May is Mental Health Awareness Month!
Mental health and chronic illness go hand-in-hand, and as May comes to a close, I wanted to acknowledge that it’s Mental Health Awareness Month. I invited a guest writer to share her thoughts on this topic with you, and I’m pleased to introduce Licensed Mental Health Counselor Karen Walter.
Karen holds a Master’s degree in Counseling Psychology from Salem State University and is committed to fostering growth through compassionate and collaborative care. With nearly a decade of experience supporting children and families across community, school, summer camp, and outpatient settings, she has developed a deep appreciation for the unique strengths and challenges each individual and family brings. Her time as a clinician in an elementary school especially shaped her holistic approach to creating a safe and supportive space where clients can feel truly seen and heard. The challenge of learning to live with chronic illness is one of the many specialties that Karen treats in children and adults.
She works at Launch Psychological Associates in Massachusetts, a woman-owned, close-knit group of clinicians who are passionate about helping their clients live fully. Telehealth appointments are available.
I want to thank Karen for openly sharing the story of her own chronic illness and how it informs her work as a therapist. So much of what she wrote resonated with me, and I know it will for many of you as well. Here is Karen Walter’s story:
Being diagnosed with a chronic illness brings many changes to a person’s life, and learning to cope with those changes can sometimes feel just as stressful as learning to live with the physical illness. Lifestyle and mental health challenges caused by chronic illness are often overlooked, but treating them concurrently with the physical health challenges can significantly improve quality of life.
When someone is diagnosed with a chronic illness, they often have little information about how to cope with the physical and emotional fatigue, frustration, and lifestyle changes that come with it. As a licensed mental health counselor, I use my training as a therapist, my empathy, and my lived experience coping with chronic illness to support clients who are also living with chronic illness.
When I was in my early twenties, during a routine exam, my doctor discovered an abdominal tumor about the size of a softball and recommended surgery to remove it. Without realizing how life-changing this procedure would be, I lost my ileocecal valve (I had never heard of it before – most people haven’t), as well as parts of my large and small intestines. I went from being someone who could eat anything and never gave food a thought, to someone who had difficulty digesting food and lost most of my nutrition within a few minutes of eating. I was constantly tired, underweight, under-nourished, and dehydrated. I was also living with significant vitamin deficiencies because I was no longer able to get some vitamins through food.
After years of living with this condition without knowing what was wrong, I began to look and feel like a sick person. I was unable to do much other than going to work and going home afterwards. My life felt smaller and smaller because I lacked the energy to participate in most of the things I wanted to do. This made me feel sad and frustrated. Sometimes it seemed as though, if I could just manage to try a little harder, I could summon the energy to do the things I wanted to do and make others happy. Of course, this wasn’t true; the physical illness needed to be accurately diagnosed and treated.
I sought encouragement and advice from siblings who have colitis and Crohn’s disease because I had received several inaccurate diagnoses and needed to learn how to manage illness. I advocated for myself by talking the situation over with my PCP. She referred me to a new gastroenterologist who specialized in treating patients with similar surgery outcomes, and who diagnosed me with: chronic B12 deficiency (an uncorrected B12 deficiency can cause symptoms like extreme fatigue, anemia, poor sleep, depression, nerve damage, weakness, memory loss, and cognitive difficulties, with symptoms worsening over time); SIBO (small intestine bacterial overgrowth, a common result of my type of surgery); malabsorption (difficulty absorbing nutrients through food); and chronic malnutrition (most of what I ate was not being digested at all, something that can be managed but not fixed).
We talked about regular, lifelong B12 intramuscular injections, bloodwork, antibiotics, probiotics, and GI medication, and she also referred me to a nutritionist. The most memorable aspect of that appointment was that I felt validated – my health problems were being directly addressed in a practical manner and understood as real. This helped me understand how to manage physical symptoms and made a huge difference in my quality of life.
Over the years, through working with a nutritionist and therapist and through lived experience, I began to find strategies that helped me to cope with the stress and lifestyle changes that accompany a diagnosis of chronic illness:
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I try to do more on the days when I feel well, even if that means changing my plans.
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I try to practice giving myself grace on the tough days – the kindness and understanding you would extend to a friend going through the same thing.
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I enjoy spending time in nature as much as I am able to within the limitations of my illness, and I have found friends with chronic illness who share and validate my experiences.
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Watching funny videos, adding new activities and connections that help me to feel strong in other ways, and learning to advocate for my health during appointments have also been helpful, as is focusing on helping others.
Chronic illness affects the energy level of those living with it, and as a result, some people may need to change many of their daily habits. This can lead to lessened engagement in the activities they enjoy, which can, in turn, cause feelings of depression, frustration, and sadness. I have found it’s also important to acknowledge that it is completely normal to have those days when I feel frustrated and bored with everything related to managing illness. Sometimes, the best thing is just to rest and start fresh the next day.
Finding a therapist, support group, or spiritual or social support that can be understanding of the patient’s lived experience and validate it as authentic can broaden your support system and help you learn new coping skills. Our healthcare system can feel incredibly invalidating, and not everyone we are exposed to in our lives is going to be well-educated about chronic illness.
Your therapist may suggest using evidence-based interventions such as:
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Behavioral activation (changing your mood by doing an activity you enjoy instead of sitting with a negative feeling)
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Cognitive behavioral techniques (such as challenging and replacing negative thoughts)
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Somatic therapy interventions (moving your body to help calm your nervous system)
Other therapeutic techniques include learning stress management and relaxation techniques through therapy, yoga, meditation, etc. It may be important to acknowledge and process feelings of anger or grief related to the loss of your previous health situation or lifestyle. You may also need to learn to be flexible as you identify and connect with your values and goals. In doing so, you are working towards acceptance of the changes in your energy, abilities, and situation – but gradually, and at your own pace, over time.
A therapist can also help you work towards normalizing and expecting the unpredictable, cyclical nature of living with chronic illness. That means knowing there will be good days and bad days, ups and downs, no matter how well we take care of ourselves. Your therapist may also encourage you to notice and challenge an all-or-nothing thought process; thinking “if I can’t live life exactly how I did before illness, nothing feels right” can make us feel disappointed or stuck, while saying “It takes a lot of strength to do this, and I will figure out over time what feels right for me” creates room to grow and adapt. Focusing on the things you can control is another cognitive behavioral strategy he or she may recommend.
It is important to maintain healthy emotional boundaries by discussing your illness only with those who can be understanding and supportive to the extent that you need them to be. Working on assertiveness skills, if needed, to aid with self-advocacy within the healthcare system, or choosing a family member to act as your patient advocate and accompany you to medical appointments, are helpful steps.
If you find yourself struggling with depression related to your diagnosis, health issues, or stress levels, you may consider the idea of an exploratory conversation about psychiatric medication with your chronic illness specialist (in conjunction with a PCP or psychiatric medication provider). It’s critical to loop in the healthcare provider who helps you manage your chronic illness because they have information the medication provider will need to know to determine what is safe and appropriate for you in the context of your physical health.
Balancing the twin challenges of physical and emotional symptoms resulting from chronic illness is an often-overlooked health issue, but essential for living our lives to the fullest. It is my goal as a clinician to use my professional training, my empathy, and my own ongoing experience with chronic illness to help others.
Each issue of “What’s Her Problem?” includes questions for further discussion. Leave a comment below!
This week’s questions:
How do you balance your mental health and physical health, especially if you deal with chronic illness? Which therapeutic techniques have been most beneficial for you?
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