contemplated suicide. He stuck around because of his father.

“Sometimes even to live is an act of courage.” Lucius Annaeus Seneca\

This quote has helped me through some of my worst days. I don’t give myself enough credit. I’ve endured for thirty years pain, fatigue, loneliness, financial struggle, uncertainty, hospital stays, surgery, thousands of needles, countless medications and I’m still here. If you’ve endured or are still enduring with health challenges don’t beat yourself up. Sometimes just getting out of bed and showering are acts of courage. Remember your strength. You can continue to endure and even thrive in the face of adversity. That is a lesson I’ve taken to heart from the Stoics as well.

“There is nothing in the world so much admired as a man who knows how to bear unhappiness with courage.” Seneca

When I read Seneca’s letters which are the main source of the above quotes, its as if he is speaking directly to me. Stoics were interested in helping each other live a happier life through controlling one’s thinking. They could be viewed as some of the first pioneers of the self-help movement and even the hippie new age movement. I used to struggle with the fact I didn’t feel I was a part of nature. I was so flawed that I didn’t even feel “human”. This quote continues to inspire and remind me that I am “natural” no matter how many organs I’m missing or if I have to defecate into a plastic bag.

“Everything is the product of one universal creative effort. There is nothing dead in Nature. Everything is organic and living, and therefore the whole world appears to be a living organism.”  Seneca

I view Stoicism as an anti-inflammatory means of organizing my thoughts. My attitudes and beliefs determine my emotional reaction to external stimuli. I have the power to determine if what I’m experiencing is good or bad. This goes along with what Viktor Frankl wrote during his experience while imprisoned in a concentration camp during WWII.

“When we are no longer able to change a situation, we are challenged to change ourselves.”

Applying the teachings of Stoicism in my life helps me to lessen the impact emotions have over my body and mind, helps me to detach emotionally from the outcomes and to accept pain and loss as part of the price of living as a human being. Stoicism isn’t meant to turn me into a robot that has no feeling or passively accept life as it happens. Rather it helps me to experience emotions in a more productive way and that allows for a happier existence in spite of being chronically ill and in near constant pain. Being “stoic” doesn’t just mean suffering in silence. It teaches the old school values that used to be valued in society, patience, kindness, self responsibility, courage, and  having a positive attitude. But the teachings of Stoicism also do help me to endure pain, loneliness, loss, and overcome the anxiety of living chronically ill. I don’t buy into all that Stoicism has to offer. But I do believe in the taking of what is useful from any source and applying it in my own life. And Stoicism is chock full of ideas that I’ve found helpful.

http://blogs.exeter.ac.uk/stoicismtoday/what-is-stoicism/ (an excellent primer on the teachings of Stoicism)

Two thing are occurring in my brain when I feel awful. There are chemical changes and also physical changes. Reducing overall inflammation is a great way to limit my the sickness behavior response. One of the best ways for me is to reduce my anxiety and I’ve found Stoicism to be an excellent tool to do this. The mind-body connection is a powerful one and its a two way street. I have the power to choose not only what I think but also what I feel according to my attitude. Stoicism for me is a philosophy of optimism and empowerment. To this day I still struggle with anxiety. The thought of another tomorrow filled with the pain fills me with dread. But I know that I have the power to create a more peaceful internal mental world by what I focus on. Stoicism helps me to focus on positive actions I can take in the moment and to accept the things I can not change.

One of the most powerful pieces of Stoic writing for me is Seneca’s piece “On the shortness of life”. This is a youtube audio version of it. https://www.youtube.com/watch?v=EYWEAa-D5vM

Also check out Tim Ferris’ blog. This is an article on how entrepreneurs can apply Stoic lessons in their lives but I believe it also is helpful for people who are chronically ill or dealing with chronic pain as well.

http://fourhourworkweek.com/2009/04/13/stoicism-101-a-practical-guide-for-entrepreneurs/

Stoic in Training

Brad Miller

If you’ve found Stoicism or other philosophies helpful in your own life please share your experience below.

