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Glenn, a fifty-year-old clinical psychologist, has cancer of the kidney that metastasized to his lung, and he has remained stable for four years. Therefore, no treatment was being given, since chemotherapy was considered inappropriate for his disease.
In his first drawing, Glenn showed his cancer surrounded by white cells and the cancer mass gradually being reduced to a single cell. During his relaxation/mental imagery activity, he had difficulty eliminating the last cell, but he found when he was jogging that he could see the final cancer cell being absorbed by a giant white cell and disappearing.
Although in the drawing he does finally succeed in eliminating the cancer, there were some weaknesses in the imagery. The white blood cells seemed to work around the periphery of the cancer; there was little interaction, and they met the cancer only on the surface. (This desire to stay on the surface of the problem sometimes indicates an unwillingness to investigate the details of why one has developed cancer.) Also, destroying the last cancer cell required a tremendous effort on Glenn’s part: He had to be jogging before it could occur. There appeared to be something almost magical about that last cell, almost a hanging on to the disease and an indication that it would take a very large white cell and an extraordinary event finally to get rid of the cancer.
Six months later, his drawing showed more interaction between the white blood cells and the cancer, yet the size of the tumor relative to the size of the white cells did not suggest overwhelming strength on the part of the body’s defenses. A single, large white cell was shown suddenly appearing and shattering the tumor mass, and the tumor fragments were then absorbed by the ordinary white cells. Again, the drawing showed that an extraordinary event was required, and that until this magical event occurred, the cancer would remain intact. To us, Glenn’s picture illustrated an unwillingness to deal with small component problems and a tendency to wait for the one event that would explain and remedy everything.
Similar to his imagery, Glenn’s cancer has not regressed, though his general health is superb and he continues as professor and long-distance runner.
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When a new problem develops, it is tempting to indulge in negative thinking. After all, negative thinking is a part of human nature, and we all fall victim to it on occasion. Because RA is a chronic condition and the problems it poses often appear overwhelming, it is only natural that negative thoughts will occupy you from time to time.
Conversely, it is bard work to maintain a positive attitude. When we’re in the middle of a thunderstorm, it is difficult to focus on the sun hidden behind the clouds. Despite the difficulty of maintaining a positive attitude, let it be said: Persistent negative thinking is harmful. Persistent negative thinking can be our worst enemy. For one thing, negativism is often irrational in that it is based on emotions more than on facts. Focusing on negative thoughts usually makes us feel worse, and negative thoughts can lead us to take negative actions, alienating the people we love and need. Finally, negative thinking does not lead us to develop solutions to problems or help us to accomplish goals. In other words, it doesn’t lead us where we want to be.
Try to be vigilant about negative thinking: When you notice yourself thinking negative thoughts, stop yourself and redirect your thoughts. Tell yourself what you need to hear to stop these thoughts. For example, you might ask yourself, “How does this thought help me?” Or you can say to yourself, “Stop this useless rubbish”; “Enough of this negative thinking”; “These ideas are getting me nowhere.” Perhaps the words that work for you are as simple as “Cut this out.” In fact, sometimes if you become a little angry with (or even insulting to) yourself, you can “snap out” of negativity with relative ease.
Once you recognize the negative thought, think about it. What caused you to have this thought? Did this thought help you? Hurt you? Then modify the thought into something constructive. This strategy, called positive reappraisal, can be an extremely useful tool in coping with any chronic illness.
Here are some examples of positive reappraisal:
Negative thought: “I can’t do this.”
Modified thought: “This will be a challenge, but I’ll try to do it one step at a time.
“Self-message: I am innovative and capable.
Negative thought: “I can’t play ball with Billy like other fathers can with their kids.” Modified thought: “I’ll show Billy the antique cars at the auction and we’ll have a great time together.” Self-message: I have a lot to offer, and others enjoy my company.
Negative thought: “I’ll just be in their way.”
Modified thought: “We always have a good time together.”
Self-message: They love me, not my joints.
