In our continuing interview series, we will get a chance to hear today from Doctor Deb who is not only a popular blogger but is also a mental health professional. Anyone who deals with a chronic illness such as Multiple Sclerosis will undoubtedly have some emotional challenges to overcome. Doctor Deb provides her expertise and experience with how to best cope with some of these psychological challenges.
I now present to you...Doctor Deborah Serani
BIO: Dr. Deborah Serani is a psychologist who practices in New York. Her specialties involve depression and trauma, and she has published many articles on these subjects. She is also an adjunct professor at Adelphi University where she teaches pathology and psychoanalysis at the graduate level. Dr. Serani has also been a technical advisor for the television show, Law & Order: Special Victims Unit and serves as a media consult for the American Psychological Association.
Name: Deborah Serani, Psy.D.
Type of therapy you do: Psychoanalytic Psychotherapy
Blog name and title: Dr. Deb: Psychological Perspectives
1. When a patient comes to see you and tells you that they have a chronic lifelong illness such as Multiple Sclerosis, what sorts of issues do you think you will most likely work on with this person?
Chronic illness is a significant issue that impacts greatly on a person's life. Managing medical issues and finding a meaningful quality of life are usually the main focus in the therapy I do. I think it is so vital to have realistic goals when dealing with chronic illness and disease, as well as to touch upon the sadness and loss that often accompany the trajectory of such illnesses.
2. In your experience, what impact does having a chronic illness have upon a person's primary relationships?
Chronic illness has a profound impact on a person's nuclear and extended family, as well as with friends and coworkers. It is extremely important for family and friends to understand as much as possible about the chronic illness. I often encourage patients to share the day to day intricacies, challenges and frustration not only in words, but by showing with "living examples", so that others can comprehend the breadth and depth of what goes on. Ignorance is a common fall-out with chronic illness -- as many do not truly understand that a good day can be followed by a bad one. Or that just because you see me smiling doesn't mean that I am not being challenged at this very moment. Chronic illnesses that are not "visible" (i.e. Sarcoidosis, Epstein Barr) receive less understanding than those which are more obvious (i.e. Multiple Sclerosis, Psoriasis or Huntington's Chorea). Fighting the stigma that often accompanies chronic illness is a big part of the work that I do.
3. For a person who does not cry or grieve very much over the fact that they have a disease such as MS, does this mean that they are in denial or could it mean that they are coping well?
I tell patients all the time that there are no crying and grieving rules that everyone follows. Dealing with the emotional intensity of chronic illness may have one person in tears and collapsing with grief, while another person becomes angry and rages at the world. Coping well requires you to find a realistic way to address your chronic medical and psychological needs and live a meaningful life. Usually a person who is diagnosed with a chronic illness will move through a series of psychological stages. Not everyone will move through these stages in the same way. But the goal is to get to Stage 4.
Stage 1- "Shock" - This stage occurs when a person first learns about his or her medical condition. Feeling stunned, bewildered or detached may occur.
Stage 2 - "Encounter" - In this stage, a person registers the impact of the illness, but begins to feel hopeless about life. Sometimes despair and confusion can lead to even greater helplessness. Getting stuck in this stage can be very debilitating.
Stage 3 - "Retreat" - During this stage, a person may move into denial or minimize the life altering implications of the chronic illness.
Stage 4 - "Adjustment" - When an individual reaches this stage, he or she has come to accept the reality of the chronic illness and is ready to make adjustments.
4. How does one best deal with the anger quite often present after one is told that they have a chronic illness?
Express it! And give yourself permission to do so. It is so important to take note of all that you feel when a chronic illness enters your life. Passive ways of expression like writing, paint or blogging can help. If you can, express in physical ways the emotions that you feel. Express your emotions privately or in the presence of others. But when you let the negative emotions out, makes sure you find your way back to what the chronic illness HAS NOT taken away from you.
5. How can caregivers, family, and friends best emotionally support a loved one who has MS?
Family and friends should educate themselves about the chronic illness. This is a must! It is also important for people you love to give you the time and space to move through "bad" days if you want to be alone. No one likes being around a cheerleader 24/7. And to share in the joy of the good moments when they happen. I think the most precious gift a loved one can give a person with chronic illness is understanding.
6. How can an MS patient differentiate between normal grief over being diagnosed with MS and having clinical depression?
I have found in my experience that there is no such thing a normal grief. I have worked with a diverse range of individuals who have experienced trauma in different forms. Recovery is about finding balance, and each person's time schedule for reaching such balance differs. The best advice I can offer if a person is struggling emotionally for a period of six months or more is to call in a mental health specialist to assess what is going on.
7. Are there any specific medications which best help the depression as a symptom of Multiple Sclerosis?
I don't prescribe meds personally and don't like to comment on them because they are out of my area of training. It is always best to find a specialist who not only is a trained medical doctor, but one that also understands chronic illness. Depression often accompanies chronic illness, so it would be important to address both. One effects the others, so finding the right medications may take some time. Be patient, be informed and make sure you have a good team working with you.
8. Do you have any suggestions for MS patients who also suffer from anxiety due to their disease?
The lack of control over your life from chronic illness can leave you feeling depressed, but it can also surge anxiety. Cognitive Behavioral techniques are really great at reducing panic. Learning how to "talk to yourself" and move through issues can help diminish anxiety. Acknowledging what you can control over what you cannot control puts the focus on your strengths, not your weaknesses. It is also noteworthy to watch your caffeine and chocolate intake as such foods can raise heart rate and blood pressure. Big no-no's if you are feeling panicky or anxious.
9. Any advice on how to cope with the cognitive effects of MS including memory loss and difficulty processing information?
The cognitive fog that comes and goes with MS or any other chronic illness does produce challenges. I think using tools like journaling, making lists or even using recording devices can help you in such moments. I also think it is important to be assertive and self-confident, letting others know that you are having a rough time today and need them to repeat what they just said. "I have MS and I am having a hard time understanding you. Could you say that again to me?" People are very flexible and accommodating when you inform them of your difficulties.
Published On: February 23, 2009