spoons + willpower = ?
I mentioned a few months ago about how I was procrastinating by reading a book about procrastination. In a similar realm of the ironic, I’ve been avoiding some of my own academic research by reading a book on… wait for it… academic research on willpower. Despite this so-called procrastination, I am coming to the conclusion that I have a great deal of willpower, and that my problem is not so much the will to begin (or complete) tasks, but rather the basic reserves of energy necessary to power that “will” into action. Will requires spoons. Which tells me that I need to work on being more realistic about how much I can actually accomplish in a given day or week or month, since the spoons come and go. That and I need to continue to hone my prioritizing skills. None of this sounds particularly thrilling, but I have to admit I feel a small sense of accomplishment at how smoothly my little world manages to run, despite my sense that life keeps throwing obstacles in my way. (I sometimes imagine an autoimmune troll gleefully throwing nails onto the road in front of my car.)
The book I’ve been reading is Willpower: Rediscovering the Greatest Human Strength. My interest was originally piqued when I read this interview between The Happiness Project‘s Gretchen Rubin and Willpower co-author John Tierney. I’m only about halfway through the book, but I’m fascinated by the contemporary anecdotes, historical figures, and psychological research that fill the chapters. One of the phenomena that Tierney and his co-author Roy F. Baumeister (a leading researcher on self-control) focus on in the early chapters is the concept that willpower is a finite resource that becomes depleted as we use it. Though they divide willpower into four broad categories (control of thoughts, control of emotions, impulse control, and performance control), they note that we “use the same stock of willpower for all manner of tasks.” For people with chronic pain, research suggests that our stock of willpower is consistently depleted by all the energy we expend trying to ignore our pain. No wonder we’re consistently short on both energy and “will.”
My pain levels have increased again in the past week and I’m not sure why. Likely it’s a combination of med changes, the weather, the absurdly high pollen count, and some added work and school stress. As my pain goes up, my productivity (and mental sharpness) goes way down. I’ve had a few insights about willpower and chronic illness while reading Baumeister and Tierney’s book, but I think I’ll hold off on talking about them until I finish it. In the meantime, let’s hope I can get a handle on this latest round of pain.
I hope everyone else is having a good week, despite this unseasonably warm weather all over the US. For my readers from elsewhere (Australia, NZ, England, Europe…): has your weather been strange? Or are we just in the midst of a North American heat wave?
Dreaming of Dead Doctors and Listening to My "Gut"
A few weeks ago I dreamed that I saw my former rheumatologist, the one who passed away suddenly during the fall. In my dream, he told me to take a vitamin E supplement. I woke up surprised by the clarity of the dream, as well as the normalcy of our interaction. It was as though I had simply returned for a follow-up appointment. I immediately googled “vitamin e lupus” and discovered this study from 2007, which suggests that vitamin E supplementation helps to suppress autoantibody production in lupus patients. (And animal models suggest that vitamin E reduces joint destruction in RA-like diseases.) To say I was surprised by both the dream and the research it inspired is an extraordinary understatement. The whole thing still takes my breath away. Needless to say, I’ve added vitamin E to my daily regimen!
In my waking life, I have been haunted by the parting exchange between my doctor and me during my last appointment. As I was checking out at the front desk and preparing the leave the office, he called out my name and when I turned around, he was studying me with a look of both sadness and compassion. He said “We’ll figure this out.” I must have replied with something in the affirmative and continued toward the door. I turned back one more time as I walked through the door to the waiting area, and he was still watching me, the same look on his face. I remember feeling simultaneously troubled and reassured at the time—like he knew something and wasn’t telling me, but that he truly cared about me. The fact that it was the last time I saw him only adds to the mystery of the exchange. I requested a copy of my notes from his office, to give to my new rheumy, but apart from the blood order and diagnosis codes, there are no notes from my final visit with him.
In the last few weeks, I have been in the process of interviewing for a temporary administrative position at my university— one with more flexibility and more benefits, but also more hours than my current position. On the one hand, it would be an excellent move, career-wise, and it would also be an improved work environment. On the other hand, while I was excited about the position, I was also concerned about my ability to work a full 40 hour week, even if some of that time was spent working from home.
Well, it seems that the universe was keyed into my ambivalence, because I found out on Tuesday that the position won’t be full time after all, and that the length of the commitment would be significantly shorter than expected, at least for now. Though this is disappointing for financial reasons, it has allayed my fears about potentially over-extending myself. I will also have time to work with gifted kids again this summer, teaching creative writing, which I realized in retrospect I had been sad about giving up. So all is right with the world again. Now let’s hope I can keep my disease activity stable enough to enjoy it!