Negative thought: “I don’t even want to get out of bed.”
Modified thought: “I’ll feel so much better after my nice warm shower.”
Self-message: I can help myself.
Negative thought: “My boss is a heartless jerk.”
Modified thought: “I’ll talk to my boss about ways that I can be more effective in my job.
“Self-message: I am on the way to becoming a more valued employee.
Negative thought: “This is all my fault.”
Modified thought: “I’d rather not have arthritis, but I will learn to work with it.
“Self-message: Many good people have RA. I am a good person and I did not cause myself to have RA.
Negative thought: “I’ll never get ahead.”
Modified thought: “I am really becoming organized.”
Self-message: I can develop skills I never had before.
Negative thought: “No one helps me; I’ll just do it myself.”
Modified thought: “I will develop a chore list for the kids and discuss why it’s necessary that we work together as a family.
“Self-message: Communication is essential; asking for help is okay.
Negative thought: “I will end up in a wheelchair.”
Modified thought: “Most people with RA live normal lives, and I will too.
“Self-message: Facts, not emotions, should control my thoughts.
Finally, it’s important to remember that you only compound your troubles if you feel guilty about your negative thoughts. Everyone has them. You simply need to learn to redirect them and not let them control you.
A good mental attitude is extremely powerful. It can’t eliminate the arthritis, but it can definitely improve your ability to function, mentally and physically. Positive thoughts can provide you with sanctuary in even the most troublesome of situations. You can concentrate on treasuring each of your blessings rather than toting up all of your disappointments. This will fortify you and make you a person with whom other people will want to spend time.
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How could excessive appearance concerns—which might seem clearly caused by sociocultural factors, such as the media’s influence, or by psychological factors, such as low self-esteem—be rooted in a person’s penes and brain chemistry? How could BDD be a brain disease?
I start with this perspective because I think it’s likely that neurobiology lays the groundwork for BDD—that genetics and biologically based tendencies make BDD possible by creating a vulnerability to developing the disorder.
This hypothesis seems less strange when you consider that some patients themselves believe that BDD has a neurobiological basis. “My obsession may or may not be related to my childhood experiences, but it mostly feels chemical— out of my control,” Ron said. “It feels like something biological is driving it.” Other people, after searching for a psychological explanation for their symptoms in therapy, are unable to find one. While it could be argued that this therapy outcome reflects unconscious resistance to uncovering a psychological reason for the symptoms, this seems unlikely to be the case for many patients.
A neurobiological basis for body image disturbance actually has a long historical tradition. Early in this century, neurologists explored the neurobiological basis of several types of distorted body image. These included anosognosia (the inability to recognize or acknowledge impaired bodily functioning, such as paralysis) and neglect of one side of the body (e.g., shaving only one side of the face or using only one sleeve of a robe). In 1931, a neurologist reported that some of his patients had interesting reactions toward their left-sided paralyzed limbs, considering them “strange, ugly, disfigured … thickened, shortened, or snake like.”
Such body-image disturbances are related to brain processes and are often caused by brain damage, such as a stroke, in the brain’s parietal region. Injury to the occipital lobes of the brain—the primary visual processing area—can impair visual perception, including perception of facial images. And damage to another area of the brain, the border of the occipital and temporal lobes, can result in an inability to visually identify previously known faces. Some people with damage to this brain area can’t identify their own face in the mirror. An example of the bodily misperception that brain injury can cause is a case published in 1947 in which a man described a dog as a person with “curious hair.”
An unusual case of BDD-like symptoms also points to the involvement of neurobiological factors in the disorder’s development. A 21-year old man who became preoccupied with thoughts that his ears had become smaller, one foot was bigger than the other, and other appearance concerns was eventually discovered to have subacute sclerosing panencephalitis, a rare and diffuse brain disease that was presumably related to the BDD-like concerns. While it’s likely that very few cases of BDD are caused by an identifiable neurological disorder this case illustrates that brain processes gone awry can lead to distorted bodily perception and excessive bodily preoccupation.
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