When we are coping with a chronic illness we are reacting to a constant stressor in our lives. We are reacting emotionally. We are choosing responses and how to cope. Some of this is based on how typically respond to stress and our very personality. So how does personality affect how we cope with chronic pain? I am fascinating with how coping with illness can over time change us in ways we do not expect. Ways that are in many ways beneficial to our survival.
The Big Five Personality-
How we respond to stressors can depend on our personality type. Often our inherent coping can depend on the personality factors we have. The Big Five looks at Openness, Agreeableness, Neuroticism, Extroversion and Consciousness.
Neuroticism is a factor where people who score high tend to be nervous, insecure, worry a great deal and low scorers are more calm, relaxed and secure. People who are high on Neuroticism tend not to cope well and choose ineffective coping strategies. They engage in a lot of self-blame, have difficulty with problem-solving, practice more avoidance when stressed. *waves hand. Hello me* But this is something we actually work on as we adapt to illness. We can have maladaptive coping and then slowly learn beneficial ways to adapt.
Those high on the Extroversion scale of things, however, tend to be quite effective copers, perhaps because they use a variety of coping strategies. How a person rates on the Big Five can affect how they will choose to cope with stressors. For example, someone low on Extroversion would rather retreat, avoid and self-blame. I can attest to that. Retreating and self-blame are my forte.
Someone low on Openness might have difficulties finding effective coping strategies and less inclined to try them. The fact is if we use negative coping strategies and have problems with problem-solving it could easily lead to hopelessness and depression.
Therefore, if our personality inclination is maladaptive to our reality of living with chronic pain, then we must consciously think about our habitual reactions in order to consciously find a way to adapt. I know seeing a pain psychologist has greatly helped with my inclinations to retreat and self-blame. I think we all have a mix of healthy and unhealthy strategies, which is why coping can be such a challenge.
‘To the extent that a chronic illness challenges core beliefs, integrating the illness experience into their pre-existing beliefs should promote psychological adjustment. Cognitive processing has been used as the phrase to define cognitive activities that help people view undesirable events in personally meaningful ways and find ways of understanding the negative aspects of the experience, and ultimately reach a state of acceptance. Attempts to find meaning or benefit in a negative experience are ways patients may be able to accept the losses they experience. Focusing on the positive implications of the illness or finding the personal significance of a situation are two ways of finding meaning in the illness. When considering meaning-making coping, one must distinguish coping activities that help individuals to find redeeming features in an event from the successful outcome of these attempts.’ (Link)
We may be inclined to avoid the problem, engage in wishful thinking, disengage and retreat, instead of actively engaging in the world using several coping strategies. Here is the thing, the strategies we start with, that may not have worked with us, are not the strategies we evolve to decades later. We adapt and learn and even our personality evolves as we do.
So what can happen to our personality when coping with chronic pain?
A) The Pain Haze- one thing that happens when you are in acute pain is your ability to interact with others and your environment becomes severely limited. You are in survival mode. For example, if someone were to have broken every bone in their body I would not expect them to have an informed conversation with a priest about Nietzsche. Other people will literally see you shut down, your personality becoming dimmed and your awareness hindered. Loved ones will say they do not even recognize you, you become a completely different person. This is essentially a zombie shut down mode, where none of your personality shines through. This is where limited capacity to cope is. It is just literally getting through it.
B) There are a few psychological disorders that can develop which then influence your personality and your worldview- Basically facets of your personality help people deal in different ways to stressors. With chronic pain, a constant stressor that then affects all aspects of your life, your defined, habitual responses kick in. However, few of us have the skills and coping mechanisms that enable us to deal with this long-term stressor. And comorbid mental illness can really complicate the issue. “Scientists believe that chronic pain often leads to chemical and structural changes in the brain triggering mood swings and even personality changes. The changes are often manifested in the form of depression or anxiety. The psychological changes also induce feeling that the original pain “hurts” worse.” (Link). We are at higher risk for comorbid mental illness, because as the above quote mentions the brain isn’t exactly having fun with the situation. For me depression developed and it compromised my capacity to cope with chronic pain for a very long time.
“How can anyone with a significant degree of chronic pain only be affected physically? Pain makes you feel tired, mentally fuddled, irritable and often depressed. It affects you mentally and emotionally as well as physically. Many of the effects come into play quite quickly. If a family member changes from relaxed and easy-going, to irritable and worried by continued pain, how many weeks will pass before family relationships begin to change? Similarly, an employer who had confidence in a promising employee does not take too long to change his or her attitude to one who constantly looks tired and strained.” (Link)
Chronic pain is an emotional experience. We cannot deny that. Pain is connected to the emotion centers in the brain. We have a Reaction to it. Even without comorbid mental illness we have to cope with that emotional strain and the moods it causes. In various ways we all find ways to cope with the emotional strain that comes with chronic pain.
C) The externally perceived behaviors: People are not defined solely by who they think they are, but how others perceive them by their behaviors. We develop a façade to deal with reality and cope and that too becomes part of who we are. I am actually a really reserved, introverted person, but in order to cope with pain many years ago I started using humour a lot. Just to keep people at a distance. To mask the pain. To make it easier to deal with. And it has become a facet of my personality now, that I actively encouraged to cope. But I am still reserved. Still introverted.
D) Life view: That is not to say all personality shifts lead to mental and emotional problems. Not so at all. “For example, people who have a serious illness may report that as a result, they have found a new appreciation for life or that they place greater value on relationships. Patients may also develop an explanation for the illness that is more benign (e.g., attributing it to God’s will). While cognitive processing theory constructs have been applied to adjustment to losses such as bereavement (e.g., Davis et al. 1998), these constructs have received relatively little attention from researchers examining coping with chronic illness.” (Link). The very fact that we must make so many sacrifices for our health can lead to appreciating all the things we can do. Certainly, as we learn to develop positive coping strategies we learn to live a more fulfilling life that considers all our needs, instead of being driven towards a goal and ignoring all other considerations. Coping with a chronic illness makes us look deeper into ourselves than perhaps we ever would have before, which then leads to more sympathy and understanding of others. Therefore, some of our coping strategies enrich our lives and have very positive results.
E) Self-identity- We actually so struggle a lot with our own self-identity. Who we are with illness. Who we are without being able to work. Our own self-worth. It is this quest for self-identity that can lead to new ways to fulfill our lives. New ways to cope with pain. It is something I have struggled with a few times and every time something comes from it.
One thing that cannot be denied is that pain affects our personality in the long run, just as when we are learning to cope our personality affects how we react to pain. Still, it is odd to think that our outward personality can be so fundamentally different from our inward one. And I am left thinking who the am I now? My core self, has changed beyond recognition. If you took away all the medication would I be different? If you took away all the pain would I return to who I was? Does years of coping, different ways to deal with pain in the world, different facades, change a person’s personality fundamentally, more so than life would normally? Otherwise, how would we survive it? We would not. The center does not hold, it cannot hold. And we cope and we change and hopefully, we survive.