I was in my late teens the first time I saw a counselor. It was the first time I’d talked about rheumatoid arthritis (RA) and my disability to someone who was trained to listen and to guide me as I was working out my feelings. The experience changed my life. I learned about the value of counseling and about how to work through muddled feelings. This was also the experience that gave me the goal of helping others in similar situations.
Since then, I have sought counseling several times when I felt stuck or hopelessly depressed and it has always been helpful.
Living with RA is hard. Getting a diagnosis brings the relief of having an answer and the devastation of finding out you have a chronic illness. The pain of active disease requires a whole new set of coping skills as you face the pain and impact on your mobility of RA. Even remission can bring with it anxiety about the possibility of your medication no longer working. And that’s just a few of the issues we who live with this disease deal with every day.
It is unreasonable to expect that you can cope brilliantly with whatever RA throws at you. There’s a lot in many ways, getting RA is very much like getting an entirely new life. It’s normal to feel overwhelmed by it all. Let me repeat that: it’s normal to feel overwhelmed. Yet, so many of us seem to expect that we should be superhuman, gliding through life with RA with perfect equanimity and a permanent smile.
When you see it written down like that, it does look ridiculous, doesn’t it?
Depression and RA
Counseling can help. In fact, I’ve been known to advocate that a diagnosis of RA shouldn’t just come with a prescription for a DMARD to treat the disease, but also a referral to a social worker or other kind of therapist. As you move through your journey with RA, counselling continues to have a role to play. This is such a variable disease, ebbing and flowing over the years, bringing new challenges and revisiting old ones.
Many people with RA experience depression. In fact, having RA doubles the risk to develop depression compared to the general population. A significant proportion of people with RA who are depressed think about suicide.
You don’t have to go through it alone. In fact, soldiering through on your own may extend the time you spend depressed and have difficulty coping. Our culture values stoicism, but living with RA is not normal. That means the normal way of dealing with things goes out the window. Asking for help is a proactive way of advocating for yourself. Talking to your family doctor or rheumatologist about getting a referral for counseling is one of the healthiest things you can do for yourself.
Cognitive behavioral therapy
There are many different types of therapy, following different approaches to helping people feel better. Sometimes, seeing a social worker for short-term, practical therapy and resources in approaching a particular problem can be extremely useful. At other times, especially with depression and chronic illness, cognitive behavioral therapy can work wonders.
Cognitive therapy theorizes that if we change the way we think about a situation, it will affect how we feel about it. It is an extremely pragmatic approach that requires active involvement from the person receiving the counseling. In fact, this type of therapy can be especially useful for people who have a chronic illness.
Cognitive therapy is particularly applicable if your depression is mild to moderate. If you experience severe depression, you may benefit from medication and other types of therapy. Keep in mind that if you are thinking about suicide, please reach out to your doctor or a suicide hotline. There is help and there is hope. See some resources below.
National Suicide Prevention Lifeline 1-800-273-TALK (8255)
Suicide.org list of state-specific hotlines and international hotline.
The physical basis for depression
You may also wish to keep in mind that sometimes, there is a physical reason why you are depressed. In the late 1990s, I’d seen a cognitive therapist for a few years and it had been incredibly useful in helping me to approach living with a chronic illness in a different way. I was easing out of therapy, but found myself going back for "refresher sessions" every three or four months. After about a year of this, I realized that I went back to see my therapist when I was flaring. Then I saw my rheumatologist instead, switched medications, and started feeling much better.
Sometimes, your depression is because you are having a hard time coping and need help developing new ways of dealing with the change in your situation. At other times, your depression can be because you need better treatment of your RA. Doing a mental check-in with yourself about how you’re doing can help you distinguish whether you need treatment for your physical or emotional needs.
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Lene writes the award-winning blog The Seated View. She’s the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.