Which came first? Chicken v. egg question.

[Anna Flaxis, BSN, RN]

I've noticed that a significant proportion of those I care for who suffer from long term, chronic illness often demonstrate impaired coping ability.

This has led me to wonder, which came first? Does the very nature of chronic illness wear down a person's ability to cope, or were there coping deficits already present in that person's makeup that are simply accentuated by their circumstances?

Is this a statement about our society in general and how little support is available to these individuals and families, leading to impaired coping, or is there some sort of correlation (like Type A personality having increased risk of MI) between poor coping and an increased risk of developing chronic illness?

Is it more complex than that?

I don't mean to be insulting, as I know there are several members here on AN who deal with chronic illness, and I can imagine that it is very difficult. That's why I posted this question here on AN, just to see if anyone else has wondered this same thing, and if so, what conclusions you have drawn?

[Do-over, ASN, RN]

I think some folks can handle stuff, and others can't. I personally believe it has alot to do with upbringing, etc. I also believe that some people enjoy the sick role, or at least the attention it brings to them. Maybe they could cope at one time, but NOT coping got them a reward?

I wouldn't say most of mine are "impaired". I think I see plenty of troopers.

This is all assuming I understand your question.

[xtxrn, ASN, RN]

I think it also goes in waves. Sometimes I'll cope better than others (like just about anybody, I'd imagine). If it's been a bad run with one disorder, or everything is being annoying, there are days when just getting through it is the only goal. Since I'm alone, nobody has to deal with those days (there are a few here who PM, or do a morning thread where those who post there give a rundown about how things are going, among all of us).

I agree with lack of support resources. I live alone, and struggle to keep things in running order here. But at the same time, I want to do all I can on my own- so when I shop, I usually go in the middle of the night- with better handicapped parking, and fewer people running their carts up my backdoor. Then, unloading my stuff is all I can do for the day- and I'll need pain meds. I can't afford to pay someone (prescription co-pays are going up- will be about 650.00 every 3 months - along with 450.00 in insurance premiums. I'm going to have to rearrange those schedules and break up the delivery times to split the amount I pay for the meds in any ONE month.

That causes stress. Just wondering how I'm going to get by. I do have a part of my budget set aside for something enjoyable (has to be something at home, since I'm VERY limited at how much I can go out, and where I can go.

I avoid the "worst" situations (going to someones home, where I have to cope with their thermostat; I have heat sensitivity, and that leads to cardiac symptoms that ruin being there- and if it goes too far, I'll pass out- then that's a rigamarole for whoever I'm around- and I refuse to put them, or myself in that position. At home, I can just lie down and turn on the AC- even in the winter.

Oh well, just my :)

I've met the professional chaos magnets.... I'll give someone the benefit of the doubt for a while. I'll be supportive if I can- but if I sense something not right, I'm done.

[merlee]

Yes, the very nature of chronic illness can wear someone down and create issues with coping.

Imagine 10 years of sticking your finger multiple times a day, adjusting your insulin, watching your diet and still developing multiple complications - at some point you may simply throw up your hands and say 'why'.

I recently had a variety of depressing things happen in my life, and I simply stopped doing my fingersticks and injections. Needless to say, my sugar skyrocketed, I developed a miserable vag itch, went to the doc who sent me to the ER - my BS was 472. Had chest pain in the waiting room. Took two days to get my sugar under control. Had an echo and a chemical stress test.

Some days are better than others, but some days it just takes every ounce of energy just to stay on track.

[Do-over, ASN, RN]

I guess I also perceive a difference in folks that are really wrung out and exhausted and those folks that are probably whiners whether they are sick or not.

"chaos magnets" I like that.

[Chico David, BSN, RN]

I think it's a case of the two things each accentuating the other, if I get what you mean by poor coping skills. In other words, you can make bad choices for a long time and sort of get away with it if you have good luck with your health - but once you start to have some bad fortune with your health, then your bad choices magnify and accentuate it and make it more difficult to either deal with or recover from, the illness.

A couple of perhaps somewhat related thoughts:

Back in the latter part of nursing school we had psych and public health in successive semesters. During the public health part, I spent a lot of time with very poor families who were not dealing well with life in various ways. I also spent some time with the correctional nurse at our county jail. During the psych semester, we spent time in both inpatient and outpatient mental health settings. I was struck by the fact that the folks I saw in all those settings were largely the same people and came to believe that what they all had in common was an inability to deal successfully with life. The folks I saw in the mental health system also were poor and usually had some brushes with the law. The folks I saw in the jail were also poor and had some mental health issues - etc. Whether they were labeled as mentally ill, or criminal, or simply chronically poor was largely an accident of what system they came in contact with first.

Second thought: I've studied some history. During a great deal of human history, the vast majority of people had very few choices available to them. Most people lived in smallish communities and made their living in the same way everyone else did around them, often in the same way as their father and grandfather. Most people saw relatively little cash. If you were at the low end of the economic ladder, you worked as a farm laborer or as a workman in a shop owned by someone else. You did simple repetitive tasks and typically got your pay in room and board and a very small amount of cash. If you took your weekly pay and spent it all on drink on Saturday night, you still had a place to sleep and food to eat and a job to go to the next day.