Resolutions and Irrational Self-expectations
This blog was written as part of the Chronic Babe blog carnival on new years resolutions.
As I think I’ve said before, I’m not really one for new years resolutions. I tend to save my personal resolutions for my birthday, and my professional/academic resolutions for the beginning of the school year. For me, those times feel more natural for goal-setting and making changes. Plus, January and February have always been the most depressing months of the year for me—the holiday decorations are down, it’s dark, cold, and wet, the second semester is dragging along—not exactly the best time to start lecturing myself about all my perceived problems and failings.
About a month ago I read Neil Fiore’s book The Now Habit which is all about breaking the procrastination cycle (ironically—and perhaps unsurprisingly—I was reading a book on procrastination in order to avoid grading papers). Someone had recommended it to me and it seemed like it might have some useful tools for helping get my dissertation written. It’s pop psychology, so don’t expect any elaborate, grand-unified-theory explanations. But I found his observations and solutions for negative self-talk really helpful.
Basically Fiore suggests that instead of approaching the tasks that one dislikes (or that feel challenging and/or threatening) as things that one “should” do— un-enjoyable activities require chiding and self-punishment to complete—one can instead use language like “I will begin X project today [or tomorrow, or on a specific day] and work on it for X amount of time.” By simply resolving to start (or continue) a project, and then following through, one must take responsibility for doing just that. This also helps to overcome the initial inertia that often causes procrastinators to obsess and make themselves miserable over a task or project and then only start it at the very last possible minute (this describes my relationship to grading papers perfectly). Fiore’s argument is that this small change in language (and the behavior it leads to) can release one from a great deal of guilt and misery, freeing up time to do enjoyable things without a black cloud of “shoulds” hanging over one’s head.
What, you might be asking, does this have to do with chronic illness or new years resolutions? I find that I often chide myself for not being more productive on my bad days, making those days even worse. Rather than treating my tired, aching self like a petulant child, I will try to speak to myself more kindly, as I would any ill person I encountered, taking my own pain seriously.
So my only resolution for the new year is to continue finding ways of being kinder to myself, a resolution I originally made when I turned 30. For me, this means learning coping strategies that allow me to enjoy my good days more; treating myself with the same kindness that I treat others, rather than holding myself to an impossible ideal; avoiding toxic and disrespectful people, especially in my personal life; and accepting that some days will be better than others, but having faith that the good days will come, just not always when I expect them. I will determine what I want and need, and try to ignore the disapproving voice that lectures me about what I should or shouldn’t be doing.
Living with chronic illness is no picnic, and I think sometimes the worst thing we can do is think about all the things we’d like to change about ourselves, rather than all the positive qualities we already have. Most of us are incredibly caring and empathetic people, we just sometimes forget to extend that care and acceptance to ourselves. Breathe. Sleep. Love. The rest will work itself out.
On Pain, Language, and Perception
Physical pain does not simply resist language, but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned.
—Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (4).
In many ways I’ve had a good week—I received great feedback on my research and teaching, spent quality time with friends, prepared for the holidays, reconnected with loved ones who live far away, attended an engagement party for a dear friend, and welcomed a new baby into my extended family. But I’ve also had one of the most painful weeks on record since last May (= the vasculitis debacle). And everything fades into a sort of dull background when my mind and body are so exhausted by managing the pain.
It’s been a week now since I took my first dose of injectable MTX (I took my second dose last night) and unfortunately, for the past week I’ve had an intense flare of joint pain, swelling, and general exhaustion (and possibly kidney involvement? 5+ lbs of water weight gain suggests “yes,” but it’s hard to tell). I don’t know if there’s a causal relationship between the MTX and the flare. I would like there to be, but I doubt it. Likely the flare is the result of the stress of the end of the semester and the beginning of the holidays combined with massive weather fluctuations and the generally unpredictable nature of flares.
I wish I had some easily controllable catalyst I could pin the cause of my flares to—sugar, caffeine, alcohol, lack of leafy greens, too much meat, nightshade vegetables, too little sleep, etc—but sadly, that doesn’t seem to be the way my illness works. (Plus, I’ve cut or severely limited most of the items on the preceding list anyway. I’m the healthiest sick persion I know. The baking I tried to do last week seems a much more plausible cause.) But I’m not feeling particularly hopeful that the injectable MTX is going to be any more helpful than the oral. On the other hand, being on the MTX this fall has made my seasonal allergies almost invisible, so at least it’s having something of an impact on my overvigilant immune system. But I’m so tired of waiting for something to control my arthritis!
