At some time in our lives we are all challenged by adversity, whether it be stress, illness, pain, disability or a mental difficulty. We have to cope with whatever life throws at us and we vary enormously in our effectiveness in coping with our situations. How we cope determines to a great extent how effectively we manage our lives and how happy we are with the result. The greater our ability to be realistic and plan our future the more likely we are to be successful.
Loss figures in many of the challenges we face and this needs to be recognised as many consequences flow from this. We accept without question when we do not have any pain and feel a loss when our bodily comfort is removed. Simple activities are affected such as doing the gardening, getting the shopping and sitting in a restaurant or cinema. As we get older many changes creep up slowly upon us and we may not be happy with these and find them hard to accept. A sudden and dramatic change in our comfort or ability is much more difficult to accept, particularly if we are young or very active.
Many things which happen to us can engender depression and threaten our feelings of self esteem and self worth. These include losing a body part, loss of our income or our life role or occupation, relationship failure or a family death. Apart from endogenous causes, depression is largely the result of cumulative losses and is the most disabling condition of mental origin in the world. Our brain chemistry is altered when we become depressed and this leads to a negative view of events happening to us and a negative skew in how we think about our future. Depression is important in its own right as a mental illness but also because many depressed people also suffer a pain condition.
We may not be that successful in coping with and coming to terms with these losses. Hopelessness may be the result if we become depressed so we lose the motivation to take the required actions which would ameliorate our condition and situation. Cognitive therapy and antidepressant drugs can be used as required to kick start the improvement process of more realistic thinking and begin generating helpful approaches to our troubles. We can react in an entirely different manner to these challenges by fighting strongly against them.
Many times have I heard patients say to me I'm not going to let the pain beat me as if it is a competition and the pain is just not going to get the upper hand. This is a common strategy as people try desperately to keep going in the face of adversity, continuing to the best of their ability to do the things they feel they need to. There is a big disadvantage here however. When the adversity is too great the costs of keeping going by fighting against the pain can become too high, leading to a downward spiral of pain, disability and depression.
This introduces the important concept of conflict, the conflict between our expected abilities and what we can in reality see our ability is. Aggressive feelings can be developed against our pain problems and towards the demanding world. Our relationships with others can develop a conflicting edge and we stick with our typical unhelpful behaviours, unable to generate new alternatives to attempt to solve our problems. A non-acceptance of our situation is at the root of this difficulty and we will be unable to move forward and generate new ideas until this is settled.
Resignation should not be taken as the same idea as acceptance. When we are resigned to something we accept it passively exactly as it is and feel there is no point in taking any actions to change anything as this will have no effect. We have a negative slant on the situation, rating it as permanent as it is, making us more likely to suffer some depression as a result with the consequences that we won't feel like taking the actions to improve things. Resignation is not a helpful state of mind and working hard to achieve some realistic level of acceptance is much more likely to be functionally useful.