Crisis InterventionWith CFIDS it is redundant to argue about which comes first: assault to the human organism or psychological response to trauma. Mind, body, neurochemistry and the human spirit are inextricable.
It must be stressed that an individual in crisis, including the trauma of catastrophic illness, may mimic the characteristics of a variety of psychiatric disorders. Once past the crisis phase, especially where basic survival issues are concerned, many "psychological" concerns will dissipate.
When a person with CFIDS (PWC) seeks psychological assistance, she or
he must be assessed for potential crisis intervention. Specific issues
include: 1) the collapse of a personal denial system which, heretofore,
would not accommodate the illness; 2) inaccurate assessment and inappropriate
treatment by physicians (may include patronizing or overt emotional abuse);
3) lack of emotional support from family, friends and persons in the workplace;
and 4) legitimate fears regarding career, financial depletion and possible
loss of health insurance.
The mental health professional must be educated to appreciate the devastation that this illness wreaks. Much of the panic, anxiety and depression are consequent to multiple personal losses and the unreliability of physical and mental capacities.
Children and adolescents with CFIDS suffer the loss of important psychosocial developmental skills and fall behind in their studies. Women and men of all ages ponder whether or not to have children and parents suffer remorse because they cannot adequately meet the needs of their children.
Many losses, such as an intense, fast-track career and strenuous athletic pursuits, may be permanent. Some PWCs previously enjoyed a life full of diverse and varied activities. Some PWCs have a compulsive nature that worked for them in our achievement-oriented society until they collapsed. Most PWCs will have to adjust to a dramatic change in lifestyle, including a downward spiral in finances and a future filled with uncertainty.
Education about and validation of the illness is important to PWCs.
Many can address their issues reasonably in the context of therapy and
their personal lives once they understand what they are dealing with.
Paying close attention to what the body says and respecting its needs
are part of the repertoire of skills needed to cope with the illness effectively.
Contrary to popular belief (which insinuates hypochondriasis), PWCs have tended to repress or deny their bodies' limitations until illness resulted in collapse. CFIDS challenges and contradicts much of today's popular ideas about health; CFIDS research will eventuate new medical models that supersede our present bimodal model .
IT CANNOT BE OVERSTATED that the complications of CFIDS may lead to suicide. For some, the pain and suffering is beyond endurance. Physicians may not provide adequate pain control or the PWC may not have financial resources to obtain medication that could modulate the illness symptoms.
Lack of social support systems may be a second major factor in suicide.
The PWC may legitimately feel misunderstood and abandoned by society.
Love can be the tie that binds us to the living. With lack of love, the
soul can shrivel. With lack of dignity and respect the will-to-live may
falter. We humans are communal creatures. PWCs may feel least loveable
when love and reassurance are needed the most.
A third potential precursor to suicide may be pride. Not all previously capable and independent individuals are able to span the emotional leap to humility and grace required of one dependent upon others for assistance.
Finally, total exhaustion of basic survival resources may precipitate a suicide attempt. "I wouldn't survive on the street" and "I refuse to be a bag lady" are phrases I have repeatedly heard. These comments represent legitimate fears regarding the loss of housing and medical care, which our society has yet to address.
Every PWC is forced to grapple with existential concerns such as mortality, illness, pain and suffering, his or her place in the universe, and the need to make meaning of the human condition. Existential emotions include despair, loneliness, grief, depression and helplessness in the face of the unknown. Some view this illness catastrophe as a force-fed introduction to a more artistic, contemplative and spiritual life. All individuals devastated by CFIDS are challenged to develop what I call "a new way of living."
Like the mythical Phoenix, we are continually consumed in the flame (of our illness) and reborn from the ashes (of our remissions). And like Job 14:7 so aptly states, "There is hope for a tree that has been cut down; it can come back to life and sprout." (Good News Bible: Today's English Version) It is testament to the human spirit that so many courageous PWCs successfully let go of the old and open themselves to a creatively meaningful, alternative lifestyle.
Originally published in Summer 1995 by: