Maladaptive Coping Strategies in Chronic Illness

Source: Katie Willard Virant

Limits. The word sounds like it feels — a crisp cutting off of possibility, a boundary that prevents freedom of movement, a constraint that chafes. Although we all live with limitations, the depth and breadth of limitations imposed by chronic illness are particularly onerous.

For many of us, our health status influences virtually every decision we make, including when and what we eat, how and how much we socialize, and where we are able to go. Our educational and career trajectories, partnering and parenting decisions, and travel opportunities are affected by chronic illness. Often, our illness forces us to make limiting choices: We have the energy to shower or do the dishes, but not both. We can go without medication and suffer symptom exacerbation or we can take medication and risk dangerous side effects. We can roll the roulette wheel of exercise as we wonder, "Will movement make me feel better or worse today?”

Facing these multiple limitations day after day, week after week, year after year is difficult. We find ways to cope because we have to, and some of our coping mechanisms can be maladaptive. I’ve noticed three maladaptive ways that people respond to chronic illness limitations: magical thinking, withdrawal from life, and either/or orientation.

Magical thinking. Magical thinking is the belief that we can will things to be as we would like them to be. When we’re engaged in magical thinking, we pretend we’re not sick. It’s not that we actually forget about it; it’s more that we wad up the knowledge of our illness into a compact little package and hide it in the back of our minds. We take on a new project when we don’t have the capacity, choosing to ignore that rest is essential for our well-being. We don’t refill our medication, telling ourselves that a couple of days without it won’t matter. We insist upon adhering to societally-defined norms (“I must finish college in four years”; “I must work full-time”), admonishing ourselves to stay tough and disregard our bodies. If we ignore reality, then we don’t have to face it.

Withdrawal from life. Saying “I can’t” due to illness feels so powerless that we’d rather say “I won’t” and maintain the belief that we are calling the shots. When we withdraw from life in this way, we cite absolute beliefs about ourselves and/or others justifying our actions. It feels better to say, “I don’t have friends because people are stupid,” rather than, “I don’t have friends because I’m afraid I’ll be rejected due to my illness.” We maintain an illusion of control when we say, “Who wants to travel anyhow? I’d rather stay at home.” As with magical thinking, withdrawal from life protects us from the painful frustration of wanting things that our illness may deny us.

Either/or orientation. In either/or thinking, we imagine that people are either healthy or ill. In this worldview, health provides a passport to employment, relationships and fulfillment; conversely, Illness creates an insurmountable roadblock to any good thing. One either has everything or nothing, with no in-between. A person engaged in either/or thinking might say, “If I can’t fulfill my dream of being a physician, then no other career is worth having.” “If I can’t go away to college and live on my own, then I may as well do nothing.” “If I can’t socialize like everyone else, then I’ll just be alone.” In either/or thinking, we won’t allow ourselves to imagine working productively within limitations.

All of these maladaptive coping styles have a common purpose: to protect us from the pain of grief. If we refuse to realistically face the limitations imposed upon us by illness, then we don’t have to grieve them. “Well, sure,” you might say. “Why on earth would I want to grieve?” It’s a good question. Grief feels terrible. In grief, we are sad, angry, fragile, and lonely. We grieve when we have to, not because we want to. But refusal to grieve brings its own pain. if you’re noticing cracks in your life — perhaps in the form of anxiety, depression, or isolation — then you may be ready to reach behind your protective coping styles and tap into the grief they hide.

For now, reflect on all the ways that you engage in magical thinking, withdrawal from life, and either/or orientation. You may wish to return to the descriptions of each coping style and identify the particular ways in which you tend to use them. Once you become aware of your specific thought patterns, try to notice each time they occur. This is harder than you might think, so be sure to give yourself credit for stretching your mind and practicing this skill.