Optimism in the Face of Chronic Illness

Having a chronic illness is really hard. In addition to the physical symptoms, there is the utter relentlessness of it all: you don't know when (or if) it will end, treatment is more crap shoot than sure thing and we are left feeling like the subjects of a science experiment (often with not particularly well versed scientists in charge.)

It's enough to challenge the sunniest of dispositions, and most of us struggle--to some degree-- with depression on top of everything else.

And yet, optimism matters.  This is from the Positive Psychology UK website:

 Research has shown that optimism is correlated with many positive life outcomes including increased life expectancy, general health, better mental health, increased success in sports and work, greater recovery rates from heart operations and better coping strategies when faced with adversity.

Sounds like something we could all use a big fat dose of, doesn't it? And yet while health is included on this list in a couple ways, it doesn't say anything about how hard it is to sustain optimism in the face of long term pain and decreased capacity.

We talked in an earlier blog about the power of belief in healing. Optimism and pessimism are a kind of "meta-beliefs" that underpin everything else. If you fundamentally believe that you will get well, that is like psychic grease on your wheels.

So how are we doing in the optimism department anyway? Here's the survey results from that question:

So first off, I'm amazed at all of you! In spite of everything, 46.3% of us have sustained optimism, and 25.9% haven't yet slipped into pessimism. This community shows remarkable emotional reserves.

I started to pull out the data on how much improvement people have experienced cross-tabbed with their answers to this question, and realized that there was way to serious of a chicken and egg problem with this one: Of course you'd be very optimistic about full recovery if you are most of the way there! But maybe some of those folks did start out optimistic and it has been a factor in their getting there... ugh.

Same goes for length of infection: do we report being more pessimistic the longer we've had the infection--which we do-- because we started out that way, the length of it has worn us down or because all the optimists got well and moved on?

What I need to do instead is the study that tracks people over 5 years and asks them this question every year... I'm working on it! I want to know if optimism really does help us, if it speeds our recovery, etc.


Hope for the hopeless?

Here's an interesting study that talks about how pessimism might actually be helpful... in the short run.

Norem and Cantor (1989) highlight defensive pessimism as a coping style, which focuses around a specific context.  They looked at academic performance.  The defensive pessimist in this context is one who anticipates and worries about a poor result despite a prior good track record.  This is perceived as self protective and thus defensive in two ways, either acting as a buffer if it turns out to be right, or acting as a spur into action.

The result is that defensive pessimists tend to perform as well as academic optimists. Interestingly however, this is not true over the long term.  After 3 years the defensive pessimists were no longer performing as well as the optimists, and moreover were reporting less life satisfaction and more psychopathological symptoms.

I imagine that a lot of us adopt pessimism as a coping mechanism in our situation as well. And while this might be fine in the short term, I imagine the same basic pattern of it losing its usefulness would apply to health issues as well (though if someone knows of some data to the contrary, please post!)

So assuming that optimism would be a better option in the long run, what can someone do if they find themselves (oh so easily) drawn into feeling pessimistic?

There is a whole field within psychology called positive psychology which looks at how to be healthy, rather than focusing on pathologizing. Optimism is one of the many topics studied a lot within this field, and the ABCDE method around learning to be more optimistic (or at least less pessimistic) is one interesting piece of work to come of it.

ABDCE follows a kind of classic cognitive therapy modely, for those familiar with psychology. Here's what it stands for:

A = adversity (something isn't the way you'd like it to be)
B = beliefs you automatically have when it occurs
C = consequences of the belief (what happens in your life when you buy into those beliefs)
D = dispute your routine belief – using facts and logic
E = energizing affect of disputing a belief successfully

The E is the desired outcome of this process: if you pay attention to how you feel, you are likely to get an energy boost from getting out from under your prior negativity on the topic. (Tired in the afternoon? Maybe try a dose of ABCDE.)

The link above gives a lot more detail on this process.

There are many other ways to shift out of habitual pessimism. A good talk with a friend who makes you laugh, spiritual practice, taking a walk and shifting perspectives, and reading stories of those who have kicked lyme in its big fat rear end are just a few other possibilities. What works for you is going to be highly individualized.


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I have a particular take on optimism that comes out of my years of work in ecological activism, and that I articulate in detail in my book, Passion as Big as a Planet. I think sometimes optimism gets confused with a kind of ungrounded pollyanna-ism, an essential denial of the way things are.

For me optimism is the ability to look at things as they are (such as, "I have a debilitating chronic illness that is hard to treat") and hold to a knowing that all things change, and this thing will change for the better. Or, barring positive change, that we will be fundamentally OK regardless.

Pessimism seems to me to be a lack of imaginination: this is how things are, and I don't see any reason to believe it will be different. To some extent, this is utterly logical: you haven't seen yourself get well, you have no reason to believe it will change, it is what it is. In fact, more pessimistic folks often see themselves as realists, and bristle if you tell them they are being self-defeating.

My opinion is that neither pollyanna-ism nor pessimism will help us get well. The first won't look things straight on (and if you won't look at it, you can't strategize intelligently) and the second is unlikely to help us find creative solutions because you simply aren't geared toward looking for them if you don't believe it will matter.

For me, optimism is the middle ground that requires us to have one foot in how it is, and one foot in possibility.

The big thing for me is not what is true or even likely; it is what is going to help the most in the long run. Whatever you can do to cultivate optimism will be a move in the right direction.