 

Philosophy And Chronic Illness

“Sometimes even to live is an act of Courage.” Seneca

I’ve wanted to give up countless times over the past thirty years. I’ve wanted the pain and loneliness to be over. I wanted to be done with the hospitals, the doctors, wearing a bag, getting stuck, taking pills. Even though I’ve wanted to quit many times it was never for very long. I’ve always gotten back up. I credit this to my family and the ideas from the authors I’ve read during my illness. Over these last thirty years I’ve read up a lot on philosophy, self-help and neuroscience.What I’ve concluded after all this reading is that my personal philosophy affects my health more than anything else I can do or others can do for me.

I hate being sick. I hate hurting. There is no philosophy that I’ve found that explains with any logic or merit why I’m sick or what purpose it serves. I used to believe in god but that ended when I was in my twenties. My personal philosophy doesn’t seek to understand or justify or explain why I’m sick or in horrific pain. What I’ve sought out is a practical system of thinking to help me live my best life today, enjoy life more and help others around me enjoy more of life as well. I see a personal philosophy as series of ideas that inform my choices, help me set priorities, and endure in the face of overwhelming sickness and pain.

When I ran my first marathon I came across the concept of having an Internal Locus of Control which I added as a key tenet of my personal philosophy. I decided to complete a marathon after almost dying from complications from a surgery. The recovery was horrifically painful. But I decided when I was in the hospital I would compete a marathon. My intention was to reestablish the paradigm that my mind controlled my body and not the other way around. I started walking around the hospital, then when I got home I started walking around the pool and then into the neighborhood.

I had purchased the book “Non-Runner’s Marathon Trainer” years before I started the training. So after the surgery I started reading it. Immediately I knew this would be one of the books that changed my life forever. It introduced me to the concept of having an Internal Locus of Control. This means that my actions determine my fate. The opposite is having an External Locus of Control meaning that external events and other people determine the course and outcome of my life. At the time my doctors and family all thought I was nuts to complete the training let alone complete a marathon. I highly recommend the book even if you never plan on completing a marathon.

https://www.amazon.com/Non-Runners-Marathon-Trainer-David-Whitsett/dp/1570281823

Seven months after almost dying I completed my first marathon, it took me five and a half hours but I finished. Those seven months of training were more about training me how to think rather than how to run. Later on in the training schedule I would use the techniques in the book to breeze through an 8 mile run after work. Look back on that now seems impossible. But at the time it was just what I did. One of the techniques I really liked was the concept of typing out on an imaginary computer positive sentences while I was running. I would imagine my fingers hitting each letter on a keyboard then it would display upon on the computer screen in my mind. I would spell out “I am strong”, “I can run all day” and “I enjoy running”. These ideas became true. Now its been almost 9 years since I completed the marathon and I haven’t ran much recently. But I have begun using this technique again to help me get my chronic pancreatitis under control.

Having a personal philosophy is vitally important to everyone but especially for those who have a chronic illness. For those who are suffering it can feel like your body, your doctors, the insurance companies and the government are in control of your life, instead of you. But that is merely a choice of how to think. Once you decide that a key part of your personal philosophy is having an Internal Locus of Control new cognitive and physical doors will begin to open. Your body responds to your thoughts I’ve not personally been able to heal myself through thinking. I know it’s not a quick fix but I do believe my thoughts have an extremely important part in healing and helping me to make choices that will lead to a fuller more fulfilling life.

A key part of my personal philosophy is that I do have an Internal Locus of Control. I have the ability to find a solution to every health issue I have and to create the life I want to live. Even if its not a full solution or so called “cure” and even if it takes years to figure it out. I will never stop improving myself and seeking to feel better. I do have the ability to finding ways to live better each day. It’s not always easy to feel like and I have my doubts somedays especially on those days when I don’t even want to get out of bed. But the underlying idea of having an Internal Locus of Control that helps me to keep getting back up after I get knocked back down, whether it’s by a bowel obstruction or a severe pancreatitis attack. I want to live. I want to experience all that life has to offer. I want to fall in love. I want to feel good. I want to feel pleasure not merely be pain free. And that desire plus the belief that my actions can change my fate are what keep me going.

My next two posts will be on the ways Stoicism and the Paleo lifestyle have shaped my personal philosophy and my relationship to my chronic pain and autoimmune diseases.

Keep taking those small steps – they add up

Brad Miller

 

Please leave a comment if you’ve found philosophy helpful in dealing with chronic illness or chronic pain.