Often a pain patient or chronic illness patient says, “It is impossible to make any type of commitment because I often have to break it, and people find me unreliable”.
Chronically ill or pained patients have to think about commitment in a whole different way than others. It is important in society to make commitments to family, friends and employers, but chronically ill/pain patients have to understand that their first commitment has to be to their health or they will not be able to keep other commitments, even basic ones. They/we are used to “all or nothing” views about commitment and work ethic that can be very useful for healthy people, and very admirable, but are completely impossible and destructive for those with chronic pain. Here are some examples of types of “all or nothing”, “ black and white” thinking that are cognitive distortions, or incorrect beliefs about pain/illness.
If I go to one ball game, I have to go to the whole series. Overcommitment. We have no idea how we’ll feel on a given day, so an over commitment of this sort is not helpful. It is very helpful to sports teams that are practicing together or healthy college students, but not the chronically ill or in pain because it is not doable. It discourages chronically ill/pain patients from doing the activities they enjoy on a more part time, doable basis.
If I go to an event, I have to stay the whole time. Again, overcommitment for a person with limited health resources. Going and leaving at the halftime is absolutely fine, even if we’re not used to it. It may be hard, because of what we have been taught about doing things halfway, etc., but half an event for a chronic illness/pain patient is better than no event. Most friends would want us to enjoy the half event if they knew it was all we could do without getting sicker or more in pain.
If I start a project, I have to finish it the same day. Not helpful or in keeping with the kind of pacing that will actually get projects done for a person with illness or pain. Chunking, or taking a little bit at a time systematically, is more likely to get the job done without damaging health. This work ethic is again admirable for healthy folks, but a tool of destruction and further disability for us chronic pain/illness folks.
I have to work full time. Some people with pain or illness are not capable of working full time and will put themselves down and in danger for longer periods if they don’t schedule more rest into the day. Slow and steady wins the race, they say. We may have to adjust downward the financial means and lifestyle at times to preserve our fitness. Consult a financial planner or community resource for how to manage these situations.
I have to throw all the annual holiday parties. Sometimes a small holiday tea for a manageable period of time will go farther than wearing yourself out. Consider catering from a restaurant you like or more of a dressy pot luck approach to reduce work and still have an enjoyable occasion.
I have to be the Cub Scout Mom, the Choir Leader, and the Soccer Coach Assistant this year. It won’t do any good if this combination puts you down for weeks this spring. Consider doing one of these tasks well, and go for the long range fitness and fulfillment. Hard to do, but better for the kids to have a functional parent in the long run.
These changes will be very difficult for most of us because we are used thinking in certain culturally approved, linear ways. We will find our new attitudes awkward, they will feel wrong. But, unless we change our beliefs to more adaptive ones, we find our selves in more pain, sicker, and more trapped by these things.
I use the phrase “ write it in pencil”, because it is a healthy way to plan events and make commitments. We can’t stop involving ourselves with others, making plans, commitments, involvements, without compromising who we are and our mental health, self esteem, etc. On the other hand, if we write in stone or ink, and our bodies won’t walk with us to the event, we are in great conflict and feel bad about ourselves. This requires more honesty with self and others about the nature of our disability or ailment and how it will affect our participation. Bowing out of everything will depress us, overcommittment makes us stressed and anxious. So write it in pencil!!