What’s the point of therapy for chronic illness?

When you live with chronic illness, it defines so much of your life, even though it only captures a small part of who you are.

There are very real implications to chronic illness (limited energy, many appointments, ongoing stress, isolation), but so much of the shame and emotional pain around chronic illness is due to the messages we receive about what chronic illness means about us. Our culture tells us that we are not valuable if we aren’t “productive”. And that we are a drain on society or our loved ones. And that if we only took better care of ourselves, we wouldn’t be struggling.

It tells us that something about us is wrong. Not just that something bad happened to us, but that we are bad.

This is true of both visible disabilities and invisible ones, each with their own set of additional messages. Those with visible disabilities may be taught that their disability is their whole personality, that they should be grateful for help, or that they don’t know what’s best for themselves. Those with invisible disabilities might be told that they are making it up, that their pain doesn’t count, and that they don’t deserve help.

These are some of the internalized messages that we can explore in therapy.

Talk therapy can help to name some of these beliefs and debunk them on a cognitive level, while EMDR can help connect them to past experiences and move those experiences from the trauma center of the brain to memory storage where they aren’t as painful. This opens up the possibility that you can be living with your disability while also holding positive regard for yourself and the life you want to live.

EMDR is also particularly useful for processing medical trauma—whether from intrusive evaluations or traumatic interventions—flare-ups, regrets you might hold related to your illness, or specific judgements or microaggressions you’ve experienced.

Therapy can’t make your illness go away, but it can change your relationship to it and to your sense of self, by acknowledging and validating your experiences, while affirming your worth, your goals, and your strength.

Wheel of Emotions

This image is frequently used by therapists to help clients get more specific about what they are feeling. Start in the middle to identify your overall feeling and then look at the corresponding feelings in the bigger circles to narrow it down.

Tapping Meditation from EMDR

Tapping Meditation from EMDR for self-regulation. Using a nice, slow pace, you can tap your hands on your chest, like a butterfly, or in a hug around your arms, or on your lap (or even on a table or desk).

Trauma and The Body

Below is an edited excerpt of “Embodied Therapies for the Treatment of Trauma” by Gabriella Feingold, MSW.

In theatre, we understand that humans use our bodies constantly to perform, even when we are not aware of it. An actor embodies a character, changing the behaviors, language, and appearance they usually assume in order to become someone else.

Our bodies are constantly performing the roles we have learned to play, like mother, teacher, neighbor, and friend, and they are also the sites of our suffering and joy, of our oppression and privilege. Author of The Body is Not an Apology (2018), Sonya Renee Taylor, writes,

When we speak of the ills of the world—violence, poverty, injustice—we are not speaking conceptually; we are talking about things that happen to bodies. When we say millions around the world are impacted by the global epidemic of famine...millions of humans are experiencing the physical deterioration of muscle and other tissue due to lack of nutrients in their bodies.... Racism, sexism, ableism, homo- and transphobia, ageism, fatphobia are algorithms created by humans’ struggle to make peace with the body. (p. 4-5)

The privilege, oppression, identity, and roles imposed on our bodies have mental and behavioral health implications beyond the obvious, such as eating disorders or gender dysmorphia. For example, someone managing depression is expected to be a “productive” member of society (i.e. to be able to use their body to its highest functional capacity) but may have a body that requires more rest and slowness; and disproportionate health issues among racial minorities is associated with the policing of and discrimination against the bodies of people of color.

Understandings of Trauma

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as follows:

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (Menschner & Maul, 2016, p.2)

This definition alludes to the spectrum between “little t” and “big T” trauma. Major, or “big T” trauma, may include events in which one’s actual or perceived physical safety is imminently under threat, as well as less threatening physical distress, such as invasive medical procedures, car accidents, or stress in utero, or psychologically damaging experiences, such as childhood neglect, systemic discrimination, or sudden loss of a friend or family member.

I conceptualize “little t” traumas as repeated pressures and negative experiences that become (often unknowingly) internalized into one’s self-perception, such as being “parentified” as the oldest child, feeling left out or struggling academically, experiencing ongoing rejection or failure, microaggressions, and so on.

The most useful understanding of trauma for our purposes is not which event has occurred, but how the body and nervous system of the person has reacted to the event.

Peter Levine, the creator of Somatic Experiencing, defined trauma as an event that creates long-term dysregulation of the nervous system, regardless of what the event was.

Addressing the Body in Trauma Treatment

Our bodies are the vehicles in which we experience and process trauma, even when the trauma is not of a physical nature.

When confronted with danger or the perception of danger, the amygdala signals an alarm which triggers the release of cortisol and adrenaline, putting the body on alert, and the brain stem releases the stimulant norepinephrine. These signals travel down the spine and activate the sympathetic nervous system, sending a signal to all the major organs to increase heart rate, blood pressure, and rate of breathing so that we can fight or flee. The nervous system reacts before the prefrontal cortex has a chance to interpret information accurately.

Clinical social worker and somatic therapist Resmaa Menakem explains that due to this physiological response to stress, our bodies hold knowledge in ways that our cognitive brains do not. Depending on how safe we feel, we experience “constriction or expansion, pain or ease, energy or numbness...The body is where we fear, hope and react...and where we reflexively fight, flee, or freeze” (Menakem, 2017, p.5).

Before they can cognitively process what is happening, someone who has experienced major or minor trauma may find themselves activated and overreacting to everyday situations with embodied sensations created by the nervous system response, that then is interpreted by the cognitive brain as fear, anxiety, depression, aggression, and so on. The more frequently or severely the body responds to stimulus with the need to fight, flight, or flee, the more symptomatic someone with a trauma history will appear and the more out of control they will feel.

Trauma can also impact the brain’s ability to encode and retrieves memory, to manage executive function, to receive sensory information, and to maintain attention and decision making.

Mainstream therapeutic models tend not to integrate the physiological state with the mental state. But given these changes in a brain that has experienced trauma using cognition- or language-based treatment for PTSD may not be possible. Embodied therapies like EMDR are a useful avenue when a client is not ready to address their traumatic memory directly. A client need not share the actual incident to experience relief, rather these strategies allow for association and integration of all those parts of life that are touched by the trauma.

Our bodies are the experiencers, interpreters, and reminders of the events of our lives. Our nervous systems react quicker than we can consciously think and control our reactions to everyday events. As my vision board says, “Listen to your body. It’s smarter than you are.” Through embodied therapy, we can offer our clients new paths to that wisdom and to deep healing.