I’ve had a lot of friends ask how I’m doing in the past few days, and it’s hard to know what to say. I usually go for my default response when someone is genuinely concerned (and not just offering a polite, social-lubricant “How have you been?”): “It’s been a rough week.” Often, they assume I’m talking about work, not about my health, and I usually let them persist in that assumption. Because once we get past those opening lines, I’m never sure where to go next. I know that we all struggle to describe the pain we experience—I see it come up over and over again on the blogs I read and with my friends and acquaintances on Twitter. We tell people we’re in pain, but they just don’t get it.
I even struggle to explain to my doctors the kind of pain I’m experiencing. I realize, in hindsight, that my explanation of “everything hurts,” while literally true, did nothing to assist in the diagnosis of a connective tissue disease. Doctors hear “everything hurts” and they think fibromyalgia (or CFIDS/ME, and/or depression). And while many of us have coincident fibro to go with our other rheumatic diagnoses, it’s my experience that a primary fibro diagnosis will prevent other doctors, even rheumatologists, from looking for additional causes for joint pain and fatigue. (Not that I’m bitter that it took anyone years to test my ANA and CRP. Nooo, not me.) So I’ve become very conscious of differentiating between “all over” diffuse pain and the distinct, precise pain of specific joint inflammation, even if those joints are seemingly “all over.” (Which they were this week. Even my jaw, which was a new one for me and oh my f—king goodness did it hurt.)
But what, exactly, does the joint pain feel like? When I try to describe it, I lapse into bad analogies and similes, the kind or purple prose I ask my students not to use in their essays:
- It’s like a pack of angry dogs have gnawed through my wrists and ankles and refuse to let go.
- Someone is jabbing a stick into the joint underneath my kneecap and poking around until the pain radiates into my calf.
- My hands feel like someone has filled my joints with hot gravel and then forced me to wear a pair of ski gloves. They ache all the time and when I try to bend them I feel myself fighting both pressure and sharp pain.
- When I walk, it feels like the joints in the balls of my feet and my toes are each being struck by a hammer every time I take a step.
I wish I could say that these are simply the creative inventions of a poet, which I suppose they are, since I am a writer of poetry, but they are also the closest I can come in language to describe the pain I experience on a regular basis.
And when the pain becomes more than I can bear, it’s like my brain places a sheer curtain or a piece of frosted glass between me and my body— really between me and all my perceptions of the world. The pain becomes more diffuse and manageable, but all sensation and thought becomes cloudy, dampened, and difficult to sustain. Periodically the specific pain of individual joints breaks through, and I become both distracted and distraught. After several days (or weeks) of this, I’m an emotional wreck. So much of my energy is expended trying to manage and ignore the pain that I cannot focus on anything else, and little annoyances become insurmountable obstacles. Painkillers dull but do not silence the pain and bring their own set of annoyances and side effects.
How do you describe the pain of your arthritis or chronic illness? Do you even try?
Self-injection, Pity Parties, and Speckled Cells
I like my new rheumatologist. So far she seems insightful, focused, and kind. She wants me to give the MTX another month at a higher dose, but she’s going to have me switch to the injectable form. They’ll do the first injection in the office this Friday afternoon, but from there I’m on my own. Gulp. Time to ask my Type 1 diabetic friends for pointers. In the meantime, I discovered that my ANA appears in the speckled and nucleolar staining patterns. I find the details and vocabulary of the immune system really fascinating.
I ended up spending my whole day at the hospital— between the doctor visit, labs, and xrays—with no lunch. I had to cancel a couple of meetings with my students in the late afternoon which made me really frustrated with myself. I realize of course that I couldn’t know that it would take that long, but by the time I was done (hungry, sore, exhausted, freaked out about self-injection) I just burst into tears in my car. Once that little pity party was over, I drove home and took a nap, which I suppose was the upside to having my schedule totally turned inside out. Instead of feeling pressured to go to campus and cram a bunch of meetings in, I just cancelled everything and went to bed for a few hours. I woke up feeling significantly better than I have in a long time, syringes and wine-free holidays be damned.
In a shining example of why it’s so nice to have a network of fellow spoonie bloggers and twitter denziens, Leslie at Getting Closer to Myself just posted on Sunday about MTX and “The Art of Self-Injection” and talked about a tool that helps the needle-averse do injections. I think I need one. When I went to the pharmacy to fill the prescription, the pharmacist asked: “Do you have enough syringes at home?” Umm… no? My injecting experience pretty much stops at basting turkeys and irrigating my gums.