Now, even the poorest, lowest paid people have to cope with a lot of choices, make a lot of decisions, often in the face of very sophisticated advertising trying to get them to make bad decisions - buy things they can't afford, spend their money on gambling or alcohol, etc. And a certain percentage of folks are just not equipped intellectually to cope with the choices that modern life presents. They aren't bad people. In a simpler society they would have gotten along fine. But they can't handle the modern world. And, as the world continues to be more complex, the social safety net continues to erode, as wealth becomes ever more concentrated and as the value of simple jobs declines, their lot is not going to get any better.

[PMFB-RN, RN]

BTW there is no chicken vs egg question. The egg came long, long before the chicken.

[roser13, ASN, RN]

I think it's similar to the nature vs. nurture argument. We will never quite know for certain and there are strong arguments either way.

We have all seen inspiring stories of individuals who have suffered extreme setbacks and/or disabilities, yet have managed to not only survive but lead productive lives. They usually are quite positive individuals, who will often say that their trials and tribulations have significantly added to the meaning of their lives.

We've also seen (nurses perhaps more than the average Joe) individuals who, by all rights, have had many positives in their lives: good health, good parents, economically secure, yet who manage to make their lives miserable. Sometimes they appear to actually bring illness and adversity upon themselves.

I don't have an answer, but I'm enjoying this thread!

[Ruthiegal]

Have 2 chronic illnesses on top of arthritis it's not easy to cope some days. I liken it to having at least 2 full time jobs on top of your regular 40 hour per week job to earn the money to try to keep things going, pay for doctors and medications, try to poke, plan and rest... 24 hours in a day just are not enough, so yes sometimes I whine, sometimes I cry, and sometimes I get lucky and have a good day. I try to stay positive, but when it's hard to breathe, keep blood sugar stable, and your joints are killing you every time you move, you just don't care what others think, and coping is out of the question, you just want to go back to bed from the fatigue...

[MN-Nurse, ASN, RN]

BTW there is no chicken vs egg question. The egg came long, long before the chicken.

I actually looked this up. Last year some researchers published some evidence that it was the chicken. Their position is that there is a protein in chicken ovaries that accelerates the calcite process and hardens the eggshell. This protein only exists in mature chickens - not eggs - so the chicken came first. So only until that first "true chicken" created the protein to quickly make a hard shell, there were no eggs.

That "first chicken" obviously arose from *some* type of egg (like we all do), but its parents did not have the mutation that creates the protein to made a chicken egg as we know it. The first chicken did have this protein and after maturing used it to create the "first egg."

They weren't trying to answer this question, they were simply studying how chickens make eggshells and discovered a protein that makes eggshells crystallize faster.

I suspect the real answer is that neither came "first." Chickens and eggs evolved right alongside one another along with everything else. You only get a "first" when you put a stake in the ground as the recent researchers did : "No fast crystalline structure formation - no egg."

[Anna Flaxis, BSN, RN]

BTW there is no chicken vs egg question. The egg came long, long before the chicken.

Oh, don't be so literal! It's just an expression!

[kids]

I think it's more complex than a what came first (but as with anything there are going to be people who are the exception).

Diabetic A: Does all the things they are supposed to do, enjoys good glycemic control, sees their doctor twice a year, has good labs and overall is in good health. They stub their toe and after 3 months of 3x a week visits to the wound care clinic it doesn't heal and they have the toe amputated. Inpatient they seem to do pretty well in terms of coping and seem to take it all in stride.

Diabetic B: Does all the things they are supposed to, their blood sugars are all over the place, they are in the doctors office monthly, their BP is rising and their renal function is declining and they never feel 'good'. They stub their toe and after 3 months of 3x a week visits to the wound care clinic it doesn't heal and they are admitted to have the toe amputated. Inpatient they are a basket case with no apparent ability to cope with what has and is happening.

Who has better coping skills?

With chronic illness/disability it's the 'hits' (big and small) that can add up until you hit the wall.

Sometimes what pushes you over is something minor.

How much anyone can take is as individual as pain tolerance, with many if not all the same variables.

With chronic illness/disability so many tasks that are so simple that most people don't give them any thought, aren't simple. Often, normal every day tasks require more time, thought and effort.

Think about what going grocery shopping involves for you (the collective you).

When I go grocery shopping I do all the same thing, ie; make a list, find my wallet, grab my keys, hop in the car and go. Except I also have to make sure I have my grabber and my backpack of supplies and once I get out the door I have to transfer into the car, dismantle and load my chair.

My choice of store is limited based on my experiences as to which ones have a bathroom I can actually use, how helpful the employees are and even if the handicap cutouts in the sidewalk are too steep (many of them are).

Once I get to the store I have to circle the parking lot until I can get a parking spot with the correct orientation, unload and assemble my chair and transfer into it. My purchases are limited to what I can carry in my lap or hang off my chair, my choices are limited to what I can reach with or without a grabber or asking a passerby to reach something for me.

Last week while loading up to go home after a trip to the grocery store I smacked myself in the glasses with a footrest. I sat in my car and cried for 10 minutes. I just wanted to surprise my husband with his favorite dinner and that minor blow to the face was, at that point, just too much. It was the straw that broke the camels back for me.

As I said above, with chronic illness/disability it's the 'hits' (big and small) that can add up until you hit the wall. Sometimes what pushes you over is something minor.

But it's more than just that.

Sometimes those minor hits that add up and that push you over, come in rapid succession and you never really get the chance to recover in between. Consequently it takes fewer hits to push you over and eventually you lose the ability to recover at all (at least for a little while).