This article covers the crossover between chronic illness (and/or trauma) that is not adequately explored or talked about. It’s such an important topic because a lack of awareness and understanding can lead to further isolation and stigmatisation of those with chronic health issues.
This is information that my clients most commonly remark upon being an important aspect to gaining a sense of control and empowerment as lifts an internalised burden.
What do you even think about the world anyway?
Decades of cognitive and developmental psychology has shown us that as we progress through developmental stages, we are constantly trying to make sense of our experience. Broadly speaking, we are trying to understand ourselves, who we are and what our impact is, others and how they will treat us and respond to us and the world; how safe or dangerous it is and what we may expect to happen.
Our brain is not fully developed until we are in our mid-twenties and in our childhood and adolescence we therefore rely more heavily on our “emotional brain” with less access to areas of our frontal cortex that helps us inhibit impulses but also helps us to direct our attention and weigh up a multitude of competing information.
Consequently, we tend to make “template beliefs” that are quite categorical. These start off broad and may become slightly more refined. However, they remain quite generalised and non-nuanced and are often held subconsciously. For example “the world is a safe place”, “people are generally kind”, “I am an ok person”. A lot of these are assumptions we might hold but we don’t have conscious consideration of them a lot of the time (if at all). Certainly, these are not the sort of beliefs that come into consciousness often to the degree that we are likely to be verbalising them and reflecting on them (unless in therapy or specific situations prompt this).
For lots of people who haven’t suffered high levels of adversity, trauma or ill-health, such beliefs can generally be quite benign and positive even. A common such assumption for people who haven’t grown up with health issues, is “when I am ill, I can get help to make me better”.
An unhappy discovery
When someone gets ill or experiences a severe trauma (like sexual assault or natural disaster) it is intuitive to identify that primary experience as the subject of horror and extreme distress. Having terrible pain or having had your life threatened is a truly awful experience. These are experiences that can swiftly flip beliefs from “I am safe” to “I am in danger” or “the world is safe” to “the world is dangerous”.
This is difficult enough to deal with. In fact, this takes a lot of processing. In trauma-focussed therapy, this is the focal point. To try and recalibrate a brain that has swiftly flipped from one end of the spectrum to another, so that we can get more of an even (and realistic) ground.
However, one of the most difficult sticking points I find people struggle with is the flipping of a very specific belief. It is the sense of being able to access help disintegrating to a sense of “there is no help” or “I can’t be helped” that is so destabilising and horrifying for so many people.
And it makes sense. It erodes a fundamental foundation of safety. Without it, it can feel impossible to ever feel safe and able to relax again.
Situations like this belief-flip
Hostile healthcare staff.
These are but a few examples of how people come to learn that when they are vulnerable, they can’t take for granted that they will be helped. Particularly problematic is the fact that a lot of these experiences are not flashes in the pan. They are ongoing experiences that keep communicating the same message “you are not going to be helped”.
Once a threat belief system is activated
Once a threat belief system is activated, the brain quickly looks to generalise out. Not because it wants to make you feel bad, but because it wants to be vigilant to potential threatening consequences or outcomes. This catalyses a sense of hypervigilance but also isolation. Two key ingredients that really muster up a chaotic cocktail of nervous system dysregulation.
Once you have seen you can’t unsee.
I had a client once who had a lovely start to life. Was able to follow their (pretty precarious) dreams, get some success and financial reward for it, find love, experience a lot of freedom. Then one day they had a pretty huge health event that was life threatening. It was completely out of the blue and were it not for them being promptly rushed to the hospital in the nick of time, they would have died. In therapy we came to explore how life had felt much lighter and simpler before all this. And yet, in their own time, my client came to recognise that perhaps it wasn’t the most helpful and realistic way to have lived or viewed things. They felt a sense of meaning in choosing how they know viewed things and intentionally working out how that informed what they did and what they prioritised.
For this client, that actually lead to leaving an unhealth relationship and intentionally seeking to improve existing relationships. It also enhanced a sense of savouring the moments of enjoyment in their profession, which were really beautiful to explore together.
This was post-traumatic growth. This was my client seeking to renegotiate the fundamental foundations in their life. To do this, they had to work to be ok with more uncertainty. And that was hard. They also had to work to recalibrate a threat-focussed brain autogenerating fearful predictions. Finding safety was no longer a given, it was something that had to be sought, but they did it and they found meaning in doing so.
Overwhelming evidence to the contrary
What if there is too much evidence to the contrary? How can you hope to find a middle ground again?
It can be hard. I won’t pretend it is a simple journey and yet it is always possible for everyone. And I say that with confidence because of this. Nothing stays the same. For some people that can feel really scary. And for others it feels an urgent, necessary reality because the now feels so hard. Whatever side of the coin, we know that it is a truth. And with that, no matter your experiences to date, there is always room for more experiences that can provide safety, joy and nourishment. It can feel like we will never get them and then they come along. And it just takes that one little glimmer, for the beam of light to shine brighter and brighter.
The reason I am an optimist
My old supervisor and I used to grin at one another over a case review, when I would reel off the list of difficulties the client was facing and she asked me whether it was a suitable referral for the primary care service, given all the complexity. We measured outcomes of therapy in this service and there were targets for clinicians to get their clients “recovered”. We were grinning because I near-always felt that glint of hope that things could really change in just 12 sessions, no matter the complexities. And if I could push it, I would extend the sessions out, pointing to any marker of progress to justify the extension of treatment.
And you know what? So many times, I was proved right. Of course, not always. And not always was the proof in the questionnaire scores. But it was in what the clients were saying to me. What they were now able to do. How they were now able to view things and respond.
Sometimes the people with the most challenging of circumstances would just dazzle me in what they did during therapy. How their relationships with themselves changed. Clients who were entirely isolated, clients who were put into care, clients who had lost their homes, fled warzones, lost jobs, become immobile. Because one thing is for sure, adversity (health, social or otherwise) and level of adversity didn’t determine whether someone could find emerge stronger, happier, healthier. That could be had by all. Sometimes it just took time, the right time and the right support.
Before you finish reading, you might like to consider these questions
In your lifetime have you experienced a significant to flip your beliefs or assumptions?
How did this change them?
How did you deal with this?
If you’re still dealing, what could help to recalibrate the belief flipping?
What has helped in the past?